Curriculum of Obstetrics
TOPIC 1
FERTILIZATION, IMPLANTATION, AND EARLY DEVELOPMENT OF THE FETUS, PLACENTA, AND CORD
RATIONALE
Pregnancy occurs when mature capacitated sperm in the ampulla of the fallopian tubes fertilizes the ovum. The zygote migrates toward the uterine cavity and implantation of the blastocyst occurs in the fundus. Since the first birth of a baby conceived extracorporeally in 1978, an enormous amount of information has been gathered on fertilization and pre-implantation development. Observing human oocytes and embryos in vitro has given researchers the opportunity to observe and study anomalies of a gross morphological nature.
GOAL
Know the basic physiological background of fertilization, implantation, and early development of the fetus, placenta, and cord
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Describe briefly the concept of fertilization, including hints on ovum and sperm transport and sperm capacitation
l Describe briefly the differentiation of the decidua and chorion
l Describe the development of the placenta and its appearance at full term
l Describe the development of the cord, its appearance at full term, and its abnormalities
l Describe briefly the early development of the fetus
CONTENT
l Definition, layers, and functions of decidua
l Fertilization
l Implantation
l Placenta and cord
TOPIC 2
PLACENTAL FUNCTIONS AND ABNORMALITIES
RATIONALE
The human placenta is a villous, hemochorial structure that is of critical importance in maternofetal transfer, has a complex synthetic capacity, and plays a fundamental role in the immunological acceptance of the fetal allograft. The placenta is usually attached to the upper uterine segment. The tissue that separates the maternal and fetal blood is called the placental barrier. It is important to know the functions of the placenta because its abnormalities may lead to major health and obstetric problems.
GOAL
Know the different placental functions and abnormalities
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List different placental functions including barrier function, nutritive, respiratory, execratory functions, and endocrine functions
l Describe various placental abnormalities and its implications on placental functions
CONTENT
l Placenta at term
l Function of placenta
l Placental abnormalities
l Placental insufficiency and its investigations
TOPIC 3
FORMATION AND FUNCTIONS OF LIQUOR AMNII
RATIONALE
It is clearly advantageous for the fetus to develop in a fluid environment. The liquor amnii, clear fluid that surrounds the fetus, is about 1 liter in volume and protects the fetus against physical trauma, permits uninhibited fetal growth free from distortion by neighboring structures, and provides a thermally stable environment. Its decrease and increase may cause fetal and maternal complications.
GOAL
Know the theories of formation and functions of liquor amnii
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List different theories of liquor formation
l Describe functions of liquor amnii
l List the value of amniocentesis
CONTENT
l Character of liquor amnii
l Sources and origin
l Functions of liquor amnii
l Abnormality of liquor amnii
l Amniocentesis
TOPIC 4
FETAL CIRCULATION
RATIONALE
Understanding fetal circulation is important in obstetric practice, especially with advances in ultrasonographic modalities that may help in early diagnosis of vascular and cardiac anomalies in intrauterine life. Doppler ultrasound provides a non-invasive method for the study of fetal hemodynamics. Investigation of the uterine and umbilical arteries provides information on the perfusion of the uteroplacental and fetoplacental circulations.
GOAL
Know the basis of fetal circulation
LEARNING OBJECTIVE
By the end of this course, the student will be able to:
l Describe the hemodynamics of fetal circulation and its postnatal changes
CONTENT
l Hemodynamics of fetal circulation
l Postnatal changes
TOPIC 5
PHYSIOLOGICAL CHANGES DURING PREGNANCY
RATIONALE
Almost all body systems change during pregnancy. Understanding these physiological changes will help the physician to understand the pathophysiological changes and enable the physician to deal with the problems of pregnant women.
GOAL
Know the basic physiological changes produced by pregnancy
LEARNING OBJECTIVES
l Describe genital changes during pregnancy, with emphasis on the difference between upper and lower uterine segments
l Describe the breast changes during pregnancy
l Describe the cardiovascular changes during pregnancy
CONTENT
l Changes in genital organs
l Changes in skin (coetaneous changes)
l Changes in urinary system
l Endocrine and metabolic changes
l Other systems (GIT, respiratory)
TOPIC 6
DIAGNOSIS OF PREGNANCY
RATIONALE
Early clinical diagnosis of pregnancy is importantespecially in primigravidato explain to the client the changes that occur with pregnancy.
GOAL
Know how to diagnose pregnancy in each trimester
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the symptoms of early pregnancy
l Interpret correctly a pregnancy test in urine and serum
l Interpret ultrasound findings in early pregnancy
l List symptoms of mid pregnancy
l Enumerate signs of mid pregnancy
l List sure signs of pregnancy
l Give differential diagnosis of fetal heart sounds
l Diagnose pregnancy from breast signs
l Diagnose pregnancy from abdominal signs
l Auscultate fetal heart sounds
CONTENT
l Diagnosis of pregnancy in first, second, and third trimesters
l Ultra sonic diagnosis of pregnancy
l Sure signs of pregnancy
TOPIC 7
ANTENATAL CARE
RATIONALE
Antenatal care is the program of preventive obstetrics in which regular visits are used to detect and manage any health problems and complications during pregnancy. The goal of antenatal care is to have a healthy mother and child.
GOAL
Know the basic principles of antenatal care
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define antenatal care
l List the objectives of antenatal care
l Plan a protocol for antenatal care including determining the minimal number of visits
l Mention the value of the first visit correctly
l Mention the objectives of subsequent visits
l List routine investigations for pregnant women
l List the warning symptoms of pregnancy
l Know the risk factors for pregnancy
l Take an appropriate history from a pregnant woman during an antenatal visit
l Diagnose some obstetric and general conditions from the results of routine investigations
CONTENT
l First visit
l Frequency
l Investigations
TOPIC 8
HYPEREMESIS GRAVIDARUM
RATIONALE
About 50 percent of pregnant women suffer from morning sickness. Rarely, the vomiting is repeated throughout the day and affects the womans general condition.
