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Special Tutorial Programme

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... sure Contraception Naegles rule First trimester ultrasound scan Later ultrasound scan Past Obstetric History Gravida Parity Outcomes Gestational age Mode of ... – PowerPoint PPT presentation

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Title: Special Tutorial Programme


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 OG programme
    successfully
  • Every individual is competent to provide basic
    care in OG 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
  • Downs 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
18
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19
Obstetric examination
  • Third trimester
  • Antepartum haemorrhage

20
General examination
  • Appearance
  • Vital signs pulse
  • 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
Antenatal care
  • Routine Antenatal Care
  • Healthy Pregnant Woman
  • Evidence-Based Guideline
  • see handout

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

32
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