Medical and Surgical Management of Normal Spontaneous Delivery

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					                        Didactic Learning Objectives
                      Obstetrics & Gynecology (Tucson)
                        (adapted from APGO Medical Student
                          Educational Objectives, 8th edition)

Simulation Labs
   1. Become familiar with instruments and techniques of surgical suturing and knot-
      tying.
   2. Become familiar with laparoscopic instruments and techniques via use of
      laparoscopy simulation at the Arizona Simulation Technology and Education
      Center (ASTEC).
   3. Become familiar with the process of a normal spontaneous vaginal delivery via
      use of an obstetric simulator.

Peri-Operative Concerns
   1. Describe the key components of pre-operative evaluation and planning, including
      complete medical histories, the informed consent process and working with
      consultants.
   2. Describe the common peri-operative prophylactic measures, including steps
      taken to reduce infection and deep venous thrombosis.
   3. Compare the relative risks and benefits of various forms of anesthesia/analgesia
      utilized during surgery and labor.
   4. Discuss the role of nutrition in achieving optimal peri-operative outcomes.
   5. Discuss common postoperative complications such as bleeding, myocardial
      infarction, pulmonary embolus, and infection (including urinary tract infection,
      pneumonia, wound infection, and anastomotic leak).

Imaging
   1. Compare the characteristics of functional cysts, benign ovarian neoplasm and
      ovarian malignancies.
   2. Describe the use of ultrasound in the evaluation of first trimester bleeding.
   3. Describe the use of ultrasound in antenatal care:
         a. Detection of fetal anomalies
         b. Assessment of fetal growth abnormalitites
         c. Assessment of fetal well-being

Postoperative Complications
  1. Postpartum hemorrhage
        a. List the risk factors for postpartum hemorrhage.
        b. Formulate a differential diagnosis of postpartum hemorrhage.
        c. Describe the immediate management of the patient with postpartum
            hemorrhage.
  2. Postpartum infection
        a. List the risk factors for postpartum infection.
        b. Describe the pathophysiology of postpartum infection.
        c. Identify the organisms involved in postpartum infection.
         d. Describe the evaluation and management of the patient with postpartum
            infection.
   3. Postpartum anxiety and depression
         a. Identify the risk factors and diagnose postpartum “blues,” postpartum
            depression and postpartum psychosis.
         b. Describe treatment options for postpartum “blues,” postpartum depression
            and postpartum psychosis.

Breast Disease
   1. List history and physical finding that may suggest:
          a. Mastitis
          b. Fibrocystic changes
          c. Intraductal papilloma
          d. Fibroma
   2. Discuss the diagnostic approach to a woman with the chief complaint of breast
      mass, nipple discharge or breast pain.

Urology
   1. Incorporate screening questions for urinary incontinence when eliciting a patient
      history.
   2. Discuss the difference between stress, urge and overflow incontinence.
   3. Identify pertinent history components to differentiate between incontinence types.
   4. Identify the following elements on physical exam: cystocele, rectocele, vaginal
      vault/uterine prolapse.
   5. List behavioral, medical and surgical methods to appropriately treat incontinence
      and pelvic organ prolapse.

Surgical Emergencies (or “OB/GYN in the ED”)
   1. Ectopic pregnancy
         a. Develop a differential diagnosis for bleeding and abdominal pain in the
             first trimester.
         b. Identify risk factors for ectopic pregnancy.
         c. Discuss the evaluation and diagnosis of a patient suspected of having an
             ectopic pregnancy.
         d. Describe treatment options for patients with ectopic pregnancy
   2. Spontaneous abortion
         a. Differentiate the types of spontaneous abortion.
         b. Discuss the evaluation and diagnosis of a patient suspected of having a
             spontaneous abortion.
         c. Identify the causes and complications of septic abortion.
   3. Other (ex. Ovarian torsion, Ruptured cysts
         a. Develop a differential diagnosis for acute pelvic pain in the Emergency
             Department.
         b. Describe the evaluation and initial management of patients presenting to
             the Emergency Department with acute pelvic pain.
Trauma
   1. Traumatic injuries
         a. Review the consequences of trauma that occurs during pregnancy.
         b. Describe the evaluation and management (both maternal and fetal) of
            trauma that occurs during pregnancy.
   2. Sexual Assault/Intimate Partner Violence
         a. Identify patients at increased risk for sexual abuse/intimate partner
            violence.
         b. List the components of a history, physical examination, and counseling for
            a victim of sexual assault/intimate partner violence.
         c. Discuss the prevalence and incidence of violence against women.
         d. Discuss appropriate counseling of patients for short-term safety and long-
            term management (local sources of support).

