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  13. Maternal fetal medicine

Maternal fetal medicine

Objectives for fourth year maternal-fetal medicine rotation:

Daily schedule: hours 6:00 a.m. - sign-out at 5:30 p.m.

Weekday Mornings:

Daily- Externs are expected to make rounds with the obstetrical service on antepartum, postpartum and labor and delivery patients, prior to perinatal rounds, starting at a time to be determined by the chief obstetrical resident.

Monday, Tuesday, Wednesday and Thursday
7:30 a.m. - Low Risk OB Rounds
8:00 a.m. - Perinatal Service Rounds-3 West Conference Room

Friday
7:00 a.m. – 10:00a.m. Resident Educational Meetings. Participation in the resident lecture series is strongly recommended.

Following Perinatal Service Rounds, externs are expected to participate in the care of and delivery of patients in labor and delivery, under the supervision of residents on the obstetrical service. This experience should include:

  • Admitting patients to labor and delivery
  • Management of patients during the labor process and those with pregnancy complications
  • Participation in the delivery of patients
  • Assisting in the cesarean delivery of patients
  • Other procedures as determined by senior resident staff

Weekday afternoons:

Tuesday Afternoons:
Externs are expected to participate in the resident high-risk obstetrical clinic in the Maternal-Fetal Medicine Office. (Parkside Suite 325)

Monday and Thursday afternoons:
Participation in Maternal-Fetal Medicine attending staff office sessions and/or observation of obstetrical ultrasounds in the Maternal Fetal Medicine office is expected. These dates may change according to attending schedules and other student rotations.

Call schedule:

While not mandatory it is recommended that participants in the maternal fetal medicine rotation choose one night per week for in-house call on the labor and delivery unit. The day for call should be determined after discussions with the senior obstetrical resident. The schedule for the student on the day after call should be in accordance with guidelines of the particular school the student attends.

Presentation:

It is expected that the externs will give a presentation to the obstetrical service on the last Friday of the rotation. The topic of this presentation should be one of interest and significant to the high-risk obstetrical rotation. Please select a topic in the first week of the rotation and make sure it is approved by the Chief OB resident. Overheads and or slides would enhance the presentation but are not mandatory. An outline or handout of the presentation should be available for participants. The presentation should last approximately 10 minutes and should highlight the presenters understanding of the topic, and ability to organize the topic/presentation appropriately.

Maternal-Fetal Medicine Rotation Objectives:
The following objectives are given to enhance participant’s abilities to organize the studies regarding the high-risk obstetrics rotation. These objectives are not all-inclusive and participants should strive to cover these topics at a minimum along with other topics relating to patients under their care. For recommendations on books to use during this rotation please check with senior obstetrical residents or Maternal-Fetal Medicine attending physicians.

A) Maternal-Fetal Physiology
The student will demonstrate knowledge of the following:

  • Maternal physiologic changes associated with pregnancy
  • Physiologic functions of the placenta and fetus
  • Effect of pregnancy on common diagnostic studies

B) Antepartum Care
The student will demonstrate knowledge of the following:

  • Medical conditions such as diabetes mellitus, chronic hypertensive vascular disease, and heart disease.
  • Recurrent pregnancy loss
  • History of genetic abnormalities
  • Maternal age over 35
  • Substance Abuse
  • Assessment of gestational age
  • Assessment of fetal growth, well being, and maturity

The student will demonstrate the following skills:

  • Performing a physical examination on obstetric patients
  • Answering commonly asked questions concerning pregnancy, labor and delivery

C.) Intrapartum Care
The student will demonstrate knowledge of the following:

  • Characteristics of true and false labor
  • Initial assessment of the laboring patient
  • Stages and mechanism of normal labor
  • Techniques to evaluate the progress of labor
  • Pain management during labor
  • Methods of monitoring the mother and fetus
  • Management of normal delivery and episiotomy repair
  • Indications for operative delivery
  • Postpartum care of the mother

D.) Medical and Surgical Conditions in Pregnancy
The student will demonstrate knowledge of the following conditions in pregnancy:

