This is a very brief informal introduction for new doctors starting Obs and gynae. I found it useful to make templates of the consultations. Keep these on my computer login and then copy into the healthrecord and then change for each patient. Using a template meant that I covered all the red flags and had a basic management plan ready to go for most people. If this is useful then please feel free to use and share it. Also feel free to make changes.

1. O&G Survival Guide
Some templates and SOPs for being an SHO
May 2022
DRAFT V2

2. Contents
1. Post Natal Review Indications
2. W8 Gynae Ward Rounds
3. Weekend Schedule
4. OOH Schedule
5. Triage Presentations
6. Acute Gynae Presentations
7. Triage Template
8. Post Natal Review Template
9. EPAU and Acute Gynae Template
10. ANC template
11. Useful guidelines
12. Growth chart summary
This guide has been set out in this format for 3 reasons:
1 – It is easy to copy and paste
2 – It is easy to up date
3 – It is easy to print out pages to stick up on the wards

3. Post Natal Review Indication
1. Acutely unwell patient
2. New fever, abnormal observations, severe pain
3. HDU step-down = Senior Review
4. EBL >500ml
5. D1 C-Section or difficult instrumental delivery
6. Change of medication – GDM, T1DM, T2DM,
HTN, PET, other chronic disease management
7. Antibiotic review
8. TTO required
9. Patient Queries/Concerns
10. Contraception advice
The following indications are listed in priority order.
Please write the appropriate number on the
handover list for the medical team to review.

4. W8 Ward Round
• Should be conducted everyday
• Weekend Consultant WR will review every patient
• The Whiteboard lists the patients
• “Pre” = Day case and pre-op patients
• Seen by theatre team
• “Post”= Post-op patients
• Seen by Consultant on day 1
• If >1 day post op then may need review
• “EA” = Emergency admissions
• Seen by Gynae SpR and EPAU SHO
• W8 jobs to be completed by Gynae SpR and EPAU SHO
• Acute Gynae referrals are taken by the SpR, who should
then inform the SHO and W8 or EPAU.
• Both the SpR and SHO should work as a team to clerk
the new admissions
• Any consent should be taken by the SpR or appropriately
trained SHO

5. Weekend Schedule
Time Triage SHO Ward SHO Delivery Suit
Team
0830 Handover on DS TTO round Handover on DS
0900 - 1000 1. Unwell patient
reviews
2. Theatre
3. Triage Clerking
4. Post-Natal
Reviews
Bleep Free Period
W8 Consultant led
Gynae WR
Gynae SpR to assist
DS ward round
and emergency CS
1000 - 1300 As above Jobs in priority order:
1. Unwell patient
reviews
2. Gynae jobs
3. Acute Gynae
clerking
4. Post Natal
Reviews
5. Inform SpR of
senior reviews
Senior SpR does
w1 WR
Junior SpR does
DS jobs
Senior SpR will do
ward reviews
when free
1300 - 1330 BLEEP FREE PERIOD
1330-1700 As above As above DS jobs
1700 - 2030 1. Unwell patient
reviews
2. Acute Gynae
clerking
3. Triage Clerking
Handover and leave SpR to complete
Post-Natal reviews
if required
2030 - 2100 Handover Handover
Bleeps: Triage SHO 1011, Junior SpR 1012, ward SHO
Gynae SpR is onsite from 0900 to 1300 on the weekend for
assistance with the W8 WR and Gynae referrals

6. Out of Hours (OOH) Schedule
Time Triage SHO Ward SHO Delivery Suit
Team
1700 Day Team leave Handover on DS
1700 - 2030 1. Unwell patient
reviews
2. Theatre
3. Triage Clerking
1. Unwell patient
reviews
2. Gynae jobs
3. Acute Gynae
clerking
DS ward round
and emergency CS
2030-2100 Handover Handover and leave Handover
2100 - 0830 1. Unwell patient
reviews
2. Theatre
3. Acute Gynae
clerking
4. Triage Clerking
Leave DS jobs
0830 - 0900 Handover Handover Handover
Bleeps: Triage SHO 1011, Junior SpR 1012, ward SHO
Only 1x SHO and 2x SpR available overnight

