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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 Downs 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

Obstetric examination
Third trimester
Antepartum haemorrhage

General examination
Appearance Vital signs

pulse 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

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

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