GOAL
Learn diagnosis, differential diagnosis, and management of hyperemesis gravidarum
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Identify symptoms and signs of hyperemesis gravidarum
l Describe the different investigations
l List differential diagnosis of vomiting during pregnancy
l Outline management of hyperemesis
l Take appropriate history about conditions that cause vomiting during pregnancy
CONTENT
l Etiology
l Difference between emesis and hyperemesis gravidarum
l Pathology
l Clinical picture
l Differential diagnosis
l Treatment
l Indications for termination of pregnancy
PYELITIS WITH PREGNANCY
RATIONALE
Pyelitis affects about 1 percent of pregnant women and is usually preceded by asymptomatic bacteruria. If untreated, it may lead to serious health problems during pregnancy.
GOAL
Understand the causes, diagnosis, differential diagnosis, complications, and management of pyelonephritis during pregnancy
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Describe the predisposing factors and clinical picture of pyelonephritis
l Mention the complications
l Take appropriate history from pregnant women with urinary symptoms
l Order the investigations and select the proper antibiotics for patients with pyelonephritis
CONTENT
l Incidence and predisposing factors
l Organisms
l Clinical picture
l Differential diagnosis
l Treatment
TOPIC 10
ABORTION
RATIONALE
Abortion is the major cause of bleeding in the first 20 weeks of pregnancy. According to the 199293 maternal mortality survey, 4.5 percent of all maternal deaths and 6.4 percent of all direct obstetric deaths were caused by abortion. Abortion is therefore considered a very important health and psychological problem.
GOALS
l Define abortion, understand its pathology, and emphasize preventable and avoidable causes to reduce maternal mortality
l Ensure that graduates can competently manage each type
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define and differentiate between symptoms and signs of each type of abortion
l Define causes and risk factors of abortions
l List complications of each type
l Describe first aid and actual management of each type of abortion
l List causes of and investigations for recurrent abortion
l Know E&C, dilation, evacuation, curettage, and cerclage techniques
l Counsel couples for their future fertility and support them psychologically
CONTENT
l Definition and clinical types of abortion
l Pathology of abortion
l Causes of abortion
l Methods and criteria of diagnosis of each type of abortion
l Complications of abortion
l Management of different types of abortion
l Guidelines for surgical evacuation
TOPIC 11
ECTOPIC PREGNANCY
RATIONALE
The risk of death from an extra-uterine pregnancy is 10 times greater than that from a vaginal delivery and 50 times greater than from an induced abortion. Moreover, the prognosis for a successful subsequent pregnancy is reduced significantly in women who experience extra-uterine pregnancy. With earlier diagnosis, both maternal survival and conservation of reproductive capacity are enhanced.
GOALS
l Define the problem of ectopic pregnancy
l Reduce maternal mortality due to ectopic pregnancy and apply anti-shock measures properly
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define, know the incidence of, and list the causes of ectopic pregnancy
l List the main symptoms, signs, and differential diagnosis (DD) of ectopic pregnancy
l State available methods for management
l List anti-shock measures
CONTENT
l Definition of ectopic pregnancy and its incidence
l Risk factors for ectopic pregnancy
l Pathology of ectopic pregnancy
l Different clinical presentations of ectopic pregnancy
l Main symptoms and signs of ectopic pregnancy
l Special investigation of suspected ectopic pregnancy
l Management of ectopic pregnancy
TOPIC 12
VESICULAR MOLE
RATIONALE
Vesicular mole (VM) is a benign tumor of young chorionic villi. It not only carries the risk of hemorrhage, sepsis, and thrombosis but also the risk of malignant transformations, so it is a very important health problem.
GOALS
l Reduce maternal mortality and morbidity from VM
l Institute prompt treatment and followup of VM
By the end of this course, the student will be able to:
l Define VM correctly
l Define causes and genetic background for molar pregnancy
l Describe the pathological types of VM
l List the main symptoms and sign of VM
l List the complications of VM
l Mention available methods of evacuation and followup
l Describe the indications for chemotherapy
CONTENT
l Definitions, pathological types, and causes of VM
l Diagnosis and complication of different types of VM
l Special investigation for diagnosis
l Followup protocol
l Indications for chemotherapy
TOPIC 13
HYPERTENSIVE DISORDERS DURING PREGNANCY
RATIONALE
Hypertension is one of the most common complications of pregnancy, and is a common cause of fetal and maternal morbidity and mortality. Hypertensive diseases are the second most common cause of maternal mortality in Egypt (26:100,000). If hypertension is untreated, convulsions may develop.
GOALS
l Reduce maternal and fetal mortality and morbidity from hypertensive disorders
l Ensure that graduates can competently diagnose and manage pre-eclampsia and prevent eclampsia
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define correctly the various hypertensive disorders
l Describe pathology and effects of pregnancy induced hypertension (PIH)
l List symptoms, signs, and complications of PIH
l List the criteria of severe PIH
l Outline management of PIH
CONTENT
l Definition of PIH and its classification
l Pathology of PIH
l Clinical diagnosis and complication of PIH
l Criteria of severe PIH
l Management of PIH
TOPIC 14
ANTEPARTUM HEMORRHAGE (PLACENTA PREVIA)
RATIONALE
Hemorrhage is the leading cause of maternal mortality in Egypt. It accounts for almost one-third (32 percent) of all maternal deaths (51.7/100.000). The maternal mortality ratio for antepartum hemorrhage (APH) is 13/100,000. A large majority of APH deaths (84 percent) are associated with placental abruption, while the remainder are due to placenta previa (PP).
GOALS
l Reduce maternal mortality and morbidity from APH
l Ensure that graduates can competently manage APH
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define and list different types of APH
l Define and list degrees of PP
l List symptoms signs and investigations of APH
l Describe first aid management and outline the treatment modalities
CONTENT
l Definition and different types of APH
l Definition and degrees of PP
l Symptoms, signs, special investigations, and complications of PP
l Management of PP
TOPIC 15
ANTEPARTUM HEMORRHAGE (ACCIDENTAL HEMORRHAGE)
RATIONALE
Hemorrhage is the leading cause of maternal mortality in Egypt. It accounts for almost one-third (32 percent) of all maternal deaths (51.7/100.000). The maternal mortality ratio for antepartum hemorrhage (APH) is 13/100,000. A large majority of APH deaths (84 percent) are associated with placental abruption, while the remainder are due to placenta previa (PP).
