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Obstetrics and Gynaecology Services - Otago | Southern

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    Gynaecology services at Dunedin Hospital provide secondary level outpatient and inpatient care to the local population and tertiary level care to the wider district population (Southland).
     
    This service provides elective and 24 hour acute care.
     
    The rural hospitals within the Otago catchment purchase outpatient clinic services from the Dunedin Hospital based service. A Southern DHB Gynaecologist visits Oamaru, Balclutha and Dunstan once a month.
     
    Main areas of care are:
    • Gynaecology Outpatients
    • Colposcopy Clinic
    • Urogynaecology Clinics
    • Gynaecology Oncology Clinics
    • Inpatient Services
    • Early Pregnancy Clinic
    • Termination of Pregnancy Services
     
    What is Gynaecology?
    Gynaecology is the area of medicine that deals with health issues and conditions that are specific to females. This generally includes the female reproductive organs and genitalia. The reproductive organs consist of the ovaries that release an egg every month, the fallopian tubes that lead from the ovaries, the uterus (womb), which is where a baby will grow if the egg is fertilised during sexual intercourse, the cervix (opening of the uterus) and the vagina.
     
    Laparoscopy
    Many gynaecological investigations are performed by laparoscopy. This is a procedure to view the inside of the abdomen (stomach) through a specially lit type of mini telescope (laparoscope) that is inserted through a small cut in the abdomen. The laparoscope also contains a small camera that sends pictures to a screen that the doctor can watch.
    Sometimes surgical procedures (keyhole surgery) can be performed at the same time. A laparoscopy is performed under a general anaesthetic (you are asleep).
     
    Obstetrics services are delivered at Dunedin Hospital, Clutha Health First, Dunstan Hospital, Oamaru Hospital and via Telehealth at the Wanaka Lakes Health Centre. 
     
    What is Obstetrics? 
    Obstetrics is the area of medicine concerned with the treatment of pregnant people (antenatal), labour and delivery, and the time after childbirth (postnatal). Once pregnancy has been confirmed, regular antenatal checks should be performed by a midwife, GP or obstetrician (doctor who is specialised in obstetrics). In the first 28 weeks, these checks will be done every month but will increase as the pregnancy progresses.
     
    • Gynaecology Assessment Clinic
    • Obstetric Ultrasound
    • Amniocentesis
    • Chorionic Villus Sampling
    • Toxaemia of Pregnancy (pre-eclampsia)
    • Gestational Diabetes
    • Intrauterine Growth Restriction (IUGR)
    • Epidural
    • Induction of Labour
    • Caesarean Section
    • Foetal Distress
    • Premature Baby
    • Postpartum Depression
    • Infertility
    • In Vitro Fertilisation
    Procedures

    Endometriosis

    The endometrium is the name of the tissue that lines your uterus (womb). Endometriosis is a condition where tissue, like the endometrium, grows in other parts of the body. Usually these growths occur inside the pelvic cavity in places such as the ovaries, bowel, or a lining of the pelvic cavity and abdomen called the peritoneum. Each month, as the endometrial lining of the uterus builds up with blood that will be lost during your period, these other growths of endometrial tissue get bigger and can bleed and cause inflammation and adhesions (internal scarring).   Some people with this condition do not have many symptoms, whereas others suffer severe pain and problems such as infertility and tiredness.   Treatment includes medication that will help control the pain and inflammation, and some people may need surgery to remove the tissue growths.

    Fibroids

    Fibroids are noncancerous growths or tumours on the muscular part of the uterus (womb); sometimes they are also called myomas. Fibroids may be very small (about 5mm) or can grow to be quite large (about 100mm).   Many people with fibroids do not notice any symptoms and will not need treatment, whereas others may experience problems such as painful and heavy periods. Treatment includes medication to shrink the fibroids and, in some people, surgical removal.

    Ovarian Cysts

    An ovarian cyst is a fluid-filled sac or pouch in the ovary.  In most cases, the cyst grows as a result of ovulation (when the egg is released from the ovary), and it will usually shrink over time. Sometimes, the ovarian cyst may cause pain.   The best way to check for an ovarian cyst is by ultrasound examination, and the treatment will depend on how troublesome the symptoms are. Sometimes it is best to leave the cyst alone and just check it regularly with ultrasound. In other cases it may need to be removed by laparoscopic surgery.

