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Obstetrics Ginecology

Obstetrics & Gynecology - Female Health In Focus

One of the primary concerns of pregnant women is choosing the right obstetrician who will accompany her and the baby during pregnancy, childbirth and postnatal treatments.

Before the 18th century midwives and female relatives assisted in the labour, it was considered an exclusively female realm. Because of the taboo nature of childbirth the medical science of obstetrics did not evolve until the mid-18th century when the first medically trained male midwives appeared.

For long centuries obstetrics was the black sheep of medical sciences because many male practitioners refused to accept it as a medical science. The general acceptance by the medical profession came only in the 20th century, and even today, midwives play an important part in the act of childbirth. The 20th century witnessed an impressive drop in mortality rates of mothers and babies.

 The work of the obstetrician can be divided into four phases:

  • Pregnancy preparation
  • Prenatal care:
    • Some compulsory diagnostic tests involve blood tests, urine tests, HIV screening, genetic screening mainly for Downs syndrome, ultrasound screening, glucose loading test.
    • Blood pressure control.
    • Fetal screening (position, chromosomes, gender, congenital problems).
    • Ultrasound imaging (to establish the gestational age, detect abnormalities).
  • Childbirth:
    • If the safety of the fetus or the mother is endangered by some condition during pregnancy, they apply induction, which is an artificial stimulation of childbirth.
    • During normal labour the obstetrician is responsible for assessing the fetus and the mother’s condition, control anesthesia, surgical assistance and perform Caesarian section.
  • Postnatal Care: Monitoring and stabilizing the health of the mother and the baby until they leave hospital.

The education and training for obstetrics and gynecology usually overlaps therefore the professional is commonly referred to as obstetrician – gynecologist. They can work in hospitals, clinics or set up a private practice to exercise their professional focus. In the U.S. they are certified by the American Board of Obstetrics and Gynecology once the certifying exams are taken.

The field of obstetrics is exceptional, because the practitioner is responsible for two people at the same time.

 Obstetrics Surgeries

Basically the two major fields of obstetric surgery are Cesarean section and fetal surgery.

Cesarean section rate varies between 20 and 35% in developed countries, but in some private clinics this percentage can reach 85%. China and Italy are reported to have the highest rates with an annual fluctuation of 46-60%

It is the most common procedure performed in hospitals and numbers are rising steadily. There are medically justifiable operations (large baby, prolonged labour, uterine rupture, transverse position, multiple births) and elective or pre-programmed Cesarean sections.

The WTO implied a correlation between the higher costs of Cesarean section might motivate an obstetric surgeon to recommend the surgery more often. Studies also indicate that the tolerance for pain and confidence in women have dropped considerably in the 21st century.

Fetal Obstetrics Surgeries

It is a set of surgical procedures performed on fetuses in the uterus to address birth defects such as neural tube defects, congenital heart diseases). The obstetric surgeon has two options, depending on the fetal condition:

  • The complete opening of the uterus (similar procedure to the Cesarean section) or
  • Fetoscopic surgery (aka Fetendo), which is less invasive and dangerous for both mother and fetus.

Operated fetuses are usually delivered preterm with Cesarean section. 

Gynecology – Female Health In Focus

Reproductive health means life, vigor and emotional well-being, so from birth it deserves special attention. Female reproductive organs are fragile in nature so no wonder a whole medical specialty has evolved around them. Gynecology cannot be separated from obstetrics, dealing with women while and after pregnancy, the proper name therefore is Obstetrics and Gynecology.

 The Proper Examination Procedure

  • Women usually see a gynecologist without involving other physician if the country’s health policies make it possible.
  • It is a very specially-instrumented intimate examination, mutual trust and openness is essential to avoid embarrassment.
  • An initial dialogue should cover the following topics: menstrual history, complaints, pain, discharges, sexual relationships, obstetrics history, contraception methods, past diseases and surgeries and last cervical smear, general lifestyle (smoking, drugs).
  • All the essential organs should be covered, the cervix, uterus and the ovaries, either with manual palpitation or ultrasound examinations.
  • A breast scanning is also an integral part of a gynaecology visit.
  • The examiner is always assisted by another female (chaperone).

 What Are The Most Common Diseases?

  • Fungal, bacterial or viral infections of the female organs.
  • Irregular, too heavy or absent menstrual periods.
  • Infertility.
  • Displacement of the uterus.

OB\GYN Sub-specialties

  • Gynecologic oncology
  • Reproductive Endocrinology and fertility
  • Maternal-fetal medicine
  • Urogynecology

Depending on the conditions treatments may involve medical (especially antibiotics and hormone therapies) or gynaecology surgical procedures.

 Gynaecology Surgery

Most gynecologists are also surgical practitioners, and general surgeons are also instructed in basic gynecology surgical procedures.
The most common operations are:

  • Curettage (clearing of the uterus)
  • Hysterectomy (most common gynaecology surgical procedure)
  • Tubal ligation (permanent sterilization)
  • Removing cysts
  • Invasive exploratory examinations

 Obstetrics and Gynecology

They are strongly interwoven medical specialties to be able to treat both pregnant and non-pregnant women. All gynecologists receive extensive training in obstetrics; however, not all obstetrics are also gynaecologists.

Some sub-specializations are:

  • Infertility treatment, reproductive endocrinology
  • Family planning
  • Menopausal treatments
  • Cancer treatments
  • Female urology and incontinence testament
  • Pediatric gynecology

 Preparing For Your Gynecology Surgery

  • You will be treated using either laparotomy (for repair and removal they open the abdomen) or laparoscopy (small incision is made and rigid instruments are inserted for visualization and treatment). The latter reduces recovery time, complications and bleeding considerably.
  • At your work calculate a recovery period of 4-6 weeks of laparotomy and 48 hours in case of minimally-invasive treatments.
  • Count on various hospital made preliminary tests 7 or 10 days before gynaecology surgical procedures (blood, urine, pregnancy, X-ray, EKG).
  • You will be advised to stop certain ongoing medication and herbal supplements cures one week before the operation.
  • You have to take antibiotics to prevent infection.
  • Shaving of the affected area at home is not advised, it can increase infection risks.
  • You are not allowed to eat from midnight before the surgery.
  • Depending on the procedure you might be given an enema and catheter.
  • Certain operations you are outpatient. It is advisable to pack loose-fitting clothes for the way home.
  • Right after surgery you might experience nausea, abdominal pain or discomfort. In case of laparoscopy, the belly button area can be especially sensitive. Bloating is also a common side-effect of the operation because of the gases or air accumulated during the operation.
  • In laparotomy operations bowel functions normalize in 2-4 days. You have to follow a prescribed diet to avoid bloating or constipation.
  • Moderate vaginal bleeding and discharge can be expected for two weeks after the surgery.
  • Do not take baths just showers until the next medical visit.

 For a complete list of gynaecology surgical procedures, please visit the links below)

See blow the entire list of Obstetrics and Gynecology proccedures