Special Tutorial Programme

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Special Tutorial Programme

• Professor Deirdre J Murphy
• Trinity College

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Course aims

• Medical knowledge
• Clinical skills
• Professionalism
• Formative assessment
• Student feedback

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Goals

• Every student completes OG programme
  successfully
• Every individual is competent to provide basic
  care in OG as a qualified doctor

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Introduction to Obstetric Care
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Objectives

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

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Obstetric history

• Woman in late pregnancy admitted with vaginal
  bleeding

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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

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Dating

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

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Past Obstetric History

• Gravida
• Parity
• Outcomes
• Gestational age
• Mode of delivery
• Birth weight
• Complications

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Past Medical History

• Medical
• Surgical
• Psychiatric
• Gynaecological
• Allergies

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Family History

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

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Social History

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

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Antenatal course

• When booked
• Folic acid
• Screening Bloods
• Rhesus
• Downs screening
• Anomaly / Placental site
• Visits
• Previous admissions

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Presenting complaint

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

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Antepartum haemorrhage

• Placenta praevia
• Placental abruption
• Local causes
• Unknown

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Intelligent history

• Comprehensive but efficient
• Differential diagnosis
• Targeted questioning
• Prioritising diagnosis
• Focussed examination

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Obstetric examination
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Obstetric examination

• Third trimester
• Antepartum haemorrhage

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General examination

• Appearance
• Vital signs pulse
• blood pressure
• temp
• Cardiovascular
• Respiratory
• Legs

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Obstetric examination

• Inspection
• Measurement
• Palpation
• Auscultation

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Inspection

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

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Measurement

• Symphysis- fundal height
• Finger breadths below xiphisternum

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Palpation

• Lie
• Presentation
• Engagement
• Fetal back
• Liquor
• Contractions
• Tenderness / Rigidity

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Auscultation

• Fetal heart rate
• Pinard / Doppler
• CTG

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Basic Obstetric Skill

• Careful history
• Comprehensive examination

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Further management

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

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Objectives

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

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Antenatal care
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Antenatal care

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

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Objectives

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

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