Overview

Women usually undergo several stages throughout their life. Sometimes, transitioning from one phase to another comes with many challenges that can negatively impact the overall lifestyle and wellbeing. Also, certain health conditions, including reproductive system disorders, affect them from time to time. 

Obstetrics and gynecology is thus a special medical unit designed to address all these issues. The initial objective is to help women battling various reproductive system-related problems and enable them to live a good healthy life. 

What are Obstetrics and Gynecology?

Obstetrics and gynecology is a special medical branch that majorly specializes in women's comprehensive care when pregnant and during delivery. It’s also concerned with diagnosing, treating, and preventing health conditions affecting the female reproductive system and the organs. Furthermore, obstetrics and gynecology deal with other related health issues of women’s urinary system. 

What is an obstetrician/gynecologist?

Obstetricians and gynecologists or OB-GYN are the medical providers who specialize in the female reproductive system's general health. Obstetricians work with women during the entire pregnancy phase and when giving birth. On the other hand, gynecologists are concerned with the female reproductive system while treating and managing a range of diseases. 

An OB/GYN is a doctor who has undergone specialized study and training in the management of pregnancy, childbirth, and puerperium, as well as the female reproductive system, including the diagnosis and treatment of illnesses and diseases. As caretakers, they are competent to deal with a wide range of medical and surgical complications that develop throughout pregnancy and throughout life.

Obstetrics and gynecology is an appealing job since it provides health care to a wide range of women, with a focus on illness prevention and continuity of treatment. Almost 80% of OB/GYN patients are between the ages of 15 and 45, when preventive treatment can be of substantial help in protecting health and when many patients are receptive to preventative messaging. Participating in the wonder of birth and the emotional benefits that ensue endure a lifetime are significant reasons for fulfillment in the specialty. This significant life event frequently results in a long-lasting attachment between the patient and the physician.

Students who prefer working with their hands and are drawn to a procedure-based specialty may be shocked at how many surgical and office procedures OB/GYNs perform. Abdominal and vaginal operations such as hysterectomy, laparoscopic surgery, hysteroscopic treatments, or laparotomy with pelvic organ surgery are examples of major surgeries. Amniocentesis, umbilical vein sampling, colposcopy, abortion, cervix conization, hysteroscopy, and saline-infused sonograms are examples of office operations.

Subspecialties of Obstetrics and Gynecology

There are various significant subspecialties of obstetrics and gynecology medical practice. They include the following;

Maternal-fetal medicine

This is an obstetrical sub-branch concerned with the treatment and surgical care or management of high-risk pregnancies. It also involves performing a surgical operation on the fetus with the objective of minimizing mortality rate and morbidity. 

Obstetrics care includes preconception, pregnancy, delivery, and the weeks after childbirth. The following are the stages:

• Preconception counseling is provided to women and couples who are planning to get pregnant. It tries to improve the odds of a healthy pregnancy by detecting and managing health hazards in women. To help in the treatment of male or female infertility, a fertility expert may be engaged.

• Prenatal care is provided throughout the pregnancy, with monthly planned appointments from week 4 to 28, twice monthly visits from weeks 28 to 36, and weekly visits from week 36 until delivery.

1. During the first trimester, the mother will be subjected to a battery of testing to confirm that no medical issues exist that might affect the pregnancy. An STD test, Pap smear, urinalysis, and genetic testing for Down syndrome and other congenital diseases may be included. Your OB/GYN will also give you an estimated due date.
2. During the second trimester, your OB/GYN will continue to check your health to ensure that the pregnancy goes smoothly. The healthcare professional would monitor the baby's development, check for a fetal heartbeat, and screen for gestational diabetes and neural tube problems at this period. If you are over the age of 35 or have an aberrant genetic test result, an amniocentesis may be performed.
3. During the third trimester, you'll be monitored for symptoms of early labor, vaginal bleeding, or placental leaking. You'd also be tested for group B streptococcus (GBS), a common bacterial illness that can be harmful to your kid. As the due date approaches, your OB/GYN will assess the baby's location in the womb and offer you with the required vaccines to avoid infection.
4. Labor and delivery can be induced or natural, with either a vaginal or cesarean section (C-section). Your OB/GYN would also be engaged in the pain treatment, which might include epidural, spinal, or combination spinal-epidural (CSE) anesthesia.

• Neonatal care is the care given to neonates soon after delivery. The degree of care is determined by the baby's health and is defined as:

1. level I (well newborn delivery),
2. level II (special care nursery), or
3. level III (neonatal intensive-care unit)

• Postpartum care begins soon after birth for both the mother and child and continues for at least six weeks.

