MIDWIFERY/OBSTETRIC AND GYNECOLOGY NURSING-II INCLUDING SAFE DELIERY

Unit

Topic

Hours

I

Recognition and Management of Problems during Pregnancy

·         Assessment of high-risk pregnancy, Problems/Complications of Pregnancy

·         Hyper-emesis gravidarum,

·         Bleeding in early pregnancy – Abortion, Ectopic pregnancy, Vesicular mole

·         Unintended or mistimed pregnancy

·         Post abortion care & counseling

·         Bleeding in late pregnancy – Placenta previa, Abruption placenta, Trauma

·         Medical conditions complicating pregnancy – Anemia, PIH/Pre-eclampsia, Eclampsia, GDM, Cardiac disease, Pulmonary disease, Thyrotoxicosis, STDs, HIV, Rh incompatibility

·         Infections in pregnancy – Urinary tract infection, Bacterial, Viral, Protozoal, Fungal, Malaria in pregnancy

·         Surgical conditions complicating pregnancy – Appendicitis, Acute abdomen

·         COVID-19 & pregnancy and children

·         Hydramnios

·         Multiple pregnancy

·         Abnormalities of placenta and cord

·         Intra uterine growth restriction

·         Intra uterine fetal death

·         Gynaecological conditions complicating pregnancy

·         Mental health issues during pregnancy

·         Adolescent pregnancy

·         Elderly primi, Grand multiparity

·         Management and care of conditions as per the GoI protocol

·         Policy for the referral services

·         Drugs used in management of high-risk pregnancies

·         Maintenance of records and reports

12(T)

10(L)

80(C)

II

Recognition and Management of Abnormal Labour

·         Preterm labour – Prevention and management of preterm labour; (Use of antenatal corticosteroids in preterm labour)

·         Premature rupture of membranes

·         Malpositions and abnormal presentations (posterior position, breech, brow, face, shoulder)

·         Contracted pelvis, Cephalo Pelvic Disproportion (CPD)

·         Disorders of uterine action – Prolonged labour, Precipitate labour, Dysfunctional labour

·         Complications of third stage – Retained placenta, Injuries to birth canal, Postpartum hemorrhage (bimanual compression of the uterus, aortic compression, uterine balloon tamponade)

·         Obstetric emergencies – Foetal distress, Ruptured uterus, Cord prolapse, Shoulder dystocia, Uterine inversion, Vasa previa, Obstetrical shock, Amniotic fluid embolism

·         Episiotomy and suturing

·         Obstetric procedures – Forceps delivery, Vacuum delivery, Version

·         Induction of labour – Medical & Surgical

·         Caesarean section – Indications and preparation

·         Nursing management of women undergoing

·         Obstetric operations and procedures

·         Drugs used in management of abnormal labour

·         Anesthesia and analgesia in obstetrics

20(T)

15(L)

80(C)

III

Recognition and Management of Postnatal Problems

·         Physical examination, identification of deviation from normal

·         Puerperal complications and its management

• Puerperal pyrexia
• Puerperal sepsis
• Urinary complications
• Secondary postpartum hemorrhage
• Vulval hematoma
• Breast engorgement including Mastitis/Breast abscess, Feeding problem
• Thrombophlebitis
• DVT
• Uterine sub involution
• Vesico vaginal fistula (VVF), Recto vaginal fistula (RVF)
• Postpartum depression/psychosis

·         Drugs used in abnormal puerperium

·         Policy about referral

9(T)

5(L)

40(C)

IV

Assessment and Management of High Risk Newborn (Review)

