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. Following diagnosis, certification is subject to a satisfactory gynaecological report and adequate symptom control. Any associated cardiovascular or metabolic disease should be considered. Hormone therapy is acceptable subject to confirmation of no adverse side effects. Endometriosis Following diagnosis, certification is subject to a satisfactory gynaecological report and adequate symptom control. Hormone therapy is acceptable subject to confirmation of no adverse side effects. Simple analgesics such as paracetemol are acceptable. Hormone Replacement Therapy Acceptable, subject to satisfactory symptom control and no adverse side effects.
(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 Following diagnosis, certification is subject to a satisfactory gynaecological report and adequate symptom control. Hormone therapy is acceptable subject to confirmation of no adverse side effects. Simple analgesics such as paracetemol are acceptable. Haemoglobin should be within acceptable limits

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 A pilot undergoing a first cycle of IVF should be made unfit. Recertification may be considered subject to a specialist gynaecologist report confirming no evidence of ovarian hyperstimulation or other associated side- effects and future management including medication. The pilot should remain unfit if pregnancy is confirmed. Periods of unfitness for subsequent cycles should be determined according to any issues experienced during the first cycle. Termination of Pregnancy A pilot who undergoes 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 subject to a satisfactory gynaecological report confirming full recovery from the effects of the medication/procedure used. There should be no continuing vaginal blood loss and haemoglobin should be above 10.5g. AMEs should ensure psychological stability prior to recertification. Miscarriage A pilot who has had a miscarriage should be assessed as unfit. Recertification is subject to a satisfactory report from their GP or gynaecologist confirming full recovery. There should be no continuing vaginal blood loss and haemoglobin should be above 10.5g and AMEs should ensure psychological stability prior to recertification. 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