  • Anemia
  • Diabetes mellitus
  • Urinary tract disorders
  • Infectious diseases, including:
    • Herpes
    • Group B Beta strep
    • HIV
    • Hepatitis B.
  • Cardiac disease
  • Asthma
  • ETOH, tobacco, and other substance abuse
  • Acute abdominal symptoms

E.) Pre-eclampsia-Eclampsia Syndrome
The student will demonstrate knowledge of the following:

  • Definitions and classifications of hypertension in pregnancy
  • Pathophysiology of preeclampsia-eclampsia syndrome
  • Symptoms, physical findings and diagnostic methods
  • Approach to management
  • Maternal and fetal complications

F.) D-Isoimmunization
The student will demonstrate knowledge of the following:

  • Antigens of the Rh system
  • Use of immunoglobulin prophylaxis during pregnancy
  • Clinical circumstances under which D-isoimmunization is most likely to occur
  • Methods to determine severity of fetal involvement

G.) Multifetal Gestation
The student will demonstrate knowledge of the following:

  • Etiology of monozygotic, dizygotic and multizygotic gestation
  • Altered physiologic state with multifetal gestation
  • Symptoms, physical findings and diagnostic methods
  • Approach to antepartum, intrapartum and postpartum management

H.) Abnormal Labor
The student will demonstrate knowledge of the following:

  • Various abnormal labor patterns
  • Methods of evaluating feto-pelvic disproportion
  • Fetal and maternal complications resulting from abnormal labor
  • Indications and contraindications for oxytocin use and administration
  • Management of abnormal fetal presentations
  • Vaginal birth after cesarean section

I.)Third Trimester Bleeding
The student will demonstrate knowledge of the following:

  • Approach to the patient who presents with third trimester bleeding
  • Symptoms, physical findings, and diagnostic methods that differentiate patients with placenta previa and abruption placenta from those with other causes of third trimester bleeding
  • Complications of placenta previa and abruptio placenta

J.) Preterm Labor
The student will demonstrate knowledge of the following:

  • Impact of preterm labor and delivery on neonatal morbidity and mortality
  • Factors predisposing to preterm labor
  • Signs and symptoms of premature uterine contractions
  • Causes of preterm labor
  • Principles of tocolysis

K.) Premature Rupture of Membranes
The student will demonstrate knowledge of:

  • History, physical findings and diagnostic methods to confirm premature rupture of membranes
  • Conditions favoring expected to management vs. timely delivery
  • Methods to monitor maternal and fetal status in expectant to management

L.) Intrapartum Fetal Distress
The student will demonstrate knowledge of the following:

  • Techniques of intrapartum fetal surveillance including
  • Ascultation
  • Electronic fetal monitoring
  • Reassuring fetal heart rate patterns
  • Recognition and management of non-reassuring fetal heart patterns

M.) Postpartum Hemorrhage
The student will demonstrate knowledge of the following:

  • Risks associated with postpartum hemorrhage
  • Immediate management of the patient with postpartum hemorrhage including:
  • Inspection for laceration
  • Use of and types of uterine contractile agents

N.) Postpartum Infection
The student will demonstrate knowledge of the following:

  • Risk factors for postpartum infection
  • Infectious organisms
  • Evaluation and management of the patient with postpartum infection
  • Use of prophylactic antibiotics

O.) Mortality
The student will demonstrate knowledge of the following

  • Maternal death
  • Fetal death
  • Neonatal death
  • Perinatal death

P.) Postterm Pregnancy
The student will demonstrate knowledge of the following:

  • Normal period of gestation
  • Risks of post maturity
  • Antepartum fetal surveillance
  • Management of prolonged gestation
  • Methods and agents for cervical ripening

Q.) Fetal Growth Anomalies
The student will demonstrate knowledge of the following:

  • Definitions of macrosomia and fetal growth restriction.
  • Etiologies of abnormal growth
  • Methods of detection of fetal growth abnormalities
  • Associated morbidity and mortality