·         Models of newborn care in India –NBCC; SNCUs

·         Screening of high-risk newborn

·         Protocols, levels of neonatal care, infection control

·         Prematurity, Post-maturity

·         Low birth weight

·         Kangaroo Mother Care

·         Birth asphyxia/Hypoxic encephalopathy

·         Neonatal sepsis

·         Hypothermia

·         Respiratory distress

·         Jaundice

·         Neonatal infections

·         High fever

·         Convulsions

·         Neonatal tetanus

·         Congenital anomalies

·         Baby of HIV positive mothers

·         Baby of Rh negative mothers

·         Birth injuries

·         SIDS (Sudden Infant Death Syndrome) prevention, Compassionate care

·         Calculation of fluid requirements, EBM/formula feeds/tube feeding

·         Home based newborn care program – community facility integration in newborn care

·         Decision making about management and referral

·         Bereavement counseling

·         Drugs used for high risk newborns

·         Maintenance of records and reports

7(T)

5(L)

40(C)

V

Assessment and Management of Women with Gynaecological Disorders

·         Gynaecological assessment – History and Physical assessment

·         Breast self-examination

·         Congenital abnormalities of female reproductive system

·         Etiology, pathophysiology, clinical manifestations, diagnosis, treatment modalities and management of women with:

• Menstrual abnormalities
• Abnormal uterine bleed
• Pelvic inflammatory disease
• Infections of the reproductive tract
• Uterine displacement
• Endometriosis
• Uterine and cervical fibroids and polyps
• Tumors – uterine, cervical, ovarian, vaginal, vulval
• Cysts – ovarian, vulval
• Cystocele, urethrocele, rectocele
• Genitor-urinary fistulas
• Breast disorders – infections, deformities, cysts, tumors
• HPV vaccination
• Disorders of puberty and menopause
• Hormonal replacement therapy

·         Assessment and management of couples with infertility:

• Infertility – definition, causes
• Counseling the infertile couple
• Investigations – male and female
• Artificial reproductive technology
• Surrogacy, sperm and ovum donation, cryopreservation

·         Adoption – counseling, procedures

·         Injuries and Trauma; Sexual violence

·         Drugs used in treatment of gynaecological disorders

12(T)

5(L)

80(C)

Unit 1: Recognition and Management of Problems during Pregnancy

1.1.

High-Risk Pregnancy

17

1.1.1.

Introduction

17

1.1.2.

Risk Factors for High-Risk Pregnancy

17

1.1.3.

Assessment of High-Risk Pregnancy

17

1.1.4.

Management of High-Risk Pregnancy

18

1.1.5.

Prevention of High-Risk Pregnancy

19

1.1.6.

Referral and Follow-up for High Risk Pregnancy

19

1.2.

Problems/Complications of Pregnancy - Hyper-emesis Gravidarum

19

1.2.1.

Introduction

19

1.2.2.

Causes of Nausea and Vomiting in Pregnancy

19

1.2.3.

Signs and Symptoms of Hyperemesis Gravidarum

20

1.2.4.

Complications of Hyperemesis Gravidarum

20

1.2.5.

Diagnosis of Hyperemesis Gravidarum

20

1.2.6.

Management of Hyperemesis Gravidarum

21

1.3.

Bleeding In Early Pregnancy

22

1.3.1.

Introduction

22

1.3.2.

Abortion

22

1.3.3.

Post Abortion Care and Counseling

28

1.3.4.

Ectopic Pregnancy

31

1.3.5.

Vesicular Mole

35

1.4.

Unintended or Mistimed Pregnancy

38

1.5.

Bleeding in Late Pregnancy -  Antepartum Haemorrhage

39

1.5.1.

Introduction

39

1.5.2.

Causes of APH

39

1.5.3.

Placenta Previa (Unavoidable Haemorrhage)

39

1.5.4.

Abruptio Placenta (Accidental Haemorrhage)

43

1.5.5.

Trauma in Pregnancy

47

1.6.

Medical Conditions Complicating Pregnancy

51

1.6.1.

Anaemia

51

1.6.1.1.

Iron Deficiency Anaemia

52

1.6.1.2.

Megaloblastic Anaemia

54

1.6.1.3.

