Obstetrics and Gynaecology

Implementing Rules (IRs), Acceptable Means of Compliance (AMCs) and Guidance Material (GM) on obstetric and gynaecological conditions

The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to obstetrics and gynaecology.

Implementing Rules

Acceptable Means of Compliance

Guidance Material

MED.B.045 Obstetrics and Gynaecology
(a) Applicants shall not possess any functional or structural obstetric or gynaecological condition which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).

Polycystic Ovary Syndrome (PCOS).
Applicants with a diagnosis of polycystic ovary syndrome (PCOS) should inform the Authority (Class 1) or AME (Class 2).  Ongoing medical certification is subject to a specialist gynaecologist report.  This should include a cardiovascular and metabolic risk assessment and review of any symptoms of obstructive sleep apnoea (OSA).  A diagnosis of cardiovascular, metabolic disease or OSA entails unfitness and risk factors should be addressed.

Hormone manipulation therapy is acceptable subject to confirmation of no side effects and adequate symptom control.  Note: Metformin & thiazolidinediones are unlicensed for use in PCOS and may only be used in consultation with the AMS on a case-by-case basis.

Endometriosis
Applicants with a first diagnosis of endometriosis should be assessed as unfit.  Recertification is considered subject to a specialist gynaecologist report.  Recertification is considered if the applicant is symptom free, on minimal analgesics and/or has minimal side effects from hormone manipulation therapy.  Surgery entails unfitness.  (See below)


Hormone Replacement Therapy
Applicants undergoing, or changing, hormone replacement therapy (HRT) should refrain from flying/controlling for at least 2 weeks to ensure they have no side effects from the medication.  Failure to control symptoms of concern should entail unfitness until stability on appropriate medication is achieved.  A report from a gynaecologist or General Practitioner (GP) which should include a cardiovascular risk assessment, confirmation of no side effects of therapy and adequate symptom control, should be reviewed by the AME.


(b) Applicants who have undergone a major gynaecological operation shall be assessed as unfit until full recovery.

Class 1
(a) Gynaecological surgery
An applicant who has undergone a major gynaecological operation shall be assessed as unfit for a period of three months or until such time as the effects of the operation are not likely to interfere with the safe exercise of the privileges of the licence(s) if the holder is completely asymptomatic and there is only a minimal risk of secondary complication or recurrence.

Class 2
(a) Gynaecological surgery
An applicant who has undergone a major gynaecological operation should be assessed as unfit until such time as the effects of the operation are not likely to interfere with the safe exercise of the privileges of the licence(s).


Gynaecological Surgery
The period of unfitness will vary according to the type of surgery and any post-operative complications.  A minimum period of 1 week should elapse after a Dilatation and Curettage (D&C), 6 weeks after laparoscopic hysterectomy, 8 weeks after vaginal hysterectomy and 12 weeks after an abdominal hysterectomy.  Laparoscopy involving insertion of gas in to the abdominal cavity may require 2 weeks prior to returning to flying.  A gynaecological report should be obtained.
Class 1
(b) Severe menstrual disturbances
An applicant with a history of severe menstrual disturbances unamenable to treatment shall be assessed as unfit.

Menorrhagia
Applicants requiring specialist investigation for menorrhagia should be assessed as unfit.  Recertification is considered subject to a satisfactory specialist gynaecologist report.  The applicant should be symptom free and/or have minimal side effects from hormone manipulation therapy.  Haemoglobin should be within normal limits.  Surgery entails unfitness until symptom-free following recovery. 



Implementing Rules

Acceptable Means of Compliance

Guidance Material


(c) Pregnancy
   (1) In the case of pregnancy, if the AeMC or AME considers that the licence holder is fit to exercise her privileges, he/she shall limit the validity period of the medical certificate to the end of the 26th week of gestation.  After this point, the certificate shall be suspended.  The suspension shall be lifted after full recovery following the end of the pregnancy.
   (2) Holders of class 1 medical certificates shall only exercise the privileges of their licences until the 26th week of gestation with an OML. Notwithstanding MED. B.001 in this case, the OML may be imposed and removed by the AeMC or AME.
Class 1
(c) Pregnancy
   (1) A pregnant licence holder may be assessed as fit with a multi-pilot limitation during the first 26 weeks of gestation, following review of the obstetric evaluation by the AeMC or AME who shall inform the licensing authority.
   (2) The AeMC or AME shall provide written advice to the applicant and the supervising physician regarding potentially significant complications of pregnancy.

In Vitro Fertilisation
Applicants undergoing a first cycle of IVF should be made unfit.  Recertification may be considered subject to an acceptable specialist gynaecologist report.  The report should confirm no evidence of continuing ovarian hyperstimulation or other associated side effects and intended future management including medication.  The applicant should remain assessed as unfit if pregnancy is confirmed.

Pregnancy Information Sheets
Class 1 - Professional Pilot
Class 2 - Private Pilot

Periods of unfitness for subsequent cycles should be determined according to the issues experienced during previous cycles.

 

Miscarriage or Termination of Pregnancy
Applicants who suffer a miscarriage or have a termination of pregnancy should be assessed as unfit.  

Class 2
(b) Pregnancy
   (1) A pregnant licence holder may be assessed as fit during the first 26 weeks of gestation following satisfactory obstetric evaluation.
   (2) Licence privileges may be resumed upon satisfactory confirmation of full recovery following confinement or termination of pregnancy.

Recertification is considered subject to a GP or gynaecologist report.  The report should confirm they have fully recovered, with no residual symptoms, a normal haemoglobin and comment on psychological status.  Before returning to flying Class 1 applicants should undergo an assessment by their AME of their psychological state. 


Pregnancy Information Sheet
Pilots should be advised to give a copy of this information sheet to their midwife or doctor for inclusion in their medical notes.

Class 1 - Professional Pilot 
Class 2 - Private Pilot