The document provides an overview of obstetrics and gynecology (OB/GYN) including: 1. OB/GYN deals with surgical care of the female reproductive system, including care for pregnant and non-pregnant patients. 2. There are several OB/GYN subspecialties focused on areas like high-risk pregnancies, infertility, cancers, and pelvic issues. 3. OB/GYN care is organized through ambulatory practices, maternity houses, gynecology departments, and various levels of hospitals.

1. Introduction to OB/GYN
Department of OB/GYN, DSMA
Medvedev M.V., MD, PhD

2. Contents
Subject of OB/GYN
Organization of OB/GYN service
Short history of OB/GYN
The principles of preconception and antepartum care

3. Subject
 Obstetrics and Gynaecology (often abbreviated to
OB/GYN, O&G or Obs & Gynae) are the two surgical
specialties dealing with the female reproductive
organs, and as such are often combined to form a
single medical speciality and postgraduate training
program. 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.

4. Organization
 Examples of subspecialty training available to physicians in the US are:
 Maternal-Fetal Medicine - an obstetrical subspecialty that focuses on the
medical and surgical management of high-risk pregnancies
 Reproductive Endocrinology and Infertility - gynaecologic subspecialty
focusing on the medical and surgical evaluation of women with problems related
to the menstrual cycle and fertility
 Gynaecological Oncology - gynaecologic subspecialty focusing on the
medical and surgical treatment of women with cancers of the reproductive
organs
 Urogynaecology and Pelvic Reconstructive Surgery - gynaecologic
subspecialty focusing on the diagnosis and surgical treatment of women with
urinary incontinence and prolapse of the pelvic organs. Sometimes referred to
(incorrectly) by laypersons as "Female Urology"
 Advanced Laparoscopic Surgery
 Family Planning - gynaecologic subspecialty offering training in contraception
and (sometimes) pregnancy termination (abortion)
 Pediatric and Adolescent Gynaecology
 Menopausal and Geriatric Gynaecology

5. Organization
 In Ukraine we have 3 years of postgraduate training.
Some OB/GYN surgeons elect to do further subspecialty
training in programs known as 'fellowships' after
completing their residency training, although the majority
choose to enter private or academic practice as general
OB/GYNs. Fellowship training in an obstetric or
gynaecologic subspeciality can range from one to four
years in duration, and these 'fellowship' programs
usually have a research component involved with the
clinical and surgical training.

6. Organization
Ambulatory
practice
Maternity Gynecology
house department
(Labor &
delivery
department)

7. Levels of OB/GYN care organization
III
II
I

8. History
 The Kahun Gynaecological Papyrus is the oldest known medical
text, (dated to about 1800 BCE) dealing with women's complaints -
gynaecological diseases, fertility, pregnancy, contraception etc.
Treatments are non surgical, comprising applying medicines to the
affected body part or swallowing them. The womb is at times seen
as the source of complaints manifesting themselves in other body
parts.
 According to the Suda, the ancient Greek physician Soranus
practiced in Alexandria and subsequently Rome. He was the chief
representative of the school of physicians known as "Methodists."
His treatise Gynaikeia is extant (first published in 1838, later by V.
Rose as Gynaecology, in 1882, with a 6th-century Latin translation
by Moschio, a physician of the same school).
 In the United States, J. Marion Sims is considered the father of
American gynaecology.
 In Ukraine and Russia first school for obstetritians and 1st obstetric
clinic were founded in 1757 due to order of Kondoidi. 1st professor of
obstetrics and author of 1st russian book was Maksimovich-Ambodik
(1744-1812)/

9. PRECONCEPTION COUNSELING
AND CARE
 Family planning and pregnancy spacing
 Family history
 Genetic history
 Medical, surgical, psychiatric, and neurologic histories
 Current medications
 Substance use
 Domestic abuse and violence
 Nutrition
 Environmental and occupational exposures
 Immunity and immunization status
 Risk factors for sexually transmitted diseases
 Obstetric and gynecologic history
 Physical examination
 Assessment of socioeconomic, education, and culture context

10. Patients should be counseled regarding the
benefits of the following activities:
 Exercise
 Reducing weight before pregnancy, if obese; increasing weight, if
underweight
 Avoiding food faddism
 Avoiding pregnancy within one month of receiving a live attenuated vaccine
(e.g., rubella)
 Preventing HIV infection
 Determining the time of conception by an accurate menstrual history
 Abstaining from tobacco, alcohol, and illicit drug use before and during
pregnancy
 Taking 0.4 mg of folic acid daily while attempting pregnancy and during the
first trimester of pregnancy
 Maintaining good control of any preexisting medical conditions (e.g., diabetes,
hypertension, asthma, systemic lupus erythematosus, seizures, thyroid
disorders, inflammatory bowel disease).

11. ANTEPARTUM CARE
 Diagnosing pregnancy and determining gestational age
 Monitoring the progress of the pregnancy with periodic
examinations and appropriate screening tests
 Assessing the well-being of the woman and her fetus
 Providing patient education that addresses all aspects of
pregnancy
 Preparing the patient and her family for her management
during labor, delivery, and the postpartum interval.
 Detecting medical and psychosocial complications and
instituting indicated interventions

12. Diagnosis of pregnancy
Subjective signs
Physical examination
measure human chorionic gonadotropin (hCG)
Ultrasound examination
Detection of fetal heart
activity (“fetal heart tones”)

13. Estimated Date of Delivery
Gestational age is the number of weeks that
have elapsed between the first day of the last
menstrual period (not the presumed time of
conception) and the date of delivery
Naegele’s rule is an easy way to calculate the
EDD: add 7 days to the first day of the last
normal menstrual flow and
subtract 3 months
Obstetric ultrasound

14. Every prenatal assessment includes
the following assessments:
Blood pressure
Weight
Urinalysis for albumin and glucose
Fundal height measurement
Fetal heart rate

15. Additional tests
 First trimester screening (10–13 weeks of gestation),
which includes serum screening for pregnancy-associated
plasma protein A (PPA) and beta-hCG, and an ultrasound
assessment of nuchal transparency.
 Second trimester screening (15–20 weeks of gestation)
consisting of triple (maternal serum α-fetal protein
[MSAFP], estriol, and hCG) or quadruple (“quad”)
(MSAFP, hCG, estriol, and inhibin) screening tests.
 Ultrasound examination for neural tube defects, in the
second trimester

16. Additional tests
Glucose challenge test (GCT) and a glucose
tolerance test (GTT)
Universal screening for group B streptococcus
(GBS)
Hemoglobin and hematocrit levels is repeated in
the third trimester

17. Assessment of Fetal Well-Being
Indications for Fetal Testing
• Antiphospholipid syndrome
• Hyperthyroidism (poorly controlled)
• Hemoglobinopathies (hemoglobin SS, SC, or S-
thalassemia)
• Significant heart disease
• Systemic lupus erythematosus
• Chronic renal disease
• Insulin-treated diabetes mellitus
• Hypertensive disorders

18. Assessment of Fetal Well-Being
 Pregnancy-related conditions:
• Pregnancy-induced hypertension
• Decreased fetal movement
• Oligohydramnios
• Polyhydramnios
• Intrauterine growth restriction
• Postterm pregnancy
• Isoimmunization (moderate to severe)
• Previous fetal demise
• Multiple gestation (with significant growth discrepancy)

19. Assessment of Fetal Well-Being
 NONSTRESS TEST and CONTRACTION STRESS TEST

20. BIOPHYSICAL PROFILE

21. DOPPLER ULTRASOUND OF
UMBILICAL ARTERY