OBSTETRIC PRACTICES IN PRESENT SCENARIO BY DR SHASHWAT JANI

1. Dr. Shashwat Jani.
M. S. ( Obs – Gyn ), F.I.A.O.G.
Diploma in Advance Laparoscopy.
Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : +91 99099 44160.
E-mail : drshashwatjani@gmail.com

2. Good Or Bad …???
• In the last several decades, obstetrics, as a
science has undergone phenomenal development
with a proper understanding of the entire
process of pregnancy & childbirth.
• But, In view of these developments, the
expectations of all concerned - patient, relatives,
attending doctors & authorities including legal
system has undergone a sea change so that a small
mishap will be viewed seriously.
23-Jul-18
Dr. Shashwat Jani.
+91 99099 44160.
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3. Change…!!!
 The Only Thing That Is Constant …. is
“Change”
 If you do not get Updated ……….
you will be Outdated!
 If you do not Change, on your own ,
there is going to be somebody who will change
YOU!
 Flexibility is Physiology &
Rigidity is Pathology…!!!
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Dr. Shashwat Jani.
+91 99099 44160.
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Change Is Must….

5. What are the Changes…???
• Changes in the Practice Environment & patterns…
• The General Obstetricians………
• The specialist ……..
• To be A owner ? Or an Employee ?
• To have a Dispensary /Nursing Home/Hospital ?
• A time to think about Group Practice…..
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Dr. Shashwat Jani.
+91 99099 44160.
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6. Changing trends… Patients
• Changes in Patient Environment…….
• More Intelligent , More Knowledgeable
• More demanding.
• More choosy……
• More aware……..
• Willing to spend money….
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Dr. Shashwat Jani.
+91 99099 44160. 6

7. Changing Pattern… Obstetrics
• Changing Disease Pattern
• Increase number of High Risk Pregnancies
• Associated Medical Disorders
• Increase in Multifetal pregnancies due to IVF.
• New epidemics like…
DM , Obesity , Hypothyroidism …
• Advance maternal Age and associated problems
• Increase in LSCS rate
• Increase in Adherent Placenta
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Dr. Shashwat Jani.
+91 99099 44160.
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8. Changing trends… Our Knowledge
• Changing, evolving & exploding
knowledge…
• New discoveries ,new medicines, new
technology…
• Increasing burden of continuous learning…
• Digitization of Medicine…..
• The encroachment of Internet…
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Dr. Shashwat Jani.
+91 99099 44160.
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9. Changing Trends…. Money
• From a Noble profession to Professional Business.
• Role Of marketing of Practice…….
• Learning Management techniques….
• Facing untoward practices ……
• Learning to manage money……
• Earning laterally……
• Providing for Retirement. ( Retirement Plan )
• Insurance coverage. Mediclaim, Indemnity, Life,
Property…….
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Dr. Shashwat Jani.
+91 99099 44160.
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10. Changing Trends… Law , Govt. & Public
• Increasing interference of Government….
• Various laws applicable… PNDT , MTP , Prof. Tax…
• Consumer Protection Act.
• Facing Death, Mob Violence in Practice…….
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11. Preconception Care
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+91 99099 44160.
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15. Traditional ANC Model
• Began two hundred years ago and instituted programs
and interventions that were traditionally thought to
benefit the mother and her fetus.
• Activities were not scientifically tested as to their
effectiveness or benefit.
• Followed a visit pattern of 4 weeks until 28th week; then
every 2 weeks until 36th week and a weekly visit with at
each visit Led to upto 14 visits and cost incurred for
many investigations that were not necessarily warranted
• It has recently been suggested that the traditional ANC
practice be replaced by new models of focused ANC
programs.
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Dr. Shashwat Jani.
+91 99099 44160.
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16. Small Family Concept
• Multiparity & BOH were very common and
neglected previously.
• But Nowadays…
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17. ‘WHO’ FOCUSED ANC MODEL
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18. Medical Disorders in Pregnancy
Increase in prevalence.
Associated Risk Factors :
• Advance maternal age
• Infertility treatment ( IVF )
• Obesity
• HTN / GDM / Thyroid Disorders
• Smoking , Alcohol
• Lifestyle ( Dietery Habbits , sleep pattern ) etc…
23-Jul-18
Dr. Shashwat Jani.
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19. Incidence Of GDM
Worldwide
• Hyperglycemia in pregnancy: 1 of 6 live births
(16.8%)
• Diabetes in pregnancy: 16%
• Gestational diabetes mellitus: 84%
India: High Incidence.
↑ delivery rates
↑ diabetes
High MMR, PNM
Poor pregnancy outcomes