Sickle Cell Anaemia

56

1.6.2.

Pregnancy-Induced Hypertension (PIH)

57

1.6.2.1.

Pre-Eclampsia

58

1.6.2.2.

Eclampsia

61

1.6.3.

Gestational Diabetes Mellitus (GDM)

63

1.6.4.

Cardiac Disease

68

1.6.5.

Pulmonary Disease

71

1.6.5.1.

TB (Tuberculosis)

71

1.6.5.2.

Asthma

73

1.6.6.

Thyrotoxicosis

74

1.6.7.

Sexually Transmitted Diseases (STDs )

75

1.6.8.

Human Immunodeficiency Virus (HIV)

76

1.6.9.

Rh Incompatibility

82

1.7.

Infections In Pregnancy

84

1.7.1.

Bacterial Infection

84

1.7.1.1.

Urinary Tract Infection

84

1.7.1.2.

Tuberculosis (TB) in Pregnancy

85

1.7.1.3.

Bacterial Vaginitis

85

1.7.1.4.

Salpingitis

86

1.7.2.

Viral Infection

87

1.7.2.1.

Toxoplasmosis

87

1.7.2.2.

Other Agents

87

1.7.2.3.

Rubella Virus

88

1.7.2.4.

Cytomegalovirus

89

1.7.2.5.

Herpes Simplex Virus

89

1.7.3.

Protozoal Infection

90

1.7.3.1.

Trichomonas Vaginitis

90

1.7.3.2.

Toxoplasmosis

91

1.7.3.3.

Malaria

91

1.7.4.

Fungal Infection

92

1.7.4.1.

Moniliasis (Candidiasis)

92

1.7.4.2.

Skin Fungal Infections (Tinea)

94

1.8.

Surgical Conditions Complicating Pregnancy - Acute Abdomen Conditions

94

1.9.

Corona Virus Disease (COVID-19) and Pregnancy and Children

96

1.10.

Hydramnios

99

1.10.1.

Introduction

99

1.10.2.

Polyhydramnios

99

1.10.3.

Oligohydramnios

101

1.11.

Multiple Pregnancy

103

1.12.

Abnormalities of  Placenta and Cord

109

1.12.1.

Placenta

109

1.12.2.

Umbilical Cord

111

1.13.

Intra Uterine Growth Restriction (IUGR)

112

1.14.

Intra Uterine Foetal Death (IUFD)

115

1.15.

Gynaecological Conditions Complicating Pregnancy

117

1.15.1.

Retroversion and Retroflexion

117

1.15.2.

Uterine Prolapse (Procidentia)

119

1.15.3.

Uterine Malformations

120

1.15.4.

Uterine Fibroids

121

1.15.5.

Ovarian Cysts

123

1.15.6.

Uterine Polyps

125

1.15.7.

Uterine Cancer

126

1.16.

Mental Health Issues During Pregnancy

128

1.16.1.

Introduction

128

1.16.2.

Risk Factors for Mental Disorders

128

1.16.3.

Classification of Mental Disorders

128

1.16.3.1.

Depression

128

1.16.3.2.

Panic Disorder

129

1.16.3.3.

Obsessive-Compulsive Disorder (OCD)

129

1.16.3.4.

Bipolar Mood Disorder

130

1.16.3.5.

Schizophrenia

130

1.17.

Adolescent Pregnancy

130

1.18.

Elderly Primi Gravida

132

1.19.

Grand Multiparity

134

1.20.

Management and Care of Conditions as per the GoI Protocol

135

1.21.

Policy for the Referral Services

136

1.22.

Drugs Used In Management of High-Risk Pregnancies

136

1.22.1.

Drugs Used to Treat Hyperemesis Gravidarum

136

1.22.2.

Drugs used to Treat Ectopic Pregnancy

137

1.22.3.

Drugs used to Treat GDM

138

1.22.4.

Uterotonics

138

1.22.4.1.

