.
Obstetrics and Gynecology
Study Course Description
Course Description Statuss:Approved
Course Description Version:12.00
Study Course Accepted:27.02.2023 09:02:49
| Study Course Information | |||||||||
| Course Code: | DUGK_002 | LQF level: | Level 7 | ||||||
| Credit Points: | 6.00 | ECTS: | 9.00 | ||||||
| Branch of Science: | Clinical Medicine | Target Audience: | Medicine | ||||||
| Study Course Supervisor | |||||||||
| Course Supervisor: | Dace Rezeberga | ||||||||
| Study Course Implementer | |||||||||
| Structural Unit: | Department of Obstetrics and Gynaecology | ||||||||
| The Head of Structural Unit: | |||||||||
| Contacts: | Riga, Miera street 45, Riga Municipality Ltd. Riga Maternity Hospital, dzgk rsu[pnkts]lv, +371 67293837 | ||||||||
| Study Course Planning | |||||||||
| Full-Time - Semester No.1 | |||||||||
| Lectures (count) | 5 | Lecture Length (academic hours) | 2 | Total Contact Hours of Lectures | 10 | ||||
| Classes (count) | 14 | Class Length (academic hours) | 3 | Total Contact Hours of Classes | 42 | ||||
| Total Contact Hours | 52 | ||||||||
| Full-Time - Semester No.2 | |||||||||
| Lectures (count) | 0 | Lecture Length (academic hours) | 0 | Total Contact Hours of Lectures | 0 | ||||
| Classes (count) | 15 | Class Length (academic hours) | 3 | Total Contact Hours of Classes | 45 | ||||
| Total Contact Hours | 45 | ||||||||
| Study course description | |||||||||
| Preliminary Knowledge: | Human anatomy, histology, medical cell biology, embryology, human homeostasis, physiology, medical microbiology, medical genetics, pathology, propedeutics, functional morphology, basics of topographic anatomy, adaptation of functions of the body, internal diseases (cardiology), clinical pharmacology, introduction in surgery, radiology, pathology and morphology of the tumors, medical ethics. | ||||||||
| Objective: | To provide students with knowledge about the onset and course of pregnancy, physiology and pathology of labour and puerperium and to teach the skills for application of acquired knowledge in practice. To provide students with knowledge about physiology and pathology of reproductive system during different periods of woman’s life, main gynecological pathologies – diagnostics, differential diagnostics, principles of treatment, prophylaxis, including prophylaxis of oncological diesases, importance of life style factors on womenš health, knowledge about family planning methods, as well as to teach practical skills to use the obtained knowledge. | ||||||||
| Topic Layout (Full-Time) | |||||||||
| No. | Topic | Type of Implementation | Number | Venue | |||||
| 1 | Obstetrics and gynaecology as a speciality. | Lectures | 1.00 | E-Studies platform | |||||
| 2 | Regulation of the menstrual cycle, menstrual cycle disorders. | Lectures | 1.00 | E-Studies platform | |||||
| 3 | Infections of the reproductive tract. | Lectures | 1.00 | E-Studies platform | |||||
| 4 | Obstetrics and gynaecology for adolescents. | Lectures | 1.00 | E-Studies platform | |||||
| 5 | What every doctor needs to know about sexual health? | Lectures | 1.00 | E-Studies platform | |||||
| 6 | Preconception period and its importance. Physiologic changes during pregnancy. Diagnosis of pregnancy. Placenta and its functions. Effects of teratogenic factors on fetus. Medications during pregnancy and lactation. Healthy diet during pregnancy and lactation. Prevention of of noncommunicable diseases. Reproductive history | Classes | 1.00 | E-Studies platform | |||||
| 7 | Antenatal care, role of health care providers. What examinations should be performed, why, how to interpret them and what should be done in case of abnormal findings. Genetic screening. Isoimmunization during pregnancy, management, prophylaxis. Assessment of fetal growth and well-being during pregnancy, screening for anomalies. Gravidogram. Iron defficency anemia during pregnancy. | Classes | 1.00 | clinical base | |||||