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Dr. Shashwat Jani.
+91 99099 44160.
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Dr. Shashwat Jani.
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22. Antenatal Profile
Before
• Hb
• Blood Group
• HIV
• Urine Albumin
Now
• Complete Hemogram
• Blood group
• RBS / GTT
• Thyroid Profile
• HIV
• HBsAg
• VDRL
• THALESSEMIA
• Urine – R /M
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Dr. Shashwat Jani.
+91 99099 44160.
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Rising number of twins and triplets among mothers in
their forties as women turn to IVF to start a family

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Dr. Shashwat Jani.
+91 99099 44160.
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+91 99099 44160.
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27. Kahaa Gaye Wo Din…?!?!?! 
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Dr. Shashwat Jani.
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28. The practicing obstetrician of today is likely
to have reservations about using instrumental
labour management methods of unpredictable
course & outcome.
Hence today instrumental deliveries are
becoming rarer and rarer.
In the last two decades, not only very few
developments have taken place in this field,
many of the instrumental deliveries have
become obsolete.
23-Jul-18
Dr. Shashwat Jani.
+91 99099 44160.
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29. PercentofDeliveries
30
25
20
15
10
5
0
1980 1982 1984 1986 1987 1988 1990 1992 199419951996 1997
Rates of Operative Delivery in the
United States From 1980-97
LSCS
Forceps
Vacuum

30. Williams Obstetrics
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Dr. Shashwat Jani.
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31. • However in the present day concept of active
management of labour , forceps still have their
own place and should be considered in
suitable cases, particularly in developing
countries like India.
• If performed judiciously by proper selection of
cases and careful & timely application, forceps
delivery can be useful in reducing not only
unnecessary caesarean sections but also foetal
& maternal complications due to prolonged
labour.
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Dr. Shashwat Jani.
+91 99099 44160.
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32. Open the lock and bring out the
Golden jewel!!

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35. Cesarean Section Rate
RCOG, Oct 2001:
70% of caesarean sections indications Were
• CPD
• Dystocia
• Foetal distress
• Breech
• Previous caesarean section
RCOG Clinical Effectiveness support unit October 2007; 3
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Dr. Shashwat Jani.
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36. Common factors responsible for
increased caesarean section rate
• Rising maternal age
• High levels of maternal education
• Previous caesarean section
• Obstetric complications
• Maternal request
• High income level and social class
• Prevention of pelvic floor Injury
• Fear of litigation
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Dr. Shashwat Jani.
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Tatar M et al Soc Sci Med 2000; 50 : 1227-33.
Lynch CM et al Eur J Obstet Gynaecol Reprod Biol
2002; 432 : 1-4

37. Adherent Placenta
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38. INCIDENCE
 It varies widely all over the world.
Increased dramatically over the last 3 decades
( Because of Increase in LSCS rate …  ).
 A.C.O.G.  1 Per 2500 deliveries.
Accreta : 75 -78 %
Increta : 15 – 18 %
Percreta : 5 -7 %
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39. Associated Condition :
 Placenta Previa
 Previous Surgeries such as …
- Cesarean Section - D & C
- Myomectomy - M.R.P.
- Synecolysis - Cornual Resection
 Uterine Malformation
 Septic Endometritis
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40. Frequency of placenta accreta according to number of cesarean
deliveries and presence or absence of placenta previa
Adapted from SMFM. Am J Obstet Gynecol 2010
.
Cesarean Delivery
First (primary)
Second
Third
Fourth
Fifth
≥ Sixth
Placenta previa
3.3%
11%
40%
61%
67%
67%
No Placenta previa
0.03%
0.2%
0.1%
0.8%
0.8%
4.7%
In a large prospective observational study that
considered the number of prior cesarean deliveries
and presence or absence of placenta previa,the risk
of placenta accreta was

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Dr. Shashwat Jani.
+91 99099 44160.
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42. Stem Cell Therapy
• Stem Cell technology has taken the world by
storm.
• The potential benefits are innumerable and
newer uses are coming on over the horizon.
• It has already shown promise in treating over
75 diseases.
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Dr. Shashwat Jani.
+91 99099 44160.
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44. Fetal Medicine
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