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.
MED.B.045 Obstetrics and Gynaecology
CLASS 2 - AMC2 MED.B.045 (a) Gynaecological surgeryApplicants who have undergone a major gynaecological operation should be assessed as unfit until recovery is complete, the applicant is asymptomatic, and the risk of secondary complication or recurrence is minimal.
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.
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)
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.
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.
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.
CLASS 1 - AMC1 MED.B.045
(1) A pregnant licence holder may be assessed as fit with an OML during the first 26 weeks of gestation, following review of the obstetric evaluation by the AeMC or AME who should inform the medical assessor of the licensing authority.
(2) The AeMC or AME should provide written advice to the applicant and the supervising physician regarding potentially significant complications of pregnancy.
CLASS 2 - AMC2 MED.B.045
(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.
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 Sheet
Class 1 - Professional Pilot (PDF)
Periods of unfitness for subsequent cycles should be determined according to the issues experienced during previous cycles.
Applicants who suffer a miscarriage or have a termination of pregnancy should be assessed as unfit.
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 2 - Private Pilot (PDF)
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