P.S.G. HOSPITALS, COIMBATORE – 641 004

DEPARTMENT OF OBSTETRICS & GYNAECOLOGY

HOSPITAL MANUAL

1. DEPARTMENT ORGANOGRAM

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Head of the department

Unit chiefs

Professors

Associate professors

Assistant professors

Selection Grade Tutors

Resident Doctors

CRRIs

Support staffs

Secretary

Staff nurses

Counsellor

Nursing assistant

Technicians

Attenders

2. ACADEMIC FUNCTIONS OF THE DEPARTMENT

Teaching schedules are followed as per university regulation in both

undergraduate & postgraduate

The teaching consists for

1. Undergraduate

2. Postgraduate

3. CRRI

Undergraduates:

Teaching schedule preparation:

A maser chart is prepared by the department registrar consists the details

of all batches teaching schedule for a month in date wise manner. It

consists the time, topics and the faculty name for every session. The

chart is being displayed in the student’s notice board.

The format of the chart is as below:

Date Lecture topics Clinical teaching

Batch /

Phase

Time Topic Faculty Batch /

Phase

Time /

Sessio

n

Topic Faculty

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

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Symposium

Small group teaching

Integrated teaching

Lecture classes:

This is a period of 1 hour and the topics are scheduled as per the list

recommended by the university. Students are attending the Obstetric &

Gynaec lecture class from 4th semester onwards. Every phase of students

is having one lecture class in a week for this subject.

Tutorial session:

In final year clinical teaching, students are having tutorial session which is

scheduled as each topic for a day from Monday to Friday. In Saturday

they are having General clinical session. (Some Mondays are scheduled

for internal assessment test)

Case presentation session:

All phase students except introductory phase is having case presentation

session on everyday (Monday to Friday) of clinical postings. Every batch is

divided in to subdivisions which may consists of 4 students and the each

subdivision is responsible for case presentation on that particular day and

they have to report to the faculty prior to 1 or 2 days. They will be given a

case for presentation by the faculty. The student observes and takes

notes of the history & presenting complaints of the case and they prepare

for presentation. The diagnosis & management of the case is discussed

on the case presentation session by the faculty & the students.

Symposium:

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The scheduled symposium topics are prepared by the concern students

group with the guidance of faculty and presented by the students. Each

student gets a chance of symposium presentation in the final year phase.

Small group teaching:

In final year clinical teaching, students are having small group teaching

session which is scheduled as Monday 2.00 pm to 4.00 pm & Wednesday

3.00 pm to 4.00 pm.

Internal assessment :

Theory test are conducted on Mondays for III MBBS part B students in

concern subjects by rotation. Test scheduled is prepared and display in

the 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 that

phase, and valuated mark details are sent to the Academic cell and

displayed in the student’s notice board.

Model exams are scheduled prior to the university exams and model

exams are conducted in the university’s question & marks pattern in both

theory and clinicals. Mark details are sent to the academic cell & students

notice board.

Final year student’s record note: Student’s has a faculty in-charge

for record note book and they get correction and signed from that faculty

by weekly in a regular manner. Friday 2.00-4.00 is the time schedule for

record note correction. At the finishing of the final year posting they

should get complete correction of the record note book and HOD’s

signature, and then submitted to the department. The record marks are

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given by record in-charge faculty of the student. Record mark awarded in

the format of

Case record perfection - 8 marks

Presentation - 4 marks

Regularity - 4 marks

Neatness - 4 marks

Total - 20 marks

The computerized student’s attendance report of every month is

verified by the head of the department and the checked statement is sent

to 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

3RD SEMESTER - 2 weeks - Introduction to OG

The introductory posting topics are taught by the facultyDAY 1 Introduction to Obstetrics . Fertilisation & ImplantationDAY 2 Duration of pregnancy I + II + III trimesters. AN care.DAY 3 Few complication in pregnancy in I + II + III trimestersDAY 4 Outcome of pregnancy.

