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P.S.G.

HOSPITALS, COIMBATORE – 641 004


DEPARTMENT OF OBSTETRICS & GYNAECOLOGY
HOSPITAL MANUAL1.DEPARTMENT ORGANOGRAM
1
Head of the departmentUnit chiefsProfessorsAssociate
professorsAssistant professorsSelection Grade TutorsResident
DoctorsCRRIsSupport staffsSecretaryStaff
nursesCounsellor Nursing assistantTechniciansAttenders
2.ACADEMIC FUNCTIONS OF THE DEPARTMENT
Teaching schedules are followed as per university regulation in
bothundergraduate & postgraduate The teaching consists
for1.Undergraduate2.Postgraduate3.CRRI
Undergraduates:Teaching schedule preparation:
A maser chart is prepared by the department registrar consists
the detailsof all batches teaching schedule for a month in date
wise manner. Itconsists the time, topics and the faculty name
for every session. Thechart is being displayed in the student’s
notice board. The format of the chart is as below:
DateLecture topicsClinical teaching
Batch /Phase Time TopicFacultyBatch /Phase Time
/Session TopicFaculty
Class conducting system:
The students are expected to see their schedule
earlier.Undergraduate’s timetable is divided as

Lecture classes
Tutorial session

Case presentation session

Symposium

Small group teaching


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Integrated teaching
Lecture classes:
This is a period of 1 hour and the topics are scheduled as per
the listrecommended by the university. Students are attending
the Obstetric &Gynaec lecture class from 4
th
semester onwards. Every phase of studentsis having one
lecture class in a week for this subject.
Tutorial session:
In final year clinical teaching, students are having tutorial
session which isscheduled as each topic for a day from Monday
to Friday. In Saturdaythey are having General clinical session.
(Some Mondays are scheduledfor internal assessment test)
Case presentation session:
All phase students except introductory phase is having case
presentationsession on everyday (Monday to Friday) of clinical
postings. Every batch isdivided in to subdivisions which may
consists of 4 students and the eachsubdivision is responsible for
case presentation on that particular day andthey have to report
to the faculty prior to 1 or 2 days. They will be given acase for
presentation by the faculty. The student observes and
takesnotes of the history & presenting complaints of the case
and they preparefor presentation. The diagnosis &
management of the case is discussedon the case presentation
session by the faculty & the students.
Symposium:
The scheduled symposium topics are prepared by the concern
studentsgroup with the guidance of faculty and presented by
the students. Eachstudent gets a chance of symposium
presentation in the final year phase.
3

Small group teaching:


In final year clinical teaching, students are having small group
teachingsession which is scheduled as Monday 2.00 pm to 4.00
pm & Wednesday3.00 pm to 4.00 pm.
Internal assessment
:
Theory test
are conducted on Mondays for III MBBS part B students
inconcern subjects by rotation. Test scheduled is prepared and
display inthe notice board at prior time, the test notice consists
of the topics, date,time.
Clinical tests
are conducted at the last clinical posting day of thatphase, and
valuated mark details are sent to the Academic cell
anddisplayed in the student’s notice board.
Model exams are scheduled
prior to the university exams and modelexams are conducted in
the university’s question & marks pattern in boththeory and
clinicals. Mark details are sent to the academic cell &
studentsnotice board.
Final year student’s record note:
Student’s has a faculty in-chargefor record note book and they
get correction and signed from that facultyby weekly in a
regular manner. Friday 2.00-4.00 is the time schedule forrecord
note correction. At the finishing of the final year posting
theyshould get complete correction of the record note book
and HOD’ssignature, and then submitted to the department.
The record marks aregiven by record in-charge faculty of the
student. Record mark awarded inthe format of Case record
perfection- 8 marksPresentation- 4 marksRegularity- 4
marksNeatness - 4 marks
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Total- 20 marks
The computerized student’s attendance
report of every month isverified by the head of the department
and the checked statement is sentto academic cell and
student’s notice board.
MBBS students semester wise clinical posting details:II MBBS
students
are attending clinical posting for a period of 10 weeks
3
RD
SEMESTER
-2 weeks-Introduction to OG
The introductory posting topics are taught by the faculty
DAY 1
Introduction to Obstetrics . Fertilisation & Implantation
DAY 2
Duration of pregnancy I + II + III trimesters. AN care.
DAY 3
Few complication in pregnancy in I + II + III trimesters
DAY 4
Outcome of pregnancy.Abortion, Labour :Preterm, Term & Post
term
DAY 5
Causation & Stages of labour
DAY 6
Modes of deliveryComplication in labour. Puerperium –
duration, problems
DAY 7
AN History taking, AN Case
DAY 8
Introduction to GynaecologyMenarche, Normal menstrual
cycle, Menopause
DAY 9
Common problems in adolescence, reproductive age group
andmenopa

