Download KUHS MBBS 4th Year Gynaecology Syllabus

Apart from the above theoretical knowledge, the following practical skills have to be acquired at
the end of the course of studies:
? Examine a pregnant woman and diagnose abnormalities like preeclampsia, anaemia,
GDM, abnormal presentations and to make appropriate referrals if necessary.

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? Conduct a normal labour and to provide postnatal care.
? Resuscitation of newborn babies.
? Perform a pelvic examination and to diagnose common gynaecological diseases.
? Examine a vaginal smear for trichomonas and fungus, and to take a pap smear.
? To offer appropriate contraceptive advice to a couple, and to assist in insertion of

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IUCD.
? Interpret common investigation results (biochemical, histopathological, ultrasound
etc)
Integration:
At the end of the training period the student must be able to provide preventive,promotive,

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curative and appropriate rehabilative care of women and new born with a life cycle approach
integrate activities with other departments like community medicine and paediatrics, in
programmes like newborn care, immunization, nutrition, and other maternal & child health
and adolescent activities
General Guidelines for training:

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1. Training in the department of Obstetrics & Gynaecology with facilities prescribed by MCI, for a
period of 24 weeks with due exposure to antenatal, intranatal and postnatal care and family
planning and general gynaecological care
2. The student should maintain a log book for clinical postings from 3rd semester till 9th semester
and frequently verified by the faculty members.

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3. Of this period of clinical instruction, not less than 4weeks be spend as resident pupil in the
department.
4. During this period, the student shall conduct at least 10 normal deliveries under supervision,
and assist in 10 cases including abnormal deliveries and obstetric emergencies. These cases
include postnatal follow up also.

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5. The student shall maintain a record of the work done in the department, get it certified from
the department and submit for the Final University examination
Syllabus ? Details:
Summary:
Duration of course

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Postings in 5 Semesters (III, V, VI, VIII & IX )
Total number of hours:
Theory
300
Lectures

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100
Innovative sessions :
200
Clinical Work
As per the schedule attached

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Innovative sessions :- must include problem based learning,seminars,structured
discussions, drills eg: PPH drill, shoulder dystocia drill, eclampsia drill,emergency rescucitation in
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acute collapse, New born rescucitation, Preventive Health ? Education for early detection of

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breast lumps, Ca cervix
Video sessions ? eg ; presentations of mechanism of labor, conduct of labor, common
surgeries,common precedures etc
SESSIONS which will improve communication skills and attitude should be given
moreimportance.

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Details of lectures:
Pregnancy:
Diagnosis, clinical features, differential diagnosis, relevant tests and the principles underlying
the tests
Antenatal care: Objectives of antenatal care routine antenatal check up, pre pregnancy care

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and couselling
Assesment of period of gestation, Obstetric examination, General examination, other system
examination
Clinical monitoring of maternal and fetal well being, detect abnormality
Common Problems in Pregnancy:

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Oedema, Pruritis, heart burn, piles, varicose veins, clothing and foot ware, Exercise, sex,
hygiene
Nutrition, Rest, drug in pregnancy
Drugs: Immunization, Drug prescription relevant blood examination, urine examination and
interpretation of the results & physiological changes in pregnancy Ultrasound examination

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Foetal surveillance
Normal Labour
Physiology of onset of labor, fetal skull &pelvis
Mechanism of labour
Labour monitoring Partogram, CTG Labour analgesia

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Induction of labor (various methods of induction-merits and demerits)
Acceleration of labor and drugs used in labor
Delivery:
Stages of labour, management of first of labour
Management of second stage of labour (vaginal delivery) use of restricted

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episiotomy
Management of third stage of labor:
Active management of third stage of labor
Prevention of PPH, Management of PPH
Other complications of third stage of labor and management

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immediate postpartum care, care during fourth stage of labor
Abnormal labor:
Partogram, labor abnormalities, prolonged labor, dystocia
Hypertonic contractions, hypotonic contractions and
Incoordinate uterine action

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CPD, obstructed labourand Rupture uterus
Caesarean section (indications, complications)
Vaginal delivery after caesarean