Abortion, Labour :Preterm, Term & Post termDAY 5 Causation & Stages of labourDAY 6 Modes of delivery

Complication in labour. Puerperium – duration, problems

DAY 7 AN History taking, AN CaseDAY 8 Introduction to Gynaecology

Menarche, Normal menstrual cycle, MenopauseDAY 9 Common problems in adolescence, reproductive age group and

menopauseDAY 10 Gynaec history taking, Gynaec casesDAY 11 Infertility

DAY 12 LucorrhoeaDAY 13 Descending PV, Mass abdomenDAY 14 Post menopausal bleeding

4TH SEMESTER - 4 weeks - 3 weeks - AN history taking,

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Obs palpitation,Gyn. History taking , cases4th week - Family Planning

Family planning

Day 1 - Natural family planning & Barrier methods

Day 2 - IUCD

Day 3 - OCP

Day 4 - Other hormonal contraceptives

Day 5 - Injectable

Day 6 - Female

Day 7 - Male sterilisation

5TH SEMESTER - 4 weeks - Clinical assessment & Management in brief

III A MBBS students are attending clinical posting for a period of 6

weeks

6TH SEMESTER - 6 weeks - Clinical assessment Peripheral centers postings

III MBBS Part A students:

In OPD 2 students are posted by rotation and they are taught

interesting OP cases by faculty.

In peripheral maternity centers 2 students are posted by rotation and for witness of deliveries

The III B MBBS students are posted for a period of 8 weeks

8TH SEMESTER - 8 weeks - Clinical teaching P.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 by rotation

for witness of deliveries conducting in labourward and caesarean

sections and other gynaecological procedures in Operation Theater.

o One student of III MBBS Part B students is posted in OPD Ultrasound

room

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The III MBBS Part B students are attending clinical classes from 9.00 am

to 1.00 pm.

Postgraduate teaching:

Postgraduates are posted in OPD, Labourward, Antenatal ward,

Gynaec ward & Postnatal ward, peripheral posting by rotation as per

university regulations.

The postgraduate students are posted under a particular faculty in

an unit by rotation.

Attendance register is maintained and the monthly attendance

report is sent to the academic cell.

Postgraduates are mainly involved in examining patients, following

up, 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 postgraduate

with unit faculties.

They are trained to perform minor procedures like D & C, puerperal

sterilization, IUCD insertions assistance in all major and minor

Obstetric and Gynaec procedures.

They perform caesarean section, hysterectomy and other

gynaecological procedures with consultant assistance.

A separate logbook is maintained by each postgraduate student for

recording academic activities

Classes scheduled by monthly and displayed in postgraduate’s

notice board. The monthly teaching schedule consists of class topic,

time and the faculty name.

A journal club is arranged monthly once

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Perinatal care unit meeting is arranged to discuss the

complicated & high risk pregnancy cases. Postgraduate

discusses about the cases with the various specialty

consultants like Newborn, Paediatrician, Paediatric surgeon,

Pathologist.

Every postgraduate student presents an interesting case by

weekly

Each MD(OG) postgraduate student is guided by a faculty for their

thesis work and scheduled for thesis work as follows

o After 6 months from the joining they will guided to do the

following before completion 1st year

Decide topic of thesis

Presentation of review of literature and methodology

Submit title of thesis

Presentation of questionnaire (Proforma) and finalization

o In 2nd year

Finish data collection

Data analysis to be completed and presented

o 3rd year

Thesis book (hardcopy & softcopy) to be prepared

To be submitted

o Postgradautes are expected to attend CME programmes and

conferences (in a minimum of 3 programmes they 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 corresponding

unit’s faculty.

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Their postings is scheduled as follows

2 weeks - Labour ward

2 weeks - Newborn

2 weeks - Elective posting

The rest of period they do OPD, ward, Operation Theater and intensive care

areas duty.

In OP posting CRRIs are taking history and doing preliminary examination for

new cases. Subsequently the cases are followed up with the consultant. The

case will be thoroughly examined by the consultant and disposed.