use
DAY 10
Gynaec history taking, Gynaec cases
DAY 11
Infertility
DAY 12
Lucorrhoea
DAY 13
Descending PV, Mass abdomen
DAY 14
Post menopausal bleeding
4
TH
SEMESTER
-4 weeks-
3 weeks
- AN history taking,Obs palpitation,Gyn. History taking , cases
4
th
week- Family Planning
Family planningDay 1 - Natural family planning & Barrier
methodsDay 2- IUCDDay 3- OCPDay 4 - Other hormonal
contraceptives
5
Day 5- InjectableDay 6- FemaleDay 7- Male sterilisation
5
TH
SEMESTER
-4 weeks-Clinical assessment &Management in brief
III A MBBS students
are attending clinical posting for a period of 6weeks
6
TH
SEMESTER
-6 weeks-
Clinical assessment
Peripheral centers postings
III MBBS Part A students:

In OPD 2 students are posted by rotation and they aretaught


interesting OP cases by faculty.

In peripheral maternity centers 2 students are posted


byrotation and for witness of deliveries
The III B MBBS students are posted for a period of 8 weeks
8TH SEMESTER-
8 weeks-Clinical teachingP.S.G.Posting – LWCase discussion,
Tutorials, SGT, IT
III MBBS Part B students postings:
o
Two students of III MBBS Part B are posted for Labourward
byrotation for witness of deliveries conducting in labourward
andcaesarean sections and other gynaecological procedures in
Operation Theater.
o
One student of III MBBS Part B students is posted in
OPDUltrasound room The III MBBS Part B students are
attending clinical classes from 9.00 amto 1.00 pm.
Postgraduate teaching:
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Postgraduates are posted in OPD, Labourward, Antenatal
ward,Gynaec ward & Postnatal ward, peripheral posting by
rotation as peruniversity regulations.

The postgraduate students are posted under a particular
faculty inan unit by rotation.

Attendance register is maintained and the monthly
attendancereport is sent to the academic cell.

Postgraduates are mainly involved in examining patients,
followingup, management and progress of the patient.

They are also involved in bed side teaching & OMP

They see OP cases with a faculty presiding.

Complicated cases are shown and discussed by the
postgraduatewith unit faculties.

They are trained to perform minor procedures like D & C,
puerperalsterilization, IUCD insertions assistance in all major
and minorObstetric and Gynaec procedures.

They perform caesarean section, hysterectomy and
othergynaecological procedures with consultant assistance.

A separate logbook is maintained by each postgraduate student
forrecording academic activities

Classes scheduled by monthly and displayed in
postgraduate’snotice board. The monthly teaching schedule
consists of class topic,time and the faculty name.

A journal club is arranged monthly once

Perinatal care unit meeting is arranged to discuss


thecomplicated & high risk pregnancy cases.
Postgraduatediscusses about the cases with the various
specialtyconsultants like Newborn, Paediatrician, Paediatric
surgeon,Pathologist.
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Every postgraduate student presents an interesting caseby
weekly

Each MD(OG) postgraduate student is guided by a faculty for
theirthesis work and scheduled for thesis work as follows
o
After 6 months from the joining they will guided to do
thefollowing before completion 1
st
year

