1. Special Tutorial Programme Professor Deirdre J Murphy Trinity College

2. Course aims Medical knowledge Clinical skills Professionalism Formative assessment Student feedback

3. Goals Every student completes O&G programme successfully Every individual is competent to provide basic care in O&G as a qualified doctor

4. Introduction to Obstetric Care

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

6. Obstetric history Woman in late pregnancy admitted with vaginal bleeding

7. 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

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

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

10. Past Medical History Medical Surgical Psychiatric Gynaecological Allergies

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

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

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

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

15. Antepartum haemorrhage Placenta praevia Placental abruption Local causes Unknown

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

17. Obstetric examination

19. Third trimester Antepartum haemorrhage

20. General examination Appearance Vital signspulse blood pressure temp Cardiovascular Respiratory Legs

21. Obstetric examination Inspection Measurement Palpation Auscultation

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

23. Measurement Symphysis- fundal height Finger breadths below xiphisternum

24. Palpation Lie Presentation Engagement Fetal back Liquor Contractions Tenderness / Rigidity

25. Auscultation Fetal heart rate Pinard / Doppler CTG

26. Basic Obstetric Skill Careful history Comprehensive examination

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

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

29. Antenatal care

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

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

32. Write short notes