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Abnormal presentations and management: Occipito posterior position, Breech presentation,
transverse lie, brow/ face presentation
Abortions: Types, etiopathology, investigations and management
Recurrent pregnancy loss: causes, investigations and management
Ectopic pregnancy: etiopathology, early diagnosis, late diagnosis, clinical features,

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differential diagnosis and principles of management (conservative, medical and surgical)
Trophoblastic diseases: aetiopathology, classification, clinical features, Diagnosis,
management, long term follow up and complications
Hyperemesis gravidarum: definition, aetipathology, clinical features advice and drug therapy
Abnormal puerperium: Cause clinical presentation investigations and management

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Abnormal
pregnancy, Medical Complicationss like hypertension, anaemia, Diabetes, Heart
disease,Liver disease, Antepartum haemorrhage, abnormalities of placenta and cord, HIV in
pregnancy
Multiple

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pregnancies
Intra uterine death
PROM (premature rupture of membranes)
Preterm labor
Post datism

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IUGR
Elderly primi, Grand multipara, Rh negative, Gynaecological disorders complicating
pregnancy
Fetus and new born:
Fetal distress: definition, diagnosis and management neonatal resuscitation

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Care of new born, examination of new born and identifying congenital abnormalities
Jaundice in new born
Breast feeding
Contraception:
Various methods and devices, selection of patients, counselling of the Couples, follow up,

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side effects, complications, and failure rates, guidelines on male and female sterilisation
Medical termination of pregnancy:
MTP Act, Legal and ethical aspects, POSCO act, methods, complications and
management
Operative obstetrics

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Indication and steps of the procedure of episiotomy, perineal tears
Vacuum extraction, forceps delivery
Dilatatation and Evacuation
Caesarean section,
Assisted breech delivery, breech extraction External

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cephalic version, internal podalic version Cervical
encirclage extra amniotic instillation& Manual
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removal of placenta

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Ultrasound MRI in obstetrics: diagnostic and interventional
Fetomaternal medicine: Screening for congenital abnormalities,
Blood tests (maternal and fetal) Amniotic fluid analysis,
Foetal tissue biopsy
Medical disorders in pregnancy:

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Hypertensive disorders of pregnancy
Heart diseases complicating pregnancy
Anemia in pregnancy
Diabetes in pregnancy
UTI, Hepatitis, TB- -, respiratory diseases, Chest disease complicating pregnancy

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sexually transmitted diseases, Veneral disease, infections, HIV complicating
pregnancy Thyroid disorders, Immunological disorders, like SLE, APLA, and
Thrombophilia complicating pregnancy
Jaundice in pregnancy Haemorrrhage and coagulation disorders in
Obstetrics & Immunology in Pregnancy

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Dummy pelvis, Mannequins Resuscitation of new born
GYNAECOLOGY:
Abnormal menstruation:
Normal menstrual cycle ? physiology of ovulation and menstruation
Abnormal menstruation Definition, classification, clinical features and principles of

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investigations, diagnosis and management
Amenorrhoea: Definition, classification, causes, investigations and management.
Abnormal uterine bleeding and Postmenopausal bleeding:
Definition, causes, investigations, and management
Hormonal therapy: when to give, when not to give, type of hormones with dosage, duration of

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hormonal therapy, complications and contraindications for hormonal therapy Infertility: Types,
definition, causes, counselling, examination of couple and essential
investigations, ART: Various methods of assisted reproductive techniques, Setting up of ART lab
including legal and ethical issues
Genital injuries including fistulae: Causes, diagnosis, Clinical features, and principles of

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management and prevention.
Genital infections: STDs, PID, HIV infection and AIDS, genital TB- etiopathology, diagnosis and
principles of management
Vaginal hygiene, common infections,
Neoplasms of Genital tract ? Benign and Malignant. Aetiopathology, Clinical features,

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diagnosis, principles of management, and cancer screening and preventive aspects
Abnormal vaginal discharge: Causes clinical examination, diagnosis, Investigation and
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management.Counsel ing regarding prevention of STD's

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Correction of enterocele, diagnosis and operation for vault prolapse
Endometriosis: aetiopathology, classification, clinical features, diagnosis and management of
pelvic floor dysfunction
Contraception
Operative Gynaecology:

