Obstetrics and Gynaecology induction booklet was contributed by the following;
written by Dr Dr Amy Chan
reviewed byMs Banerjee
updated by Dr Fatima Junaid
Select the booklet titles below to expand the table to view more information.
Obs and Ward Timetable
| Day | Monday | Tuesday | Wednesday | Thursday | Friday |
|---|---|---|---|---|---|
|
AM |
Gynae outpatient clinic (GOPD) |
Protected FY1 Teaching |
Gynae |
Elective C-section list |
Obstetrics |
|
PM |
Gynae outpatient clinic (GOPD) |
Gynae |
Gynae |
Obstetrics |
Obstetrics |
Consultant Obstetricians and Gynaecologists (with their initials)
- Mr Hesham Ghoneimy (HG)
- Uzma Zafar (UZ)
- Sudipta Banerjee (SB)
- Eric Watson (EW)
- Hasan Morsi (HM)
- Basem Muammar (BM)
- Manjula Subramanian (MS)
- Josephine Achiampong (JA)
- Sadia Ijaz (SI)
- Rashda Imran (RI)
- Nasreen Syeda (NS)
- Mr Hashem El-Hossamy (HE)
- Mr Andrejs Smirnov (AS)
- Sushma Gupta (SG)
- Vandana More (VM)
Middle-grade doctors consist of permanent trust grades and O&G registrars. SHOs consist of O&G trainees and GP trainees.
Bleep numbers:
- Obstetric on-call consultant: 7053
- Obstetric on-call registrar: 7809
- Obstetric on-call 2nd registrar: 7140
- Obstetric SHO: 7019
- Obstetric on-call anaesthetist: 1032
- Gynaecology on-call consultant: 7339
- Gynaecology Registrar: 6207
- Gynaecology SHO: 7340
- Anaesthetist for emergency theatre: 7010
- Emergency theatre coordinator: 7224
Phone extension numbers:
- Maternity Triage: 3053
- Obstetric Theatre Coffee Room: 5287
- Gynaecology Main Theatre 1: 1266
Obs and Gynae - Obstetrics work
The Role of an FY1
Your day starts at 8:30am and finishes at 4:30pm. Arrive on time and leave on time! You you will be performing a similar role to SHOs. It is mainly ward-based and you will be working alongside the on-call SHO for either obstetrics or gynaecology. At other times, you may be assisting in theatre or seeing patients in outpatient clinics.
All patients that you clerk must be discussed with seniors to confirm management. FY1s are not responsible for accepting referrals and you cannot discharge a patient without senior discussion first.
Bleeps
If O&G is your first rotation of the year, you will not have a personal bleep for the first three months of your rotation. In the fourth month, you may carry the SHO bleep and receive referrals and advise or accept them, which you can always check with a senior first. This is to ease you into the workload as you come to understand the expectations of an FY1 in your first rotation.
If O&G is your second or third rotation, you may be asked to carry the bleep on occasion from an earlier point in the rotation, but you should always be on the ward with an SHO who you can ask for help. On the rare occasion (e.g. exceptional rota gaps), you may be asked to carry the obstetric SHO on-call bleep temporarily. Only a consultant has the power to ask the FY1 to carry the on-call bleep.
Maternity
The maternity unit is based on the second floor of Russells Hall Hospital. Access to all areas here is via ID badge swipe access. There is also security on the front desk 24/7. When you enter the unit, go to the left side for the maternity ward and obstetric theatres.
If you are on the rota for “SHO Obs”, this means that you will be based on the maternity ward. These are some of the things you may be doing:
- Reviewing postnatal patients to facilitate discharges
- Assisting in Caesarean sections
- Seeing patients that require a medical review for any medical issues
- Assessing antenatal and postnatal women in maternity triage and discussing them with a senior to formulate a management plan
- Doing jobs such as prescribing, cannulation and venepuncture
If you need help, call the obstetric SHO first. Most of the time the SHO will be on the ward with you. If you cannot reach them, escalate upwards to the on-call obstetric registrar or consultant if needed. They will be available via their bleeps or you can find them on the maternity/delivery unit. There is also an on-call anaesthetic team available on the unit.
Midwives
Midwives are specialists in their own right, so communicate with them effectively and be respectful towards them. If you are kind to them, they will be kind to you!
