Special Tutorial Programme

Professor Deirdre J MurphyTrinity College

Course aims

Medical knowledgeClinical skillsProfessionalism

Formative assessmentStudent feedback

Goals

Every student completes O&G programme successfully

Every individual is competent to provide basic care in O&G as a qualified doctor

Introduction to Obstetric Care

Objectives

Obstetric history and examination

Antenatal care / Healthy pregnancy

Formative assessment

Obstetric history

Woman in late pregnancy admitted with vaginal bleeding

Components of History

Basics – Name - AgeDating of pregnancyPast Obstetric historyPast Medical/Surgical/Gynae historyFamily historySocial historyAntenatal coursePresenting complaint

Dating

Menses – regular, length, sureContraceptionNaegles ruleFirst trimester ultrasound scanLater ultrasound scan

Past Obstetric History

GravidaParity

Outcomes Gestational age Mode of delivery Birth weight Complications

Past Medical History

MedicalSurgicalPsychiatricGynaecologicalAllergies

Family History

Hypertension / CardiovascularVenous thromboembolismPregnancy complicationsTwinsInherited diseaseCongenital malformations

Social History

OccupationMarital status / supportSmokingAlcoholDrugsDomestic violenceChildcare / Housing

Antenatal course

When bookedFolic acidScreening BloodsRhesusDown’s screeningAnomaly / Placental siteVisitsPrevious admissions

Presenting complaint

Vaginal bleedingColour / mucusVolumeProvokedAssociated painAssociated contractionsLoss of liquorUnwellFetus

Antepartum haemorrhage

Placenta praeviaPlacental abruptionLocal causesUnknown

Intelligent history

Comprehensive but efficientDifferential diagnosisTargeted questioning

Prioritising diagnosisFocussed examination

Obstetric examination

Obstetric examination

Third trimester

Antepartum haemorrhage

General examination

AppearanceVital signs pulse

blood pressuretemp

CardiovascularRespiratoryLegs

Obstetric examination

Inspection

Measurement

Palpation

Auscultation

Inspection

DistensionMovement on respiration ScarsLinea nigraStriae gravidarumFetal movement

Measurement

Symphysis- fundal height

Finger breadths below xiphisternum

Palpation

LiePresentationEngagementFetal backLiquorContractionsTenderness / Rigidity

Auscultation

Fetal heart rate

Pinard / Doppler

CTG

Basic Obstetric Skill

Careful history

Comprehensive examination

Further management

Differential diagnosisRevise/Prioritise diagnosisInvestigationsTreatment / Management

Exclude placenta praeviaSpeculum examination

Objectives

Obstetric history and examination

Antenatal care / Healthy pregnancy

Formative assessment

Antenatal care

Antenatal care

Routine Antenatal Care

Healthy Pregnant Woman

Evidence-Based Guideline

see handout

Objectives

Obstetric history and examination

Antenatal care / Healthy pregnancy

Formative assessment

Write short notes