Oxytocin

138

1.22.4.2.

Ergot Alkaloids

139

1.22.4.3.

Prostaglandins

140

1.22.5.

Tocolytics

141

1.22.6.

Antihypertensives

142

1.22.7.

Anticonvulsants

145

1.22.8.

Anticoagulants

146

1.22.9.

Diuretics

146

1.22.10.

Analgesia and Anaesthesia

148

1.23.

Maintenance of Records and Reports

152

1.24.

Exercise

154

Unit 2: Recognition and Management of Abnormal Labour

2.1.

Preterm Labour

159

2.2.

Premature Rupture Of Membranes (PROM)

163

2.3.

Malposition and Abnormal Presentations

167

2.3.1.

Introduction

167

2.3.2.

Causes of Malposition and Abnormal Presentations

167

2.3.3.

Risk Factors of Malposition and Abnormal Presentations

167

2.3.4.

Signs and Symptoms of Malposition and Abnormal Presentations

167

2.3.5.

Complications of Malposition and Abnormal Presentations

168

2.3.6.

Diagnosis of Malposition and Abnormal Presentations

168

2.3.7.

Management of Malposition and Abnormal Presentations

168

2.3.8.

Types of Malposition and Abnormal Presentations

168

2.3.8.1.

Occipito-Posterior (OP) Position

168

2.3.8.2.

Breech Presentation

172

2.3.8.3.

Brow Presentation

177

2.3.8.4.

Face Presentation

179

2.3.8.5.

Shoulder Presentation

181

2.3.8.6.

Compound Presentation

183

2.3.8.7.

Transverse Lie

183

2.4.

Contracted Pelvis

185

2.5.

Cephalo Pelvic Disproportion (CPD)

191

2.6.

Disorders of Uterine Action

193

2.6.1.

Introduction

193

2.6.2.

Causes of Disorders of Uterine Action

193

2.6.3.

Classification of Disorders of Uterine Action

193

2.6.4.

Hypotonic Uterine Action - Uterine Inertia

193

2.6.5.

Hypertonic or Uncoordinated Uterine Action

195

2.6.5.1.

Spastic Lower Uterine Segment

195

2.6.5.2.

Colicky Uterus

196

2.6.5.3.

Constriction or Contraction Ring

196

2.6.5.4.

Uterine Tetany or Generalised Tonic Contraction

197

2.6.5.5.

Cervical Dystocia

198

2.6.6.

Precipitate or Rapid Labour

198

2.6.7.

Bandl’s or Pathological Retraction Ring

201

2.7.

Prolonged Labour

202

2.8.

Dysfunctional Labour

205

2.9.

Complications of Third Stage

206

2.9.1.

Retained Placenta

206

2.9.2.

Injuries to Birth Canal

209

2.9.2.1.

Injuries to Vulva

209

2.9.2.2.

Pelvic Hematomas

211

2.9.2.3.

Visceral Injuries

212

2.9.3.

Postpartum Haemorrhage (PPH)

213

2.10.

Obstetric Emergencies

220

2.10.1.

Introduction

220

2.10.2.

Foetal Distress

220

2.10.3.

Ruptured Uterus

221

2.10.4.

Cord Prolapse

224

2.10.5.

Shoulder Dystocia

228

2.10.6.

Uterine Inversion

231

2.10.7.

Vasa Previa

234

2.10.8.

Obstetrical Shock

237

2.10.9.

Amniotic Fluid Embolism (AFE)

240

2.11.

Episiotomy and Suturing

242

2.11.1.

Introduction

242

2.11.2.

Indications of Episiotomy

242

2.11.3.

Process of Episiotomy

242

2.11.4.

Types of Episiotomy

243

2.11.5.

Degrees of Episiotomy

243

2.11.6.

Complications of Episiotomy

243

2.11.7.

Benefits of Episiotomy

244

2.11.8.