GOALS
l Reduce maternal mortality and morbidity from APH
l Ensure that graduates can competently manage APH
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define and list different types of APH
l Define and list types of accidental hemorrhage
l List symptoms, signs, and investigations of APH due to accidental hemorrhage
l Describe first aid management and outline treatment modalities
CONTENT
l Definition and types of accidental hemorrhage
l Symptoms, signs, and complications of accidental hemorrhage
l Management of accidental hemorrhage
TOPIC 16
DIABETES DURING PREGNANCY
RATIONALE
Before 1922, no infant of a diabetic mother survived. With the advent of insulin, the incidence of infant mortality has dropped dramatically. Rigid control of maternal blood sugar during pregnancy is of utmost importance for the reduction of perinatal mortality.
GOALS
l Reduce fetal mortality and maternal morbidity due to diabetes during pregnancy
l Ensure that the graduates can competently manage and investigate Diabetes mellitus (DM) during pregnancy
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define and list different types of DM during pregnancy
l List fetal and maternal complications during pregnancy, labor, and puerperium
l Investigate and list the indications of glucose tolerance testing during pregnancy
l Mention the maximum and optimum allowable glucose levels during pregnancy
l Describe the management during pregnancy, labor, and puerperium
CONTENT
l Definition of types complications (fetal and maternal) of DM during pregnancy
l Management of DM during pregnancy, labor, and puerperium
TOPIC 17
ANEMIAS DURING PREGNANCY
RATIONALE
Anemia is the most common medical disorder in pregnancy. There is an additional demand for iron in pregnancy to meet the increased maternal and fetal requirements and prevent the risk of its deficiency.
GOALS
l Reduce maternal and fetal complications due to anemia
l Ensure that graduates can competently screen for and manage anemias during pregnancy
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define and list the different types of anemia during pregnancy
l List fetal and maternal complications of anemia during pregnancy, labor, and puerperium
l Know the minimum allowable hemoglobin levels during pregnancy
l Describe the management of iron deficiency anemia and the role of routine iron supplementation
CONTENT
l Definition, types, and complications of anemia during pregnancy
l Management of anemia during pregnancy, labor, and puerperium
TOPIC 18
HIGH-RISK PREGNANCY
RATIONALE
Pregnancy is an important event that plays a great role in family stability. A high-risk pregnancy is a pregnancy in which the mother, fetus, or neonate is in jeopardy, and women in this situation require greater attention before, during, and after pregnancy. The most important challenge is early diagnosis; therefore, different authors have proposed several high-risk identification systems. Taking of a thorough history and performing a physical examination of every obstetric patient are the best ways to identify a high-risk patient. Because there are advances in this field for many cases that were formerly considered incurable, the knowledge and skills of the graduates should expand to cover the recent modalities in investigation and treatment. Pre-conception counseling is also important.
GOALS
l Understand the magnitude of high-risk pregnancy, its different etiologies, and identification systems, and emphasize preventable and avoidable causes
l Recognize and utilize basic diagnostic tools such as the non-stress test and contraction stress test
l Raise the awareness of maternal-fetal medicine
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define high-risk pregnancy
l List risk factors
l Describe management of high-risk pregnancy
l Enumerate methods of antepartum assessment of fetal well-being
l Identify patients with high-risk pregnancies in antenatal clinics
CONTENT
l Definition of high risk pregnancy
l Etiology
l Identification of the high-risk patient
l Pre-conceptional counseling
l Methods of fetal surveillance for high-risk patients
l Guidelines for preventive aspects and treatment
TOPIC 19
OLIGOHYDRAMNIOS AND POLYHYDRAMNIOS
RATIONALE
The amount of amniotic fluid (AF) in the amniotic cavity is variable, dependent on fetal and maternal factors. One of the anomalies most commonly found during routine office ultrasound examination is the AF alteration (oligohydramnios and polyhydramnios). It is of utmost importance to know what is normal in order to identify that which is abnormal. There are many methods for the diagnosis of AF volume. Knowledge and skills of the graduates should be updated to accommodate the recent modalities for the diagnosis and treatment of such problems.
GOALS
l Understand the magnitude of the problem, its different causes, and types
l Recognize and utilize basic diagnostic tools
l Emphasize complications and management strategies
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List different causes of oligo- and polyhydramnios
l State the types of polyhydramnios
l Mention the clinical and sonographic diagnosis
l List the complications of oligo- and polyhydramnios
l Identify patients with high-risk factors who may develop the problem in antenatal clinics
CONTENT
l Definition and types of oligo- and polyhydramnios
l Etiology
l Preventive aspects
l Normal AF parameters
l Diagnosis and investigatory tools
l Guidelines for prevention of complications
l Guidelines for management
TOPIC 20
FETAL GROWTH AND ITS DISORDERS
RATIONALE
Fetal growth disorders may be associated with significant fetal morbidity. Each year, about one-fifth of the almost 4 million in infants in the United States are born at the low and high extremes of fetal growth.
GOALS
l Understand the magnitude of fetal growth disorders and their different etiologies
l Utilize the basic diagnostic tools and recognize the problems of fetal growth disorders
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define Intra-uterine growth retardation (IUGR) and fetal macrosomia
l List causes of IUGR and fetal macrosomia
l Choose the appropriate method for diagnosis of IUGR and fetal macrosomia
l Enumerate the hazards of IUGR and outline its management
l Describe management of shoulder dystocia
l Identify patients with high-risk pregnancies for macrosomia and IUGR in antenatal clinics
CONTENT
l Definition and types of fetal growth disorders
l Etiology of IUGR and macrosomia
l Diagnostic tools of fetal growth disorders
l Guidelines for the treatment of macrosomia and IUGR
l Shoulder dystocia
TOPIC 21
RH ISO-IMMUNIZATION DURING PREGNANCY
RATIONALE
Rh iso-immunization is an important cause of recurrent fetal wastage. However, with proper prenatal care, this risk can be avoided.
GOAL
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List types of blood groups, their prevalence, and inheritance
l List causes of Rh iso-immunization and sequelae of antigen antibody reaction
l State the pathologic and clinical effects of hemolysis on the fetus and neonate
l State methods of antenatal diagnosis
l Describe prophylaxis against Rh iso-immunization
l Outline the management of the sensitized patient
l Describe the differential diagnosis of neonatal jaundice
l Take history from Rh iso-immunization patient
CONTENT
l Incidence, pathology, etiology, diagnosis, prevention, and treatment of Rh iso-immunization
TOPIC 22
COMMON FETAL ANOMALIES
RATIONALE
Congenital fetal anomalies are an important factor contributing to perinatal mortality and morbidity. Prenatal detection of congenital malformations is an integral part of antenatal care. Furthermore, routine examination of the neonate is important for early detection of congenital anomalies.
