COMMUNICATION IN OBSTETRICS AND

GYNAECOLOGY

DR. ALEXANDER E. OMU FRCOG

DEPARTMENT OF OBSTETRICS AND

GYNAECOLOGY FACULTY OF MEDICINE.
KUWAIT UNIVERSITY KUWAIT

Prepared for 6th year Medical students in posting

in Obstetrics and Gynaecology
Learning Objectives
* Significance of good Communication
* Initial patient Evaluation and presentation
•Patients follow up
* Breaking bad news
* Preparation of patient for informed consent
* Report synthesis; Essays, monthly or
annual reports
* Domestic Abuse
* Introduction to Ethics in Obstetrics and
Gynaecoloy.
Prerequisites of a good communicator
* Pleasant personality
* Ability to establish and sustain rapport
* Self confidence
* Knowledge of the language of communication
* Knowledge of the subject of communication
* Patient Confidentiality
* Facilities for communication
Patient’s evaluation
a. * History taking
* Reason for attendance or admission
(Full history of present complaints)
* Obstetric and Gynaecological history
* Past and present medical history
* Family and social history
* Systemic Review
b. Physical examination
* First explain to the patient what exam
* Eye contact with patient
* Keep flow of discuss as you proceed
* Explain your findings to the patient
* Documentation of your findings
c. Investigations
* Explain rationale to patient
* Type of sample - blood, urine etc.
* How to get the results
d. Provisional diagnosis
* Probability
* Plan of action
Preparation for Informed Consent
Counselling about procedure
* Necessity and Nature of Surgery
* Preoperative care
* Control of any disorder
* Type of anaesthesia and blood transfusion
* Post operative care
* Follow up
Special Informed consent
Spousal Consent Needed
* Reproductive organ involvement
* Termination of pregnancy if indicated
* Life threatening situation for the more or fetus
Post-operative counselling
Early post-operative
* Information about the findings at operation

At discharge
* Advise: diet, sexuality, work, follow up

Follow-up
* Discussion about results
eg. histopathology
 Breaking bad news
Obstetrics - Loss of pregnancy - * missed abortion
* Inevitable abortion
* IUFD
- Maternal mortality
- Early neonatal death
Gynaecology - positive results of investigation
- STD
- Malignancy
- Any other chronic condition
- Decision about operation
Strategy
- Selection of environment of disclosure
- eg office
- The receiver should have social support
(with other close relations)
 Report writing
a. Essays
* Time - frame is important
* Planning
* Essay
* Introduction
* Significance of problem / subject
* Resuscitative measures
if emergency
* Patient evaluation
* Treatment - medical
surgical
both
* Follow - up Progression?
* Conclusion
 Types of essays used for examination
a. Short essays
There are short notes eg.
Write short notes on the following
1. Bromocriptine
2. What is perinatal mortality? and What are
the main causes?
The main need here is on factual knowledge which
can be set out in short notes
b. Long essay
1. Problem based eg. A 28 year old primigravida is
admitted to labour room at 38 weeks with strong contractions occurring
every three minutes and lasting about fifty seconds. Discuss the
management of this lady.
2. Factual essay eg. Write an essay on "Secondary
Infertility"
 Essentials of good essay
1. An essay must have a beginning, middle and end
in principle. So an essay must be
1. Organised purposefully
Plan the different parts. eg.
Introduction
Body of the essay
End (conclusion)
2. Vary as much as possible to avoid monotony and tautology.
3. Engaging and sustaining in interest
4. Probable, so that all its components are logically consistent.
Create arousal and fulfillment of expectation
Organisation
Structure To direct attention to problem
Style Solving
The essay should reveal a cause-to-effect order of events. It should
show a balance of relevances in the care of the patient.
 Principles of an essay
1. The basic idea or thought is to transform your action
into prose

2. The goal of the doctor is to save the life of the patient

3. Discipline, to move actively and purposefully within a

time frame

4. The time frame - where 20 minutes, 40 minutes or 60

minutes
Planning of an essay

Introduction
What is the importance of the subject? You
can give a definition if necessary

What is the possible outcome if quick action

is not taken? ie. Complications
 Body of the essay
Clinical evaluation to know the extent of the problem; in form of
history, physical examination and laboratory investigations
Treatment.
1. Initial management on admission in emergency cases
2. Medical treatment
3. Pre-operative, intraoperative and postoperative care
4. Possible complications and their management
5. Discharge from hospital and follow-up

Conclusion:
Justify the mode of treatment chosen compared to
any other(s)
The need for follow-up
 For the structure of the essay, we shall use the question
"28 year primigravida admitted at 38 weeks of gestation
with strong abdominal pain..............."