They are attending the ward rounds taking by the unit chief and faculty and

follow the chief consultant orders. Ward CRRIs monitor the ward patient’s

progress 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 broadly

divided under the following categories:

1. Antenatal care

2. Intra partum and post partum care

3. Operative and emergency Obstetrics

4. Gynaecological and operative Gynaecological care

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a. Screening for cervical cancer

b. Basic and special investigations of Infertility

5. Urogynaecology

6. Family planning

Antenatal care protocol:

1. Diagnosis of pregnancy

2. Monitoring of the health status of mother and fetus

a. Upto 6th month - monthly checkup

b. 7th month & 8th month - 15 days once

c. from 9th month onwards - weekly monitoring

3. Identification of risk factor

4. Detection of associated medical, surgical disorders

5. Screening for the woman for infections

a. Tamilnadu Aids Control Society project – PPTCT program for

counseling & educating the woman about HIV infection and

preventing methods and screening.

6. Antenatal investigation includes the following

a. Blood group

b. Heamoglobin

c. Urine routine

d. VDRL

e. GCT

f. HIV

g. HBsAg

h. Ultrasound at early diagnosis of pregnancy to rule out intra

uterine pregnancy and fetal viability

i. Ultrasound at 18-20 weeks to rule-out structural fetal anomalies

which can be detected by ultrasound.

j. Ultrasound at term to assess fetal growth & AFI

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7. Educating the woman about the effect of health, nutrition, drugs etc.,

on pregnancy

8. Preparing the woman for labour, breast feeding.

Outpatient department

1. At patient entry, they register at the Medical Record Department

depending on the complaints is registered to the concerned

department

2. Once the registration is made the OP file (medical record) of the

patient is transferred to the outpatient department by the MRD

attender. The OP file is checked weather the file is transferred to

proper department or not and then received by the department

secretary.

3. The patients are called in the order of registration time and a token

is placed for every attended patient’s file serially. If the called

patient is not in the OP waiting hall, it will be informed to the MRD

and 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 condition

warrants immediate treatment, she will be consulted by a

Gynaecologist immediately.

6. The patient’s history & presenting complaints will be entered in the

file by the junior doctor. The patient history includes:

1. Presenting complaints

2. Menstrual history

3. Marital history

4. Obstetric history

5. Previous gynaecological history

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6. Medical & Surgical history

7. Family history

8. Personal history

7. A general examination is done by the junior doctor and recorded on

the case sheet. The general examination includes the following: BP,

Pulse, pallor, edema, CVS, RS and temperature.

8. Then the patient will be consulted by a consultant Gynaecologist.

9. The patient is thoroughly examined by the consultant and a

provisional diagnosis arrived at.

The examinations are:

Abdominal examination

Vaginal examination

Speculum examination

10. The required investigation to substantiate the diagnosis is

recommended after counseling the patient & their attender.

11. After the sample collected for the investigations the patient is

advised about the probable time taking for investigation report and

the report copy will be available on the patient’s file at all. The

probable time taken for investigation report is 2-3 hrs from, some

investigation report takes few days like culture takes 3 days, for

histopathology 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. Date

is fixed for the procedure if the patient is willing to undergo the

further procedure. If the condition warrants and immediate medical /

surgical treatment, she is counseled regarding the treatment and

admitted. The admission orders written by the Gynaecologist in the

case sheet.

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14. The admission patient is shifted from the outpatient area to the

ward by the OPD attender with the OP file and the patient attender

is informed for wait in the IP patient attender area.

15. Day care procedure which do not warrant admission and deal with in

the OPD and the patient discharged on the same after when she is

stable.

Inpatient department

1. Following admission to the ward, the patient is assessed and if

intensive care is necessitated the patient is admitted to the critical

care units of ward & monitored intensively.

2. If the patient is admitted for a major / minor procedure the required

investigations which were ordered by the consulted Gynaecologist

are sent results are collected by the ward staff. Pre-op protocol

followed.

3. If the patient is admitted for observation, the results of the

investigations and the patient status are followed and informed by

the concerned ward interns & resident doctor to the consultant.