Decide topic of thesis

Presentation of review of literature and methodology

Submit title of thesis

Presentation of questionnaire (Proforma) and finalizationIn 2
nd
year

Finish data collection

Data analysis to be completed and presented
o
3
rd
year Thesis book (hardcopy & softcopy) to be prepared To be
submitted
o
Postgradautes are expected to attend CMEprogrammes and
conferences (in a minimum of 3 programmesthey should
attend) and guided for paper presentations.
CRRIs teaching:
They are posted for a period of 3 months in the department of
Obstetric &Gyanec. They are posted under a unit and guided by
the correspondingunit’s faculty. Their postings is scheduled as
follows2 weeks - Labour ward2 weeks - Newborn2 weeks -
Elective posting
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The rest of period they do OPD, ward, Operation Theater and


intensive careareas duty.In OP posting CRRIs are taking history
and doing preliminary examination fornew cases. Subsequently
the cases are followed up with the consultant. Thecase will be
thoroughly examined by the consultant and disposed. They are
attending the ward rounds taking by the unit chief and faculty
andfollow the chief consultant orders. Ward CRRIs monitor the
ward patient’sprogress and inform the patient’s status and
reports to the consultant. They are expected to perform
procedures like starting IV line, dressing,suturing, suture
removal and intensive care monitoring. They are trained up in
assisting and doing minor surgeries in Operation Theater. In
labourward posting they conduct deliveries, perform
episiotomy,assist for caesarean section & monitor patient in
labour.
3.CLINICAL / PATIENTS RELATED FUNCTIONS OF THE
DEPARTMENT
The clinical work in the department of Obstetric &
Gynaecology broadlydivided under the following
categories:1.Antenatal care2.Intra partum and post partum
care3.Operative and emergency Obstetrics4.Gynaecological
and operative Gynaecological carea.Screening for cervical
cancerb.Basic and special investigations of
Infertility5.Urogynaecology6.Family planning
Antenatal care protocol:
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1.Diagnosis of pregnancy2.Monitoring of the health status of


mother and fetus
a.
Upto 6
th
month- monthly checkup
b.
7
th
month & 8
th
month- 15 days once
c.
from 9
th
month onwards- weekly monitoring3.Identification of risk
factor4.Detection of associated medical, surgical
disorders5.Screening for the woman for infections
a.
Tamilnadu Aids Control Society project – PPTCT program
forcounseling & educating the woman about HIV infection
andpreventing methods and screening.6.Antenatal
investigation includes the followinga.Blood
groupb.Heamoglobinc.Urine
routined.VDRLe.GCTf.HIVg.HBsAgh.Ultrasound at early
diagnosis of pregnancy to rule out intrauterine pregnancy and
fetal viability
i.
Ultrasound at 18-20 weeks to rule-out structural fetal
anomalieswhich can be detected by ultrasound.
j.
Ultrasound at term to assess fetal growth & AFI7.Educating the
woman about the effect of health, nutrition, drugs etc.,on
pregnancy8.Preparing the woman for labour, breast feeding.

