The Schedule Of An Obstetrician and Gynaecologist

Obstetrics and gynaecology is a combined specialty that involves training in the diagnosis and management of pregnancies in women and the care of the female reproductive organs, respectively. This is a medical and surgical discipline as conditions in obstetrics and gynaecology can be managed conservatively and aggressively with both medical and surgical interventions.

Training

Candidates wanting to specialise in obstetrics and gynaecology first have to complete their undergraduate studies (M.B.,Ch.B, M.B.B.S or M.D) to first become a qualified medical doctor. A 1-2 year internship phase also needs to be completed in order for the local medical council to allow doctors access to specialty posts.

A qualified doctor will then apply for a post in obstetrics and gynaecology at a medical school that has specialist consultants available to mentor and train them in this discipline. If the candidate is successful with their application, they will then join the department and the training in this residency programme lasts for 4-5 years, depending on the country you train in.

When a specialist has qualified, they can then decide to carry on as a general obstetrician and gynaecologist who focuses on all pathologies associated with this discipline, as well as focus on pregnancies and ante- and post-natal care of women. These specialists can also decide to focus on either one of the main disciplines or even sub-specialise further. In order to do this, the specialist will have to receive further training in a fellowship programme that can takes 1-2 years to complete.

The fellowship programmes for gynaecology include the following sub-specialties:

• Female pelvic medicine and surgery, also known as female urology, focuses on conditions such as pelvic organ prolapse and urinary incontinence.
• Advanced laparoscopic surgery - this sub-specialty focuses on the investigation and management of issues of the female reproductive organs through minimally invasive procedures.
• Gynaecological oncology – a sub-specialty focusing on the medical and surgical treatment of women with cancers of the reproductive organs.
• Infertility and reproductive endocrinology – a discipline that focuses on the causes and management of female infertility.
• Family planning – involves training in contraception and the termination of pregnancies.
• Paediatric and adolescent (teenage) gynaecology.
• Menopausal and geriatric gynaecology.

Procedures in Obstetrics and Gynaecology

The main surgery that an obstetrician and gynaecologist will perform, regarding obstetrics, is a Caesarian Section. This is a procedure where a baby is delivered through the abdominal wall of a pregnant mother via surgery. This specialist may also have to make use of instruments, such as forceps or a vacuum apparatus, to help them with a normal vaginal delivery.

READ Cesarean Vs Vaginal Delivery: Get The Facts Right

The main surgical procedures in gynaecology include the following:

• Cervical or cone biopsy - done to analyze cervical tissue that is suspicious for pathologies such as cancer.
• Endometrial or uterine biopsy - to check uterine tissue for the above-mentioned.
• Dilation and curettage (D&C) - removing products of conception that haven't cleared from the uterus.
• Endometrial ablation - destroying bleeding vessels on the inner wall of the uterus.
• Colposcopy - visualising the cervix and vaginal vault with a specialised piece of equipment.
• Hysteroscopy - visualising the uterus with mentioned device.
• Myomectomy - removing a part of the muscular section of the wall of the uterus.
• Hysterectomy - removing the entire uterus
• Oophorectomy - removing one or both ovaries.
• Suspensions of the uterus and/or vaginal vault for prolapses of these organs.

The Daily Schedule Of An Obstetrician And Gynaecologist

Obstetric and gynaecology (OBGYN) specialists will consult with their hospital patients 1-2 times a day and these can include medical and post-surgical patients. Medical patients can include those who are receiving treatment, such as intravenous antibiotics, for infections that affect the female reproductive organs.

OBGYNs will also be on call for the hospitals they work at and they may provide emergency services 1-2 times a week depending on how many specialists are available. These doctors can be consulted by primary healthcare workers and casualty doctors working at the hospital's emergency room. They will be called to consult with patients dealing with emergency cases such as bleeding during a viable pregnancy, ectopic pregnancies, complicated pelvic inflammatory disease (PID) and miscarriages.

Monday

After seeing their hospital patients, the OBGYN will start the day in the office by confirming their surgical lists for the week and by making sure when they need to attend certain important meetings. 

The specialist will then start consulting with patients and provide conservative management where applicable. Procedures that can be done in the procedure room of the office includes uterine and transvaginal ultrasounds to confirm or follow up a pregnancy and "Pap" smears for cervical cancer screening.

If a patient needs to have surgery, they will be scheduled for one depending on the urgency of the situation.

Tuesday

A full surgical list awaits the specialist on this day. Procedures that would typically be done include laparoscopies to investigate the female reproductive organs such as the uterus and ovaries for endometrial tissue growth (endometriosis), sub-total and total hysterectomies, oophorectomies, D&Cs and myomectomies.

Emergency surgeries such as resection of an ectopic pregnancy (eg. a fertilized egg in the fallopian tube), Caesarian Section due to fetal distress and a laparotomy due to an acute abdomen caused by a complicated PID may be done at any time.

Wednesday

The morning may be used to perform elective Caesarian Sections on women who have been scheduled to have this procedure done when a normal vaginal delivery in contraindicated.

The OBGYN will use the afternoon to further consult with patients and managed them accordingly.

READ 7 Signs That Your OBGYN Sucks

Thursday

The morning will be set aside for theatre procedures again and the list may be similar to that of a Tuesday. 

The afternoon will be used for continued professional development sessions to further the specialist's knowledge, to offer training to under- and post-graduate doctors or for filling in of chronic prescriptions and letters to medical insurance companies.

Friday

The morning is reserved for consulting with patients and in-office procedures. The afternoon will be used for finishing up any unresolved administrative issues.

The specialist will then finish up the day by having the surgical lists for the following week confirmed and printed out. The doctor who will be working the weekend will be responsible for the care of their patients and those of any colleague that has discussed their patients with the doctor who is on call.