4. All nursing as well as medical work is supervised by the unit

concerned in a standard manner which includes conventional ward

rounds taken, thrice a day, in the morning, after noon and late

evening

5. If any complaints encounteded during the night is handled by

consultant & resident on duty.

4. JOB SPECIFICATIONS

Head of the department:

The HOD will function as the administrative head of her/his

department in addition to the professional responsibilities

To supervise punctuality and regularity in reporting

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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 unit

as well as the department

To supervise the quality of work done by the Assistant

professors and Residents

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

smooth functioning of the department

To shoulder all the responsibilities of the HOD during his/her

absence

To supervise the work done by the other category staff in the

maintenance of the professional zones of the institution

Plan and implement protocols for clinical work as well as

academic 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 and

Professors in the smooth functioning of the department

To perform all the duties allotted by the institution administrative

heads and the HOD regarding patient care and academic activity

To extend sufficient professional help to the Assistant Professors

whenever required

Assistant Professor:

To carry out the work responsibilities allotted by the HOD

To do stay in duties as per schedule

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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

enough practical skill

To pay attention to the maintenance of outpatient, inpatient zones

and special areas

To maintain absolute harmony in the unit/department by full co-

ordination with 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 register

3. Colposcopy register

4. Ultrasound register

5. Scan appointment register

6. Cu-T insertion register

7. Family planning progamme – sterilization register

8. MTP register

9. OP Things stock account register

10. High risk cases register

11. Interesting cases register

12. Perinatal care unit meeting register

13. Departmental library books register

14. Department staffs & faculty leave register

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15. Letters & communication dispatch register

16. Postgraduate attendace register

17. Undergraduate attendance register

18. CRRI – Intensive care areas attendance register

19. OPD daily Statistics

All register’s format enclosed in separate sheets

List of registers maintained in Labourward

List of registers maintained in Daycare room

List of registers maintained in OG ward

6. 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 presence

in OPD. If patient not present at OPD waiting area verification is

done 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 with

presenting complaints is taken by the Resident doctor.

6. Subsequently the patient is consulted, examined and diagnosed by

a Gynaecologist

7. Advised for the investigation required, proposed line of treatment.

8. Explained for probable charges and duration stay if any

hospitalization required.

9. Procedures done in OPD:

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a. USG – Pelvis, Obstetrics

i. Patient takes a prior appointment, pays the bill on that

particular day & get USG done

ii. It is done on the same day depends on the urgency

iii. Explained consent obtained for obstetric scan

b. IUCD insertion

i. Patient is advised for IUCD

ii. Patient purchases IUCD at pharmacy

iii. IUCD is inserted by the consultant and advised about

medication and followup

iv. The patient has to pay the insertion procedure charge

and the miscellaneous charges

c. Colposcopy & cervical biopsy

i. Usually done by Papsmear result’s indication.

ii. Colposcopy directed biopsy is taken. If Colposcopy is

normal, no need for cervical Biopsy

iii. After the procedure the patient is advised for medication

and report review (Histopathology report processing time

- 7 days)

d. Cryo cautary: following the histopathology report, if indicated

patient is offered cryocautery in post menstrual phase.

10. Inpatient :

Admission requisition sent by the consulting doctor

Patient & patient’s relation is accompanied by the OP attender to

the admission counter

According to the patient choice the ward / room is allotted for the

patient

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Patient & patient’s relation is accompanied by the admission

counter attender to the allotted ward

The concern unit ward resident doctor and CRRI are informed by

the ward staff nurse who is receiving the admission patient.

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

staff nurse

The ordered investigations requisition to the lab is written by the

ward Resident doctor

Blood samples are collected by the ward staff and sent to the lab

by the ward attender

Routine blood & urine investigation processing takes 3 hrs for

reporting

Some special investigations like CT, Ultrasound, MRI are done by

a prior appointment. The appointments are made by the ward

staff nurse.

In case of any emergency, urgent requisition can be made and

the results can get ready within 2 hr as soon as possible. It is

informed to the unit faculty by the CRRI immediately after the

result obtained

The results are collected by the ward attender

The results are review in the next ward rounds by a consultant

and decided for further treatment.

