Introduction of Gynaecology and Obstetrics.

1. PT&SR Introduction
izlwfr rU= ,oa L=h jksx ifjp;
PT&SR Introduction
DR. RAMVEER SHARMA
M.D. Ayu. (Gynae)
I.P.G.T.&R. Jamnagar
MMM Govt. Ayu. College UDAIPUR
Mob. 9414757932
Email. ramveersharma1960@gmail.com

2. PT&SR Introduction
Etymological origin of the word Stree,
(Definition of Gynaecology)
 LR;k¸;rs ¼xHkZ%½ - Fertilization take a place,
 LR;kuh Hkofr ok fLFkja Hkofr ¼xHkZ%½ - Embedding of a zygote.
 o`f)a izkIuksfr ¼xHkZ%½ ;fLeu~ lk AA - Development of a foetus.

 Means, the person who has complete three process in her body
like wise Fertilization, Embedding and Growth of the foetus is
called Stree.
 The diseases are suffer with Stree, are called as Stree Roga.
Dr. Ram Veer Sharma

3. PT&SR Introduction
Gynaecology -
 Gynae - Women,
 Logos - Study – Sum of knowledge in particular subject.
Definition -
Gynaecology -
 It is the medical practice dealing with the health of the female
reproductive system (Uterus, Vagina and Ovaries).
 Out side of medicine it means – the science of the women.
Dr. Ram Veer Sharma

4. PT&SR Introduction
Obstetrics:-
 Obstrect – to stand with.
 It is surgical specially dealing with care of women and their
children during pregnancy, child birth and postnatal period.

Midwifery - It is the non surgical care of pregnant women.
 According to Ayurveda it is a branch of Kaumarbhritya as
stated by Acharya Sushruta and Hareeta.
Dr. Ram Veer Sharma

5. PT&SR Introduction
 r= dkSekjHk`R;a uke dqekj Hkj.k /kk=h{khj nks’k fuokj.kkFkZa nq’VLrU;xzgleqRFkkuka
O;kk/kukeqi”keukFkZa pAAlq-lw- 1AA
a. dqekj Hkj.k - Nutrition of a child before and after birth.
b. /kk=h{khj nks’k fuokj.kkFkZa – Management of Lactational or Brest
disorders.
 nq’VLrU;xzgleqRFkkuka O;kk/kukeqi”keukFkZa A lq-lw- 1AA - Management of
feeding or germ generated diseases of the child.
Dr. Ram Veer Sharma

6. PT&SR Introduction
Kaumarbritya.
 The science which deals the Nutrition of a child before and
after birth, management of lactational or Breast disorders and
treatment of the diseases originated by the feeding and germs
(Graha) is known as Kaumarbritya.
Dr. Ram Veer Sharma

7. PT&SR Introduction
 xHkksZidze foKkua lwfrdksidzeLrFkk A
 ckykuka jksx “keue~ Ks;a ckyfpfdfRlre~~AA
 xHkksZidze foKkua -
 The process of the Fertilization and its management for foetal
and maternal wellbeing , Pre conception planning, Antenatal
and Internatal care .
 lwfrdksidzeLrFkk - Postnatal or Puerperal management,
 ckykuka jksx “keue - Management and treatment of the neonates
and children.
Dr. Ram Veer Sharma

8. PT&SR Introduction
 Ks;a ckyfpfdfRlre~~AA gkjhr~AA
 The science which deals the process of the fertilization,
Antenatal, Internatal and Postnatal care of a baby and mother
and management and treatment of the neonate and children is
called Kaumarbritya.
Dr. Ram Veer Sharma

9. PT&SR Introduction
(2)Stree Vayo bheden Stree Sangya
(Age wise Nomenclature of Stree)
 ckyk rq xh;rs ukjh ;ko}’kkZf.k ‘kksM”k%A Up to - 16Yrs.
 rrLrq r#.kh Ks;k }kf=a”koRljkof/k%AA Up to - 16 - 32 Yrs.
 rrks)Z∙f/k:<kL;kr i¥~pk”k}rLjkof/k%AA Up to 32 -50 Yr
 o`)krRijrks Ks;k lqjrksRlo oftZrk%AA Hkk- iz- More than - 50yrs.
Dr. Ram Veer Sharma