| 8 | Pregnant woman in delivery ward – methods of examination and interpretation of the , ethical principles. Pelvic bone in women, different types of pelvis. Birth canal and fetus. Terminology in obstetrics. Fetal position (Leopold’s maneuvers, sonography). Biomechanics of labour. (Leopold’s maneuvers demonstration by teacher) | Classes | 1.00 | clinical base | |||||
| 9 | Normal labour. Partogram. Management of normal delivery. Mechanisms of fetal adaptation to hypoxia during labour. Monitoring of fetal well-being. CTG. | Classes | 1.00 | clinical base | |||||
| 10 | Assessment of newborn after delivery. Apgar’s score. Physiological adaptation of the newborn after birth. Primary resuscitation of the newborn. (Demonstration of newborn resuscitation according to the videos in e-studies). After this lecture students are welcome to record 2 obstretical manipulations of obstetrics (Leopold’s maneuvers and newborn resuscitation). | Classes | 1.00 | METC | |||||
| 11 | Labour simulation in Medical Education Technology Centre. | Classes | 1.00 | METC | |||||
| 12 | Normal puerperium, assessment of patient after delivery, obstetrical early warning score (OEWS). Physiology of lactation. Complications after delivery, management. Lactation. | Classes | 1.00 | clinical base | |||||
| 13 | Dystocia. Operative deliveries – Cesarean section, forceps, vacuum extraction. Traumatic deliveries. Prophylaxis of deep venous thrombosis and pulmonary embolism after delivery and in post-operative period. Abnormal fetal pand presentation – breech presentation. External cephalic version. | Classes | 1.00 | clinical base | |||||
| 14 | Pregnancy complications caused by reproductive tract infections (intrauterine infections, GBS). TORCH infections during pregnancy (toxoplasmosis, rubella, syphilis, herpes, cytomegalovirus, HIV, varicella), prophylaxis of vertical transmission of TORCH infections. Urinary tract infections during pregnancy. | Classes | 1.00 | clinical base | |||||
| 15 | Preterm delivery. Prolongation of pregnancy, induction of labor. Post-term pregnancy. Assessment of fetal well-being in case of prolonged pregnancy. Twin / multi-fetal pregnancy | Classes | 1.00 | clinical base | |||||
| 16 | Vaginal bleeding in late pregnancy (placental abruption, placenta praevia), in labour and in early puerperium. Iron supplements, blood transfusion. Uterotonics, dosage, use in obstetrics. | Classes | 1.00 | clinical base | |||||
| 17 | Hypertensive disorders during pregnancy. Systemic medical diseases and pregnancy – renal disases, cardiovascular diseases, antiphospholipid syndrome, DVT, PATE. Medications, side-effects. Risk assessment in antenatal care, risk reduction strategy, multidisciplinary approach. | Classes | 1.00 | E-Studies platform | |||||
| 18 | Endocrine diseases (gestational diabetes, diabetes mellitus, thyroid diseases), neurological disorders (epilepsy, headache), respiratory diseases (bronchial asthma, tuberculosis, pneumonia), depression in pregnancy and in post partum period, surgical diseases in pregnancy. Abdominal pain in pregnancy, differential diagnosis. Medication, side effects. Risk assessment in early pregnancy, minimizing risk, multidisciplinary approach. | Classes | 1.00 | E-Studies platform | |||||
| 19 | Clinical skills - theory and algorithm: Obstetrics. Each student will be asked to demonstrate the theoretical and practical knowledge in performing obsterical manipulations, which will be scored by the teacher (Leopold maneuers, fundal hight measurement, newborn resuscitation, evaluation/suppurt of newborn adaptation after birth, labour management outside the hospital, umbilical cord clamping, management of the placental period) | Classes | 1.00 | clinical base | |||||
| 20 | The most frequent complaints in gynecology. Examination methods their informativity: examination per speculum, bimanual palpation, taking Pap smear (cytology), taking samples for bacteriology and bacterioscopy, cervical biopsy, endometrial biopsy, cervical and uterine curettage (D&C), puncture of the Douglas pouch, methods of checking permeability of ovarian tubes, endoscopic methods (colposcopy, hysteroscopy, office hysteroscopy, laparoscopy), visual (USG, MRI, CT, hysterosalpingography) and la | Classes | 1.00 | clinical base | |||||
