PREFACE
During the days when my textbook on Gynaecology was in the phase of completion I felt so exhausted and worked up that I could not imagine that I will enter into another writing. Contrary to this the situation changed soon after the introduction of the said textbook. A large number of students conveyed their satisfaction regarding my approach of writing and stressed upon the need for a textbook on Obstetrics. It was highlighted time and again that there is intense need for a book in this speciality, which should contain the management of obstetrical problems according to the circumstances of our country.
Once decided, I initially reviewed all undergraduate as well as postgraduate textbooks available in our country, which obviously are written by western authors. One thing, which is most alarming in his textbooks is that they address the disorders which are prevalent in the western world and are deficient in the disorders which concern us in this country. For example, the text on anemia is only few lines, Rhesus isoimmunization is given only little attention, and some of the books even say that eclampsia is a rare event. This does not go well with the situation in our country where anemia and eclampsia still remain the commonly seen problems. Moreover we still see more acquired than the congenital maternal heart disease during pregnancy. Rubella vaccination in mothers is still deficient. The attitude of our patient towards prolonged pregnancy is different. The average birth weight in our newborn is less than the Caucasian population hence influencing the subject of IUGR and CPD. Breast-feeding needs to be encouraged over bottle-feeding as it prevents the newborn from various diseases arising from the polluted water. The design of antenatal care is different from the developed world. The medical students who are our future doctors need to be talked about the management of complicated obstetrical cases in the remote areas of the country, and which patient and when should be referred to tertiary care hospitals. The books, which are not oriented to the local issues, will surely leave our students permanently deficient n the management of most prevalent problems of our country.
The objective of medical studies should not only be to pass the examination but also to attain the knowledge vast enough to provide comprehensive health care to the members of society. Fundamentals of Obstetrics is written according to the needs of health care in our country yet using the international data. Every obstetrical and medical problem is given attention in accordance to its prevalence and significance. A special attention is paid to the subjects of anemia, hypertensive disorders, hepatitis and diabetes during pregnancy. Emergency obstetrics differs greatly in our country as a larger proportion of our women are still labouring outside hospital and this subject has specially been focused in this book. Special interest is taken to describe the ways to improve the care during labour, which is often considered a physiological process and is left to juniors to learn on their own. Clinical methods make the backbone of expertise of every health care provider. Though the need for such manoeuvres is declining with the advancing technology but they can never be replaced. All clinical methods essential for comprehensive obstetrical care are described in detail, so that a future doctor learns these methods in his student life.
In our country antenatal care is provided on individual basis and there is no joint family physician and hospital care system. The means in which it can be made effective in absence of such systems are described in this book.
Counseling of patients is specialized subject and its need is increasing with the increasing awareness of the public about health problems. To avoid the medico legal problems a medical person thus needs to develop a command over the communication skills to be able to convey the situation to the patient and her relative in a way that they understand the exact problem. How an individual problem should be discussed with the family of the patient is describes in this book
Neonatologist facility is not available in all maternity setups in Pakistan. A chapter on the resuscitation and care of the newborn is hence added to facilitate the learning of basics in the subject, so that the obstetrician can help the baby in different situations. Statistics is one area where we are truly deficient. The basic definitions for the collection of obstetrical data are given in the last chapter to facilitate the maintenance of records.
The medical students need a book, which is easy to read, friendly to understand, and above all is totally reproducible. The postgraduate trainees require a book, which helps them to correct their theoretical knowledge into practice smoothly but swiftly. The practicing doctors need a book to consult in emergency situation which is to the point and does not waste time in unnecessary details. Fundamentals of Obstetrics fulfills the needs of the whole variety of readers.
Writing of a textbook is a teamwork and surely not one man's job. The production of Fundamentals of Obstetrics would have not been possible without the hard work of the whole team. I remain indebted and grateful to all my friends and colleagues who extended their valuable comments, contributed in the form of text and put in extensive physical work to this extensive and tiring work to bring it to its completion.
The completion of a textbook over a relatively short period of time is most taxing on one's family. I could only do it because of friendly, cooperative, encouraging, supporting and helping nature of my wife. During the whole period of writing there was not a single moment when I felt unsupported by her. I have no words to acknowledge her contribution. My children Moiz and Mishaal have always remained cooperative and I love them for their innocent care.
Arshad Chohan
FOR DETAILS: VISIT
FOR DETAILS: VISIT
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