GOAL
Recognize the causes, types, and methods of diagnosis of common congenital anomalies
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List different causes of congenital anomalies
l Describe different methods of prenatal diagnosis of congenital anomalies
l Recognize the management of pregnancy complicated by fetal anomalies
CONTENT
l Classification of congenital anomalies
l Etiology of congenital anomalies
l Prenatal diagnosis of congenital anomalies
l Role of prevention in the management of congenital anomalies
TOPIC 23
ANTEPARTUM
ASSESSMENT OF FETAL WELL-BEING
RATIONALE
Antepartum fetal surveillance has evolved as a method of screening patients at risk for intrauterine fetal death and identifying fetuses in distress so that measures can be taken in time to avert permanent damage or death.
GOAL
Orient graduates to the different methods for assessment of fetal well-being
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List different methods of antepartum assessment of fetal well-being
l List the indications for the assessment
l Differentiate the normal from abnormal in various tests
CONTENT
l Definition and indications of fetal well-being
l Different methods of assessing fetal well-being
l Interpretation of the results of the tests
l Actions according to the results
TOPIC 24
ANATOMY OF THE FEMALE BONY PELVIS AND FETAL SKULL
RATIONALE
Knowledge of the basic anatomy of the bony pelvis and fetal skull is the basis for understanding the process of labor, the problems that may arise during labor, and the way to manage labor properly.
GOAL
Orient graduates to the basic surgical anatomy of the female pelvis and fetal skull
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Describe the anatomy of the pelvic inlet, cavity, and outlet
l List the diameters of the pelvis and their obstetric importance
l Describe the fetal skull and list its diameters
CONTENT
l Basic anatomy of the bony pelvis
l Diameters of the pelvis inlet, cavity, and outlet
l Basic anatomy of the fetal skull
l Diameters of the fetal skull
l Molding of the fetal head
TOPIC 25
NORMAL LABOR
RATIONALE
Labor is a series of regular, coordinated uterine contractions that result in progressive cervical dilatation and effacement, allowing for fetal descent and expulsion. Detailed knowledge of the process of normal labor is mandatory for medical students at this stage of their education.
GOAL
Recognize the physiology, mechanism, and management of normal labor
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define normal labor and its stages
l Describe the mechanism of delivery of the fetal head and shoulder
l Describe the steps in proper management of normal labor
CONTENT
l Definition of normal labor
l Stages of normal labor
l Powers of labor
l Mechanism of normal labor
l Management of normal labor
l Episiotomy: indication, type, and advantages
TOPIC 26
ANALGESIA AND ANESTHESIA IN OBSTETRICS
RATIONALE
The importance of analgesia and anesthesia during pregnancy and labor is unquestioned. A considerable number of maternal morbidity and mortality cases are caused by to anesthetic complications.
GOAL
Understand the different methods of local, regional, and general anesthesia and their complications
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different analgesic and anesthetic agents that are used in obstetrics
l List the complications of using these agents and describe how to manage them
CONTENT
l Indications for analgesia and anesthesia in obstetrics
l Different anesthetic techniques in obstetrics
l Complications (maternal and fetal) of anesthesia in obstetric practice
TOPIC 27
OCCIPITOPOSTERIOR POSITION
RATIONALE
Most often, fetuses in the occipito-posterior position undergo spontaneous anterior rotation followed by uncomplicated delivery. Failure of spontaneous anterior rotation can occur, and these cases need instrumental delivery or cesarean section. Accordingly, the knowledge and skills of the graduates should be updated so that they are able to diagnose and manage the complicated cases.
GOALS
l Recognize the causes, diagnosis, and management of occipito-posterior position
l Ensure that graduates can competently diagnose and manage the occipito-posterior position in order to reduce maternal and fetal mortality and morbidity
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define occipito-posterior position
l List the causes of occipito-posterior position
l List the causes of failure of spontaneous anterior rotation
l State the complications that may be associated with occipito-posterior position
l Describe how to diagnose occipito-posterior position
l List the different ways of managing occipito-posterior position
CONTENT
l Definition of occipito-posterior position
l Causes of occipito-posterior position
l Mechanism of labor of occipito-posterior position
l Diagnosis of occipito-posterior position
l Management of occipito-posterior position
TOPIC 28
FACE AND BROW PRESENTATION
RATIONALE
In the absence of a contracted pelvis, and with effective labor, successful vaginal delivery usually occurs. In cases with persistent brow and in some cases of face presentation, cesarean section may be needed. Accordingly, the knowledge and skills of the graduates should be updated so that they can diagnose and manage the complicated cases.
GOALS
l Recognize causes, types, positions, diagnosis, and management of face and brow presentation
l Ensure that graduates can competently diagnose and manage the face and brow presentation in order to reduce maternal and fetal mortality and morbidity
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define face and brow presentation
l List causes of face and brow presentation
l Recognize the types and positions of face and brow presentation
l Describe the complications that may be associated with face and brow presentation
l State how to diagnosis face and brow presentation
l List the different ways of managing face and brow presentation
CONTENT
l Definition of face and brow presentation
l Causes of face and brow presentation
l Mechanism of labor of face and brow presentation
l Diagnosis of face and brow presentation
l Management of face and brow presentation
TOPIC 29
BREECH PRESENTATION
RATIONALE
The incidence of breech presentation is about 3-4 percent of singleton deliveries. Because of the greater frequency of operative delivery (including cesarean section), there is higher maternal and fetal morbidity and mortality for pregnancies complicated by persistent breech presentation. Appropriate management of breech presentation can achieve a measurable reduction in maternal and fetal morbidity and mortality. Accordingly, the knowledge and skills of the graduates should be updated so that they can diagnose and manage the breech presentation.