    Polycystic Ovarian Syndrome (PCOS)

    Polycystic ovarian syndrome (PCOS) is a hormonal disorder that can cause you to have a variety of symptoms, including no periods or irregular periods, increased hair growth on the face and body, acne (pimples) and increased bodyweight. PCOS is also one of the main causes of infertility in females. The ovaries of people with PCOS often contain many small cysts (fluid-filled sacs), but this does not seem to be the cause of the condition.   For people who have not reached menopause, the most common treatment is the birth control pill, which will regulate your periods. There are also other medicines that can help control the symptoms.

    Menstrual Problems

    Menstruation is the medical name for your monthly period. This is when blood and tissue from the lining of the uterus (womb) is shed through the vagina and out of the body.   Menstruation starts at puberty and it is stimulated by hormones that make the body able to become pregnant. This usually happens anytime between the ages of 9 and 16 years. Menstruation will recur about every 28 days (the menstrual cycle), unless interrupted by pregnancy, and will stop at menopause, which occurs at about 50 years of age.   There are a number of problems that can occur with menstruation ranging from mild to severe. More than half of people who menstruate will have cramps (dysmenorrhoea) during the first day or two of their period. Other problems include very heavy or long periods (menorrhagia) or no periods (amenorrhoea).

    Endometrial Ablation

    The endometrium is the lining of your uterus (womb). Endometrial ablation is the surgical removal or destruction of this lining. There are different methods of destroying the endometrium including electricity, laser therapy or freezing.   A specialist performs the operation and it is done through the vagina, so there is no need for the abdomen to be cut open. The endometrium will heal leaving scarring, which usually reduces or stops menstrual periods.   In people who have very heavy periods (menorrhagia), an endometrial ablation can be done instead of a hysterectomy as it is an easier procedure than a hysterectomy and is quicker to recover from. Endometrial ablation is only performed in people who no longer wish to have children.

    Premenstrual Syndrome (PMS)

    Many people who have periods experience feelings of tension, anger, fatigue and depression just before and during the first days of their menstrual period. This is called premenstrual syndrome (PMS) and is probably caused by the change in hormone levels.   In most people with PMS, symptoms will not be severe enough to require treatment, but some will need to discuss their symptoms with a doctor. Sometimes symptoms can be improved by avoiding some types of food, such as coffee and foods high in salt.

    Cervical Dysplasia

    Cervical dysplasia is the growth of abnormal cells around the cervix (entrance to the uterus). Although this condition is not cancer there is a small risk that these cells could become cancerous.

    Sometimes no treatment is needed as the condition may improve by itself. For more severe dysplasia, treatment involves removing the abnormal cells by freezing, laser therapy (a tiny beam of light) or electrical burning. Whether you have treatment or not, you should have more frequent Pap smears in the future.

    Pap Smear

    A Pap smear is a test to check for signs of cancer on the cervix (entrance to the uterus). A doctor will put an instrument called a speculum into the vagina to open it, and then gently wipe or brush a few cells from the cervix to send to the laboratory for testing. A Pap smear can show if cervical cells are going through any changes that happen before cancer grows. It will also show if cancer cells are present.   Regular Pap smears make it possible to prevent cancer before it grows, or to pick up the cancer early so that it is more easily cured. A National Cervical Screening Programme aims to provide all New Zealand people with a cervix with regular smears and recommends that a Pap smear be done every three years between the ages of 20 and 70 years.

    Colposcopy

    A colposcopy is a detailed examination of the cervix (entrance to the uterus) with a specially lit microscope (colposcope). As with a Pap smear, an instrument called a speculum is inserted into the vagina, and then the colposcope is positioned outside the vagina with its light directed on the cervix.   A specialist will perform a colposcopy if your Pap smear has shown abnormal or cancerous cells on the cervix. During the colposcopy further samples of tissue (biopsies) are usually removed and examined in the laboratory so the doctor can get a clearer idea of the extent of the abnormal cells.