Select the titles below to find out further information.
After handover, go to midwives’ office on the maternity unit and find the yellow jobs folder. Midwives will write down any jobs that they would like the obstetric SHO/FY1 to do. The large bulk of this is postnatal reviews for discharge. Some women may only need TTOs due to medication requirements, whereas others will need a clinical review as well. It is best to confirm what exactly is needed by speaking to the midwives. You can always ask your SHO for help if you are unsure.
The questions you should be asking in a standard postnatal review include:
- Overall maternal well-being
- Pain and management
- Vaginal loss (e.g., lochia, minimal, clots)
- Passed urine (needs 2x good voids after removal of catheter)
- Bowels opened (not necessary for discharge; you can advise women to go to their local pharmacy for laxatives if needed)
- Fever
- Neurological symptoms
- Oral intake of food and drink
- Nausea and vomiting
- Mobilisation
- Signs of DVT/PE
- Wound assessment (e.g., clean and dry, bleeding, discharge, pain)
- Mood and mental health
- Breastfeeding or bottle feeding
All hospital inpatients are assessed for risk of venous thromboembolism (VTE).
To summarise:
VTE 0 – 1 (discontinue LMWH on discharge)
VTE 2 (discharge with LMWH for 10 days),
VTE 3 and above (discharge with LMWH for 40 days).
LMWH of choice is enoxaparin and the dose depends on the patient’s booking weight. Guidance on duration and doses are found in the white coloured VTE booklet. *Note, therapeutic LWMH dose is based on the patient’s current weight.
Discharge letters for postnatal discharge should include the following information:
- Mode of delivery (e.g., normal vaginal delivery (NVD), elective lower segment Caesarean section (ELSCS), emergency lower segment Caesarean section (EMLSCS), forceps, Kiwi/Ventouse)
- Details of any perineal trauma and repair
- Estimated blood loss (EBL) during surgery for Caesarean sections
- Any other complications
- VTE score
- Prescription of the appropriate dose and duration of enoxaparin if required
- Prescription of ferrous sulphate 200mg TDS for postnatal anaemia, where Hb<100 after delivery
- Prescription of other medications such as antibiotics or anti-hypertensives if indicated by the senior obstetric team
- Any instructions for follow-up with the GP or community midwife
There is an elective Caesarean section list every morning (typically the maximum of 3 sections), for which a team debrief for the surgeon, anaesthetist and theatre staff starts around 8:30am in Obstetric Theatre 2.
Most women are suitable for “Enhanced Recovery” following an elective Caesarean section, which means that they can be discharged 24 hours post-surgery by midwives if all is well.
You may also be called by the on-call obstetric consultant or registrar to assist in emergency Caesarean sections in Obstetric Theatre 1.
Obs and Gynae - Obstetrics Triage
The Role of an FY1
The department has a triage service that runs 24 hours and 7 days a week for antenatal and postnatal women. Women can call the service directly, or they may be referred by community midwives, GPs, or from the antenatal clinics downstairs. Midwives will triage patients who attend and contact the obstetric SHO, registrar or consultant for review as appropriate.
As an FY1, you can help with assessing patients highlighted for SHO review. Take a thorough history and examine patients as appropriate. Document your findings in the triage booklet and then discuss the case with the SHO or registrar to confirm management. Remember that you are not allowed to discharge patients without senior approval. You may find that it’s appropriate to perform a speculum examination to assess fully and to take some vaginal swabs. If this is the case, always ensure you have a chaperone with you (this could be your SHO or the triage midwives/student midwives).
Obstetric unit ward round
There is an obstetric unit ward round every day by the obstetric consultant and registrar. They will handover in the office on the obstetric unit (delivery side) at 8:30am. If you are interested, you can always ask the consultant if you can join. You may also be asked to do jobs on this side of the ward by your seniors if they require extra help, and may have the chance to witness vaginal births, including forceps delivery, for example.
Common presenting issues in triage:
- Antepartum/postpartum haemorrhage (APH, PPH)
- Decreased fetal movements (DFM)
- Postnatal wound review
- Urinary tract infections
- Spontaneous rupture of membranes (SROM)
- Premature rupture of membranes (PROM)
- Pain – g. abdominal, chest, legs
You are not expected to know exactly how to assess and manage these problems as you start your post. Your seniors will be there to teach and guide you through, particularly in performing speculum exams properly.
