Obstetrics and Gynaecology
Procedures and Operative Observations
Obstetric and gynaecological procedures for MBBS, from Pap smear and episiotomy to hysterectomy, laparoscopy and hysteroscopy, mapped to NMC codes OG35 to OG38.
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Procedures and Operative Observations
Obstetric and gynaecological procedures for MBBS, from Pap smear and episiotomy to hysterectomy, laparoscopy and hysteroscopy, mapped to NMC codes OG35 to OG38.
This chapter covers the bedside and operative procedures a graduate should know and observe. It runs from ward and outpatient skills such as Pap smear, amniotomy, episiotomy, intrauterine device insertion and catheterisation to major operations including laparotomy, hysterectomy, dilatation and curettage, laparoscopy, hysteroscopy and sterilisation, with their indications and complications.
High-yield: Procedures and Operative Observations
- A Pap smear samples the transformation zone of the cervix to screen for premalignant and malignant change.
- Artificial rupture of membranes (amniotomy) is used to induce or augment labour and allows assessment of the liquor.
- Episiotomy is a surgical incision of the perineum; the mediolateral type is commonly used to avoid extension into the anal sphincter.
- An intrauterine device is inserted through the cervix and is a long-acting reversible contraceptive.
- Urinary catheterisation empties the bladder before caesarean and other pelvic surgery and monitors output in sick women.
- A punch biopsy of the cervix samples a suspicious lesion, often under colposcopic guidance, for histology.
- Laparotomy is opening the abdomen for procedures such as ectopic pregnancy, ovarian tumour or caesarean section.
- Hysterectomy is removal of the uterus, performed by the abdominal or vaginal route depending on the indication and uterine size.
- Dilatation and curettage dilates the cervix and scrapes the endometrium for diagnosis or to evacuate the uterus.
- Fractional curettage samples the endocervix and endometrium separately to assess the extent of endometrial disease.
- Laparoscopy allows minimally invasive diagnosis and surgery through small ports with a pneumoperitoneum.
- Hysteroscopy inspects the uterine cavity directly and can treat polyps, submucosal fibroids and adhesions.
- Laparoscopic sterilisation occludes the fallopian tubes and is a permanent, highly effective contraceptive method.
- Common surgical complications to anticipate include bleeding, injury to bladder, bowel or ureter, and infection.
Key operative procedures
- **Hysterectomy:** Removal of the uterus; abdominal or vaginal route by indication and size.
- **Dilatation and curettage:** Cervical dilatation and endometrial curettage for diagnosis or evacuation.
- **Laparoscopy and hysteroscopy:** Minimally invasive access to the pelvis and uterine cavity.
- **Common complications:** Bleeding; injury to bladder, bowel or ureter; infection.
NMC competencies in this chapter
- **OG35.14:** Episiotomy: technique, types, suturing and complications
- **OG35.15:** Intrauterine device insertion and removal
- **OG36.3:** Punch biopsy of the cervix
- **OG37.2:** Laparotomy: exploratory, for ectopic pregnancy and ovarian tumour
- **OG37.3:** Hysterectomy: abdominal and vaginal, indications, steps and complications
- **OG37.4:** Dilatation and curettage: indications, technique and complications
- **OG38.1:** Laparoscopy: principles, technique and complications
- **OG38.2:** Hysteroscopy: indications, technique and complications
Frequently Asked Questions
What is the difference between an abdominal and a vaginal hysterectomy?
Both remove the uterus, but the abdominal route uses an abdominal incision, suited to a large uterus or malignancy, while the vaginal route avoids an abdominal wound and suits prolapse and a mobile uterus.
What is dilatation and curettage used for?
It dilates the cervix and scrapes the endometrium, either diagnostically to sample tissue or therapeutically to evacuate the uterus, for example in incomplete abortion.
How do laparoscopy and hysteroscopy differ?
Laparoscopy inspects and operates on the pelvic organs through abdominal ports with a pneumoperitoneum, whereas hysteroscopy inspects and treats inside the uterine cavity through the cervix.
Which complications should be anticipated in pelvic surgery?
Bleeding, injury to the bladder, bowel or ureter, and infection are the main risks, so anatomy and careful technique are emphasised during these operations.
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