10. PT&SR Introduction
 v’Vo’kkZHkosn~xkSjh - 8 years.
 uoo’kkZ rq jksfg.khA - 9 years
 n”ko’kkZ Hkosr~ dU;k - 10 years
 vrks/oZjtLoykAA ikjk”kjAA >10 years.
Dr. Ram Veer Sharma

11. . Nomenclature Age (Yrs) Body changes Doasha Avastha
Bala, Gouri,
RohiniKanya
10 All over growth Kafa, Pitta, Vata
Kumari , Mugdha 10--12 Growth of primary and
secondary sex characters
Kafa, Pitta, Vata
Rajaswala
Bala, Mugdha
12-19 Menstruation and ability
to fertilization
Kafa, Pitta, Vata
PT&SR Introduction
Bala, Mugdha to fertilization
Yuvati, Taruni 16-40 Peak fertile period,
developmental totalize
Pitta, Kafa, Vata
Proudha, Adhirudha,
Pragalbha
40-50 Reduction of the fertility
Premenopausal period
Pitta, Vata, Kafa
Briddha More than 50 Menopause and starting
of degeneration
Vata, Pitta, Kafa
Dr. Ram Veer Sharma

12. PT&SR Introduction
PUBERTY
 It is the process of physical changes by which a child's Body
matures in to an adult body capable of sexual reproduction to
enable fertilization.
• It is initiated by hormonal signals from the brain to the gonads:
the ovaries.
 In response to the signals -
a. The gonads produce hormones that stimulate - libido and
b. The growth, function, and transformation of the Brain, Bones,
Muscles, Blood, Skin, Hair, Breasts, and Sexual Organs.
Dr. Ram Veer Sharma

13. PT&SR Introduction
PUBERTY
 Physical growth -height and weight - accelerates in the first half
of puberty and is completed when the child has developed an
adult body.
Dr. Ram Veer Sharma

14. Stages of the development
Stage Approx. Age Changes
A.Adrenarche 6 -10 Yrs Appearance of axillaries and
pubic hair
B. Gonadarche 8 Yrs Gonads start to maturing
PT&SR Introduction
C. Thalarche 11 Yrs, Females Breast development.
D. Pubarche 12 Yrs Development of pubic hairs.
E. Menarche 12.5 Yrs Appearance of menstruation.
E. Spermarche 14 Yrs. in Males Ejaculation of semen with sperm
Dr. Ram Veer Sharma

15. PT&SR Introduction
Tanner’s Staging
 Stage 1st - Flat, pre pubertal breast (Budding of the nipple)
 Stage 2nd - Firm, Tender lump under the center of the areola of
one or both breasts.
one or both breasts.
 Stage 3rd - Within six to 12 months - The soft, swelling has
clearly begun in both sides, extending beyond the edges of the
areola.
Dr. Ram Veer Sharma

16. PT&SR Introduction
 Stage 4th - Another 12 months - The breasts are approaching
mature size and shape, with areola and nipples forming a
secondary mount.
 Stage 5th - In most young women, this mound disappears into
 Stage 5 - In most young women, this mound disappears into
the contour of the mature breast.
 In the two years following Thelarche - The Uterus, Ovaries,
and the Follicles in the ovaries increase in size.
Dr. Ram Veer Sharma

17. PT&SR Introduction
Tanner’s Staging
Dr. Ram Veer Sharma

18. PT&SR Introduction
4. Pubarche -
Time - 12 Yrs - Within a few months of Thalarche -
 Stage 1st - The pubic hairs are usually visible first along
the labia majora.
 Stage 2nd - First few hairs appeared.
 Stage 3rd -Within another 6 - 12 months – Hairs are too
numerous to count and appear on the pubic mount.
 Stage 4 - The hairs densely fill the "pubic triangle.
 Stage 5 - The pubic hairs spread to the thighs and sometimes
as abdominal hair upward towards the navel.
Dr. Ram Veer Sharma