Gynecology 

Gynecology focuses on the female reproductive organs (including the ovaries, fallopian tubes, uterus, and vagina) and the breasts. Gynecologists offer both preventive care and medical or surgical interventions as needed.

Preventive wellness screenings differ depending on age and may include a pelvic exam, mammography, Pap smears, HPV vaccine, STD screening, and bone mineral density screening. In terms of therapy, gynecologists typically treat or manage the following conditions:

• Amenorrhea (absent periods)
• Cancer (including breast, cervical, ovarian, and uterine cancer)
• Dysmenorrhea (painful periods)
• Endometriosis (overgrowth of uterine tissue)
• Infertility (including ovarian insufficiency, menstrual irregularities, and structural uterine abnormalities)
• Menorrhagia (heavy vaginal bleeding)
• Osteoporosis (bone loss common in postmenopausal women)
• Pelvic inflammatory disease (the spread of a sexually transmitted bacteria from the vagina to other reproductive organs)
• Pelvic organ prolapse (when the muscles and tissues supporting the pelvic organs become weak or loose)
• Premenstrual syndrome (PMS)
• Sexually transmitted infections (including chlamydia, gonorrhea, syphilis, HPV, genital herpes, and trichomoniasis)
• Urinary tract infections (UTI)
• Urinary incontinence
• Uterine fibroids (noncancerous growths in the uterus)
• Vaginal infections (including yeast infections and bacterial vaginosis)

Many of these diseases are characterized by pelvic discomfort, cramps, vaginal discharge, abnormal bleeding, the need to urinate often, pain with urination, genital lumps, ulcers, vaginal itching or burning, or pain during intercourse.

Gynecologic oncology 

The gynecologic oncology branch comprises comprehensive management and care for women with cancer of the reproductive organs. This branch requires medical expertise in the diagnostic and treatment of major complicated gynecological cancer. 

Reproductive endocrinology and infertility 

This sub-specialty focuses on monitoring and managing complicated issues relating to reproductive endocrinology as well as infertility. This area involves the diagnosis and treatment of endocrinology and infertility health-related conditions. 

A reproductive endocrinologist can assist with any female hormone-related condition or need. These are some examples:

• Infertility. When you have difficulty getting pregnant, your doctor will ask you questions and do tests to determine the problem. The doctor will subsequently provide therapy recommendations depending on the cause.
• Fertility preservation. When you have an illness, treatment, or event that can influence your fertility, you can store sperm, eggs, or embryos (fertilized eggs). For example, a cancer patient may choose to have her eggs or embryos frozen prior to treatment.
• Frequent miscarriages. Some women can get pregnant but have trouble carrying the baby to term.
• Endometriosis. Endometriosis occurs when the lining that forms inside a woman's uterus (womb) begins to develop in areas other than the uterus. Each month, a woman's hormones provide the signal to get rid of this lining, which occurs during her monthly period. A woman with endometriosis may experience severe pain during her period as her body attempts to eliminate the lining from both within and outside the uterus.
• Menstrual problems. Some women have irregular or heavy periods, or they might not have periods at all.
• Menopause. Some women require assistance in managing menopausal hormone changes and making hormone replacement decisions.
• Sexual development. Hormone therapy is sometimes required for sexual development.

Treatments

Reproductive endocrinologists treat a variety of reproductive issues, including:

• Assisted reproductive technology, including in vitro fertilization. Any treatment in which eggs and embryos (fertilized eggs) are handled outside of a woman's body is considered assisted reproductive technology. In vitro fertilization is the most prevalent method (IVF). The doctor extracts eggs from a woman's uterus and collects sperm from the woman's boyfriend or a donor. In a lab, the eggs are fertilized outside of a woman's body. After then, a fertilized egg is implanted in the woman's uterus.
• Gynecologic surgeries. Reproductive endocrinologists perform procedures to remove uterine fibroids (noncancerous growths in the uterus), diagnose and treat endometriosis, treat a blocked fallopian tube (the tube that transports eggs from the ovaries to the uterus), and address any other obstacles to pregnancy.
• Hormone treatments. Hormones are used in conjunction with assisted reproductive technology to treat infertility or to aid a woman in carrying a child to term. Hormones are also used to treat infertility caused by conditions such as polycystic ovarian syndrome.

