Obstetrics and gynaecology
The examples and perspective in this article deal primarily with the United Kingdom and the United States and do not represent a worldwide view of the subject. (August 2019) (Learn how and when to remove this template message)
Obstetrics and gynaecology (British English) or obstetrics and gynecology (American English) is the medical specialty that encompasses the two subspecialties of obstetrics (covering pregnancy, childbirth, and the postpartum period) and gynaecology (covering the health of the female reproductive system – vagina, uterus, ovaries, and breasts). It's commonly abbreviated as OB-GYN or OB/GYN in US English, and as obs and gynae or O&G in British English.
Postgraduate training programs for both fields are usually combined, preparing the practicing obstetrician-gynecologist to be adept both at the care of female reproductive organs' health and at the management of pregnancy, although many doctors go on to develop subspecialty interests in one field or the other.
Education and training (residency)Edit
After completing medical school, one must complete a four-year residency program to be eligible to sit for boards.
For the ERAS match in 2017, there were 238 participating programs accepting applicants.
This adds up to 11–14 years of education and practical experience. The first 7–9 years are general medical training.
Experienced OB-GYN professionals can seek certifications in sub-specialty areas, including maternal and fetal medicine. See Fellowship (medicine).
OB-GYN candidates must first complete medical school and obtain a MBBS or equivalent certification. This portion typically takes five years. Following this, they are eligible for provisional registration with the General Medical Council.
Then they must complete a two years of foundation training. After the first year of training is complete, trainees are eligible for full registration with the General Medical Council. After the foundation training is complete applicants take the Part 1 MCROG examination administered by the Royal College of Obstetricians and Gynaecologists. There are an additional five years of training after this, and two more exams (Part 2 and Part 3 MCROG exams) which adds up to seven years total minimum in training, although some trainees may take longer.
Examples of subspecialty training available to physicians in the US are:
- 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 fetus 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
- Gynecological 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)
- Pediatric and adolescent gynaecology
- Menopausal and geriatric gynaecology
Of these, only the first four are truly recognized sub-specialties by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Obstetrics and Gynecology (ABOG). The other subspecialties are recognized as informal concentrations of practice. To be recognized as a board-certified subspecialist by the American Board of Obstetrics and Gynecology or the American Osteopathic Board of Obstetrics and Gynecology, a practitioner must have completed an ACGME or AOA-accredited residency and obtained a Certificate of Added Qualifications (CAQ) which requires an additional standardized examination.
Additionally, physicians of other specialties may become trained in Advanced Life Support in Obstetrics (ALSO), a short certification that equips them to better manage emergent OB/GYN situations.
There are many procedures that can be provided to people by OB/GYN's. Some procedures may include:
- Colposcopy: a pap smear screening. If the results of a routine Pap smear screening come back as abnormal, this more thorough examination of the cervix and vaginal tissues may be needed.
- Loop electrical excision procedure (LEEP): a procedure to quickly remove abnormal vaginal tissue within the cervix. A local anesthetic and a solution to enhance the points of removal visually is administered during the process. There is a chance of experiencing watery, pinkish discharge, brownish discharge, and mild cramping.
- Endometrial biopsy: a procedure that collects a tissue sample from the endometrium lining of the uterus. The sample is tested and checked under a microscope for abnormals cells or indicators of cancer.
- IUD insertion: an intrauterine device that is T-shaped and is placed in the uterus through the cervix. It is a reversible contraceptive that can be done in a doctor's office.
- Nexplanon: is about a 4 cm implant that goes into the upper forearm. This implant releases birth control hormones into the body and can last up to three years. This type of birth control has a 99% success rate for pregnancy prevention.
- Dilation and curettage (D&C): an out-patient procedure to open (dilate) the cervix to collect samples of endometrial tissue with a curette. A D&C can also be done to remove a fetus that was not passed naturally after a miscarriage or to induce an abortion.
- Tubal ligation: a surgery to close the fallopian tubes for the prevention of pregnancy. It is also known as "tying the tubes".
- Ovarian cystectomy: the removal of a cyst that either has a solid appearance, larger than three inches in diameter, has the possibility to become cancerous, or causes a constant pain. Cysts can be removed without removing an ovary. Women who do not take birth control produce small cysts every other month but they can disappear on their own.
The national demand for women's health care is forecast to grow by 6% by 2020. Most (81%) ob-gyn related services will be for women of reproductive age (18–44 years old). Growth in demand is forecast to be highest in states with the greatest population growth (Texas, Florida), where supply is currently less than adequate (western United States), and among Hispanic women. This increase in demand by 2020 will translate into a need for physicians or nonphysician clinicians, which is clinically equivalent to 2,090 full-time ob-gyns. The salary of an obstetrician varies by country or state. In the United States, as of 2017, the average salary is $222,400–$315,277.
- "ERAS 2017 Participating Specialties & Programs".
- "Entry requirements, skills and interest (obstetrics and gynaecology)". Health Careers. 2015-05-27. Retrieved 2019-04-11.
- "UK Foundation Programme". www.foundationprogramme.nhs.uk. Retrieved 2019-04-11.
- "Part 1 MRCOG exam". Royal College of Obstetricians & Gynaecologists. Retrieved 2019-04-11.
- "Training and development (obstetrics and gynaecology)". Health Careers. 2015-05-27. Retrieved 2019-04-11.
- Welcome to the American Board of Obstetrics and Gynecology Web Site: Certification of Obstetricians and Gynecologists
- "Eligibility/Board Eligibility". American Osteopathic Board of Obstetrics and Gynecology. 2012. Retrieved 19 September 2012.
- "Common GYN Procedures | Obstetrics & Gynecology | Springfield Clinic". www.springfieldclinic.com. Retrieved 2019-03-13.
- Llewellyn-Jones, Derek, Fundamentals of Obstetrics and Gynecology, 7th ed., Mosby, 1999.
- Lane, J (July 1987). "A provincial surgeon and his obstetric practice: Thomas W. Jones of Henley-in-Arden, 1764-1846". Medical History. 31 (3): 333–48. doi:10.1017/s0025727300046895. PMC 1139744. PMID 3306222.
- Stockham, Alice B. Tokology. A Book for Every Woman. o.O., (Kessinger Publishing) o.J. Reprint of Revised Edition Chicago, Alice B. Stockham & Co. 1891 (first edition 1886). ISBN 1-4179-4001-8