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Indications, complications of D&C,Fractional curettage, Pippelle sampling, cervical biopsy
Medical termination of pregnancy Evacuation of incomplete
Abortion Tubal Ligation, IUCD insertion
Abdominal hysterectomy
Vaginal hysterectomy, Sling procedures

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Ovarian tumours
Radical procedure for malignancy
Common symptoms of advanced gynec malignancy, diagnosis and management
UTI in women of different age groups, prevention and management
Endoscopy in gynaecological practice

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Laparoscopy: principles, indications, instrumentation, procedure, complication, scope of
laparoscopy: in gynaecological practices
Hysteroscopy: Principles, indications, instrumentation, procedure, Steps in present
Gynaecological practices and complications Colposcopy: Principles instrument, procedure
Endocrinology

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Post operative management:
Routine management of postoperative patient like IV fluids, drugs, antibiotics, ambulation,
nutrition
Management of fever, skin wound complications, Complications like burst abdomen, intra
peritoneal bleeding, and intra peritoneal collections Instruments, Specimens etc.

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Acute abdomen
Adolescent Gynaecology
Urological problems
- Pelvic Floor exercises
DETAILS OF PRACTICALS-Clinical postings-Ward/OP/OT/Labour room

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8.00 ? 9.00am
Lecture in clinical subjects
9.00 ? 12am
Case demonstration, Clinical discussions
12.00 ? 1.00 pm

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Lecture in clinical subjects
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Minimum one day per week is devoted for live operative Surgery demonstration and discussion
Separate clinical record should be kept and at least twenty cases to be included.

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During the clinical posting in Obstetrics the student should learn History taking, Diagnosis
of Normal pregnancy, physical changes in pregnancy, presentation, position, and lie etc., early
pregnancy complications. Abortion, Normal labour in the labour room.
Puerperium with stress on lactation, BFHI, common ailments of pregnancy like hyperemesis,
UTI, abnormal presentation, medical complications, III stage complications and abnormal

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puerperium
During the clinical posting in gynaecology. The student should learn History taking, examination,
common symptoms, applied anatomy of genital organs, physiology of menstruation and
ovulation, fibroid, Ovarian tumour, prolapse, Endometriosis, Malignancies of genital tract and
Abnormal uterine bleeding. Students should be exposed to operative procedures and diagnostic

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procedures like ultrasound endoscopy etc..
During internment, the student should conduct at least 10 normal case and assist 10
normal cases, assist abnormal labour and attend all emergencies. The classes to be taken are
palpation (review), mechanism of labour and mannequein demonstration, obstetric operations
and obstetric emergencies and various obstetric drills. This period should also be used to

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develop proper communication skills and attitude towards female patients
Keeping records and Log books
? Each students must maintain a log book carried over from 3rd semester to 9th
semester
Structure of records to include concerns of the whole person with the disease and not just

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the organ
? The record book should be submitted at the time of final average practical examination. Only
if the record book is submitted the candidate becomes eligible to appear for the clinical
examination
Partogram should be included in the record while printing the records

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FAMILY WELFARE
Applied anatomy of mechanical methods for prevention of conception
a. In female ? Barrier contraception, female condom, IUCD, tubectomy
laproscopic sterilization.
b. In male ? condom, vasectomy (NSV)

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Physiology, Endocrine and regulation of reproduction in the female. The safe period-rhythm
method of contraception, principle of use of oral contraceptives.
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Pharmacology:

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Mode of action and administration of hormonal contraceptives
Contraindications for administration of contraceptives. Side effects of
contraceptives.
Community Medicine: The need for
Family Welfare Planning, Organization of Family

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Planning service, Health Education in relating to Family Planning, counselling and consent for
variouscontraceptives, Nutrition, Physiological need of the mother, the child and the
family
Demography and the vital statistics
Details of Practical

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Demonstration of use of IUCD, condoms and technique of NSV
TEXT BOOKS RECOMMENDED