Episiotomy Suturing

244

2.12.

Obstetric Procedures

245

2.12.1.

Forceps Delivery

245

2.12.2.

Vacuum Delivery (Vacuum Extraction)

250

2.12.3.

Version

254

2.12.3.1.

External Cephalic Version (ECV)

254

2.12.3.2.

Internal Podalic Version

255

2.12.3.3.

Bipolar Podalic Version

256

2.12.3.4.

Nursing Management of Women Undergoing Version

257

2.13.

Induction of Labour (IOL)

257

2.13.1.

Introduction

257

2.13.2.

Indications for Induction of Labour

257

2.13.3.

Contraindications of Induction of Labour

258

2.13.4.

Complications of Induction of Labour

258

2.13.5.

Methods for Induction of Labour

258

2.13.6.

Nursing Management of Women Undergoing Induction of Labour

262

2.14.

Caesarean Section

262

2.14.1.

Introduction

262

2.14.2.

Indications for Caesarean Section

263

2.14.3.

Contraindications of Caesarean Section

263

2.14.4.

Types of Caesarean Section

263

2.14.5.

Preparation of the Mother for Caesarean Section

265

2.14.6.

Procedure of Caesarean Section

266

2.14.7.

Complications of Caesarean Section

270

2.14.8.

Nursing Management of Women Undergoing Caesarean Section

271

2.15.

Drug Used in Management of Abnormal Labour

273

2.16.

Anaesthesia and Analgesia in Obstetric

273

2.17.

Exercise

273

Unit 3: Recognition and Management of Postnatal Problems

3.1.

Recognition and Management of Postnatal Problems

277

3.1.1.

Physical Examination

277

3.1.2.

Psychosocial Assessment

278

3.1.3.

Identification of Deviation from Normal

280

3.2.

Puerperal Complications and its Management

281

3.2.1.

Introduction

281

3.2.2.

Puerperal Pyrexia

282

3.2.3.

Puerperal Sepsis

284

3.2.4.

Urinary Complications

287

3.2.4.1.

Postpartum Urinary Retention (PUR)

287

3.2.4.2.

Postpartum Urinary Incontinence

288

3.2.4.3.

Postpartum Urinary Tract Infections (UTIs)

289

3.2.5.

Secondary Postpartum Hemorrhage (SPPH)

289

3.2.6.

Vulvar Hematoma

291

3.2.7.

Breast Complications

292

3.2.7.1.

Breast Engorgement

292

3.2.7.2.

Mastitis

294

3.2.7.3.

Breast Abscess

295

3.2.7.4.

Inverted/Flat Nipples

296

3.2.7.5.

Cracked Nipple

298

3.2.8.

Thrombophlebitis

299

3.2.9.

Deep Vein Thrombosis (DVT)

300

3.2.10.

Uterine Sub Involution

302

3.2.11.

Vesico-Vaginal Fistula (VVF)

304

3.2.12.

Rectovaginal Fistula (RVF)

305

3.2.13.

Postpartum Depression (Baby Blues)

306

3.2.14.

Puerperal Psychosis

307

3.3.

Drugs Used in Abnormal Puerperium

308

3.3.1.

Uterotonics

308

3.3.2.

Antibiotics

310

3.3.3.

Anticoagulants

311

3.3.4.

Lactation Suppressant - Bromocriptine Mesylate

311

3.3.5.

Antipsychotics/Anti-depressants

312

3.4.

Policy about Referral

312

3.5.

Exercise

312

Unit 4: Assessment and Management of High Risk Newborn

4.1.

Models of Newborn Care in India

315

4.1.1.

Introduction

315

4.1.2.

New-born Care Corner (NBCC)

315

4.1.3.

Special New-born Care Unit (SNCU)

316

4.2.

Screening of High-Risk Newborn

319

4.2.1.

Introduction

319

4.2.2.

Apgar Scoring

319

4.2.3.