Urogynecology or reconstructive pelvic surgery 

This involves the study and surgical treatment of the female urinary tract. The entire field requires skills and expertise in complex benign pelvic health issues, pelvic floor dysfunction, reconstructive surgery, and lower urinary tract issues. 

 Although your primary care physician, OB/GYN, or urologist may be familiar with these issues, a urogyn can provide further insight. If you have prolapse issues or problematic urine or fecal incontinence, talk to your doctor about seeing a urogyn. If you have issues emptying your bladder or rectum, pelvic discomfort, or bladder pain, you may have fistulas.

Urogynecologists graduate from medical school and then pursue a residency in Obstetrics & Gynecology or Urology. These doctors are experts who have additional training and expertise in evaluating and treating problems affecting the female pelvic organs, as well as the muscles and connective tissue that support the organs.

Many, but not all, pursue formal fellowships (further training following residency) focusing on the surgical and nonsurgical treatment of noncancerous gynecologic diseases. Urogynecologists commonly treat urine incontinence or leakage, pelvic organ prolapse, and hyperactive bladder.

Conditions treated

• Fistulas
• Interstitial cystitis
• Pelvic floor problems
• Pelvic organ vaginal
• Urinary incontinence
• Urinary tract infection
• Vaginal approach prolapse repair
• Laser vaginal rejuvenation
• Treatment for chronic pelvic pain
• Suburethral sling (TVT)
• Interslim
• Robotic assisted prolapse repair

Family planning

Family planning is a gynecological sub-branch that is concerned with contraception and the termination of the pregnancy or abortion. Family planning also contains advice on how to become pregnant when it is desired, as well as infertility therapy.

Contraceptive methods

Oral contraceptive pills, implants, injectables, patches, vaginal rings, intra uterine devices, condoms, male and female sterilization, lactational amenorrhea techniques, withdrawal and fertility awareness-based treatments are all forms of contraception. These approaches work in different ways and have varying degrees of efficacy in avoiding unwanted pregnancy.

The number of pregnancies per 100 women utilizing the procedure per year is used to assess method effectiveness. Methods are categorized according to their efficacy as they are often utilized into:

• Very effective (0–0.9 pregnancies per 100 women); 
• Effective (1-9 pregnancies per 100 women); 
• Moderately effective (10-19 pregnancies per 100 women);
• Less effective (20 or more pregnancies per 100 women)

Other minor subspecialties of obstetrics and gynecology include; 

• Pediatric and adolescent gynecology 
• Menopause and geriatric gynecology 
• Critical care medicine 
• Fetal therapy (treating fetal diseases before birth)
• Laborists (specialists in managing labor and delivering babies)

Obstetrics and Gynecology Procedures 

Sometimes the obstetrics and gynecology doctors can recommend a surgical procedure to evaluate the gynecological issues further. Surgery is also crucial in treating and correcting certain reproductive organ disorders that might otherwise cause severe complications and risks. 

Overall, these are the most common procedures performed by obstetricians and gynecologists;

• Colposcopy 

Colposcopy is necessary if the outcome of the cervical cancer screening methods such as Pap smear turn out abnormal. Colposcopy is a comprehensive evaluation of the vaginal and cervix tissues using a colposcope. This is a special magnifying tool placed outside the vagina. 

During the colposcopy process, the specialists insert a speculum in the cervix. Diluted vinegar product is then placed on the cervix to portray a clearer view of the cervix. After some time, the vinegar solution will clear all the mucus in the cervix. This allows visibility of any abnormal tissues and cells during examinations. With the help of the colposcope, the physician can easily view the cervix, including the sources of the abnormal tissues and cells. 

• Endometrial biopsy 

Endometrial biopsy is a procedure to remove tissues sample from the lining of the uterus. The extracted sample is further analyzed using the microscope to check for abnormal cells or cancer signs. 

Sometimes, obstetricians and gynecologists opt for endometrial biopsy to help identify the actual cause of various reproductive system disorders, including;

• Abnormal or unusual menstruation periods; it can be heavy flow, prolonged periods, or irregular cycle. 
• Continuous bleeding after menopause 
• Thickened lining of the uterus visualized using ultrasound 
• Bleeding caused by consuming hormonal therapy medications
• Overgrowth of the lining or endometrial biopsy 
• Pregnancy issues 

• Loop electrical excision procedure (LEEP)

LEEP is a procedure that is done to quickly extract the abnormal tissues of the vagina within the cervix. It involves inserting a speculum into the vagina to view the internal parts of the cervix. During the procedure, the cervix is numbed using local anesthesia. A solution is then placed in the cervix in order to display the parts containing abnormal cells through the colposcope. 

