OBSTETRICS & GYNAECOLOGY

 

The main goal of curriculum is to enable the undergraduate students to acquire the knowledge, skills and attitudes in the discipline of Obstetrics & Gynaecology as essential for a general practitioner.

 

OBJECTIVES

The student should be able to:

• Make Diagnosis and organize management of antenatal, intranatal and postnatal period of normal and abnormal pregnancy;
• Provide adequate care of common gynae problems and emergencies
• Manage common gynae problems and emergencies
• Provide Counseling and delivery of fertility regulation methods.
• Acquire knowledge of methods of termination of pregnancy.
• Apply knowledge of vital statistics in obstetrics and RCH programme
• Develop communication skills.

Practical & clinical training

- Students should be trained about proper history taking, clinical examination.

-Advicing relevant necessary investigations and their interpretation and management.

- Posting in OPD, wards, operation theaters, labor room and family planning clinics.

- Students should observe common OPD procedures like, E.A., D & C, MTP, Pap Smear,CuT insertion. Observe normal deliveries, forceps and ventouse assisted deliveries, caesrean section.

- Ligations, minilap procedures like abdominal, vaginal hysterectomy, fothergill repair.

 

COURSE CONTENT

 

I Basic Sciences

1. Normal & abnormal development, structure and function of female & male urogenital systems and the female breast.
2. Applied anatomy of the genito-urinary system, abdomen, pelvis, pelvic floor, anterior abdominal wall, upper thigh (inguinal ligament, inguinal canal, vulva, rectum and anal canal).
3. Physiology of spermatogenesis.
4. Endocrinology related to male and female reproduction.
5. Anatomy & Physiology of urinary & lower GI (Rectum / anal canal), tract.
6. Development, structure & function of placenta, umbilical cord & amniotic fluid.
7. Anatomical & physiological changes in female genital tract during pregnancy fistulae.
8. Anatomy of fetus, fetal growth & development, fetal physiology & fetal circulation.
9. Physiological & neuro-endocrinal changes during puberty disorders, adolescence, menstruation,

ovulation, fertilization, climacteric & menopause.

10. Gametogenesis, fertilization, implantation & early development of embryo.
11. Normal pregnancy, physiological changes during pregnancy, labour & puerperium.
12. Immunology of pregnancy
13. Lactation
14. Biochemical and endocrine changes during pregnancy, including systemic changes in cardiovascular, hematological, renal, hepatic and other systems. (Anaemia)
15. Biophysical and biochemical changes in uterus and cervix during pregnancy & labour.
16. Pharmacology of identified drugs used during pregnancy, labour, post partum period with reference to their mechanism of action, absorption, distribution, excretion, metabolism, transfer

of the drugs across the placenta, effect of the drugs on the fetus, their excretion through breast milk.

17. Mechanism of action, excretion, metabolism of identified drugs used in Gynaecology, including chemotherapeutic drugs.
18. Role of hormones in Obstetrics & Gynaecology.
19. Markers in Obstetric & Gynaecology – Non neoplastic and Neoplastic Diseases.
20. Pathophysiology of ovaries, fallopian tubes, uterus, cervix, vagina and external genitalia in healthy and diseased conditions.
21. Normal and abnormal pathology of placenta, umbilical cord, amniotic fluid and fetus.
22. Normal and abnormal microbiology of the genital tract – bacterial, viral & parasitic infections responsible for maternal, fetal and gynaecological disorders.
23. Humoral and cellular immunology in Obstetrics & Gynaecology.

II Obstetrics

1. Physiology of normal pregnancy, diagnosis of pregnancy, routine antenatal care, management of common symptoms in pregnancy, investigations to be carried out in pregnancy;
2. Drugs prescription during pregnancy and lactation
3. Hypertensive disorders in pregnancy
4. Anaemia in Pregnancy : Heart disease in pregnancy
5. Antepartum haemorrhage
6. Intrauterine Growth Restriction (IUGR)
7. Antenatal Fetal Surveillance
8. Rhesus Negative Pregnancy
9. Disorders of liver, kidneys in pregnancy
10. Multiple pregnancy
11. Puerperium, and its complications
12. Perinatal and maternal mortality in India

III Gynaecology

1. Anatomy of fetal genital tract, and its variations, supports of uterus, developmental anomalies

of uterus.