Menopause
  1. Describe physiologic changes in the hypothalamic-pituitary –ovarian axis
     associated with perimenopause/menopause
  2. Perform an assessment of the symptoms and physical findings associated with
     hypoestrogenism
  3. Describe appropriate management of menopausal/perimenopausal symptoms
  4. Counsel patients regarding menopausal issues
  5. List long term changes associated with menopause, including osteoporosis
Teratology
   1. Define the principles of teratology and their use in determining risks associated
      with exposures during pregnancy
   2. Recognize the importance of timing and dose on pregnancy exposures
   3. Understand deficiencies in the FDA Pregnancy Labeling Categories as they
      relate to pregnancy exposure information
   4. Identify resources for information on exposures during pregnancy and lactation
   5. Recognize the importance of framing exposures as a risk vs. benefit analysis

Normal and Abnormal Uterine Bleeding
  1. Describe the normal menstrual cycle
  2. Define abnormal uterine bleeding
  3. Describe the etiologies of abnormal uterine bleeding
  4. Describe the evaluation methods of abnormal uterine bleeding
  5. Describe the therapeutic options of abnormal uterine bleeding
  6. Counsel patients about each therapeutic option and sequelae
Gynecologic Infections
  1. Differentiate the signs and symptoms of STIs
  2. List the physical and clinical findings in STIs
  3. Describe the methods of evaluation for STIs
  4. Describe the management of STIs
  5. Describe the pathogenesis of salpingitis
  6. List the signs and symptoms of salpingitis
   7. Describe the management of salpingitis
   8. Identify the long-term sequelae of salpingitis, including: tubo-ovarian abscess,
      chronic salpingitis, ectopic pregnancy, infertility
   9. Counsel the patient about the public health concerns for STIs, including
      screening programs, costs, prevention and immunizations, and partner
      evaluation and treatment.
STIs to be discussed: Gonorrhea, Chlamydia, Herpes simplex virus, Syphilis, Human
papillomavirus infection, Human immunodeficiency virus (HIV) infection, Hepatitis B
virus infection

Obstetrical Complications
  1. Isoimmunization
         a. Describe the pathophysiology of isoimmunization, including:
                 i. Role of red blood cell antigens
                ii. Clinical circumstances under which D isoimmunization is likely to
                    occur
         b. Discuss the use of immunoglobulin prophylaxis during pregnancy for the
             prevention of isoimmunization
         c. Discuss the methods used to identify maternal isoimmunization and the
             severity of fetal involvement

   2. Multifetal gestations
         a. Discuss the etiology of monozygotic, dizygotic and mutizygotic gestation
         b. Describe the altered physiologic state with multifetal gestation
         c. Discuss the symptoms, physical findings and diagnosis of multifetal
             gestation
         d. Discuss the approach to antepartum, intrapartum and postpartum
             management for multifetal gestation
         e. Describe the potential complications (maternal and fetal) associated with
             multifetal gestation
   3. Preterm labor
         a. Cite the risk factors for preterm labor
         b. Distinguish preterm labor from Braxton Hicks contractions
         c. Identify the causes of preterm labor
         d. Counsel the patient regarding the signs and symptoms of preterm labor
         e. Describe the initial management of preterm labor
         f. List indications and contraindications of medications used to treat preterm
             labor
         g. Describe the adverse events associated with the management of preterm
             labor
         h. Counsel the patient who has experienced preterm birth
         i. Describe cervical incompetence

Medical Complications of Pregnancy
  1. Hypertension (includes chronic hypertension, gestational hypertension, and
     preeclampsia/eclampsia)
         a. Define, classify, and diagnose hypertension in pregnancy
         b. Discuss the potential impact of hypertension on the gravid patient and her
             fetus/newborn.
         c. Discuss the potential impact of pregnancy on the course of hypertension.
         d. Describe the initial management of hypertension in the pregnant patient.
  2. Diabetes mellitus (includes pre-gestational and gestational diabetes)
         a. Define, classify, and diagnose diabetes mellitus in pregnancy.
         b. Discuss the potential impact of diabetes mellitus on the gravid patient and
             her fetus/newborn.
         c. Discuss the potential impact of pregnancy on the course of diabetes
             mellitus.
         d. Describe the initial management of diabetes mellitus in the pregnant
             patient.
Contraception & Sterilization
  1. Describe the physiologic basis of contraception (OCP’s, emergency
      contraception, patches, rings, IUD, sterilization, etc.)
  2. Describe the effectiveness of each form of contraception
  3. Counsel the patient regarding the benefits and risks for each form of
      contraception
  4. Cite the financial considerations of the various forms of contraception
  5. Describe the methods of male and female surgical sterilization
  6. List the risks and benefits of procedures, including:
         a. Potential surgical complications
         b. Failure rates
         c. Reversibility (lack of)


Gynecologic Oncology I, II (given in two parts)
  1. Gestational trophoblastc disease
        a. List the symptoms and physical findings of a patient with gestational
           trophoblastic disease
        b. Describe the diagnostic methods utilized for a patient with gestational
           trophoblastic disease
  2. Cervical cancer
        a. Describe the pathogenesis of cervical cancer
        b. Identify the risk factors for cervical neoplasia and cancer
        c. Describe the appropriate utilization of new technologies for evaluating
           cervical neoplasia
        d. Describe the initial management of a patient with an abnormal Pap smear
        e. List the risk factors for endometrial carcinoma
  3. Endometrial cancer
        a. Describe the symptoms and physical findings of a patient with endometrial
           cancer
        b. Outline the appropriate management of the patient with postmenopausal
           bleeding. Discuss the use of diagnostic methods for a patient with
           endometrial carcinoma.
  4. Ovarian cancer
a. Outline the approach to a patient with an adnexal mass
b. Describe the symptoms and physical findings of a patient with ovarian
   malignancy
c. List the risk factors for ovarian cancer
d. Describe the histological classification of ovarian neoplasm
e. Counsel a woman with risk for ovarian cancer

				
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