• Nexplanon 

Nexplanon refers to a hormone-producing contraception implant that is usually placed beneath the inner upper part of the arm's skin. It’s a small-sized implant made from soft spongy, and flexible medicinal polymer. Generally, this is a long term and the most effective way of preventing pregnancy, even for up to three years.  

• Intrauterine device (IUD) 

IUD is a special T-shaped device that physicians place in the uterus via the cervix. It’s a reversible method of contraception or birth control. The entire procedure is relatively simple and takes a few minutes.

• Dilation and curettage 

This is one of the most prevalent gynecologic procedures. It involves the removal of the uterus lining using a special surgical tool or suction equipment. 

This procedure is also used to diagnose and treat uterine conditions. Sometimes, the physician can recommend this procedure to remove; 

• Uterine fibroid tumors, 
• Part of the placenta that remains after delivery, and 
• Molar pregnancy

• Tubal ligation 

This is a surgical procedure to close up the fallopian tube so as to prevent conceptions. Tubal ligation is only recommended if the patient doesn’t want to get pregnant again.

The fallopian tubes are the pathways that the egg travels through from the ovary towards the uterus. Therefore, undergoing a tubal ligation surgery means the egg can’t move to the uterus, and you can no longer get pregnant. 

• Myomectomy 

Myomectomy is a surgery to remove myoma or fibroids. Physicians often recommend this procedure in case your fibroids occasionally cause problems such as severe pain and bleeding, but you still want to keep your uterus intact. A myomectomy is also a suitable option for treating women’s infertility issues. 

• Hysterectomy

This is a surgery to remove the uterus. It’s mainly considered an option when all the other forms of treatment such as medication, surgeries, and therapies are not effective, and the patient's life is at great risk. 

It can be used for treating health conditions such as cancer, fibroids, uterine prolapsed, chronic pain, endometriosis, and heavy bleeding. 

• Ovarian cystectomy 

Most women often suffer from ovarian cysts and can heal or disappear after some time. Women who do not use hormones as contraceptives or birth control measures develop a small cyst nearly every month. 

Depending on nature, the ovarian cysts should be removed if; 

• The cyst is solid-like 
• It is large or more than three inches across 
• It is cancerous 
• It constantly causes severe pain

Obstetrics and Gynecology Health Conditions

Obstetricians and gynecologists have a deep understanding and experience in treating a wide range of disorders of the reproductive and urinary organs. Some of the common health conditions they address include; 

• Menstrual disorders 
• Pelvic pain 
• Uterine fibroids 
• Cervical cancer
• Ectopic pregnancy
• Cancer of the reproductive organs 
• Infertility 
• Menopause
• Miscarriage 
• Menstrual cramps 
• Ovarian cysts 
• Urinal incontinence 
• Bleeding during pregnancy

When to See an Obstetrician or Gynecologist?

As a female being, you should start visiting an obstetrician and gynecologist at the age of 13 or 15. This is significant since it helps build a long-lasting, robust relation between you and the specialist. It also enables the specialist to monitor your general health as you transition from one phase to the other. 

If you are an older woman, you should consider visiting the OB-GYN at least once or twice a year for a well-woman visit. 

During such visits, the obstetrician or the gynecologist can perform several tests. This, however, will depend on the patient’s age, general lifestyle, and associated health risk factors. 

Also, you should consider visiting the specialists if you are pregnant or experiencing reproductive system disorders such as; 

• Suspected pregnancy or a miscarriage 
• Sexually transmitted diseases 
• Complications associated with pregnancy 
• Suspected infertility 
• Pain during sexual intercourse 
• Pain or burning sensation and other symptoms associated with urination 
• Sexual and reproductive health issues 

Conclusion 

The obstetrics and gynecology medical branch aim to address and manage various conditions affecting women’s reproductive and urinary systems. Obstetrics and gynecology integrates medicine and surgery, which appeals to many professionals interested in the field. It is, nevertheless, a vast discipline.

Despite the fact that several subspecialties have emerged, including maternal-fetal medicine, reproductive medicine and infertility, urogynecology (female pelvic medicine and reconstructive surgery), sexual and reproductive health, and gynecological oncology, and that others, such as community gynecology, pediatric and adolescent gynecology, are developing, more than 70% of obstetricians and gyne However, there is a growing trend among these experts to specialize as a gynecologist or an obstetrician.