GOALS
l Recognize causes, types, mechanisms of labor, diagnosis, and management of breech presentation
l Ensure that graduates can competently diagnose and manage breech presentations, in order to reduce maternal and fetal mortality and morbidity
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define breech presentation
l List the causes of breech presentation
l Recognize the types and positions of breech presentation
l State the complications that may be associated with breech presentation
l Understand how to diagnose breech presentation
l State the different ways of managing breech presentation
l List the importance of an ultrasound in breech
l Recognize the role of cesarean section in the management of breech
l State the different maneuvers in the delivery of the after-coming head and its arrest
l Assist in the management of breech cases
CONTENT
l Definition of breech presentation
l Causes of breech presentation
l Mechanism of labor of breech presentation
l Diagnosis of breech presentation
l Management of breech presentation
l Complication of breech delivery, their prevention and management.
TOPIC 30
SHOULDER PRESENTATION
RATIONALE
The incidence of shoulder presentation is about 1 in every 300 deliveries. In general, the onset of active labor in a woman with shoulder presentation is an indication for cesarean section. Physicians attend about 30 percent of deliveries in Egypt. Accordingly, the knowledge and skills of graduates should be updated so that they are able to diagnose possible shoulder presentation as early as possible and refer the cases to the nearest general hospital, where cesarean section should be done. Appropriate management of shoulder presentation can achieve a measurable reduction in maternal and fetal morbidity and mortality.
GOALS
l Recognize the causes, effects, complications, and management of shoulder presentation
l Ensure that graduates can competently diagnose and manage shoulder presentation in order to reduce maternal and fetal mortality and morbidity
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the causes of shoulder presentation
l State how to diagnose shoulder presentation
l Describe the complications and diagnosis of neglected shoulder
l State the management of shoulder and neglected shoulder presentation
l Diagnose shoulder presentation in the antenatal clinic and obstetric wards
CONTENT
l Definition of shoulder presentation
l Incidence of shoulder presentation
l Causes of shoulder presentation
l Diagnosis of shoulder presentation
l Management of shoulder presentation
l Prognosis and complications of neglected shoulder presentation
TOPIC 31
CORD PRESENTATION AND PROLAPSE
RATIONALE
There is a higher incidence of fetal morbidity and mortality associated with pregnancies complicated by cord presentation and prolapse. Appropriate management of cord presentation and prolapse can achieve a measurable reduction in fetal morbidity and mortality. Accordingly, the knowledge and skills of graduates should be updated so that they can diagnose and manage cord presentation and prolapse.
GOALS
l Recognize the causes, diagnosis, and management of cord presentation and prolapse
l Ensure that graduates can competently diagnose and manage cord presentation and prolapse in order to reduce fetal mortality and morbidity
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define cord presentation and prolapse
l List the causes of cord presentation and prolapse
l Describe the complications that may be associated with cord presentation and prolapse
l State how to diagnose cord presentation and prolapse
l Describe the different ways of managing cord presentation and prolapse
CONTENT
l Definition of cord presentation and prolapse
l Causes of cord presentation and prolapse
l Diagnosis of cord presentation and prolapse
l Management of cord presentation and prolapse
TOPIC 32
MULTIPLE PREGNANCIES
RATIONALE
There has been an increase in the incidence of multiple pregnancies in modern obstetric practice. Proper diagnosis and management of such cases is of utmost importance because it entails higher incidence of maternal and perinatal complications.
GOAL
Demonstrate familiarity with theories, placentation, complications, diagnosis, and management of multiple pregnancies
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l State the definition, incidence, and risk factors of multiple pregnancies
l Describe the types of twinning and list the modes of placentation and its time of onset
l Enumerate complications in pregnancy and labor
l Describe the methods of diagnosis during pregnancy and mention the different presentations
l Know the definition, types, and complications of fetal transfusion syndrome and conjoined twins
l Describe the lines of management during pregnancy with details about rest, diet, and tonics
l Recognize a plan for the delivery method
l List indications for cesarean section
l Demonstrate familiarity with the abdominal contour and grips
CONTENT
l Definition and incidence of multiple pregnancies
l Short résumé on conjoined twins and fetal transfusion syndrome
l Biology of twinning
l Methods of diagnosis during pregnancy
l Complications of multiple pregnancies
l Antenatal care
l Management of first, second, and third stages of labor with stress on the increased risk of postpartum hemorrhage and methods of prevention
TOPIC 33
COMPLEX PRESENTATION
RATIONALE
The incidence of complex presentation is about 1 in every 1000 deliveries. Physicians attend about 30 percent of deliveries in Egypt. Appropriate management of complex presentation can achieve a measurable reduction in maternal and fetal morbidity.
GOALS
l Recognize causes, effects, and management of complex presentation
l Ensure that graduates can competently diagnose and manage complex presentation in order to reduce maternal and fetal mortality and morbidity
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define complex presentation
l Enumerate causes of complex presentation
l State the complications that may be associated with complex presentation
l Describe how to diagnose complex presentation
l Recognize the different ways of managing complex presentation
CONTENT
l Definition of complex presentation
l Causes of complex presentation
l Mechanism of labor of complex presentation
l Diagnosis of complex presentation
l Management of complex presentation
TOPIC 34
ABNORMAL UTERINE ACTION
RATIONALE
Any abnormality in the contractile pattern of the uterine musculature that prevents the normal progress of labor is called abnormal uterine action, uterine dystocia, or desultory labor. This abnormal uterine action has deleterious effects on the mother, the process of labor, and the offspring.
GOAL
Evaluate uterine activity with stress on the diagnosis and treatment of the different types of abnormal uterine action
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define abnormal uterine action
l Describe the different clinical varieties of abnormal uterine action including hypotonic and hypertonic inertia, precipitate labor, pathological retraction ring, and cervical dystocia.
l List the causes and risks of each type and method of treatment
l Describe the partograph and list its components and the types of curves obtained in normal and abnormal progress of labor
l Describe how to feel and count normal and abnormal uterine contractions
l State how to see and feel some elements of the partograph
CONTENT
l Physiology of uterine action
l The partograph
l Classification of the different types of abnormal uterine action
l Risk factors of abnormal uterine action
l Methods of assessment of uterine contractions
l Diagnosis and treatment of each type of abnormal uterine action
l Complications of abnormal uterine action
TOPIC 35
CONTRACTED PELVIS AND CEPHALOPELVIC DISPROPORTION
RATIONALE
Generally speaking, a contracted pelvis is one that does not permit the passage of the fetus during delivery, with subsequent maternal and fetal complications. Due to improved health care, the incidence of this problem is decreasing markedly and currently the incidence is about 1-3 percent of all hospital deliveries in developing countries.
