NEWS

Obstetrics & Gynaecology

A branch of medicine that deals with the diseases and hygiene and health of women, reproductive physiology, childbirth and care of the mother.

Objectives

At the end of the training in Obstetrics and Gynaecology, the M.B.B.S. student should be able to :
  1. Appreciate the socio-cultural, economic and demographic factors that influence the practice of Obstetrics and Gynaecology.
  2. Appreciate the principles of reproductive anatomy and physiology.
  3. Understand the preconception, antenatal, intranasal and postnatal factors, including drugs that affect the mother and foetus.
  4. Recognise the changes and adaptation in the mother during pregnancy, labour and puerperium.
  5. Impart antenatal care, detect deviations from normal pregnancy and refer risk cases appropriately.
  6. Manage normal labour, recognise the factors that may lead to complications and refer such cases appropriately.
  7. Institute primary treatment in Obstetrics and Gynaecological emergencies.
  8. Resuscitate and take adequate care of the newborn.
  9. Assist couples with infertility and those requiring contraception.
  10. Know the etiopathology and management of menstrual abnormalities.
  11. Know about the benign and malignant tumours of the genital tract and appreciate the need for screening and prevention.
  12. Recognise the importance of infections and other diseases of the genital tract and give appropriate treatment.
  13. Know about the displacements of the genital tract and injuries.
  14. Understand the implications of medicolegal and ethical issues concerning the speciality.
  15. Acquire communication, decision making and managerial skills.
  16. Acquire skills to perform Obstetrical and Gynaecological examinations and certain minor investigations and therapeutic operative procedures.

COURSE CONTENTS

A. OBSTETRICS

I. BROAD PERSPECTIVES

Vital statistics, birth rate, maternal mortality, perinatal and neonatal mortality, live birth, still birth, abortion, period of viability including definitions of all the above.

II. ANATOMY OF THE FEMALE REPRODUCTIVE TRACT

Basic Anatomy: Relationship to other pelvic organs. Applied Anatomy as related to Obstetric and Gynaecological surgery.

III. PHYSIOLOGY OF CONCEPTION

  1. Gametogenesis.
  2. Ovulation, menstruation, fertilisation and implantation.

IV. DEVELOPMENT OF FOETUS AND PLACENTA

  1. Basic embryology, factors influencing foetal growth and development; anatomy of the placenta.
  2. Teratogenesis, placental barrier.

V. DIAGNOSIS OF PREGNANCY

  1. Clinical features; differential diagnosis; principles underlying the pregnancy test.
  2. Immunological tests and their interpretation; ultrasonogram.

VI. MATERNAL CHANGES IN PREGNANCY

  1. Genital tract, cardiovascular system and haematology.
  2. Respiratory and gastrointestinal system.

VII. ANTENATAL CARE

  1. Objectives of antenatal care; assessment of gestation period; detect abnormality with the help of gravidogram; clinical monitoring of maternal and foetal well-being; detect normal foetal pelvic relation (obstetrical palpation); advise against tetanus; basic investigations.
  2. Foetal well-being: biophysical monitoring; pelvic assessment.
VIII. COMPLICATIONS OF EARLY PREGNANCY
  1. Abortions: Definition, Types, Causes; Management of incomplete, inevitable abortion.
  2. Ectopic Pregnancy: Clinical features; differential diagnosis of acute abdomen; principles of surgical management; Causes and conservative management of ectopic pregnancy/
  3. Hyperemesis Gravidarum: Aetiopathology; Impact on maternal and foetal health; principles of management.
  4. Gestational Trophoblastic Tumours: Clinical features; differential diagnosis; principles of management; follow-up; Laboratory investigations and ultrasonography.

IX. ANTEPARTUM HAEMORRHAGE

  1. Classification; clinical features; differential diagnosis; principles of management.
  2. Aetiopathology; ultrasonography; complications and management.

X. ABNORMAL PRESENTATIONS AND CONTRACTED PELVIS

  1. Causes, salient features; principles of management of occipito-posterior, face and brow presentation;
  2. Obstructed labour: definition, clinical features, prevention; mechanism of breech delivery.

XI. MULTIPLE PREGNANCIES

  1. Clinical features; diagnosis and compliations; principles of management; investigations.
  2. Causes: management.
XII. PREGNANCY – INDUCED HYPERTENSION
  1. Definition; early detection; investigations; principles of management of pregnancy-induced hypertension and eclampsia.
  2. Aetiopathology; differential diagnosis of convulsions in pregnancy; complications of eclampsia.
XIII. ANAEMIA IN PREGNANCY
  1. Aetiology; classification; diagnosis; investigations; adverse effects on the mother and foetus; management during pregnancy and labour.
XIV. OTHER MEDICAL DISORDERS LIKE  HEART DISEASE / DIABETES MILLITUS AND  URINARY TRACT INFECTION
  1. Clinical features; early detection; effect of pregnancy on the disease and impact of the disease on pregnancy.
  2. Complications of the diseases.