Cardiotocographs (CTGs)
Cardiotocographs (CTGs) are reviewed by O&G trainees and consultants – you do not need to worry about interpreting them. You can however ask for teaching on these and learn to interpret them – it is a useful skill and it can be quite interesting to understand what is happening with the foetus by following the graph.
You will see rapid bedside test kits being used in triage for assessment. Ask your seniors and the triage midwives on when and how these should be used:
Actim PROM: detection of premature rupture of fetal membranes
- It works by detecting a specific protein found in amniotic fluid
- A sample of vaginal fluid from the posterior fornix is collected on the swab
- If the dipstick is positive, it would indicate rupture of membranes
Actim PARTUS: identification of women at risk of preterm (birth before 37 weeks) or imminent delivery
- Can be used from week 24
- It works by detecting a specific protein that is produced in the This protein leaks into the cervix when the decidua and chorion detach
- A sample of cervical secretion from the cervix is collected on the swab
- If the dipstick is positive, it would indicate tissue damage and high risk of preterm delivery or imminent delivery
Obs and Gynae - Gynaecology work
Rota
If you are on the rota for “SHO Gynae”, this means that you will be mainly based on B5 ward/ESH (Emergency Surgical Hub). These are some of the things you will be doing:
- Gynaecology ward round
- Jobs from the ward round
- Assessing acute gynaecology referrals and admitting patients in ESH
- Assisting in emergency procedures
You can find the list for inpatients on the Gynaecology ‘J drive’. You should have access to this following induction; if there are any issues please call IT and let Ms Banerjee know. The list should be updated before morning handover and before evening handover.
Select the titles below to find out further information.
Gynae handover takes place every morning at 8:30am in the antenatal seminar room (ground floor). This is led by the night on-call SHO, who will discuss outstanding jobs and give their bleeps to the day on-call SHOs (one who covers gynaecology ward and one who covers the obstetric unit).
The day on-call SHOs finish their shift at 5pm (and/or 9pm) and will have another handover at that point. You will not be required to attend this as FY1, however, be sure to handover any remaining jobs you have to your seniors before leaving.
Gynaecology theatre usually takes place in Main Theatre 1. On some weeks, it will be in Day Case Theatre 2. Ask the staff members on the front desk of main theatres if you are unsure where to go.
Morning lists start with team debrief at 8:30am in the anaesthetic room of the operating theatre. Debriefs for afternoon lists usually start at 1:30pm, depending on what time the morning list finishes.
In the 30 minutes prior to debrief, you can find and help the surgeon in their pre-op review of patients. This is often in the waiting areas of Day Case.
Before you enter any theatre, make sure you wear the blue scrubs (available in the main theatre changing room), clogs (wear your own if possible, as spares in the correct size are not always available) and a scrub cap.
One of the most important jobs for the theatre assistant is to complete and print the discharge letter for day case procedures. Do these immediately after the case and send it with the patient’s notes to the recovery bay. For patients requiring inpatient stay after surgery, remember to add them onto the gynaecology handover list so that they are not missed on ward rounds. Do this by bleeping the gynae SHO (bleep 7340) and providing the patient’s name, hospital number, consultant who performed the procedure, name of the procedure, and any important post-op/follow-up information.
If you start to feel unwell while assisting, let the surgeon and/or scrub nurse know immediately and excuse yourself from the operating table to recover. Fainting or feeling light-headed during surgery is more common than you think. Do not be embarrassed if this happens! You may be standing still for long periods of time while holding your body in awkward positions. There are also a lot of bright lights and it can feel quite hot underneath your gown and mask. To help your body prepare for a theatre list, make sure you eat your breakfast in the morning and have enough drinks and snacks between cases.
You may discover that you are physically not suited to theatre, so let the rota co-ordinator know if that is the case. They can tailor your timetable and put you in more ward or clinic-based roles where possible.
The gynaecology outpatient department is located at the Corbett Hospital. Free car parking is available on site for staff members; use your ID badge for swipe entry at the barriers. Remember to check your rota to see where you are for the other half of the day. For example, you may need to leave a morning clinic early in order to arrive on time to theatre back at Russells Hall. Some gynaecology clinics also run in the main hospital in Russells Hall, on the ground floor, in the Sandfield suite.