    Vaginal Infections

    The most common vaginal infections are yeast infections (also called candidiasis or thrush), trichomoniasis, or bacterial infections (also called bacterial vaginosis). Symptoms of an infection may include irritation, itching, discharge and odour.   To make a diagnosis a doctor will usually do a vaginal swab, which involves wiping a type of cotton bud gently across the infected area. The swab is then sent to the laboratory for analysis. There are many medicines that can successfully treat these infections.

    Menopause

    Menopause is also called the “change of life” and is the time when your periods will become irregular and stop. This is a natural process and for most it will occur between the ages of 45 and 55 years.   Menopause is brought on by decreasing levels of the hormone oestrogen and this can cause a variety of symptoms, including hot flushes, night sweats, mood swings, sleeping problems, memory problems, depression and vaginal dryness. Some people do not notice any symptoms or they are very mild, whereas others experience more severe problems and should go to their doctor for advice.   There are many treatments available to reduce the symptoms associated with menopause and, in some cases, lifestyle changes can also help.

    Hormone Replacement Therapy (HRT)

    Hormone replacement therapy (HRT) is when female hormones (oestrogen by itself or with progesterone) are given during or after menopause when the production of oestrogen by the ovaries declines. The hormones can be taken as tablets, implants or skin patches.   HRT has become less popular in recent years because a large study in the USA found that long-term use of HRT can increase the risk of some serious diseases, such as breast cancer and blood clots. However, for some people, short-term use of HRT (no more than 3–4 years) can provide relief from symptoms caused by having less oestrogen in their bodies, such as hot flushes and loss of bone density.   The risks and benefits of HRT should be thoroughly discussed with a doctor before treatment begins.

    Urinary Incontinence

    A person with urinary incontinence is unable to control the release of urine from their bladder. This may be an occasional leakage or a complete inability to hold on to their urine. Females experience incontinence more often than males, and this may result from muscle damage during pregnancy and childbirth or the changes associated with menopause.   The most common type of urinary incontinence in females is stress incontinence. This is when urine leaks out when movements, such as coughing, laughing or sneezing put pressure on the bladder.   The treatment of urinary incontinence will depend on the cause of the problem, but may include exercises, medication or surgery.

    Bladder Sling Procedures

    Sling procedures are common surgical operations to stop stress incontinence. This is a condition where urine leaks out when movements, such as coughing, laughing or sneezing put pressure on the bladder. Stress incontinence occurs when the muscles supporting the urethra (tube that carries the urine out of the body) become weak and the urethra no longer works well as a valve to keep the urine in the bladder. Sometimes this results from the effects of childbirth. Sling procedures provide support to the weakened muscles by placing a stitch or strip of mesh under the urethra so that it won’t accidentally release urine when there is pressure on the bladder. Burch Procedure In the Burch procedure, permanent stitches are placed on both sides of the urethra to give it more support. The Burch procedure is done under a general anaesthetic (you sleep throughout the procedure) and can be performed by laparoscopic surgery. Tension-Free Vaginal Tape (TVT) Procedure In tension-free vaginal tape (TVT) surgery, a mesh-like tape is placed under the urethra to give it support. The TVT procedure is done through small cuts in the vagina and in your pubic area or upper thighs. It is usually performed under local anaesthetic (this means that you don’t have to go to sleep during the operation).

    Uterine or Bladder Prolapse

    If the uterus (womb) or bladder slips out of position, this is referred to as a prolapse. It is caused when the supporting muscles become weak, allowing a part of the uterus or bladder to bulge into the vagina.   The most common reason that these muscles become weak is childbirth, and a uterine prolapse or bladder prolapse (also called cystocoele) is more common in people who have had a lot of babies. Symptoms include pain, heaviness in the vaginal area and a frequent need to pass urine.   In mild cases, exercises may help improve the symptoms, but people with more severe prolapses may need to have surgery.

    Hysterectomy

    A hysterectomy is an operation to remove your uterus (womb). Some types of hysterectomies include the removal of other organs as well, and this will depend on the reason for the operation. A hysterectomy is a treatment for many different diseases and conditions and it can be done through the vagina or through a cut in the abdomen.

