Special Tutorial Programme Professor Deirdre J Murphy Trinity College.

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Presentation transcript:

Special Tutorial Programme Professor Deirdre J Murphy Trinity College

Course aims Medical knowledge Clinical skills Professionalism Formative assessment Student 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 - Age Dating of pregnancy Past Obstetric history Past Medical/Surgical/Gynae history Family history Social history Antenatal course Presenting complaint

Dating Menses – regular, length, sure Contraception Naegles rule First trimester ultrasound scan Later ultrasound scan

Past Obstetric History Gravida Parity Outcomes Gestational age Mode of delivery Birth weight Complications

Past Medical History Medical Surgical Psychiatric Gynaecological Allergies

Family History Hypertension / Cardiovascular Venous thromboembolism Pregnancy complications Twins Inherited disease Congenital malformations

Social History Occupation Marital status / support Smoking Alcohol Drugs Domestic violence Childcare / Housing

Antenatal course When booked Folic acid Screening Bloods Rhesus Down’s screening Anomaly / Placental site Visits Previous admissions

Presenting complaint Vaginal bleeding Colour / mucus Volume Provoked Associated pain Associated contractions Loss of liquor Unwell Fetus

Antepartum haemorrhage Placenta praevia Placental abruption Local causes Unknown

Intelligent history Comprehensive but efficient Differential diagnosis Targeted questioning Prioritising diagnosis Focussed examination

Obstetric examination

Third trimester Antepartum haemorrhage

General examination Appearance Vital signspulse blood pressure temp Cardiovascular Respiratory Legs

Obstetric examination Inspection Measurement Palpation Auscultation

Inspection Distension Movement on respiration Scars Linea nigra Striae gravidarum Fetal movement

Measurement Symphysis- fundal height Finger breadths below xiphisternum

Palpation Lie Presentation Engagement Fetal back Liquor Contractions Tenderness / Rigidity

Auscultation Fetal heart rate Pinard / Doppler CTG

Basic Obstetric Skill Careful history Comprehensive examination

Further management Differential diagnosis Revise/Prioritise diagnosis Investigations Treatment / Management Exclude placenta praevia Speculum examination

Objectives Obstetric history and examination Antenatal care / Healthy pregnancy Formative assessment

Antenatal care

Routine Antenatal Care Healthy Pregnant Woman Evidence-Based Guideline see handout

Objectives Obstetric history and examination Antenatal care / Healthy pregnancy Formative assessment

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