Introduction: The following is a fairly good introduction.

Modern management of labour is carried by a team consisting of
midwives and obstetricians. Due to the availability of expertise and
facilities, child birth in hospital generally carries less risk to both the
mother and child. It is important to know that there are three or four
stages of labour. Since each stage of labour carries its own risks, and
all stages of labour should be monitored. So when a 28 year old
primigravida is admitted to to the labour room at 38 weeks gestation
with strong rhythmic uterine contractions, management must be carried
out to ensure the safety of mother and delivery of a healthy child.

The introduction should ideally, not be more than half a page

?
 The body of the essay
The body of the essay should be arranged in form of paragraphs
eg.

"On admission to the labour room, a detailed history and

examination are mandatory. The history should include the onset,
frequency, duration and the strength of uterine contractions. A
general physical examination is carried out to estimate the size of
the fetus, the lie presentation, position, degree of engagement and
fetal heart rate. Investigation including CBC, urine analysis for
glucose protein and ketone bodies random blood glucose and x-
match continuous electronic monitoring is carried out".
During the first stage of labour, an intravenous access is established,
after 10ml of blood have been taken for investigations and x-match of
about 2 pints of blood.
Maternal and fetal monitoring of vital stages are important with a
partogram, continuous electronic and cardiotocogram monitoring...
Analgesia should be given in form of epidural or narcotic like pethidine
50-150mg im 8 hourly.............................................
During second stage of labour the women is encouraged to bear down
with uterine contractions. Monitoring should be continued during the
second stage until the presenting part is visible in the perineum.
Active management of the third stage starts with injection of
syntometrine, with delivery of the anterior shoulder............................
Signs of separation of the place include...............................................
In the final stage careful observation of the mother for 1-2 hours after
delivery is necessary to ixclude primary postpartum haemorrhage,
retained placental fragments, vulval haematoma and circulatory
collapse. The blood pressure and other vital signs must be checked
before transfer to postnatal ward.
The vital signs should be monitored twice daily before discharge. During
the postnatal period the patient should be instructed on breast feeding,
care of the baby and herself. On discharge, the patient should be
instructed to come to hospital, if there is any fresh bleeding, fever and
any other problem with her or the baby. She should be given 4-6 weeks
appointment for postnatal clinic. contraception should be discussed.
At the postnatal clinic, we should enquire about onset of menstruation
--involution of the uterus etc, and the use of contraception. Any specific
problem should be looked into.
 Conclusion
All the stages of labour should be monitored as done in this
lady, to prevent any serous complications to the mother and
baby, and ensure their safety and good health..............
Postnatal instructions and follow-up of both mother and child
at the postnatal clinic is mandatory.

After concluding the essay, you should read through carefully

to correct any spelling mistakes or errors in the use of the
words
 Final tips of writing essays
1. Write legibly and neatly
2. Don't use abbreviations
3. Keep to the time allocated to the essay in
a. Planning
b. Writing the essay
c. Reading through at the end
The language of communication is important.
The mastery will help to write a good essay
 CONCLUSION

Practice breeds perfection

 Domestic Violence and Sexual Assault
• Domestic Violence
Threats, throwing objects,hitting,beating, sexual assault, deprivation of food or
facilities
Diagnosis and treatment
Documentation of clinical features
• Sexual Assault
Marital rape
Acquaitance rape- incest
Date rape
statutory rape
Child sexual abuse
Clinical presentation
Diagnosis and Treatment
Informed consent before examination. Documentation is mandatory
Antimicrobial therapy
Emergency contraception
Psychological support
 General Ethical,cultural/religious issues

1.Lady doctor only Syndrome

2.Chaperone during any examination
3. Patient’s consent and examination
4. The extent of examination should be
clearly explained to the patient before
the commencement.
5. Other ethical issues
 Medical-legal issues

1.Informed consent before operations

2. Rape-Definition/Implications
*medical,
* Obstetric/gynae
*Social
3. Doctors’responsibility and confidentiality
4. Issues of patients of litigation
5. Expert opinion in cases of litigations or
complaints
6. Domestic violence-spousal abuse
The borderline between law and Medicine
All’s well that ends well.
(William Shakespeare (1564-1616))

Malpractices claims are now common in Kuwait

Issues in Medical malpractice

Standard of care
Expert witness
Clinical Scenerios
Neurological Injuries
Prematurity
Role of infection
Shoulder dystocia
Ectopic pregnancy
Assisted vaginal delivery
Intrauterine fetal death
Maternal death