Outpatient department
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1.
At patient entry, they register at the Medical Record
Departmentdepending on the complaints is registered to the
concerneddepartment
2.
Once the registration is made the OP file (medical record) of
thepatient is transferred to the outpatient department by the
MRDattender. The OP file is checked weather the file is
transferred toproper department or not and then received by
the departmentsecretary.
3.
The patients are called in the order of registration time and a
tokenis placed for every attended patient’s file serially. If the
calledpatient is not in the OP waiting hall, it will be informed to
the MRDand checked up for proper registration.
4.
The called patients are checked for Height & Weight by the
staff nurse.
5.
Patient is asked to wait till their turn comes. If the patient
conditionwarrants immediate treatment, she will be consulted
by aGynaecologist immediately.
6.
The patient’s history & presenting complaints will be entered
in thefile by the junior doctor. The patient history
includes:1.Presenting complaints2.Menstrual history3.Marital
history4.Obstetric history5.Previous gynaecological
history6.Medical & Surgical history7.Family history8.Personal
history
7.
A general examination is done by the junior doctor and
recorded onthe case sheet. The general examination includes
the following: BP,Pulse, pallor, edema, CVS, RS and
temperature.
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8.
Then the patient will be consulted by a consultant
Gynaecologist.9.The patient is thoroughly examined by the
consultant and aprovisional diagnosis arrived at. The
examinations are:Abdominal examinationVaginal
examinationSpeculum examination
10.
The required investigation to substantiate the diagnosis
isrecommended after counseling the patient & their attender.
11.
After the sample collected for the investigations the patient
isadvised about the probable time taking for investigation
report andthe report copy will be available on the patient’s file
at all. Theprobable time taken for investigation report is 2-3 hrs
from, someinvestigation report takes few days like culture
takes 3 days, forhistopathology 7 days, etc.12.The patient is
advised about the review date and if any medication.
13.
On report review, if any procedure is indicated by the
investigation,patient & the attender is explained about
procedure & its risks. Dateis fixed for the procedure if the
patient is willing to undergo thefurther procedure. If the
condition warrants and immediate medical /surgical treatment,
she is counseled regarding the treatment andadmitted. The
admission orders written by the Gynaecologist in thecase
sheet.14.The admission patient is shifted from the outpatient
area to theward by the OPD attender with the OP file and the
patient attenderis informed for wait in the IP patient attender
area.15.Day care procedure which do not warrant admission
and deal with inthe OPD and the patient discharged on the
same after when she isstable.
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Inpatient department
1.
Following admission to the ward, the patient is assessed and
if intensive care is necessitated the patient is admitted to the
criticalcare units of ward & monitored intensively.
2.
If the patient is admitted for a major / minor procedure the
requiredinvestigations which were ordered by the consulted
Gynaecologistare sent results are collected by the ward staff.
Pre-op protocolfollowed.3.If the patient is admitted for
observation, the results of theinvestigations and the patient
status are followed and informed bythe concerned ward interns
& resident doctor to the consultant.4.All nursing as well as
medical work is supervised by the unitconcerned in a standard
manner which includes conventional wardrounds taken, thrice
a day, in the morning, after noon and lateevening5.If any
complaints encounteded during the night is handled
byconsultant & resident on duty.
4.JOB SPECIFICATIONSHead of the department:
The HOD will function as the administrative head of her/his
department inaddition to the professional responsibilities

To supervise punctuality and regularity in reporting


Professors:

To effectively administer his/her unit in all aspects

To ensure smooth co-operation from his/her unit members

To implement effectively the policies laid by the HOD


To train the students and CRRIs posted under him/her

To actively contribute to uplift the academic standard of unitas


well as the department
13

To supervise the quality of work done by the


Assistantprofessors and Residents

Co-operate with the HOD in all aspects so as to maintain


thesmooth functioning of the department

To shoulder all the responsibilities of the HOD during


his/herabsence
To supervise the work done by the other category staff in
themaintenance of the professional zones of the institution

Plan and implement protocols for clinical work as well


asacademic activities for junior staffs to update and keep alert
of recent development in the field
Associate professors:

To render adequate help and co-operation to the HOD


andProfessors in the smooth functioning of the department

To perform all the duties allotted by the institution


administrativeheads and the HOD regarding patient care and
academic activity

To extend sufficient professional help to the Assistant


Professorswhenever required
Assistant Professor:
To carry out the work responsibilities allotted by the HOD

To do stay in duties as per schedule

To get actively trained in the respective specialties under the


supervision of senior faculty member

Gain teaching experience by vigorous participation in the


academic activities

To adequately guide the Residents and CRRIs and help them


gather enoughpractical skill

To pay attention to the maintenance of outpatient, inpatient


zones and specialareas
14
To maintain absolute harmony in the unit/department by full
co-ordinationwith all members of the department

To ensure a very smooth public relationship


5.LIST OF REGISTERS

List of registers maintained in Outpatient department
1.
Daily OP Patient register
2.
Papsmear & Biopsy specimen register3.Colposcopy
register4.Ultrasound register5.Scan appointment register6.Cu-T
insertion register7.Family planning progamme – sterilization
register8.MTP register9.OP Things stock account
register10.High risk cases register11.Interesting cases
register12.Perinatal care unit meeting register13.Departmental
library books register14.Department staffs & faculty leave
register15.Letters & communication dispatch
register16.Postgraduate attendace register17.Undergraduate
attendance register18.CRRI – Intensive care areas attendance
register19.OPD daily StatisticsAll register’s format enclosed in
separate sheets