Pre-procedure protocols are followed for the case who got

admitted for certain procedures.

Proper consent for all procedures and surgeries is obtained by the

Resident doctor & staff nurse

7. Protocols for Surgical procedures

Pre-procedure:

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The indication for the surgical procedure and its risks involved are

explained to the patient & patient attender by the treating doctor.

A written informed consent is obtained from the patient & patient

attender.

Patient will be investigated for fitness for the surgical procedure

either as an outpatient or inpatient depending on the patient

decision.

The patient is admitted 2 days prior to the surgical procedure if the

patient wants to do all investigations and fitness opinion as an

inpatient.

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

General Physician opinion and Anaesthethic fitness will be sought

prior to the surgical procedure.

Instructions given pre-op includes

1. Preparation of the surgical site and site of locoregional

anaesthesia by the ward staffs

2. Enema is given night prior to and the morning of the surgical

procedure by the ward staffs

3. Xylocaine and antibiotic test dose given on the morning of

the surgery.

4. Patient is kept nil per-mouth from previous midnight and also

pre-anaesthetic medication is administered

5. IV hydration is maintained.

6. The patient is shifted to pre-op room half an hour before the

surgical procedure

7. The patient attender is informed when the patient has shifted

into the theater block.

8. During the process of shifting the _______ standards are

adhered to

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Per-operative :

In the pre-op room the anaesthetist re-examines the patient to

ascertain the fitness for the surgical procedure.

Inside the operation theatre, the full dose of antibiotic is

administered during induction of anaesthesia.

The patient is placed in the required position (dorsal/lithotomy) for

the surgical procedure

The patient is intensely monitored during the surgical procedure.

Strict aseptic precautions are followed during the surgical

procedure.

After the surgical procedure is completed the patient is shifted to

the post-operative care ward for monitoring.

The patient attender is explained & informed about the patient

status and the procedure done by the surgeon.

Post-operative instructions:

Patient is monitored for vitals half an hourly still stable, then two

hourly for a minimum of 6 hours to 24 hours in the post-operative

ward.

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 oral

hydration 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 for

patient at risk for the same.

Post-op analgesia is maintained with parenteral or epidural opioids

Post-op physiotherapy and early ambulation is advised.

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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

List of day care procedure

1. Fractional curettage

2. 1st trimester MTP

3. Medical abortion

4. Vulval biopsy

5. Cervical biopsy

6. Suction evacuation

Pre-procedure instructions:

a. The indication for the procedure and its risks involved are

explained to the patient & patient attender by the treating doctor.

b. Patient is examined & investigated for fitness of the day care

procedure. The routine investigations are as follows:

Haemoglobin

Urine routine

Blood grouping & typing

HIV & HBsAg

Blood sugar

USG if required

c. If the patient is fit for the procedure, a written informed

consent is obtained from the patient & patient attender and the

patient is shifted to the day care room by the OPD staffs

d. 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

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Per-procedure instructions:

a. For Fractional curettage & Suction evacuation:

IM sedation – Fortwin or Pethidine 1 amp with 12.5 mg

Phenargan given by the day care room junior doctor

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

placed in the required position

b. For Vulval / Cervical biopsy no sedation required, only local

infiltration 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 posterior

fornix. In case of missed abortion Tab. Cytotec 400 micro gm

kept vaginally followed by Suction evacuation after 4 hrs under

IM sedation and paracervical block.

d. The procedure will be done by a Gynaecologist and a junior

doctor.

Post-procedure instructions:

e. After the completion of procedure the patient will be

monitored for vitals & bleeding p/v by the team of day care

room junior doctor & staffs.

f. The Biopsy specimen / curettage specimen will be sent for

Histopathology lab with requisition of doctor.

g. After 5 hrs from the procedure, if the patient is stable the

patient is shifted out from the day care procedure room and the

patient attender is informed for the same. If the patient has any

complaints or not stable, get admitted for observation and

treated further.

h. The patient is advised for the review date in the outpatient

department, medication and the report follow up.

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9. Test SOP (Standard operating procedure)

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