2. Ectopic pregnancy; epidemiology, early diagnosis and management.
3. Physiology of menstruation, common menstrual problem.
4. Disorders of growth, amenorrhoeas
5. Fibroid uterus
6. Prolapse uterus
7. Vaginal discharge, sexually transmitted diseases
8. Precancerous lesions of female genital tract (cervix, vagina, vulva)
9. Carcinoma Cervix, epidemiology, staging diagnostic procedure, treatment.
10. Carcinoma Endometrium
11. Carcinoma ovary
12. Carcinoma vulva
13. Gestational Trophoblastic disease
14. Temporary and permanent methods of contraception
15. Menopause and related problems
16. Endometriosis
17. Genital Tract Fistulae
18. Adolescence, Pubertal changes, disorders of puberty

 

IV Contraception, Neonatology and Recent Advances

(a) Contraception (Male & Female)

(b) Medical terminal of pregnancy – safe abortion – selection of cases, technique & management of complication of medical and surgical procedures, MTP law Medical abortion & Emergency

Contraception.

(c) National health programmes.

(d) Social obstetrics and vital statistics

(e) Care of new born, neonatal resuscitation, detection of neonatal malformation.

 (f) Neonatal sepsis – prevention, detection & management.

(g) Neonatal hyper-bilirubinemia – investigation & management including NICU care.

(h) Managemenr of common neonatal problems

(i) Ethics and medical jurisprudence

TRAINING PROGRAMME : SCHEDULE

The undergraduate students in Obstetrics & Gynae must undergo the following rotation training during

their MBBS course.

4th semester : Three weeks

6th semester : Three weeks

8th semester : Three weeks

Internship : One month

During these periods they will be posted in Obstetrics & Gynaecology OPD’s Wards and OT’s, Labour Room, and Family Planning OPD and OT. They will be distributed in the 2Units of the department.

Evening tutorials during posting by  senior residents.

4th semester

During this posting the students are expected to acquire competence in history taking and examination of the obstetfics and gynaecology patient.

They will be allocated beds in the wards and completed to work up these cases for case discussions with faculty. They will also attend OPD and take history of OPD cases and examine them under the suspension of commitants / senior residents. They will be posted in Minor OT to observe OPD surgical procedures like D & C, MTP, Cu-T insertion & removal, endometrial aspirations. At the end of the posting, they have to submit the records of history taking and procedures observed.

6th & 8th semester

the students are expected to gain increasing competence in making a diagnosis and planning the management of the patient. They will follow their allotted units. In addition there will be joint case discussion with the faculty.

In OPD

They will take history and examination of pelvic organs cases under the supervision of the competent/ senior resident. They will learn to draw up a list of investigations and counsel the patient and also follow them up.

Minor OT

They will assist in the performance of minor surgical procedures.

Wards

They will be allocated beds and will be responsible for working up and following their patients.

 

 

Labour Room

They will remain in the Labour Room in the evening and nights when their respective unit is on call.

They will assist a minimum of 10 normal deliveries and witness 5 operative deliveries during each

posting.

Main OT

They will witness / assist major surgical procedures like abdominal and vaginal hysterectomy.

Family Planning

Students will learn medical and surgical methods of contraception and sterilization procedure. They will learn to perform IUCD insertion and removal and minilap tubal ligation and vasectomy. They will assist1st and 2nd trimester MTP procedure.

