CHAPTER 11: OBSTETRICS & GYNECOLOGY POSTING.
Welcome to the Obstetrics/Gynecology department, where we cater for women from adolescence to menopause.
The Obstetrics/Gynecology department comprises of two co-dependent units:
1. Obstetrics unit: also called the maternity unit, which is concerned with childbirth and the care of women giving birth.
2. Gynecology unit: which is concerned with functions and diseases affecting the reproductive system of women.
In the hospital where I did my clerkship, the two units were on separate wards. The Obstetrics (labor) ward was divided into three sections:
(Maternity ward entrance, MCMH)
Section 1: For patients in active labor.
Section 2: For immediate postpartum patients.
Section 3: For high-risk patients on observation e.g. Preterm labor, Pregnancies with comorbidities like Hypertension/Diabetes.
There was also a special room for Patients with Preecclampsia (who are high risk patients) and two Delivery rooms.
The Gynecology unit was on the Female Surgical Ward, and we had rounds whenever our patients were admitted there.
Obstetric clinics ran twice weekly (Family planning clinic and Antenatal clinic) while Gynecology clinic was once a week.
We had surgeries on Wednesdays and emergency cases were scheduled as needed.
(At the MCMH Theatre)
Shortly after starting the posting, I had the opportunity to attend the 20th Annual Perinatology conference organized by the Pediatrics/Obstetrics departments of the MCMH, and attended by doctors, medical students, midwives and other stakeholders from the Hospital and Ministry of Health, Wellness and the Environment. They presented and discussed the maternal/neonatal morbidity and mortality over the past year. According to the speakers there was an overall improvement in maternal/neonatal care in the country. The event was both fun and enlightening for me.
(At the conference with two of my colleagues and the medical officer, Dr. Cumberbatch. Photocredit: SVG Health).
(The Senior Register, Dr. Pabilona giving her speech during the conference. Photocredit: SVG Health).
Some of the presentations I saw during my 6-week posting include:
Cervical Intraepithelial Neoplasm (CIN)
Hypertension in pregnancy
Ovarian Hyperstimulation Syndrome (OHSS)
Preterm Uterine Contraction
Premature rupture of membrane
Urinary Tract Infection
And some Procedures I saw were:
Artificial Rupture of Membrane (AROM)
Insertion of Pessary
Intrauterine Contraceptive Device (IUCD) placement
(CTG procedure: which was typically left to the medical students).
Bilateral Tubal ligation
Cervical Cerclage (secondary to incompetence)
Dilation and Curettage (D & C)
Ovarian cystectomy & salpingectomy
I came across different kinds of patients too: the nervous, the confident, the cooperative, the indifferent and so on. Generally most of them were easy to relate to.
Then comes the most dramatic part. In my opinion, there’s nothing as fascinating as watching a live birth. The delivery room experience is awesome. Let me try to paint the scenario as I remember it:
A woman in labor is rushed into the delivery room, with the midwives and other birth assistants in attendance. Sometimes a doctor is there to take the delivery as well. And the partner or a family member of the patient is usually allowed to come in.
The midwife-in-charge yells, as others encourage and soothe the woman in labor. The baby’s head would then gradually descend as the midwife helps to manouver it. When the entire body of the baby comes out, usually with a distinct cry, another midwife states the sex of the baby and time of delivery. Then comes the clamping of the umbilicus which is eventually cut off under sterile condition. After a few moments on the mother’s chest amidst tears and smiles), the baby is transferred to the nursery.
Shortly after an oxytocin injection is administered intramuscularly to facilitate uterine contraction and the placenta is delivered. After ensuring that there is no part of the placenta missing, the woman is cleaned up and returned to the ward. Occasionally we’d encounter a difficult delivery that requires a procedure like episiotomy.
This wiki article gives a breakdown of what takes place during the process of delivery.
A major highlight of the posting is that I got to assist the Senior Registrar for two mini-surgical procedures…which is every medical student’s dream! Yaay!! 😀
(At the Operating Theatre, Yours truly).
Then the Preceptor I worked with is one of the most dedicated doctors I’ve met. She’s well respected not just in the Hospital but all over SVG as a country. On my last day in the department while giving her final assessment, she gave me some insight on boosting the self confidence I need further along my medical career.
(Dr. Camille Nicholls. Photocredit: SVG Health)
Recommended study materials:
· KAPLAN step 2 videos
· Blueprints (Obstetrics and Gynecology)
· Case Files (Obstetrics and Gynecology)
· First Aid for the Obstetrics & Gynecology clerkships
* * *
My ObGyn posting was one of my most remarkable clinical rotations. Although it was quite demanding and challenging, but it was quite enlightening too. The midwives, nurses, doctors and other students I worked with were quite dedicated and there was great teamwork. I was able to learn a lot from the rounds, teaching sessions, presentations and procedures. I had to clerk and admit patients, draw their blood samples and so on. Seeing as mothers bonded with their newborns was always heartwarming. It gave me reasons to seriously begin to think about motherhood! I wrote this post just before I finished from the department.
So would I consider a career in this specialty? Hmmmn…maybe not. I personally don’t think I can stand the process of taking a Normal Spontaneous Vaginal Delivery (NSVD) every other day, or being called to the theatre for an emergency Caesarean section or Evacuation of Retained Products of Conception (ERPC).
Shout outs to every Ob/Gyn Doctor out there, thank you for the amazing job you do. 🙌🙌
Thank you for reading!
PS: I have one more post to go for this series. Thanks to everyone that has supported me so far.