    Oophorectomy

    An oophorectomy is an operation to remove one or both ovaries. It is done for many reasons including ovarian cancer, ovarian cysts or to remove the source of the hormone oestrogen that is produced by the ovaries and can stimulate some cancers. If both ovaries are removed, your periods will stop and you will not be able to have children. Sometimes an oophorectomy is done together with a hysterectomy.

    Hysteroscopy and Dilatation and Curettage (D&C)

    This is an operation where the cervix (entrance to the uterus) is dilated and a hysteroscope (small lighted mini telescope) is inserted into the uterus through the vagina and cervix so the specialist can see the inside of the uterus. If no cancer is present, a small spoon-like instrument with a long handle, called a curette, is inserted and the lining of the uterus is scraped off and sent to the laboratory for examination.   This procedure can be done under a general (you are asleep) or local (you are awake but the area being investigated is numb) anaesthetic.

    Gynaecology Assessment Clinic

    Gynaecology Assessment Clinic (GAC) runs out of Gyanecology Outpatients 3 afternoons per week.  This is a specialist referral clinic, for 1st Trimester gestation pregnant people who have some diagnosed pregnancy issues, such as bleeding or unfavourable ultrasound results.

    There is a nurse coordinator, along with gynaecology and obstetric medical support for the clinic.

    Obstetric Ultrasound

    Ultrasound imaging, also called ultrasound scanning, is a method of obtaining pictures from inside the human body through the use of high frequency sound waves.   Obstetric ultrasound refers to the specialised use of this technique to produce a picture of your unborn baby while it is inside your uterus (womb). The sound waves are emitted from a hand-held nozzle, which is placed on your stomach, and reflection of these sound waves is displayed as a picture of the moving foetus (unborn baby) on a monitor screen. No x-rays are involved in ultrasound imaging.   Measurements of the image of the foetus help in the assessment of its size and growth as well as confirming the due date of delivery.

    Amniocentesis

    This is a procedure used to evaluate the health of your unborn baby and identify any problems that may exist. Using ultrasound as a guide, a thin needle is inserted through your stomach into your uterus (womb). A small sample of the amniotic fluid that surrounds your baby is then taken. This fluid contains cells from the baby, which are then studied in the laboratory.   The best time to perform amniocentesis is in the 16th week of pregnancy.

    Chorionic Villus Sampling

    Chorionic villus sampling (CVS) is used to test for genetic disorders, such as Down’s syndrome, and involves taking a small sample of the chorionic villi, which are the tiny units that make up the placenta. The placenta is the organ that grows on the inner lining of your uterus (womb) through which nourishment and oxygen pass to your fetus (unborn baby). The chorionic villi have the same chromosomes as your fetus and DNA analysis will determine if your unborn child has any genetic abnormalities.   An ultrasound is performed to determine the age and position of the fetus and the location of the placenta. A local anaesthetic is injected into the skin, and then under ultrasound guidance a needle is passed through the abdominal wall and uterus to the placenta. Very small amounts of tissue are then drawn up into the syringe. Occasionally it is necessary to insert the needle more than once to get a sample. There is some discomfort as the needle enters the uterus.

    Toxaemia of Pregnancy (pre-eclampsia)

    Toxaemia of pregnancy or pre-eclampsia is a condition that occurs in some pregnant people during the second half of pregnancy. It is characterised by high blood pressure, swelling that doesn't go away and large amounts of protein in the urine. If left untreated it can stop the placenta, which provides nourishment to the baby, from getting enough blood and thus slows the baby’s growth. The condition can also be dangerous for the pregnant person. In the early stages, simple measures such as bed rest may control the symptoms but, if not, it may be necessary to deliver the baby a week or two early.

    Gestational Diabetes

    Gestation is the length of a pregnancy from conception to birth (usually 40 weeks in humans). Gestational diabetes is a type of diabetes (glucose intolerance) that occurs in some pregnant people during pregnancy. People with gestational diabetes have a high level of glucose (or sugar) in their blood because they do not have enough of the hormone insulin to cope with the extra demands of the growing foetus (unborn baby). In most cases, gestational diabetes is managed by diet and exercise and will usually disappear after the baby is born.