Prescribed Books
1. Mudaliar and Menons Clinical Obstetrics 12th edition

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2. Text book of Obstetrics by D C Dutta 8th edition
3. Text book of Gynaecology by D C Dutta 4th edition
4. Shaws Text book of Gynaecology 14th edition
5. Text book of Obstetrics by Sheila Balakrishnan (Paras Publications)
6. Test Book of Gynaecology by Sheila Balakrishnan

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Reference books
7. Williams obstetrics 24th edition (MacGraw Hill)
8. Essentials of Gynaecology by Dr Lekshmy Sheshadri 1st edition (Published by Lippincott,
Williams & Wilkins)
Evaluation

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Theory-two papers of 2hr duration 40 marks each
Paper 1-(obstetrics & social obstetrics)
Section - A
Draw & label
-

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2
marks
SAQ (1marks x4)
-
4

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marks
SAQ (2marks x3)
-
6
marks

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Short essays (4marks x2)
-
8 marks
Section ? B
Essay (problem solving)

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-
10 marks
SAQ (1markx4)
-
4 marks

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SAQ (3marksx2)
-
6marks
Total
-

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40 marks
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Paper 2 - (Gynaecology, Family Welfare &Demography)
Section - A

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Draw & Label
-
2 marks
SAQ (1markX4)
-

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4 marks
SAQ
(2marksX3)
-
6 marks

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Short essays (4marks x2) -
8 marks
Section ?B
Essay (Problem Solving)
-

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10 marks
SAQ (1mark X 4)
-
4markS
SAQ (3marks X 2)

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-
6marks
Total
-
40 marks

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Total (Paper I + II) 40+40
-
80 Marks
Internal Assessment
-

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20marks
Viva Voce
-
30 marks
Total for Theory

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-
130 marks
Practical
-
50 marks

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Internal Assessment
-
20 marks
Total for Practical
-

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70 marks
Total for Subject
-
200 marks
Practicals

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Scheme of Practical Examination
Maximum Marks: 50
One obstetrics case - 25 marks
One Gynaecology case - 25 marks
Viva including record - 30 marks (5x4 stations) + 10 Record)

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Clinical 1
: Long Case: 1 Case Obstetrics-= 30 Min - 25 marks
(Including Writing of the Case Sheet) Clinical
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2:
Short Case- Gynaecology = 25 marks
Oral Exam
USG, CTG Partogram, Instruments, Family planning &
Operative surgery -

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20 marks
Record of delivery cases
-
10 marks
Note: These are suggested time tables. Adjustments where required, depending

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uponthe availability of time and facility, are made. (Institutional adjustments)
2.12 Practical training
List of comprehensive skills
I. Clinical Evaluation:
(a) To be able to take a proper and detailed history. Comprehensive

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(b) To perform a complete and thorough physical examination and elicit clinical signs.
(c) To be able to properly use the Stethoscope, Blood Pressure Apparatus, Auroscope,
Thermometer, Nasal Speculum, Tongue Depressor, Weighing Scales, Vaginal Speculum etc;
(d)To be able to perform internal examination ? Per Rectum (PR), Per Vaginum (PV) etc;
(e) To arrive at a proper provisional clinical diagnosis.

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II. Bed Side Diagnostic Tests:
(a) To do and interpret Haemoglobin (HB), Total Count (TC), Erythrocyte Sedimentation Rate
(ESR), Blood smear for parasites, Urine examination ? albumin/ sugar/ ketone/ microscopic;
(b) Stool exam for ova and cysts;
(c) Gram staining and Ziehl-Nielsen staining for AFB; (d)

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(e) To do and examine a wet film vaginal smear for trichomonas;
(f) To do skin scraping and Potassium Hydroxide (KOH) stain for fungus infections; (g)
To perform and read Mantoux Test.

III. Ability to carry out Procedures:

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(a) To conduct CPR (Cardiopulmonary resuscitation) and First aid in newborns, children and
adults;
(b) To give Subcutaneous (SC)/ Intramuscular (IM)/ Intravenous (IV) injections and start
Intravenous (IV) infusions;
(c) To pass a nasogastric tube and give gastric lavage;

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(d) To administer oxygen ? by mask/ catheter;
(e) To administer enema
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