Practical skills to be imparted during ward posting

Obstetrics

1. History taking and examination of a pregnancy woman
2. Watching progress of labour and conduct of a normal labour
3. Management of third stage of labour, prevention and treatment of post partum haemorrhage
4. Witness caesarean section, breech delivery, forceps and vacuum delivery
5. Essential care of a newborn
6. Non stress testing of fetus; biophysical scoring of fetus

 

Gynaecology

1. How to take history and examination of female pelvic organs
2. Making of pap smear, wet smear preparation on vaginal discharge
3. Minor gynaecologic procedures : cervical biopsy, endometrial biopsy, dilatation & curettage; fractional curettage
4. Medical termination of pregnancy (MTP) : in first & second trimesters
5. Insertion and removal of intrauterine contraceptive device

Operative Skills

1. Conduct of normal delivery
2. Making and repair of episiotomy
3. Insertion and removal of intrauterine device
4. Making of pap smear
5. Performing minilap tubectomy (under supervision)

Medico-Legal Responsibilities of Interns

As mentioned in the beginning of this document, Resident and Interns are advised to carefully read and learn the medico-legal responsibilities as related to their day-to-day work in the hospital from the department of Obstetrics & Gynaecology Residents have to attend to a lot of “rape cases” in Casualty. They must be very sure of the formalities and steps involved

in making the correct death certificates, mortuary slips, medico-legal entries, requisition for autopsy etc. Similarly, they must be fully aware of the ethical angle of their responsibilities and should carefully learn how to take legally valid consent for the different hospital procedure / therapics etc.

All students and interns are expected to attend the  CGR.

                 

Clinical Grand Round (CGR)

This is a centralized teaching activity held at 4.00 p.m. on Tuesday in LT I where the research activity

carried out by a department is presented. The total duration is one hour.

Patient care in Wards

1. Obstetric
2. Gynaecology
3. Emergency coverage or all patients with Obst/Gynae problems attending casualty on days the unit is on call. The same unit also provides emergency consultation for the hospital and attached centers who may require O & G Consultation during after office hours.

Patient Care in Labour Room

Labour emergency coverage is done by each unit concerned from 8 a.m. – 5 p.m. after which the emergency unit “on call” provides intensive care duty. Labour Room duty on Sunday is on rotation.

Operation Theatres

Each unit routinely has two days Main OT and emergency OT patient care 24x7day.

TEXT BOOKS RECOMMENDED

• Text book of Obstetrics for Undergraduates –DC DUTTAS
• Manual of Practical Obstetrics – Holland & Brews
• Shaw’s Text Book of Gynaecology
• Essentials of Gynaecology – Dr S Arulkumaran

. Essentials of  Obstetrics  – Dr S Arulkumaran

ASSESSMENT AND EXAMINATION

End of Posting Assessment

At the end of each clinical posting in each of the Obst & Gynae units mentioned above, the students are

assessed by the faculty members. This comprises of one Obstetric case, one Gynae case and a viva

Obstetrics & Gynaecology 111

voce in obstetrics, gynaecology and family planning. In the 8th semester, a theory exam also taken at the

end of the ward learning.

Pre-professional and Final MBBS Examination :

It consist of a written examination, a clinical examination to assess the clinical competencies and skills,

and a viva voce examination. The final MBBS examination is conducted by two internal examiners and

one external examiners. Candidates must exhibit acceptable level of competence in all the areas of

knowledge, attitudes and skills being evaluated by the examiners and teaching faculty.

Written theory examination is conducted with the help of traditional essay type question papers and

short notes. There is questions paper of 3 hours.

Clinical examination is aimed at assessing the clinical skills of the candidate and diagnostic reasoning.

Entirely objective evaluation of these skills is neither feasible nor desirable. However, in order to test the

various skills, the examiners may evaluate the candidates on a structured format, namely, history taking,

physical examination, diagnostic reasoning, choice of diagnostic investigations, general management,

medical and surgical procedures and strategies, and general attitude and demeanor towards the patient

and the examiners. Patients material selected for examination one obstetrics and one gynae case is

usually sufficiently representative of the type of patients for whom an internist may by called upon to

give an opinion.