GOAL
Define and describe the methods of diagnosis and treatment of the common types of contracted pelvis
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define and describe the common types of contracted pelvis
l Describe the cephalo-pelvic disproportion (CPD) tests
l Mention the complications of CPD
l Mention the methods of delivery of CPD
l Appreciate CPD testing
CONTENT
l Definition of contracted pelvis
l Causes of contracted pelvis
l Classification of contracted pelvis, with description of the common types
l Methods of diagnosis of contracted pelvis with stress on CPD tests and partographic assessment of the progress of labor
l Complications of contracted pelvis
l Treatment of contracted pelvis including description of trial labor and indications for cesarean section
TOPIC 36
SOFT TISSUE OBSTRUCTION
RATIONALE
Soft tissue obstruction includes all soft tissue obstacles that interfere with the passage of the fetal head during vaginal delivery.
GOAL
Recognize the causes, diagnosis, complications, and management of soft tissue obstruction
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different causes of soft tissue obstruction
l State how to diagnose the different causes
l Describe the complications of soft tissue obstruction
l Describe the management of each cause
CONTENT
l Ovarian tumors complicating pregnancy and delivery
l Uterine tumors complicating pregnancy and delivery
l Cervical tumors complicating pregnancy and delivery
l Stricture, edema, and hematoma of the genital tract
TOPIC 37
OBSTRUCTED LABOR
RATIONALE
Obstructed labor refers to cases in which spontaneous vaginal delivery is difficult or impossible due to insuperable mechanical obstacles. This should not be encountered in modern obstetric practice.
GOAL
Acquire the knowledge and skills to understand the causes, clinical picture, and treatment of obstructed labor, concentrating on avoidance of obstructed labor and rapid management
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define obstructed labor
l Enumerate the causes of obstruction in the passage, passenger, and/or the power
l Describe the clinical picture of early obstruction in the form of an abnormal pattern of labor
l Describe the clinical picture of late obstruction in the form of maternal and fetal distress and local signs manifesting themselves as impending rupture of the uterus
l Recognize that good observation is part of a prevention policy
l List the lines of management in early and late cases
l Be able to feel contractions with obstruction plus Bandls ring and round ligament
l Record signs of maternal and fetal distress
l Appreciate rapid intervention
l Be able to assess the progress of labor using the partograph
CONTENT
l Definition and incidence of obstructed labor
l Causes of obstructed labor
l Complications
l Methods of diagnosis
l Management, including preventive measures with stress on the importance of cesarean section
TOPIC 38
RUPTURED UTERUS
RATIONALE
Ruptured uterus is the worst obstetric complication not only because it threatens the womans life, but also because it might deprive her of her reproductive capacity.
GOAL
Acquire the knowledge to understand the causes, clinical picture, types, and treatment of ruptured uterus, concentrating on avoidance and rapid management
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define ruptured uterus and differentiate it from perforation
l Enumerate the causes of ruptured uterus, whether in pregnancy or in labor, and whether spontaneous or induced
l Describe the mechanism of spontaneous rupture in labor
l Mention types of rupture and describe silent rupture and dehiscence
l Describe the clinical picture of ruptured uterus
l Mention the lines of management
l List the complications
l Record signs of shock
l Appreciate rapid intervention
l Appreciate team work
CONTENT
l Definition and incidence of ruptured uterus
l Causes of ruptured uterus during pregnancy and delivery
l Pathology of ruptured uterus
l Clinical picture
l Complications
l Management with special emphasis on preventive measures
TOPIC 39
GENITAL TRACT INJURY DURING LABOR
RATIONALE
Genital tract injury is a common complication of delivery. The injury may affect the genital tract as well as the urethra, bladder, and/or rectum.
GOAL
Acquire knowledge of the basic physiological changes of the genital tract during labor, and enumerate the sites of possible genital tract trauma, stressing perineal tears, vaginal lacerations, and cervical tears
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Mention the sites of possible genital injury in labor
l Enumerate physiological changes in the vagina and vulva during labor
l List causes of perineal tears, types, and complications, and describe perineal repair with pre- and postoperative care
l Enumerate types of vaginal lacerations, methods of repair, and complications of laceration repair
l Describe the causes, types, complications, and methods of repair of cervical tear
l State the relationship between obstetric trauma and genital prolapse and incontinence later on
l Appreciate the value of rapid intervention
l Appreciate preventive obstetrics to avoid prolapse or incontinence
CONTENT
l Lacerations of the cervix
l Rupture of the vaginal vault
l Vaginal lacerations and para-vaginal hematoma
l Vulval lacerations
l Perineal tear
TOPIC 40
POSTPARTUM HEMORRHAGE
RATIONALE
Postpartum hemorrhage is one of the leading causes of maternal mortality in Egypt (34 percent of all cases of maternal deaths). Proper obstetric management can prevent most cases of postpartum hemorrhage. Physicians attend about 30 percent of deliveries in Egypt. Appropriate management of third stage of labor can achieve a measurable reduction in maternal mortality and morbidity.
GOALS
l Reduce maternal mortality and morbidity from postpartum hemorrhage
l Ensure that graduates can competently manage the third stage of labor
l Diagnose the cause(s) of postpartum hemorrhage and institute prompt treatment
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List and differentiate between types of postpartum hemorrhage
l Define causes and risk factors for postpartum hemorrhage
l Recognize and apply measures for prophylaxis of postpartum hemorrhage
l Describe first aid management and outline treatment modalities for each type of postpartum hemorrhage
l Recognize the importance of the fourth stage of labor (the first hour after delivery) in postpartum hemorrhage prevention
l Utilize examination and diagnostic methods correctly to diagnose the types of postpartum hemorrhage
l Use emergency treatment in correct sequence
l Treat/stabilize a bleeding patient before referring
CONTENT
l Definition of postpartum hemorrhage and reference of blood loss during normal deliveries
l Etiologies of postpartum hemorrhage
l Definition of risk factors and preventive measures (active management of third stage)
l Types of post-partum hemorrhage: primary (atonic, traumatic, and coagulopathies) and secondary
TOPIC 41
OTHER COMPLICATIONS OF THE THIRD STAGE OF LABOR
RATIONALE
In addition to hemorrhage, complications of the third stage of labor include retained placenta, shock in obstetrics, and acute inversion of the uterus. Physicians attend about 30 percent of deliveries in Egypt. Appropriate management of third stage of labor can achieve a measurable reduction in maternal mortality and morbidity. Accordingly, the knowledge and skills of graduates should be updated so that they know how to diagnose and manage complications of the third stage of labor.