List of registers maintained in Labourward

List of registers maintained in Daycare room
15


List of registers maintained in OG ward6.Format of work
instruction (operational instruction)Out Patient department
:
1.
Patient registeration at MRD
2.
File (Medical record) arrival to OP waiting area by MRD
attender
3.
Patient is called by the staff nurse and checked for patient
presencein OPD. If patient not present at OPD waiting area
verification isdone by OPD secretary.
4.
Patient is checked for Height & Weight by the staff nurse
5.
Patient is first seen by Resident doctor and the patient’s history
withpresenting complaints is taken by the Resident
doctor.6.Subsequently the patient is consulted, examined and
diagnosed bya Gynaecologist
7.
Advised for the investigation required, proposed line of
treatment.8.Explained for probable charges and duration stay if
anyhospitalization required.9.Procedures done in OPD:a.USG –
Pelvis, Obstetricsi.Patient takes a prior appointment, pays the
bill on thatparticular day & get USG doneii.It is done on the
same day depends on the urgencyiii.Explained consent
obtained for obstetric scanb.IUCD insertioni.Patient is advised
for IUCDii.Patient purchases IUCD at pharmacy
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iii.IUCD is inserted by the consultant and advised
aboutmedication and followupiv.The patient has to pay the
insertion procedure chargeand the miscellaneous
chargesc.Colposcopy & cervical biopsy
i.
Usually done by Papsmear result’s indication.ii.Colposcopy
directed biopsy is taken. If Colposcopy isnormal, no need for
cervical Biopsy
iii.
After the procedure the patient is advised for medicationand
report review (Histopathology report processing time- 7 days)
d.
Cryo cautary: following the histopathology report, if
indicatedpatient is offered cryocautery in post menstrual
phase.
10.
Inpatient :

Admission requisition sent by the consulting doctor


Patient & patient’s relation is accompanied by theOP attender
to the admission counter

According to the patient choice the ward / room isallotted for


the patient

Patient & patient’s relation is accompanied by theadmission


counter attender to the allotted ward

The concern unit ward resident doctor and CRRI areinformed


by the ward staff nurse who is receiving the admissionpatient.

The consultant orders are followed by the ward,CRRI and the


staff nurse
17
The ordered investigations requisition to the lab iswritten by
the ward Resident doctor

Blood samples are collected by the ward staff andsent to the


lab by the ward attender

Routine blood & urine investigation processingtakes 3 hrs for


reporting

Some special investigations like CT, Ultrasound, MRIare done by


a prior appointment. The appointments are made bythe ward
staff nurse.

In case of any emergency, urgent requisition can bemade and


the results can get ready within 2 hr as soon aspossible. It is
informed to the unit faculty by the CRRIimmediately after the
result obtained

The results are collected by the ward attender


The results are review in the next ward rounds by aconsultant
and decided for further treatment.

Pre-procedure protocols are followed for the casewho got


admitted for certain procedures.

Proper consent for all procedures and surgeries isobtained by


the Resident doctor & staff nurse
7.
Protocols for Surgical procedures

Pre-procedure:

The indication for the surgical procedure and its risks involved
areexplained to the patient & patient attender by the treating
doctor.

A written informed consent is obtained from the patient &
patientattender.
18


Patient will be investigated for fitness for the surgical
procedureeither as an outpatient or inpatient depending on the
patientdecision.

The patient is admitted 2 days prior to the surgical procedure if
thepatient wants to do all investigations and fitness opinion as
aninpatient.

If high risk, patient will be admitted earlier depending on the
risk.

General Physician opinion and Anaesthethic fitness will be
soughtprior to the surgical procedure.