7. Triage Presentations
>17/40
• Very Common
1. RFM = Reduced Fetal Movements
2. PVB = Per Vagina Bleeding
3. Abdo pain
4. Headache
5. Threatened pre-term labour
6. SROM (spontaneous rupture of membranes)
• Common
1. HTN = Hypertension
2. PET = Pre-eclampsia symptoms
• Headache, visual disturbance, RUQ pain, leg swelling and pitting
oedema
3. Deranged PET bloods (LFTs, U/E, platelets)
4. Unilateral swollen leg = ? DVT
5. Primary care type presentations referred for 2nd opinions
due to patient being pregnant/post-partum
6. Prescribing advice
• Less Common
1. Chest pain
2. SOB ?PE
3. Tachycardia ?arrythmia
4. Rash (abdo rash requires SpR R/V)

8. EPAU and Acute Gynae Presentations
<17/40 or not pregnant
• Very Common
1. PVB = Per Vagina Bleeding
2. Abdo pain
3. HG = Hyperemesis Gravidarum
4. Miscarriage – Threatened, Inevitable, Incomplete,
Complete
• Common
1. PV discharge
2. Ectopic
3. Post-op complication
4. PID,
5. Endometritis
6. HMB = heavy menstrual bleeding
• Less Common
1. Ovarian Torsion (Most important differential)
2. Septic miscarriage
3. Bartholins
4. Tubo-ovarian abscess
Consenting for surgery should only be done by trained staff,
initially the SpR
Consenting for Methotrexate and prescribing – SpR ONLY
Consenting for removal of POC – can be anyone, once trained

9. Triage Template
Triage GPST BLAH BLAH
G1 P0+0
/40
1 x NVD
Issues: Nil
PC: PVB
HPC: 1xPVB this morning, 1x pad, no further episodes, no clots, No previous bleeding in pregnancy, No recent sexual intercourse, Normal smears
No back pain/chest pain, no headache, no change in vision, no neurological changes, no N+V+D, no dysuria, no increased frequency, no foul smell, no
haematuria, no PR bleeding, no PV bleeding, no PV discharge, no calf pain, no faints, No SROM / watery discharge, No genital itching / discomfort
BO today as normal, PUing as normal, E+D as normal
Happy with fetal movements
Most recent scan result – Placental location low or high? Placenta previa? Normal growth?
PMHx- 1x Caesarean Section, Previous PPH with Blood Transfusion, prev PET
DHx- healthy start vitamlins, Aspirin, NKDA
SHx- no hx of abuse, lives with partner and child, non-smoker, no alcohol, no drugs
Occupation -
FHx- no VTE/ DM/ PET/ HTN/ miscarriage
ANC Plan -
Urine - ketones -ve, WBC -ve, Nit -ve, Pro -ve,
MEOWS 0 123/83, HR 99 T37.3
O/E: Comfortable at rest, walking normally,
Abdo soft, not hard, no contractions felt, gravid uterus, BS+, mildly tender suprapubic, no renal angle tenderness
Calves SNT, neurological intact
Speculum: With MW Deb chaperone and verbal consent, Os closed, Cough – no discharge, no active bleeding/clots, white discharge, HVS taken
CTG: Met DR criteria
Imp -
Plan
1 D/W SPR Blah, agreed following plan:
2 Continue ANC as planned
3 Safety netting - return to triage if dehydrated, PV bleeding, worrying PV discharge, calf pain, severe headache not resolved by paracetamol, change in
vision, reduced fetal movement or worsening abdo pain.
4 Home
5 To closely monitor for any further PVB
6 Fibronectin swab taken if ? Pre-term labour
7 SpR Blah consented for IOL (induction of labour)

10. EPAU Template
GPST BLAH BLAH
G1 P0+0
/40
Issues: Nil
PC: PVB
HPC: Reports episode of PVB this morning, 1x pad, no further episodes, no clots, No previous bleeding in
pregnancy, No recent sexual intercourse, Normal smears
No back pain/chest pain, no headache, no change in vision, no neurological changes, no N+V+D, no dysuria, no
increased frequency, no foul smell, no haematuria, no PR bleeding, no PV bleeding, no PV discharge, no calf pain,
no faints, No SROM / watery discharge, No genital itching / discomfort
BO today as normal, PUing as normal, E+D as normal
PMHx- Previous surgery, fibroids, PID, previous pregnancies, IVF
DHx- healthy start vitamlins, Contraception, NKDA
SHx- no hx of abuse, lives with partner and child, non-smoker, no alcohol, no drugs
Occupation -
FHx- no VTE/ DM/ PET/ HTN/ miscarriage
ANC Plan -
Urine - ketones -ve, WBC -ve, Nit -ve, Pro -ve,
MEOWS 0 123/83, HR 99 T37.3
O/E: Comfortable at rest, walking normally, Abdo soft, not hard, BS+, mildly tender suprapubic, no renal angle
tenderness Calves SNT, neurological intact
Speculum: With MW Deb chaperone with verbal consent, Os closed, Cough – no discharge, no active
bleeding/clots, white discharge, HVS taken
VE with consent: No adnexal tenderness, no cervical excitation
Scan: Viable Intra-uterine Pregnancy or no IUP or Ectopic
Imp -
Plan
1 D/W SPR Blah, agreed following plan:
2 Continue ANC as planned
3 Safety netting - return to triage if dehydrated, PV bleeding, worrying PV discharge, calf pain, severe headache
not resolved by paracetamol, change in vision, reduced fetal movement or worsening abdo pain.
4 Home
5 To closely monitor for any further PVB

