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Subspecialities in Obstetrics and Gynecology

Obstetrics

Junior residents (PGY-1 and 2) are responsible for the initial evaluation and management of patients presenting to the labor and delivery suite. Once the patient is admitted residents of all levels are actively involved in the management (antepartum, intrapartum and postpartum). The senior residents play a supervisory role in the management of normal intrapartum/postpartum obstetrics and uncomplicated cesarean deliveries. The senior residents also perform operative vaginal deliveries and complicated cesarean deliveries.

Gynecology

Experience in operative gynecology begins at the PGY-1 level with gradually increasing responsibility and exposure throughout the four years. Operative gynecologic procedures performed by the PGY-1 resident include dilatation and curettage, diagnostic and operative hysteroscopy, diagnostic laparoscopy, laparoscopic tubal sterilization, and minor operative laparoscopic surgeries. The PGY-2 resident is involved in similar cases, with greater involvement in operative hysteroscopy and operative laparoscopy. Minor laparotomies are also being performed at this level. PGY-3 and PGY-4 residents perform most laparotomies and vaginal surgeries. Some of the most difficult laparoscopic surgery will also be performed at this level.

Maternal Fetal Medicine

The Division of Maternal Fetal Medicine consists of 7 full-time faculty. The MFM resident is responsible for the assessment of all patients to be admitted to the MFM service. During this rotation, residents perform amniocentesis, assist in complicated procedures, receive additional hands-on training in fetal anatomy scans and survey, and serve as consultants under the MFM faculty. In addition to running the MFM service, residents attend weekly Perinatal conferences and high-risk clinic. The high-risk clinic is a unique experience where residents have the opportunity to follow patients and discuss management plans with the Chairman and MFM faculty. The rotation allows residents to become comfortable managing pregnancies complicated by preterm labor, preterm premature rupture of membranes, intrauterine growth restriction, diabetes, hematologic disease, and many other high-risk situations.

Gynecologic Oncology

The gynecologic oncology service at NYU Winthrop Hospital consists of four attending gynecologic oncologists. The group has several ongoing trials and is an NCI funded cooperative clinical trials group for gynecologic oncology patients.

The oncology service performs 500 major surgeries per year including many robotic cases each week. During the rotation, emphasis is placed on disease pathology, epidemiology, diagnosis, evaluation, treatment and prevention. The PGY-2 resident assists on many operative cases and masters the clinical and technical skills necessary for proper pre- and post-operative treatment. Office diagnostic procedures including biopsy and colposcopy are performed under the supervision of the oncologist.

The PGY-4 resident assists the gynecologic oncologist in all surgical cases. This resident is expected to master the pre- and post-operative management of their patients while supervising the junior resident. The PGY-4 resident develops a thorough understanding of the diagnosis and treatment of GYN malignancies, and hones his or her surgical techniques while fulfilling the objectives of this service.

Finally, the PGY 2 and 4 residents on the GYN-oncology service present at Tumor Board each month alongside the pathology residents. Multiple gynecologic oncology cases are presented and reviewed with supervision by the GYN oncologists.

Reproductive Endocrinology and Infertility

The division of Reproductive Endocrinology and Infertility is staffed by four full-time reproductive endocrinologists. The group has an office based in-vitro fertilization laboratory performing over 1400 assisted reproductive procedures yearly. Through their rotation on this service, residents evaluate and manage patients troubled by endocrinopathies and infertility while obtaining skills in ovulation assessment, semen analysis, Gyn ultrasound, endometrial assessment, and hysterosalpingography. Residents learn the techniques of ovulation induction and assisted reproduction, as well as the surgical skills of operative hysteroscopy/laparoscopy, tubal surgery, adhesiolysis and resection and ablation of endometrial implants.

Urogynecology and Reconstructive Pelvic Surgery

The Urogynecology and Pelvic Reconstructive Surgery division evaluates and treats urinary incontinence, pelvic organ prolapse, perineal defects, pelvic floor dysfunction, fistula repair and surgical complications.

Residents learn site specific evaluation of the pelvis, POPQ diagrams, simple and complex cystometrics, cystourethroscopy, uroflowmetry, pressure flow studies, voiding diary, and levator assessment. Once the evaluation is complete, residents learn how to formulate a treatment plan utilizing various medical, surgical, and non-surgical options that are available. Some of these treatments include pelvic floor exercises, pharmacological therapy, pessary, as well as minimally invasive and advanced surgical therapies.

Residents perform abdominal and robotic pelvic reconstructive surgery, abdominal and vaginal paravaginal repair, vaginal slings, anterior/posterior colporrhaphy, sacrospinous ligament fixation, McCall culdopexy, colpocleisis, repair of perineal breakdown, fistula repair, and enterocele repair/prevention.

Minimally Invasive Gynecologic Surgery/Robotic Surgery

In addition to laparoscopic surgeries, residents are also actively involved in robotic cases on one of our 2 DaVinci surgical robots. Through the use of NYU Winthrop’s training laboratories, residents have the opportunity to practice basic and advanced techniques of minimally invasive surgery under simulated conditions before using these techniques in the operating room. Topics covered in the laparoscopic training lab include proper laparoscopic entry, laparoscopic survey of pelvic and abdominal anatomy, laparoscopic instruments, salpingostomy, tubal occlusion, removal of endometrial implants, and closure of trocar sites. Topics concerning laparotomy include principles of abdominal incisions, survey of pelvic/abdominal anatomy, salpingo-oophorectomy, cystotomy repair, enterotomy repair, hypogastric ligation, and abdominal wound closure. During the advanced course, topics include dissection of the ureter, pelvic and para-aortic lymph node dissection, bowel resection, vena cava repair as well as laparoscopic cystotomy, suture techniques, salpingo-oophorectomy, and supracervical hysterectomy.

Ultrasound

During the ultrasound rotation the PGY-1 resident practices ultrasound skills at the Anterpartum Testing Unit while receiving feedback from the MFM faculty and sonographers. The resident masters technique of cervical lengths measurement, biophysical profile and Doppler waveforms of fetal and maternal vessels. Residents also participate in anatomy surveys, invasive fetal testing and many other procedures. Residents attend weekly perinatal conferences that provide a unique opportunity for learning and teaching. This rotation gives the PGY-1 a head-start in ultrasound proficiency and allows for early exposure to MFM.

Hospitalist Fellowship Program

NYU Winthrop Hospital established a unique 1-year OB/GYN Hospitalist Fellowship that started July 1, 2013 and is the first OB/Gyn Hospitalist fellowship in New York. The Department of Ob/Gyn at NYU Winthrop Hospital has already established a successful Ob/Gyn hospitalist program since 2010 under the Directorship of Dr. Joseph Cioffi. The program provides the fellow with the experience in managing daily obstetric and gynecologic conditions and emergencies, working closely with the residents.

Ambulatory Care

In August 2010 we opened NYU Winthrop Women’s Wellness Center (WWW), an Article 28 clinic in Hempstead, NY. The clinic provides comprehensive prenatal care including education, social work and nutritional support as well as gynecological care. There are approximately 500 visits to WWW each month. This office serves as the residents’ continuity clinic, where they follow patients throughout their pregnancies and manage gynecological pathologies. At WWW residents take ownership of their patients and actively participate in outpatient procedures such as colposcopy, endometrial biopsy and IUD or Implanon placements.