Informed choice is the right of an individual. Gynecologists have immense responsibility and a unique opportunity to guide their patients through the various milestones/changes in their life by good counseling—menarche, sexuality, pregnancy, pelvic operations, and menopause. Adolescents should be taught about safe sex practices, premarital counseling, and contraception. Preconception counseling is also important in the identification of risk factors, disease states, and potential teratogens in the pregnancy. The availability of first-trimester prenatal diagnosis and the advent of presymptomatic diagnosis by DNA analysis have created increasing opportunities to avoid disorders characterized by early death, severe disease, or irreparable mental retardation, for example, periconceptional maternal folic acid supplementation has now been shown to provide high protective effect against neural tube defects. Similarly, certain maternal diseases, including diabetes, lupus, and myotonic muscular dystrophy, impose potential maternal, fetal, neonatal, and other complications. The preconception visits provide important opportunities for intervention, avoidance, or prevention in these cases. The patients’ ethnicity and medical and genetic family history are key elements in their evaluation, whereas patients with prolonged infertility of unknown cause or recurrent spontaneous abortion may have a 3–10% risk of a parental chromosome abnormality, which may also require chromosome analysis, as do their spouses.

Recurrent miscarriage is a distressing problem that affects 1% of all women in the reproductive age group. This incidence is greater than that expected by chance alone, since 10–15% of all clinically recognised pregnancies end in a miscarriage. The calculated risk of three consecutive pregnancy losses is estimated to be 0.34%. Hence, only a proportion of women presenting with recurrent miscarriage will have a persistent underlying cause for their pregnancy losses. Maternal age and previous number of miscarriages are two independent risk factors for a further miscarriage. The advanced maternal age adversely affects ovarian function, giving rise to a decline in the number of good quality oocytes, resulting in chromosomally abnormal conceptions that rarely develop further. The eminent authors for "Recurrent Pregnancy Loss" have enumerated the various options available described in detail their experiences regarding the various aspects of the condition.

The management of medical disorders in pregnancy has undergone significant changes in the recent years. The pattern of disease has changed with improvements in socio-economic conditions. For example, the incidence of antenatal anemia has decreased progressively in the past few decades, and pulmonary tuberculosis (which used to be prevalent) is now seen only rarely. Chronic rheumatic heart disease has also become less common. On the other hand, gestational diabetes has become more common. This may be due partly to the setting up of screening services for gestational diabetes in many hospitals. The four most common medical disorders complicating pregnancy are anemia, diabetes mellitus, cardiac disease, and thyroid disorders. In addition, because of the improvements in the medical, obstetric, and anesthetic management of pregnancy, many women with medical disorders can go through a pregnancy without major problems. There has also been a progressive decrease in the perinatal mortality associated with some medical disorders, such as diabetes. It is important for all healthcare professionals involved in the management of pregnant women with medical disorders to be conversant with the latest developments in order to provide the best care to these women. The chapters in this issue are certainly helpful in this respect. The eminent authors for the various chapters have discussed the various options available describing in detail their experiences regarding the various aspects of the condition.

The diagnostic approach as well as the management of several endocrinological disorders underwent major modifications. Gynecological endocrinology made no exception, and light was finally thrown on a scarcely known area, so heavily influenced by ignorance and prejudices. Here some authoritative experts have addressed the several possibilities of hormonal interventions in the field of gynecology. The most recent research development has led to the better understanding of the physiopathological rationale, underlying appropriate treatments and even evaluation of the new routes of hormone administration. Current medical therapy of different conditions has been thoroughly reviewed, including precocious puberty, hyperandrogenism, premature ovarian failure, polycystic ovarian syndrome, and menopause. Keeping in mind the requirements of the society, the practitioners need to update themselves on the current approach and wide variety of treatment options now available. India has a distinct need for the comprehensive programs that fit into the Indian context of the situation. It has to be a continuous process, which approaches the problem on the basis of the experience of the specialists in India who are among the stalwarts in this field. In its quest to better approach the topic, Elsevier has pooled its existing resources with those of the internationally acclaimed Obstetricians and Gynecologists of India who have chosen to apply their rich clinical knowledge and expertise to serve the Indian patients.