19. PT&SR Introduction
Pubarche
Dr. Ram Veer Sharma

20. PT&SR Introduction
5. Menarche -
Average age - 12.5 Yrs. about two years after Thelarche.
 Starting of the menstrual bleeding.
 Between 11th birthday to 14th birthday.
 In fact, anytime between 8th and 16th B.D. is normal.
 Anovulatory menses- Post -
 Menarche characters - 80% - First year.
- 50% -Third years
- 10 % -Sixth years.
 The lower half of the pelvis and thus hips widen (Larger birth
canal). Dr. Ram Veer Sharma

21. PT&SR Introduction
Menarche
Dr. Ram Veer Sharma

22. PT&SR Introduction
5. Menarche -
• Increased fat tissues percentage - and distributed Fat in the
Breasts, Hips, Buttocks, Thighs, Upper arms, and Pubis.
• Average fat - A 10 years, girls have 6% more body fat than
boys.
Body odor and acne: -
• After Thalarche and Pubarche – one or more years.
 Fatty acid + Androgens – Composition of perspiration.
 Body odour by secretion of the Sebaceous glands and
Appocrine glands.
Dr. Ram Veer Sharma

23. PT&SR Introduction
Changing of a Girl in a adult
Dr. Ram Veer Sharma

24. PT&SR Introduction
Why should learn Gynaecology separately ?
Dr. Ram Veer Sharma

25. PT&SR Introduction
Difference between Male & Female
Dr. Ram Veer Sharma

26. PT&SR Introduction
Difference Between Male & Female Sharir
L=h “kkjhj oSf”k’V
 There are so many differences in male and female as -
Anatomical Physiological Psychological
(A) Anatomical -
 Total structure - Small than Male.
 Genital organs (Jananga)- Most of are internal and closely
connected to pelvic cavity.
Dr. Ram Veer Sharma

27. PT&SR Introduction
Ayurvedic View
Intestine Length - 3.5 Vyam? 3 Vyam (Su. Sha.)
 Ashaya - Three More 3
• iq:"ksH;ks∙f/kdk”pkU;s ukjh.kkek”k;kL=;%A /kjk xHkkZ”k;% izksDr% fiÙkiDok”k;kURkjsA
• LrukS izo`)kS rkoso cq/kS% LrU;k”k;kS erkSA ¼Hkk-iz-iwoZ= 3@217] 218 “kka-la-iwoZ-
• LrukS izo`)kS rkoso cq/kS% LrU;k”k;kS erkSA ¼Hkk-iz-iwoZ= 3@217] 218 “kka-la-iwoZ-
5@10 dk-
 Garbhashaya 1 + Stanyashaya 2 = 3
 Shushruta - Stanya - Pratyanga.
Dr. Ram Veer Sharma

28. PT&SR Introduction
Bahi: Mukh Srotasa -
 Three more – Stana – 2 + Yoni – Rakta waha – 1 = 3
 Jo.ku;uonu?kzk.kxqnes<zkfu uo Jksrkafl ujk.kke~ cfgeZq[kkfu ~,rkfu,o
L=h.kkeijkf.k p
 =hf.k }s Lru;ks% v/k”p jäoge pA lq- “kk-
 L=h.kkeU;srkfu =hf.k% Lru;ks% xHkZoReZfu%AA Hkk- iz-
 vkrZoogs}sr;ksewZya xHkZ”k; vkrZookfgU;”p /keU;%AA
 Muscles – Soft and less contractibility. e`nq lqdqekjA
 Excess – 20 muscles – L=h.kkarqfca”kfrjf/kd%AA
Dr. Ram Veer Sharma

29. PT&SR Introduction
 Bones - Comparatively – Small, Soft, Light and Smooth.
Due to - Ca+ Low.
 Measurements :-
 The pelvic region is large then the male.
 iq#’kksj% izek.k% L=h;k”pJksf.k%A
 The pelvic region is heavy like a chest of the male. (Su.Sha.4).
 v’Vkn”kk³~xqyfoLrkjiq#’kksj%rRizek.kL=h Jksf.k%A
 The measurement of the pelvis is of 18 Angula equal as male
chest.
Dr. Ram Veer Sharma

30. PT&SR Introduction
. Characters Male Female
Constitutional
Vitality
Lesser 100,
5 are dying by
Spontaneous
abortion
4 years - Greater
Birth ratio 105 :
Dr. Ram Veer Sharma
More cause of the
death
Other all diseases. Benign tumors,
Female reproductive
disorders,
Cancer of the breast
and cervix.

