Gynaecology and Obstetrics
Obstetrics and gynaecology (often abbreviated to OB/GYN, OBG, O&G) are the two surgical–medical specialties dealing with the female reproductive organs in their pregnant and non-pregnant state, respectively, and as such are often combined to form a single medical specialty and postgraduate training programme. This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology involving female reproductive organs, and to provide care for both pregnant and non-pregnant patients.
Subspecialties include the following:
- Maternal-fetal medicine – an obstetrical subspecialty, sometimes referred to as perinatology, that focuses on the medical and surgical management of high-risk pregnancies and surgery on the foetus with the goal of reducing morbidity and mortality.
- Reproductive endocrinology and infertility – a subspecialty that focuses on the biological causes and interventional treatment of infertility
- Gynaecological oncology – a gynaecologic subspecialty focusing on the medical and surgical treatment of women with cancers of the reproductive organs
- Female pelvic medicine and reconstructive surgery – a gynaecologic subspecialty focusing on the diagnosis and surgical treatment of women with urinary incontinence and prolapse of the pelvic organs. Sometimes referred to by laypersons as “Female urology”
- Advanced laparoscopic surgery
- Family planning – a gynaecologic subspecialty offering training in contraception and pregnancy termination (abortion)
- Paediatric and adolescent gynaecology
- Menopausal and geriatric gynaecology
Gynaecology is the medical practice dealing with the health of the female reproductive system (uterus, vagina, and ovaries). Literally, outside medicine, it means "the science of women". Almost all modern gynaecologists are also obstetricians. In many areas, the specialties of gynaecology and obstetrics overlap.
The Kahun Gynaecological Papyrus is the oldest known medical text of any kind. Dated to about 1800 B.C., it deals with women's complaints—gynaecological diseases, fertility, pregnancy, contraception, etc. The Hippocratic Corpus contains several gynaecological treatises dating to the 5th/4th centuries BC. The gynaecological treatise Gynaikeia by Soranus of Ephesus (1st/2nd century AD) is extant. He was the chief representative of the school of physicians known as the "Methodists".
Gynaecology is typically considered a consultant specialty. As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynaecological examination is quite intimate, more so than a routine physical exam.
As with all surgical specialties, gynaecologists may employ medical or surgical therapies (or many times, both), depending on the exact nature of the problem that they are treating. Pre- and post-operative medical management will often employ many standard drug therapies.
Surgery, however, is the mainstay of gynaecological therapy. Some of the more common operations that gynaecologists perform include:
- Dilation and curettage (removal of the uterine contents for various reasons, including completing a partial miscarriage and diagnostic sampling for dysfunctional uterine bleeding refractive to medical therapy)
- Hysterectomy (removal of the uterus)
- Oophorectomy (removal of the ovaries)
- Tubal ligation (a type of permanent sterilization)
- Hysteroscopy (inspection of the uterine cavity)
- Diagnostic laparoscopy – used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide a definitive diagnosis of endometriosis.
- Exploratory laparotomy – may be used to investigate the level of progression of benign or malignant disease, or to assess and repair damage to the pelvic organs.
- Various surgical treatments for urinary incontinence, including cystoscopy and sub-urethral slings.
- Surgical treatment of pelvic organ prolapse, including correction of cystocele and rectocele.
- Appendectomy – often performed to remove site of painful endometriosis implantation and/or prophylactically (against future acute appendicitis) at the time of hysterectomy or Caesarean section. May also be performed as part of a staging operation for ovarian cancer.
- Cervical Excision Procedures (including cryosurgery) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.
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