Assessment of Vital Signs

320

4.2.4.

Physical Assessment

321

4.2.5.

Assessment of New-Born for Gestation Age

325

4.3.

Protocols, Levels of Neonatal Care and Infection Control

330

4.4.

Prematurity

334

4.5.

Post-Maturity

338

4.6.

Low Birth Weight

339

4.7.

Kangaroo Mother Care (KMC)

341

4.8.

Birth Asphyxia (Asphyxia Neonatorum)

343

4.9.

Hypoxic Encephalopathy

347

4.10.

Neonatal Sepsis

349

4.11.

Hypothermia

351

4.12.

Respiratory Distress

356

4.13.

Jaundice

358

4.14.

Neonatal Infections

363

4.15.

High Fever (Hyperthermia)

366

4.16.

Convulsions

368

4.17.

Neonatal Tetanus

371

4.18.

Congenital Anomalies

372

4.19.

Baby of HIV Positive Mothers

377

4.20.

Baby of Rh Negative Mothers

378

4.21.

Birth Injuries

379

4.21.1.

Introduction

379

4.21.2.

Types of Birth Injuries

379

4.21.3.

Caput Succedaneum

379

4.21.4.

Cephalohematoma

380

4.21.5.

Facial Palsy/Bell’s Palsy

382

4.21.6.

Erb’s Palsy

384

4.21.7.

Torticollis

385

4.21.8.

Intracranial Haemorrhage

387

4.21.9.

Intraventricular Haemorrhage

389

4.22.

SIDS (Sudden Infant Death Syndrome)

390

4.23.

Calculation of Fluid Requirements

393

4.24.

EBM (Expressing Breast Milk)

394

4.25.

Formula Feeds for Neonates

396

4.25.1.

Introduction

396

4.25.2.

Reasons for Giving Formula Feed

396

4.25.3.

Types of Formula Feed

396

4.25.4.

Preparation of Formula Feed

397

4.25.5.

Schedule of Formula Feeding

399

4.26.

Tube Feeding or Ryle’s Tube Feeding

400

4.27.

Home Based Newborn Care Program

403

4.28.

Decision Making about Management and Referral

404

4.29.

Bereavement Counseling

406

4.30.

Drugs Used for High Risk Newborns

407

4.31.

Maintenance of Records and Reports

409

4.32.

Exercise

410

Unit 5: Assessment and Management of Women with Gynecological Disorders

5.1.

Gynaecological Assessment

414

5.1.1.

Introduction

414

5.1.2.

History

414

5.1.3.

Physical Assessment

419

5.2.

Congenital Abnormalities of Female Reproductive System

424

5.2.1.

Introduction

424

5.2.2.

Types of Congenital Abnormalities of Female Reproductive System

424

5.2.3.

Etiology of Congenital Abnormalities of Female Reproductive System

425

5.2.4.

Clinical Manifestations of Congenital Abnormalities of Female Reproductive System

425

5.2.5.

Diagnosis of Congenital Abnormalities of Female Reproductive System

425

5.2.6.

Treatment of Congenital Abnormalities of Female Reproductive System

425

5.3.

Menstrual Abnormalities

426

5.3.1.

Introduction

426

5.3.2.

Amenorrhoea

426

5.3.3.

Dysmenorrhoea

428

5.3.4.

Menorrhagia

430

5.3.5.

Premenstrual Syndrome (PMS)

432

5.3.6.

Cryptomenorrhoea

434

5.3.7.

Abnormal Uterine Bleeding (AUB)

435

5.4.

Pelvic Inflammatory Disease (PID)

437

5.5.

Infections of the Reproductive Tract

440

5.5.1.

Vulvitis

440

5.5.2.

Bartholinitis

441

5.5.3.

Vaginitis

443

5.5.4.

Trichomoniasis

444

5.5.5.

Candidiasis

445

5.5.6.

Metritis

447

5.5.7.