    Intrauterine Growth Restriction (IUGR)

    In a very small number of pregnancies, the baby may not grow as well as in a normal pregnancy. This is called intrauterine growth restriction (IUGR) and the unborn baby will be described as being “small for gestational age” (SGA). This means that the baby is smaller than expected for the length of time that the person has been pregnant. An unborn baby with IUGR should be carefully managed during pregnancy and delivery but will usually be healthy at birth.

    Epidural

    An epidural is a type of anaesthetic (medication that stops pain and feeling) that makes your lower body numb without putting you to sleep. It is often used during labour and delivery so that the pregnant person can remain awake but not experience the pain of the birth.   The anaesthetic medicine is injected into the epidural space (the area surrounding the spinal cord) in the lower back by an anaesthetist (a doctor specialised in giving anaesthetics). The area of skin where the injection goes in will be made numb first. Although all of the lower body becomes numb, you can still push during contractions. After the delivery you will need to remain in bed until the anaesthetic has worn off. This usually takes about two to four hours.   An epidural anaesthetic can be used for a vaginal or caesarean delivery.

    Induction of Labour

    Induction of labour is the process of starting labour artificially. This may be needed for many reasons, such as high blood pressure, toxaemia or if your waters have broken and you haven’t gone into labour by yourself.   There are a few different methods that may help to induce labour, including an internal examination by the midwife or doctor, medication that softens the cervix (entrance to the uterus) allowing it to open, or other medicine that stimulates the uterus (womb) to contract.

    Caesarean Section

    A caesarean section is the name of the operation done to deliver a baby through a cut in your stomach and uterus (womb). In some cases this is safer than a vaginal delivery. The surgery is performed by an obstetrician and it usually only takes a few minutes for the baby to be born. A general or epidural anaesthetic can be used. Most people are able to be up and about within 24 hours of the surgery.

    Foetal Distress

    A foetus is the name given to an unborn baby after the eighth week of pregnancy until birth. Foetal distress is a very general term that is used to describe any unborn baby that is showing signs of agitation, usually during labour and delivery. Signs of distress are usually diagnosed by changes in the speed of the unborn baby’s heartbeat and/or a decrease in the oxygen levels of the baby’s blood.

    Premature Baby

    A premature baby is one that is born before 37 weeks’ gestation (the length of a pregnancy from conception to birth). The normal period of gestation in humans is 40 weeks. If your baby is premature, it may need to be cared for in a specialised unit, called a neonatal unit, until his or her internal systems are more fully developed. The length of time your baby will stay in the neonatal unit will generally depend on how early it was born.

    Postpartum Depression

    The postpartum (also called postnatal) period is the time after the birth of a baby. During this time many people who have given birth will experience a feeling of slight sadness or anxiety. This is called the “baby blues”, and in some people it may develop into postpartum depression. The baby blues happen in the days just after the birth and usually only last for about a day or up to a week.   Postpartum depression can occur days or months after the baby’s birth and the feelings of sadness are worse than with the blues.

    Infertility

    About one in every six heterosexual couples in New Zealand will experience infertility. This is when they are unable to conceive a baby after one year of trying, or when the female has been unable to carry a pregnancy to a live birth. In about half of the cases, the cause of infertility is due to a problem with the female and, in the other half, the problem will be with the male.   There are now many treatments available for infertile couples and, in many cases, these treatments will result in a successful pregnancy. Doctors with a special interest and expertise in this area will usually provide the best opportunity for treatment. Local support groups and societies can be of help during the stressful time of having tests and treatment.

    In Vitro Fertilisation

    This is the process of fertilising the egg with the sperm outside of the body in the laboratory. This type of treatment is used for many infertile couples. After a successful fertilisation has taken place, the embryos (fertilised eggs) are watched closely until they have developed to an appropriate stage and then they are inserted through the vagina and placed into the uterus (womb). A pregnancy test will be performed about 10 days later to see if a pregnancy is progressing.

    This information has been provided by healthpoint.co.nz, helping people better understand and use New Zealand health services. Healthpoint and Te Whatu Ora Southern do not endorse or adopt the information or materials provided by any of the service providers, and accept no responsibility or liability for any errors, omissions, offers or details in any such information or materials.

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