31. PT&SR Introduction
. Characters Male Female
Thyroid  Larger and more active
 Enlarges during menstruation
and pregnancy,
 More prone to goiter,
Dr. Ram Veer Sharma
Resistance to cold,
 Smooth skin,
 Relatively hairless body,
 Thin layer of subcutaneous fat.

32. PT&SR Introduction
.Characters Male Female
Skeletal
Structure
• Larger head,
• Narrow face,
• More Protruding chin,
• Larger legs and Rib
 Shorter head,
 Broader face,
 Less protruding chin,
 Shorter legs and Rib
Dr. Ram Veer Sharma
cage.
• Broader shoulders and
chest.
• First finger of the hand
is shorter than the third;
cage,
 Broader Hip and
pelvis, Longer trunk.
 First finger of the
hand is Longer than
the third;

33. PT&SR Introduction
.
Characters Male Female
 Bone Density Higher Less – Low Ca+
 Fully Grown Spine ± 14% Shorter
 Flexibility of ± 7% More
Dr. Ram Veer Sharma
 Flexibility of
body
± 7% More
 Muscle Mass of
Total Body
± 41% ± 35%
 Muscles Develop
by exercise
± 6% Per week ± 4% week

34. .
Characters Male Female
 Muscles strength 50 percent more
stronger
Weak
 Teeth Longer Shorter
 Viscera Larger - Stomach,
PT&SR Introduction
 Viscera Larger - Stomach,
Kidneys, Liver, and
appendix, and Smaller –
Heart & Lungs.
Dr. Ram Veer Sharma

35. .
Characters Male Female
 Brain ± 92.5%. of men
brain.
Both hemisphere are
equally activated at a
PT&SR Introduction
time
 Fat mass of total
body
± 10% ± 20%
Dr. Ram Veer Sharma

36. . Characters Male Female
 The cardio
respiratory system
(oxygen carrying
system)
± 39% Bigger Lesser
PT&SR Introduction
 Heart ± 80% Larger 20% Smaller
 Lung capacity 30% less.
 Heart beats B/M 72 / m, 80 / m.
Dr. Ram Veer Sharma

37. . Characters Male Female
 Blood pressure Ten points less.
Less tendency of HT
before menopause.
 Oxygen consumption 17% Less
PT&SR Introduction
Dr. Ram Veer Sharma

38. .
Characters Male Female
 Blood contains More water – Na+
 Total - Blood
Volume
± 40% Less
 Red Blood Cells ± 11% more Low density of RBC
 Haemoglobin ± 11% more Less
 Basal metabolic rate Higher Lower
Dr. Ram Veer Sharma

39. . Characters Male Female
 Physiological
Function
Not present Menstruation,
Pregnancy,
Lactation.
 Performance
in events
Better lasting longer
than 2 hours
Better lasting up to 2
hours
PT&SR Introduction
in events than 2 hours hours
• Tiredness,
• Breathlessness,
• Resistance to
infection
More Less
 Emotion More responsive to laughing and crying.
Dr. Ram Veer Sharma

40. PT&SR Introduction
(2) Patho - Physiological:-
• Blood values –
• Low - Hb%%, RBC, PCV, MCHC, MCH, Cholesterol, CT
• High – WBC, ESR, Blood sugar during pregnancy and
lactation.
Dr. Ram Veer Sharma

41. PT&SR Introduction
(2) Patho – Physiological -
• Urine – SG., Sugar + Ve, Pus cells + Ve, Epithelial cells -
+Ve, Hormones (Oestrogene, Progesterone), HCG. + Ve.
• Serum – Hormones (Oestrogene, Progesterone, Prolactin)
Phenolic 18 carbon – Steroids, 43 Ketosteroids 21 carbon
 Progesterone, Oestrogene, Foetal adrenal steroids.
Dr. Ram Veer Sharma

