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is more difficult to evaluate and assess. Usually the final decision should be deferred to the medical
assessor of the Licensing Authority. The medical examiner, in consultation with a gynaecologist, should
weigh all relevant factors carefully before making a recommendation.
GYNAECOLOGICAL SURGERY
The provisions of Annex 1 state, for all classes of Medical Assessments, that:
6.3.2.19 (6.4.2.19, 6.5.2.19) Applicants with sequelae of disease of or surgical procedures on the
kidneys or the genito-urinary tract, in particular obstructions due to stricture or compression, shall
be assessed as unfit unless the applicant’s condition has been investigated and evaluated in
accordance with the best medical practice and is assessed not likely to interfere with the safe
exercise of the applicant’s licence or rating privileges.
Major gynaecological surgery will normally entail unfitness for a period of two to three months and some
procedures such as hysterectomy may require more extensive periods of recovery.
PREGNANCY
The provisions of Annex 1 state the following for Class 1 and 2 Medical Assessments:
6.3.2.21 (6.4.2.21) Applicants who are pregnant shall be assessed as unfit unless obstetrical
evaluation and continued medical supervision indicate a low-risk uncomplicated pregnancy.
6.3.2.21.1 (6.4.2.21.1) Recommendation.—For applicants with a low-risk uncomplicated
pregnancy, evaluated and supervised in accordance with 6.3.2.21, the fit assessment should be
limited to the period from the end of the 12th week until the end of the 26th week of gestation.
6.3.2.22 (6.4.2.22) Following confinement or termination of pregnancy, the applicant shall not
be permitted to exercise the privileges of her licence until she has undergone re-evaluation in
accordance with best medical practice and it has been determined that she is able to safely exercise
the privileges of her licence and ratings.
In an uncomplicated pregnancy, most organ systems adapt to the increased demands placed upon a
healthy young female in such a way that the expectant mother can carry on with routine activities in her
usual environment until close to the time of labour and delivery.
Pilots and pregnancy
A pilot applicant who is pregnant faces an unusual and hostile air environment, in which organ adaptation
can be affected. Once she believes that she is pregnant, she should report to her own doctor and an
aviation medical examiner. It is advisable, not only for her own protection but also to ensure flight safety,
that her obstetrician is aware of the type of flying she intends to carry out, particularly as the common
complications of pregnancy can be detected and treated by careful prenatal evaluation, observation, and
care.
ICAO Preliminary Unedited Version — November 2009 III-7-3
The medical examiner should consider the important physiological changes associated with pregnancy,
which might interfere with the safe operation of an aircraft at any altitude throughout a prolonged or
difficult flight:
nausea and vomiting of early pregnancy occur in 30 per cent of all pregnancies, and can
cause dehydration and malnutrition;
approximately 15 per cent of embryos will abort in the first trimester;
cardiac output rises in early pregnancy, accompanied by an increase in stroke volume, heart
rate, and plasma volume;
haemoglobin (and haematocrit) begins to fall between the third and fifth month and is lowest
by the eighth month;
adequate diet with supplementary iron and folic acid is necessary, but self-medication and
prescribed medicine should be avoided;
the incidence of venous varicosities is three times higher in females than males and deep
venous thrombosis and pulmonary embolism are among the most common serious vascular
diseases occurring during pregnancy;
as the uterus enlarges, it compresses and obstructs the flow through the vena cava;
progressive growth of the foetus, placenta, uterus and breasts, and the vasculature of these
organs, leads to an increased oxygen demand;
increased blood volume and oxygen demands produce a progressive increase in workload on
both the heart and lungs;
hormonal changes affect pulmonary function by lowering the threshold of the respiratory
centre to carbon dioxide, thereby influencing the respiratory rate;
in order to overcome pressure on the diaphragm, the increased effort of breathing leads to
greater consciousness of breathing and possibly greater cost in oxygen consumption; and
the effect of hypoxia at increased altitude further increases the ventilatory effort required to
provide for increasing demands for oxygen in all tissues.
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Manual of Civil Aviation Medicine 2(8)