The high-risk pregnant patient can present to the labor and delivery setup with significant complications that can result in morbidity and mortality. The goal of the obstetricians is always to have a safe outcome for both the mother and the baby, irrespective of the severity of the illness. Therefore, a thorough understanding of the underlying problems and expert management by the obstetrician are extremely important. Further, these parturient can be critically ill, requiring intensive care management. So, good communication among the various teams and the latest information on the management of such patients are critical in order to provide the highest possible level of care. The information in this text will hopefully give the reader the best and most up-to-date knowledge with regard to management of problems and challenges in dealing with a high-risk parturient. This book brings together an outstanding group of authors from the discipline of Obstetrics and Gynaecology in an attempt to present a comprehensive and current summary of high-risk labor and delivery and will be useful to both the practitioner in academic medicine and in private practice.

Historically, gynecologic endoscopy began in the 1930s with the development of diagnostic laparoscopy, but today gynecologic endoscopy has become an essential part of gynecologic surgery. In present practice, the benefits of hysteroscopy have become safely entrenched behind undeniable facts, to the hospitals as well as the patients. Hysteroscopy can be regarded as the gold standard for the evaluation of the uterine cavity in cases of abnormal uterine bleeding, infertility, recurrent pregnancy loss, and suspected intrauterine out-growth. It can be performed in the office setting (outpatient hysteroscopy) or as a day-case procedure, under general anesthesia (inpatient hysteroscopy). Outpatient hysteroscopy has been shown to be as accurate as inpatient hysteroscopy, and it has the advantage of reduced anesthetic risks, enhanced time–cost effectiveness, and patient preference. The factors behind the success of outpatient hysteroscopy are instrument quality, characteristics of the distension medium, the ability and experience of the operators, and recent technical advances, such as the introduction of small-diameter rigid and flexible hysteroscopes. The future looks to further simplification of instrumentation and hence, high safety and accuracy and expedited performance. "Hysteroscopy in Infertility" has addressed the relevant issues with dexterity by substantiating with relevant clinical experiences of authors, who are among the pioneers in this field.

Even though it seems simple the ability of the mother’s body to retain and nurture the fetus, which is of a non-identical genetic makeup, throughout the gestational period requires a delicate balance of hormonal orchestration to achieve the required immunological permissiveness. The obvious outcome of a failure to achieve this is rejection of the fetal "semi-allograft", which manifests as threatened miscarriage. The occurrence of threatened miscarriage or symptoms suggestive of it is fraught with anxiety both for the patient and the obstetrician, especially if the baby is eagerly awaited. In such a situation, a correct diagnosis and prompt evaluation is imperative to start immediate interventions and prevent the expulsion of the fetus. However it is equally important to rule out the other conditions that may mimic threatened miscarriage and avoid unnecessary interventions. This clinical update handbook attempts to address these and other issues associated with this potentially elusive condition. The first chapter serves to give a concise yet relevant overview about this topic. The various modes of presentation as well as the management protocol are elaborately covered in the second chapter. The chapter on Diagnostic Modalities explains how the risk factors and investigative findings can be used to predict and make an early diagnosis of the condition. It has also touched upon the other conditions that mimic threatened miscarriage and how those can be differentiated from it. The role of stress and how it affects the immunomodulation which is the basis of maternal tolerance of the fetus, is explored in detail in the fourth chapter. The last chapter highlights the complications associated with inappropriate treatment of the condition and explores the adverse effects and relative safety of the recommended treatment protocol. Most of the chapters also include several case reviews that illustrate the aspects covered and are enriched with the vast repertoire of personal experience of the eminent authors.