Instructions given pre-op includes1.Preparation of the surgical
site and site of locoregionalanaesthesia by the ward staffs
2.
Enema is given night prior to and the morning of the
surgicalprocedure by the ward staffs3.Xylocaine and antibiotic
test dose given on the morning of the surgery.4.Patient is kept
nil per-mouth from previous midnight and alsopre-anaesthetic
medication is administered5.IV hydration is maintained.
6.
The patient is shifted to pre-op room half an hour before
thesurgical procedure7.The patient attender is informed when
the patient has shiftedinto the theater block.8.During the
process of shifting the _______ standards areadhered to
Per-operative :

In the pre-op room the anaesthetist re-examines the patient
toascertain the fitness for the surgical procedure.
19


Inside the operation theatre, the full dose of antibiotic
isadministered during induction of anaesthesia.

The patient is placed in the required position
(dorsal/lithotomy) forthe surgical procedure

The patient is intensely monitored during the surgical
procedure.

Strict aseptic precautions are followed during the
surgicalprocedure.

After the surgical procedure is completed the patient is shifted
tothe post-operative care ward for monitoring.

The patient attender is explained & informed about the
patientstatus and the procedure done by the surgeon.
Post-operative instructions:

Patient is monitored for vitals half an hourly still stable, then
twohourly for a minimum of 6 hours to 24 hours in the post-
operativeward.

When the patient is stable, shifted to the ward and informed

The patient is monitored by team of intensives, interns and
staff nurses.

The patient who is presently on IV hydration will be started on
oralhydration 4-6 hours after the surgical procedure.

Broad spectrum antibiotics are administered for minimum
period of 48 hours

DVT prophylaxis started 6 hours following the surgical
procedure forpatient at risk for the same.

Post-op analgesia is maintained with parenteral or epidural
opioids

Post-op physiotherapy and early ambulation is advised.

If there is deterioration of patient status, will be retained in the
post-op ward, treated further and then shifted to ward once
stable.
8.Protocols for Day care procedures
20


List of day care procedure
1.Fractional curettage
2.
1
st
trimester MTP3.Medical abortion4.Vulval biopsy5.Cervical
biopsy6.Suction evacuation

Pre-procedure instructions:
a.The indication for the procedure and its risks involved
areexplained to the patient & patient attender by the treating
doctor.
b.
Patient is examined & investigated for fitness of the day
careprocedure. The routine investigations are as follows:

Haemoglobin

Urine routine

Blood grouping & typing

HIV & HBsAg

Blood sugar
USG if requiredc.If the patient is fit for the procedure, a written
informedconsent is obtained from the patient & patient
attender and thepatient is shifted to the day care room by the
OPD staffsd.The following orders will be instructed by the
doctor

Preparation of parts

Verify for NPO from the previous day night

Xylocain test dose

Inj. TT 1 dose

Per-procedure instructions:
a.For Fractional curettage & Suction evacuation:
21
IM sedation – Fortwin or Pethidine 1 amp with 12.5
mgPhenargan given by the day care room junior doctor

After ½ hr from the IM sedation given the patient will beplaced


in the required positionb. For Vulval / Cervical biopsy no
sedation required, only localinfiltration of 1 % of xylocaine at
biopsy site applied
c.
For Medical termination of pregnancy / abortion 2 doses
of Cytotec of 400 micro gm 4 hours apart to kept in
posteriorfornix. In case of missed abortion Tab. Cytotec 400
micro gmkept vaginally followed by Suction evacuation after 4
hrs underIM sedation and paracervical block.
d.
The procedure will be done by a Gynaecologist and a
juniordoctor.
Post-procedure instructions:
e.
After the completion of procedure the patient will be
monitoredfor vitals & bleeding p/v by the team of day care
room juniordoctor & staffs.
f.
The Biopsy specimen / curettage specimen will be sent
forHistopathology lab with requisition of doctor.
g.
After 5 hrs from the procedure, if the patient is stable
thepatient is shifted out from the day care procedure room and
thepatient attender is informed for the same. If the patient has
anycomplaints or not stable, get admitted for observation
andtreated further.
h.
The patient is advised for the review date in the
outpatientdepartment, medication and the report follow
up.9.Test SOP (Standard operating procedure)