GOAL
Recognize the types, diagnosis, and management of retained placenta, shock in obstetrics, and acute inversion of the uterus
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define retained placenta:
· List the causes
· Describe the clinical picture
· Outline the protocol of management
l Recognize shock in obstetrics:
· Define shock
· List the different types of shock in obstetrics
· Describe the management of each type of shock
l Recognize acute inversion of the uterus:
· Enumerate the causes
· Describe the clinical picture
· Outline the management
CONTENT
l Retained placenta:
· Definition of retained placenta
· Causes of retained placenta
· Clinical picture of retained placenta
· Management of retained placenta
l Shock in obstetrics:
· Definition of shock
· The different types of shock in obstetrics
· The management of each type of shock
l Acute inversion of the uterus:
· The causes
· The clinical picture
· The management
TOPIC 42
FETAL BIRTH INJURIES
RATIONALE
Birth injuries vary from minor skin abrasions to severe intracranial hemorrhage (IH). Their prevention depends on the art of obstetrics, and a balance must be struck between safety of the mother and that of the child during difficult labor. Prevention of serious birth trauma is a reflection of improvements in antenatal and perinatal care that graduates should learn well.
GOAL
Recognize the types, etiology, clinical picture, prevention, and management of IH, brachial plexus injury, and skeletal and muscle injuries
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the types and causes of IH
l Mention the clinical picture and the investigations required to diagnose IH
l List the lines of prevention of IH
l Describe the different lines of treatment of IH
l Enumerate long-term complications of IH
l Differentiate between IH and caput succedaneum
l Mention the types and causes of brachial plexus palsy
l Describe the clinical picture of brachial plexus palsy
l Outline lines of prevention and management of brachial plexus palsy
l List the complications of brachial plexus palsy
l Recognize types, lines of prevention, and management of skeletal and muscle injuries
CONTENT
l IH:
· Types and causes
· Diagnosis
· Prevention
· Treatment
· Complications
· Differential diagnosis
l Brachial plexus palsy:
· Types, causes, and clinical picture
· Prevention and management
l Skeletal and muscle injuries:
· Types and causes
· Clinical picture
· Prevention
· Management
TOPIC 43
NEONATAL RESPIRATORY DISTRESS AND NEONATAL RESUSCITATION
RATIONALE
Most neonates take a breath within seconds of birth and cry within half a minute. Prolongation of these intervals beyond 1 and 2 minutes, respectively, indicates an abnormality. Continued lack of breathing demands active resuscitation. Therefore, an individual who is qualified to perform neonatal resuscitation should be immediately available at the time of delivery.
GOALS
l Recognize how to evaluate the newborn condition and to diagnose neonatal respiratory distress
l Learn how to competently resuscitate a newborn infant in respiratory distress
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define neonatal respiratory distress
l List the types and causes of neonatal respiratory distress
l Describe the clinical picture of neonatal asphyxia including types of apnea
l Describe immediate evaluation of the newborn using the Apgar score
l Describe the steps of neonatal resuscitation
l Mention prophylactic measures against neonatal asphyxia
l Describe the treatment of the different causes of respiratory distress in the newborn
l Enumerate long-term complications of neonatal asphyxia
CONTENT
l Types and causes of neonatal respiratory distress
l Neonatal evaluation and Apgar score
l Steps of neonatal resuscitation
l Prophylaxis against neonatal asphyxia
TOPIC 44
POST-TERM PREGNANCY AND HAZARDS OF POST-MATURITY
RATIONALE
Perinatal mortality increases appreciably in post-term pregnancy. Appropriate management of post-maturity can achieve reduction in perinatal mortality. Accordingly, knowledge and skills of graduates should be updated so that they know how to diagnose and manage of post-term pregnancy.
GOAL
Recognize the causes, diagnosis, and management of post-term pregnancy and hazards of post-maturity
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define the problem of post-term pregnancy
l List the different causes of post-term pregnancy
l State how to determine the duration of pregnancy from clinical data
l Mention the management of post-term pregnancy
l List the hazards of post-maturity
CONTENT
l Definition of post-term pregnancy
l Causes of post-term pregnancy
l Diagnosis of post-term pregnancy
l Management of post-term pregnancy
l Hazards of post-maturity
TOPIC 45
PRE-TERM LABOR AND HAZARDS OF PREMATURITY
RATIONALE
There is an increasing awareness that pre-term infants require special care, as evidenced by the development of incubators and intensive care nurseries. Prematurity has become nationally visible as one of the frequent causes of death in infancy. Accordingly, the knowledge and skills of graduates should be updated so that they know how to diagnose and manage of pre-term labor.
GOAL
Recognize the causes, diagnosis, and management of pre-term labor and hazards of prematurity
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different causes of pre-term labor
l Recognize the prophylaxis of pre-term labor
l State the management of pre-term labor with special emphasis on tocolysis and the role of corticosteroids
l List the hazards of prematurity
CONTENT
l Definition of pre-term labor
l Causes of pre-term labor
l Diagnosis of pre-term labor
l Prophylaxis of pre-term labor
l Management of pre-term labor
l Hazards of pre-term labor and prematurity
TOPIC 46
INTRAUTERINE FETAL DEATH
RATIONALE
Although labor eventually ensues spontaneously in most women with fetal deathmost often within 2 weeksthe psychological stress imposed by carrying a dead fetus usually prompts induction of labor at the time of discovery. This also obviates the danger of coagulation defects that may develop. Accordingly, the knowledge and skills of graduates should be updated so that they know how to diagnose and manage intrauterine fetal death.
GOAL
Recognize the causes, diagnosis, complications, and management of intrauterine fetal death
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different causes of intrauterine fetal death
l Enumerate the complications of intrauterine fetal death
l Describe the diagnosis of intrauterine fetal death
l Describe the management of intrauterine fetal death
CONTENT
l Causes of intrauterine fetal death
l Diagnosis of intrauterine fetal death
l Complications of intrauterine fetal death
l Management of intrauterine fetal death
TOPIC 47
NORMAL PUERPERIUM
RATIONALE
Puerperium is strictly defined as the period of confinement just after birth. It includes the 6 subsequent weeks after delivery during which normal pregnancy involution occurs. Graduates should know the physiological changes during puerperium and management of normal puerperium.
