Obstetrics and Gynecology
Obstetrics and Gynecology fetal sonogram
Obstetricians and Gynecologists manage medical and surgical issues specific to women. Some may also unintentionally serve as their patients’ primary care care provider and/or hold a handkerchief as a surrogate psychiatrist when Mom has a good cry during postpartum depression*. Early in their careers, Ob/Gyns’ practice is weighted towards obstetrics, the “happy field” of medicine*, in which good outcomes are the norm…but not always…
*The top image is a sonogram of a healthy mature fetus.
Up to 8% of pregnancies in the USA are at high risk of complications due to various factors—e.g., teen pregnancy, pregnancy in older (> age 35) women, obesity, domestic violence, substance abuse, smoking, hypertension, diabetes, HIV-positivity, prematurity, and so on. The maternal mortality rate in developed countries is gratifyingly low*, with 5 maternal deaths per 105 in Japan, 9/105 in the UK, and 14/105 in the USA. In contrast, impoverished and/or war-torn countries have staggeringly high rates of maternal mortality, with 174/105 in India, 359/105 in Haiti, 396/105 in Afghanistan, and 814/105 in Nigeria.
*Data from 2015 WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group http://www.who.int/gho/maternal_health/countries/hti.pdf?ua=1
Yet, despite the most compulsive and punctual prenatal care and diet, absence of maternal and fetal risk factors, unremarkable workup and a flawless delivery, bad babies and bad baby outcomes do occur in developed countries. Physical defects and poor outcomes seen at birth or shortly thereafter include chromosomal abnormalities, neural tube defects, cleft lip and palate, congenital heart disease, cerebral palsy, and a host of etceteras. Too often, parents play the blame game and will try to pin the blame on the obstetrician, which explains why OBs pay more in malpractice insurance premiums than any other specialty* in the USA.
*In 2013-2014, OBs on Long Island, NY paid just under $196,000 annually. http://www.doctorcpr.com/blog/2013-2014-malpractice-premiums-doctors-paying-195891-a-year-for-coverage/. An OB colleague who works here on the Island, once told me that for the first 4+ months of every year, all of his income goes towards paying for the malpractice premium.
moderately-differentiated endometrial carcinoma
Ob/Gyns typically follow their once-fertile patients from motherhood to dotage, managing the matronly morbidities that accumulate with the passing years, including hot flashes, osteoporosis, urinary incontinence, increased weight and decreased sexual desire. Now wearing a gynecologist’s hat, these physicians hold hands as their patients suffer the indignities of menopause, empty nests, loneliness, and less commonly, dementia and cancer*, before they themselves buy the shiny white shoes, polyester pants, retire and migrate to Florida to live out their days.
*The image is that of an moderately differentiated endometrial adenocarcinoma, which is more common in overweight postmenopausal women.