42. PT&SR Introduction
(2) Patho – Physiological -
 HCG – From -Trophoblastic tissues – 6-8 weeks –
Glyco protein – 35000micro weight.
 HPL – From – Placenta 3-6 Weeks – Trophoblastic cells,-
Protein – 22000 micro weight,
Protein – 22000 micro weight,
 Prolactin - From Pituitary gland of mother and foetus -
Effects on Lactation, Mammary glands and decidual tissues.
Dr. Ram Veer Sharma

43. PT&SR Introduction
(3) Psychological
 DySO;a Hkh#Ro voS”kkj|a eksgks vuoLFkkua v/kksxq#Roa vlaguue~ “kSfFkY;a eknZoa
xHkkZ”k; chtHkkx rFkk;qDrkfupkijkf.kA L=hdjkf.kAAp-”kk-8@
• DySO;a - Impotency (Doesn’t initiate for sexual act.)
• Hkh#Ro - General Fearness.
• voS”kkj|a - Less expertness.
• eksgks - More desirous,
• vuoLFkkua - Less stability.
Dr. Ram Veer Sharma

44. PT&SR Introduction
(3) Physical
•v/kksxq#Roa - Anatomically – heavy or large of pelvic region.
•vlaguue~ - Constitutional – Less muscle strength.
•“kSfFkY;a – - Structural lethargies,
•eknZoa - - Softness of the behavior and structure.
•xHkkZ”k; – - Uterus
•chtHkkx - - Ovaries.
Dr. Ram Veer Sharma

45. PT&SR Introduction
Psychological
• lkgl∙u`rpiyrkek;k] Hk;vfoosd v”kkSp vnk;kAA
• voxq.k v’V lnk mj jggha ---------AA jk-p-ekul
a. The most clearly psychological differences are:-
b. Develop psychological stress faster.
c. Much more dependant on personal care.
d. Much easier to motivate
e. More difficult to work with in a group
f. Lose their fear for losing faster and will hope for success
much faster. Easier motivated by their own achievements.
Dr. Ram Veer Sharma

46. PSYCHOLOGICAL DIFFERENCE
Brain activity Man Women
 Task Single task Multi task
 Language Hard to learn multi
languages
Easily learn multi
languages
 Linguistic Can make solution Can’t make solution
PT&SR Introduction
 Linguistic
solution
Can make solution Can’t make solution
 Analytical
skill
Analyze and find
solution
Design a map easily.
Analyze and find
solution
Can’t understand &
Design a map easily
Dr. Ram Veer Sharma

47. PSYCHOLOGICAL DIFFERENCE
Brain activity Man Women
 Analytical
decision
More- Car driving –
Can drive speedily.
Brain Can immediately
classified distance,
Less - Brain take a
long time to recognize
the object direction/
speed.
PT&SR Introduction
classified distance,
object (bus or van or
car) direction and
speed of the object.
speed.
Dr. Ram Veer Sharma

48. .Brain activity Man Women
 Brain observer Can’t observe easily Super observer – can
observe
Facial expression 70%,
Body language 20%
PT&SR Introduction
Can’t lie face to face
Body language 20%
Words -from the mouth
10%.
Easily lie to men face to
face.
Dr. Ram Veer Sharma

49. .
Brain activity Man Women
Problems
Solving
• Brain clearly
classifies the
problems and puts
them in individual
• Brain can not classify
the problems.
• She wants some one to
hear that.
PT&SR Introduction
rooms in the brain
and then finds the
solution one by one.
• After telling everything
to a person she goes
happily to bed.
• She does not worry
about the problems
being solved or not.
Dr. Ram Veer Sharma