11. PN WR Template
WR GPST BLAH BLAH
G1 P0+0
1 x NVD
PN 1
EBL 500ml, Hb 100
Issues: Nil, anaemia, pain, infection, HTN, PET, GDM, VTE, failed TWOC, ileus, PPH,
thyroid, renal,
Feels well, mobilising, E+D normally,
Passed wind/ BO, TWOC’ed and PUing
Normal lochia, small amount of PVB, no clots
O/E: MEOWS 0 123/83, HR 99 T37.3
Comfortable at rest, walking normally,
Abdo soft, well contracted uterus, BS+, no renal angle tenderness
Pad – minimal bleeding / discharge
Dressing - clean
Calves SNT,
Plan
1 D/W SPR Blah, agreed following plan:
2 MLD
3 FBC 6h post-delivery if EBL >500ml
4 Oral Ferrous sulphate OD for28/7 if HB < 100 PN (TTO)
5 If HB<70. symptomatic of anaemia ?? Transfusion
6 VTE score & Weight to dose heparin if indicated (TTO), 10/7
7 TWOC when mobile, if 2x failed then catheter for 1/52
8 If HTN, <150/100 for 24h, then CMW to check BP alternate days and GP to review
in 10/7
9 Renal / Rheumatology/ Liver patients discussed with Maternal Med Team
10 GDM / T2DM/ T1DM medications updated as per Orange book plan

12. ANC Template
ANC Mr or Mrs Blah GPST BLAH BLAH
G1 P0+0
/40
1 x NVD
Issues: Nil
Scan: Normal linear growth
Urine - NAD
No back pain/chest pain, no headache, no change in vision, no neurological changes, no
N+V+D, no dysuria, no increased frequency, no foul smell, no haematuria, no PR bleeding,
no PV bleeding, no PV discharge, no calf pain, no faints, No SROM / watery discharge, No
genital itching / discomfort
BO today as normal, PUing as normal, E+D as normal
Happy with fetal movements
PMHx- Previous surgery, fibroids, PID, previous pregnancies, IVF , complex medical
background
DHx- healthy start vitamlins, Contraception, NKDA
SHx- no hx of abuse, lives with partner and child, non-smoker, no alcohol, no drugs
Occupation -
FHx- no VTE/ DM/ PET/ HTN/ miscarriage
ANC Plan - DAU scans from 32/40, OGTT, Anti D clinic appts booked
O/E: Comfortable at rest,
Imp -
Plan
1 D/W SPR Blah, agreed following plan:
2 Repeat Growth scan in 2 or 4 weeks
3 OGTT and bloods at 28/40
4 For Consultant led care or Community Mid Wife Led care
5 Wants Home birth, NVD, elective C-Section – consent taken and booked
6 Will need IOL at 38/40

13. Useful Guidelines
• Bleeding in early pregnancy
• Hyperemesis
• Diabetes + Orange book
• Hypertension
• Pre-Eclampsia
• DVT in Pregnancy (2x USS 1/52 apart)
• PE (CTPA or VQ scan if suspected or tachy)
• How to book CS and IOL on Badgernet
• How to book DAU scans, bloods and reviews
• How to book Growth Scans
• How to assist in CS

14. Growth Scans
• Reason – check growth trajectory
• >32/40, worrying if <20g/day
• Worrying if <10th centile, pathological <3rd
• Worrying if >90th centile
• Liquor volume >8cm = abnormal
• Consider OGTT and GDM screen
• Umbilical artery PI (pulsatile index) >98th or absent
= abnormal
• End diastolic flow (EDF) = if absent or reversed =
abnormal
• Position = cephalic at 36/40 otherwise abnormal
• Escalate any concerns
• If scan is normal, normally repeat in 4 weeks
• If abnormal, normally repeat in 2 weeks