Gynecology and obstetrics is what the specialist who looks after women’s diseases is trained for. In larger hospitals these may be two different services, the gynecology service that looks after diseases of the vagina, ovaries and uterus and a separate service that just does deliveries of babies and looks after high risk pregnancies. There may be a separate division that looks after infertility problems (usually called ” fertility clinics”).
Here is a brief overview of what these services cover.
The normal development of the baby is the goal. In the beginning of the pregnancy this covers genetic screening, timing of the expected date of confinement by ordering an ultrasound (sonogram). In the later part of pregnancy there is concern about proper growth (not too fast, not too little). If high blood pressure is present this has to be monitored and so does diabetes, all with the goal of decreasing mortality for both mother and child. In emergency situations a cesarean section may have to be done or a forceps delivery.
Gynecology involves a lot surgery. The uterus can get cancer, fibroids, have heavy periods (menorrhagia). The end result in all of these conditions may be that there is a need for doing a hysterectomy. In the past this was done through the vaginal or abdominal route. Now there is a laparoscopic hysterectomy that can be done as well. Discuss this with the gynecologist, if you need one of those procedures done.
After child birth there often is a laxity of the support structures for the womb (uterus). And after a hysterectomy there is still a possibility of a prolapse in the front (anterior prolapse) or in the back (posterior prolapse). I have personally assisted the gynecologist during my 16 years of general practice on many, many women who needed these procedures done (hysterectomies, anterior or posterior repairs or both). If vaginal laxity becomes a problem to the patient, this may need surgical intervention as mentioned in this blog.
The ovaries are hidden structures that need to be checked carefully during the PAP test with a pelvic exam. If in doubt, ultrasounds should be obtained in order to not overlook ovarian cancer. Often cysts are present prior to such a development. They can be seen on ultrasound. Often there may be a need for an ovariectomy on one or both sides. Depending on the situation this can be done by laparoscopy or through the abdominal approach.
The fertility center is a separate clinic that concentrates only on finding and treating the causes of infertility. This includes the husband or partner. In vitro methods are included in this work-up. Their work ends when a successful pregnancy has been achieved; now the care taker is the obstetrician.