50. . Brain activity Man Women
 Desire Want - Status,
Success, Solutions,
Big process, etc.
Want - Relationship,
Friends, Family,
Cloths and Ornaments.
etc
PT&SR Introduction
etc
• Concentration If unhappy with their
work, they can not
concentrate on the
relations.
If unhappy with their
relations, they can not
concentrate on their
work.
Dr. Ram Veer Sharma

51. .
Brain activity Man Women
 Speech Use direct language. Use indirect language
in speech.
 Handling Men act a lot without Women talk a lot
PT&SR Introduction
 Handling
Emotion
Men act a lot without
thinking
Women talk a lot
without thinking.
Dr. Ram Veer Sharma

52. PT&SR Introduction
 The Gynaecologist have so many problems in their clinic
practice because of personal confidential, shame and social
factors of the patient.
 The gynaecological examination is quite intimate more so than
a routine physical exam.
 It also required special instruments and investigations and
management.
 The gynecologist does bimanual examination to palpate the
cervix, Uterus, ovaries and bony pelvis.
Dr. Ram Veer Sharma

53. PT&SR Introduction
 Gynecologist mainly deals – Diseases are -
• Pre cancer and cancer disease of the reproductive organs.
• Urine incontinence, Amenorrhoea, Dysmenorrhoea, Menstrual
disorders,
• Prolepses, Infertility etc.
• Infections of the bacteria, fungus and parasites.
• Anartawa Roga, Yoni Roga, Stana Roga, Sootika Roga, Garbha
Vyapada, Rakta Gulma, Yoshaspamara Soma Roga.
Dr. Ram Veer Sharma

54. PT&SR Introduction
Operations
 D&C. D&E, Vaginal plastic operation, Repairing of genital
hernias,
 Hysterectomy, Oophorectomy,
 Tubal ligation, Laparotomy, Caesarean section etc.
 Tubal ligation, Laparotomy, Caesarean section etc.
Dr. Ram Veer Sharma

55. PT&SR Introduction
CONCLUSION
The main differences between men and women are:
a. Smaller body
b. Shorter legs
c. Narrower rib cage,
d. Wider hips and smaller shoulders,
e. Pelvis have a different inclination,
f. The curvature of the spine of is greater,
g. The elbows and the knees of are bigger,
h. The muscular volume is less.
Dr. Ram Veer Sharma

56. PT&SR Introduction
i. The percentage of adipose tissue of is greater,
j. The lungs are smaller and consumption of oxygen is less.
k. The heart is smaller and the circulatory capacity is limited by
a smaller heart.
l. The body has less volume of blood and a proportionally less
l. The body has less volume of blood and a proportionally less
quantity of red blood cells.
m.The neuro-muscular system has smaller muscle fibers.
Dr. Ram Veer Sharma

57. PT&SR Introduction
n. Less strength, less speed and speed endurance.
o. Emotionally more advanced
p. Muscles have excellent elasticity, flexibility and co-
ordination,
q. Have more enthusiasm, conscientiousness and patience.
q. Have more enthusiasm, conscientiousness and patience.
Dr. Ram Veer Sharma

58. PT&SR Introduction
Why should be learn Gynaecology specially?
 As we discussed above, the female is differ Physically
(Anatomically and Physiologically) and Psychologically.
 The diagnostic values and procedures are also different than
the man.
 The two type treatment is Shamana and Shodhana, because of
special physiological conditions like - Menstruation,
Pregnancy, Puerperium, the general treatment may be a
harmful during this period like-
Dr. Ram Veer Sharma

59. PT&SR Introduction
 The medicine of Ushna and Tikshna Vyavayi Vikasi property
are contraindicated during pregnancy.
 The Shastra karma (Surgery), Kshara Karma and Shodhan
Chikitsa is indicated only in special conditions for the women
and her disease.
 In the literature the indications, contraindications, special
precautions are described for women diagnosis and treatment at
place to place.
Dr. Ram Veer Sharma

60. PT&SR Introduction
 So due to special Physical, Physiological, Psychological,
Diagnostic and Treating procedures, it should be learn specially
by a medical service provider – Gynecologist / Obstetrician.
Dr. Ram Veer Sharma

61. PT&SR Introduction
.
Dr. Ram Veer Sharma
THANKS