Salpingitis

448

5.5.8.

Oophoritis

449

5.6.

Uterine Displacement (Uterine Prolapse)

450

5.7.

Endometriosis

452

5.8.

Uterine Fibroids

455

5.9.

Cervical Fibroids

458

5.10.

Uterine Polyps

460

5.11.

Cervical Polyps

461

5.12.

Tumours

462

5.12.1.

Uterine Tumours (Uterine Cancer)

462

5.12.2.

Cervical Tumours (Cervical Cancer)

465

5.12.3.

Ovarian Tumours (Ovarian Cancer)

469

5.12.4.

Vaginal Tumours (Vaginal Cancer)

472

5.12.5.

Vulvar Tumours (Vulvar Cancer)

475

5.13.

Cysts

478

5.13.1.

Introduction

478

5.13.2.

Ovarian Cysts

478

5.13.3.

Vulvar Cysts

480

5.14.

Cystocele (Prolapsed Bladder)

482

5.15.

Urethrocele (Urethral Prolapse)

483

5.16.

Rectocele (Posterior Vaginal Wall Prolapse)

485

5.17.

Genito-Urinary Fistulas

486

5.17.1.

Vesicovaginal Fistula (VVF)

487

5.17.2.

Urethrovaginal Fistula

487

5.17.3.

Ureterovaginal Fistula

487

5.17.4.

Rectovaginal Fistula (RVF)

488

5.18.

Breast Disorders

488

5.18.1.

Introduction

488

5.18.2.

Mastitis

489

5.18.3.

Breast Abscess

489

5.18.4.

Deformities - Tubular Breasts

489

5.18.5.

Benign Tumours of the Breast

490

5.18.6.

Malignant Tumours of the Breast (Breast Cancer)

491

5.19.

HPV Vaccination

498

5.19.1.

Introduction

498

5.19.2.

HPV Vaccines

498

5.19.3.

Indications of HPV Vaccines

499

5.19.4.

Contraindications of HPV Vaccines

499

5.19.5.

HPV Vaccination Schedule

499

5.19.6.

Side Effects of getting the HPV Vaccine

500

5.20.

Disorders of Puberty

500

5.20.1.

Introduction

500

5.20.2.

Precocious Puberty

500

5.20.3.

Delayed Puberty

502

5.21.

Menopause

503

5.21.1.

Introduction

503

5.21.2.

Physiological Changes

504

5.21.3.

Clinical Manifestations

505

5.21.4.

Diagnosis

506

5.21.5.

Treatment Modalities and Management

506

5.22.

Hormone Replacement Therapy

506

5.23.

Assessment and Management of Couples with Infertility

508

5.23.1.

Infertility

508

5.23.2.

Artificial Reproductive Techniques (ART)

516

5.24.

Surrogacy

518

5.25.

Sperm Donation

520

5.26.

Ovum or Egg Donation

521

5.27.

Cryopreservation

522

5.27.1.

Introduction

522

5.27.2.

Principles of Cryopreservation

522

5.27.3.

Steps in Cryopreservation

523

5.27.4.

Applications of Cryopreservation

524

5.27.5.

Advantages of Cryopreservation

525

5.27.6.

Disadvantage of Cryopreservation

525

5.28.

Adoption

525

5.28.1.

Definitions

525

5.28.2.

Adoption in India

525

5.28.3.

Principles to Govern the Adoption Process in India

526

5.28.4.

Procedure of Adoption in India

526

5.28.5.

Adoption Coordinating Agency

527

5.28.6.

Counseling

527

5.28.6.1.

Pre-Adoption Counseling of PAPs

528

5.28.6.2.

Post-Adoption Counseling

528

5.29.

Genital Injuries

529

5.30.

Genital Trauma

530

5.31.

Sexual Violence

531

5.32.

Drugs Used in Treatment of Gynaecological Disorders

534

5.33.

Exercise

535