Obs and Gynae - On Calls
On call shifts
You will not be undertaking any on-call shifts for the O&G rota. This means your only O&G shifts will be 08:30am-4:30pm.
Instead, as with every other FY1 in your cohort, you will be on a separate rota for medical and surgical on-calls.
These can be medical admission clerking and ward cover shifts, either during the day, twilight (2pm-midnight) or night shifts. These can also be surgical day or night shifts.
The on-call rota will be emailed to you at the start of the year in the form of a spreadsheet, and should also be available to access on MediRota throughout the year.
This will require you to log in to a separate ‘General Internal Medicine’ MediRota to your O&G MediRota.
After these on-call shifts, you should have some off days blanked out for compliancy with maximum weekly hours. The O&G rota co-ordinator should receive this on-call general medicine rota in advance, and your off days after, for example, a weekend of night shifts should be visible to your O&G rota co-ordinator. However, it would be useful to check this with them and to inform them of when you should be having these days off in advance.
Rota
The rota co-ordinator is Adam Worrall. Please email him regarding weekly timetables, requests for leave or any other queries. We are now on MediRota which you can request annual leave on and view your O&G timetable.
Check your emails during the working day as there may be important updates in the rota to cover unexpected rota issues. If there is a change to your specific timetabled sessions for the day, the rota co-ordinator will inform you.
Select the titles below to find out further information.
You are entitled to 9 days of annual leave per 4-month rotation in your FY1 year. Remember to organise these early on with your colleagues and rota co-ordinator. You will not be able to carry these forwards to the next placements if you miss out on taking all of your annual leave days!
Annual leave must be approved by the rota co-ordinator with completion of the Trust’s standard form. Do not make plans unless you receive authorisation of annual leave.
In O&G, you submit your annual leave requests to the rota co-ordinator on MediRota and they will then approve or reject this on the system. You will receive a notification of this on MediRota.
There is a departmental policy that only a certain number of doctors can be on leave at any one time. Generally, this means that no more than 2-3 SHOs can be on leave on the same day. FY1s are technically exempt from this rule. However, please be mindful of supporting your seniors on days where there may be fewer SHOs or registrars available.
You must follow the Trust requirements for reporting sickness absence. If for any reason you are unable to attend work, you should inform the on-call consultant (phone via switchboard) at the start of the shift, email your clinical supervisor and inform medical workforce via phone through switchboard. Avoid just leaving messages with your colleagues because it may not get relayed properly and there could be an impact on service provision in different areas.
Obs and Gynae Learning Opportunities
FY1 teaching
Russells Hall hospital (RHH) foundation teaching is organised by the postgraduate department in RHH. You will receive information about this through the postgraduate coordinator via email. On Tuesday mornings you will be expected to go to your core FY1 teaching at RHH as you need to attend a percentage of this (the percentage changes yearly) to pass the Foundation 1 programme.
In the O&G department we have weekly departmental teaching on Wednesdays 12.30-1.30pm. This is currently held on Microsoft Teams, though may be held in-person as well if there is a room on Delivery Suite.
Departmental teaching
All the consultants, middle grades and SHOs are very happy and willing to teach. If you have a keen interest in pursuing O&G or surgery as a career, let them know so that they can help tailor your opportunities. For instance, as you become more familiar and confident with assisting in theatre, the surgeon may allow you to practice suturing and knot tying during operations. The daily elective Caesarean section list is often the best time to develop skills in closure of the abdominal wall layers.
There is weekly departmental teaching for O&G. They are not mandatory for Foundation Year ARCP, but evidence of these sessions can help make up extra hours of teaching attendance. You can take the opportunity to present a topic in either of these sessions to your O&G colleagues too. You can also present audit projects in the clinical governance meetings.
If you would like to attend other activities such as MDTs, clinical governance meetings, special clinics etc. please discuss this further with your clinical supervisor.
Grand Rounds
Weekly on Thursdays between 1300-1400 in the education centre. These are lectures presented by different clinicians in the trust on useful and important topics.
Health and Wellbeing
Staff that are happy and thriving in their working environment will inevitably have a more enjoyable experience in the workplace, contributing to the provision of excellent health care for all of our patients. The Dudley Group recognises our commitment to staff wellbeing in a variety of ways.
Select the link below to find out more how the Trust can support you.