GOAL
Recognize the physiological changes during puerperium and the recommended program of postnatal visits
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l Define the period of puerperium
l Describe change in the genital organs, breasts, and general condition during puerperium
l Describe the time and frequency of postnatal visits and the time of initiation of contraception
l Diagnose involution of the uterus
CONTENT
l Definition of puerperium
l Changes in the genital organs, breasts, and general condition during puerperium
l The time and frequency of postnatal visits and the time of initiation of contraception
l Management of normal puerperium
TOPIC 48
PUERPERAL SEPSIS AND PUERPERAL PYREXIA
RATIONALE
Puerperal sepsis is the most common serious complication of the puerperium and, along with pre-eclampsia and obstetrical hemorrhage, formed the lethal triad of causes of maternal death for many decades. Proper obstetric management and sterilization can prevent most cases of puerperal sepsis. Graduates should know how to diagnose and manage puerperal sepsis in order to achieve a reduction in maternal mortality and morbidity.
GOALS
l Understand the definition of puerperal pyrexia
l Recognize the causes, pathology, diagnosis, differential diagnosis, and management of puerperal sepsis
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the causes of puerperal pyrexia
l Describe the pathology of puerperal sepsis
l List the risk factors and the prophylaxis of puerperal sepsis
l State the symptoms and signs of puerperal sepsis
l Plan a protocol for management of puerperal sepsis
l Diagnose the pathological type and complications in pathology jars
l Take appropriate history for risk factors
CONTENT
l Definition of puerperal pyrexia
l Causes of puerperal pyrexia
l Definition and causes of puerperal sepsis
l Pathology of puerperal sepsis
l The risk factors and the prophylaxis of puerperal sepsis
l Symptoms and signs of puerperal sepsis
l Protocol for management of puerperal sepsis
TOPIC 49
INDUCTION OF LABOR
RATIONALE
Induction of labor is indicated when the benefits to either the mother or the fetus outweigh those of continuing the pregnancy. The spectrum of indications for induction of labor includes emergent conditions such as ruptured membranes with chorio-amnionitis or severe pre-eclampsia. Induction of labor is associated with increased complications as compared with spontaneous labor. Complications include an increased incidence of chorio-amnionitis and increased cesarean delivery. Graduates should know the indications and complications of induction of labor.
GOAL
Recognize the indications, techniques, and complications of induction of labor
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different indications for induction of labor
l Describe the different techniques of induction of labor
l Recognize criteria for successful induction of labor with special emphasis on Bishops score
l State the complications of induction of labor and the drugs used to treat it
CONTENT
l Indications for induction of labor
l The different techniques of induction of labor
l Criteria for induction of labor with special emphasis on Bishops score
l The complications of induction of labor and drugs used to treat it
TOPIC 50
INSTRUMENTAL DELIVERY IN MODERN OBSTETRICS
RATIONALE
The proper use of forceps or ventouse remains a safe and effective technique for achieving the goal of a healthy mother and baby. Although there is periodic and vocal demand to delete assisted vaginal delivery, clinical experience provides recurring evidence that completely natural forces or the use of the scalpel will not achieve this goal. Accordingly, the role of forceps and ventouse in modern and safe obstetric practice must be clearly understood.
GOAL
Recognize the types, indications, technique, and complications of the obstetric forceps and ventouse in modern obstetrics
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different indications of low forceps and ventouse in modern obstetrics
l Enumerate the conditions to be fulfilled before forceps application
l Describe the technique of application of forceps and ventouse
l List the complications of instrumental delivery
l Enumerate the advantages and disadvantages of ventouse and low forceps delivery
CONTENT
l Indications of low forceps and ventouse deliveries in modern obstetrics
l Technique of low forceps and ventouse application
l Complications of instrumental delivery
TOPIC 51
CESAREAN SECTION
RATIONALE
The incidence of cesarean section in Egypt ranges from 10-20% of all deliveries. Accordingly, the knowledge and skills of graduates should be updated so that they are able to determine the different indications for cesarean section and refer the indicated cases to the nearest general hospital, where cesarean section can be performed.
GOAL
Know the indications, types, techniques, and complications of cesarean section
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different indications for cesarean section
l Recognize the techniques of the different types of cesarean section
l State the complications of cesarean section
l Enumerate the advantages of lower segment cesarean section over upper segment cesarean section
l Enumerate the indications of cesarean-hysterectomy
CONTENT
l Indications of cesarean section
l Technique of the different types of cesarean section
l Complications of cesarean section
l Advantages of lower segment cesarean section over upper segment cesarean section
l Indications of cesarean-hysterectomy
TOPIC 52
ULTRASOUND IN OBSTETRICS
RATIONALE
Since the first obstetrical application of ultrasound in 1958, ultrasonic evaluation of the pregnant uterus has become indispensable. Now most authorities advise routine prenatal sonographic scanning of all pregnant women. Accordingly, the knowledge and skills of graduates should be updated so that they know the different indications, types, technique, value, and safety of ultrasound in obstetrics.
GOAL
To know the indications, types, technique, value, and safety of ultrasound in obstetrics
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different indications for ultrasound in obstetrics
l Recognize the technique of the different types of ultrasound in obstetrics
l Recognize the safety of ultrasound in obstetrics
l Describe the value of ultrasound in early, mid, and late pregnancy
CONTENT
l Indications for ultrasound in obstetrics
l Technique of the different types of ultrasound in obstetrics
l Safety of ultrasound in obstetrics
l Value of ultrasound in early, mid, and late pregnancy
TOPIC 53
MATERNAL AND PERINATAL MORTALITY
RATIONALE
Maternal and perinatal mortality are of obvious importance. They also give some indication of the general health and standard of practice for women.
GOAL
Recognize the indices, causes, and prevention of maternal and perinatal mortality
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
l List the different indices of maternal and perinatal mortality
l Enumerate the most common causes of maternal and perinatal mortality
l Enumerate the prophylactic measures to decrease maternal and perinatal mortality
CONTENT
l Indices of maternal and perinatal mortality
l Causes of maternal and perinatal mortality
l Prevention of maternal and perinatal mortality