XV. NORMAL LABOUR

  1. Physiology; mechanism in occipito – anterior presentation ;
  2. Monitoring – Partogram; conduct of labour; pain relief.
XVI. MANAGEMENT OF THE THIRD STAGE OF LABOUR
  1. Complications: Predisposing factors; prevention; management of atonic postpartum haemorrhage.
  2. Management of injuries to the lower genital tract.
XVII. UTERINE DYSFUNCTION
  1. Classification; recognition of uterine dysfunction; principles of induction and acceleration of labour.
XVIII. FOETAL DISTRESS AND FOETAL DEATH
  1. Clinical features; causes; diagnosis; principles of management; prevention.
XIX. HAEMOLYTIC DISEASE INCLUDING Rh ISO IMMUNISATION
  1. Mechanism; Prophylaxis; foetal complications.
XX. PUERPERIUM
  1. Physiology; clinical features; complications: recognition and management principles; prevention of puerperal sepsis.
XXI. BREASTFEEDING
  1. Physiology of lactation; care of breast; counselling regarding breastfeeding; mastitis and breast abscess.
XXII. CARE OF NEWBORN
  1. Assessment of maturity; detect asphyxia; principles of resuscitation; common problems.
XXIII. MEDICAL TERMINATION OF PREGNANCY
  1. Legal aspects; indications; methods; complications.
  2. Management of complications.
XXIV. CONTRACEPTION
  1. Various methods and devices; selection of patients; couples counselling; side effects; failures and complications.
XXV. OPERATIVE OBSTETRICS
  1. Indications, technique and complications for episiotomy, vacuum extraction; low forceps, instrumental evacuation; menstrual regulation.
  2. Indications and operation steps: Caesarean section; assisted breech delivery; external cephalic version; cervical cerclage; intra-amniotic instillation.
XXVI. POST-CAESAREAN PREGNANCY
  1. Risks; identification of scar dehiscence.

B. GYNAECOLOGY

I. PHYSIOLOGICAL VAGINAL DISCHARGE

  1. Clinical characteristics.

II. PATHOLOGICAL VAGINAL DISCHARGE

  1. Aetiology; characteristics; clinical recognition; investigation; treatment of common causes; genital hygiene.

III. ABNORMAL & EXCESSIVE MENSTRUAL BLEEDING

  1. Definitions: classification of causes; clinical features; principles of investigation; diagnosis and management.

IV. AMENORRHOEA

  1. Causes; principles of management.

V. DYSFUNCTIONAL UTERINE BLEEDING

  1. Aetiopathology ; classification; clinical aspects and diagnosis; principles of investigation and management.
  2. Hormone therapy; management options.

VI. FERTILITY AND INFERTILITY

  1. Causes in male and female; Physical examination of female and male partners; essential investigations and interpretation.
  2. Management options; Principles of Medically Assisted Reproductive Technology (MART).

VII. ENDOMETRIOSIS & ALLIED STATES

  1. Aetiopathology; clinical features; principles of investigation and management.
  2. Implications on health and fertility.

VIII. GENITAL INJURIES & FISTULAE

    1. Causes; prevention; clinical features; principles of management.

IX. GENITAL INFECTIONS

  1. STD, AIDS and Pelvic Tuberculosis.
  2. Infections affecting individual organs.
  3. Aetiology; Pathology; clinical features; differential diagnosis; principles of basic investigation; medical therapy.
  4. Long-term implications; surgical management.

X. DISPLACEMENTS OF UTERUS

  1. Genital Prolapse: Aetiology; clinical features; differential diagnosis; management principles; preventive aspects.

XI.BENIGN TUMOURS OF PELVIC ORGANS

  1. Ovarian and Uterine tumours: Types; Aetiology; clinical features; differential diagnosis; principles of management.

XII. MALIGNANCY OF GENITAL TRACT

  1. Cancer cervix uteri: Aetiopathology; clinical features; screening procedures; investigations; diagnosis; principles of management.
  2. Epidemiological aspects; management options.

XIII. OPERATIVE GYNAECOLOGY

  1. Indications, technique and complications: Dilation and Curettage (D & C); Fractional curettage; cervical biopsy.
  2. Indications and steps of abdominal hysterectomy; surgery for ovarian tumours; vaginal surgery for utero-vaginal prolapse.
Laparoscopy; colposcopy; hysteroscopy; management of postoperative complications

SKILLS

  • Obtained a proper relevant history and performed a humane and thorough clinical examination, including internal examinations (per-rectal and per-vaginal) in adults and children.
  • Arrive at a logical working diagnosis after the examination.
  • Order appropriate investigations keeping in mind their need, relevance and cost-effectiveness.
  • Plan and institute a line of treatment which is need-based, cost-effective and appropriate for common ailments taking into consideration the:
  1. Patient
  2. Disease
  3. Socio-economic status
  4. Institutional / governmental guidelines.
  • Recognise situations which call for urgent or early treatment at secondary and tertiary centres and make a prompt referral of such patients after giving first aid or emergency treatment.
  • Demonstrate interpersonal and communications skills befitting a physician to discuss the illness and its outcome with patients and families.
  • Determine gestational age.
  • Maintain ethical behaviour in all aspects of medical practice.
  • Obtain informed consent for any examination/procedure.
  • Motivate colleagues, community and patients to participate actively in national health programmes.
  • Write a complete case record with all the necessary details.
  • Write a proper discharge summary with all relevant information.
  • Write a proper referral note to secondary or tertiary centres or other physicians with all necessary details.
  • Assess the need for and issue proper medical certificates to patients for various purposes.
  • Organise antenatal, postnatal, well-baby and other clinics.
  • Plan and manage health camps such as family welfare camps.
  • Adopt universal precautions for self-protection against HIV and hepatitis and counsel patients.
  • Do and examine a wet film of vaginal smear for Trichomonas and fungus.
  • Take a pap smear.
  • Take a punch biopsy or cervix.
  • Conduct normal vaginal delivery.
  • Do artificial rupture of membranes.
  • Perform and suture episiotomies.
  • Apply outlet forceps.
  • Do postpartum tubectomy.
  • Perform MTP in the first trimester and be able to do evacuation in incomplete abortion.
  • Insert and remove IUCD.
  • Be able to diagnose and provide emergency management of antepartum and postpartum haemorrhage.
Teaching & Learning Methods
  1. Lectures,
  2. Small group discussions,
  3. Seminars,
  4. Case studies/Simulations,
  5. Roleplay,
  6. Problem Based Learning,
  7. Videography,
  8. Integrated teachings and e-modules.