| 21 | Disorders of menstrual cycle, principles of classification, diagnostics, differential diagnosis and therapy. Abnormal uterine bleeding, etiology, examination methods, differential diagnosis and treatment. FIGO classification. Pre-cancerous lesions of endometrium, endometrial hyperplasia, classification, diagnostics and treatment. | Classes | 1.00 | clinical base | |||||
| 22 | Pre-cancerous lesions of cervix: etiology, screening, interpretation of cytology, histological examination, role of colposcopy in diagnostics of cervical pathology, observation and treatment of patients (cervical excisions and ablations). Primary and secondary prophylaxis of cervical cancer. After this lecture students are allowed to record two gynecological manipulations (bimanual examination and cervical cytology obtaining). | Classes | 1.00 | clinical base | |||||
| 23 | Amenorrhea - classification, principles of diagnostics, differential diagnosis and therapy. Hormonal tests. PCO syndrome. Sources of androgens in female body, differentiation. Premenstrual syndrome. | Classes | 1.00 | clinical base | |||||
| 24 | Reproductive tract infections: STD, endogenous and iatrogenic infections – etiology, diagnostic methods, impact on reproductive health, treatment (also during pregnancy). Pelvic inflammatory disease. | Classes | 1.00 | E-Studies platform | |||||
| 25 | Vaginal bleeding in the first trimester of pregnancy - spontaneous abortion, missed abortion, ectopic pregnancy. Pregnancy termination in case of woman’s request – legislation in Latvia. Methods of termination. | Classes | 1.00 | clinical base | |||||
| 26 | Family planning methods - effectiveness, safety, contraindications, side effects. Hormonal contraception - types, principles of choice. WHO criteria in usage for contraceptive use. | Classes | 1.00 | METC | |||||
| 27 | Infertility, reasons, principles of examination of the infertile couple, modern treatment possibilities. | Classes | 1.00 | clinical base | |||||
| 28 | Uterine fibroids, etiology, classification, workup, differential diagnosis and treatment. Adnexal masses. Acute abdominal pain in gynecology – etiology, differential diagnosis, treatment. Surgical treatment methods in gynecology. | Classes | 1.00 | clinical base | |||||
| 29 | Chronic pelvic pain. Endometriosis – etiology, pathogenesis, stages, principles of examination and treatment. Primary and secondary dysmenorrhea. | Classes | 1.00 | E-Studies platform | |||||
| 30 | Pelvic floor dysfunction. Descending of vagina and uterus – etiology, classification, principles of diagnostics, differential diagnosis and therapy. Urinary incontinence, classification, workup, treatment. Types of urinary incontinence, workup, treatment. | Classes | 1.00 | E-Studies platform | |||||
| 31 | Endometrial, cervical and ovarian cancer: diagnostics, treatment, prophylaxis. Genetic predisposition of ovarian and breast cancer. | Classes | 1.00 | clinical base | |||||
| 32 | The menopausal transition. Menopause: natural, iatrogenic, early; hormonal changes, physical changes. Effects on quality of life and organ systems - urogenital, cardiovascular, bone system, cognitive function. Hormonal replacement therapy (HRT), indications, side-effects, maintenance of quality of life in menopause. | Classes | 1.00 | clinical base | |||||
| 33 | Clinical skills - theory and algorithm: Gynecology. Each student will be asked to demonstrate the theoretical and practical knowledge in performing gynecological manipulations and tasks, which will be scored by the teacher (cervical cytology, bimanual pelvic examination, choice of family planning method according to the WHO principles) | Classes | 1.00 | clinical base | |||||
| 34 | Clinical skills – reproductive history will be evaluated and scored by the teacher. | Classes | 1.00 | clinical base | |||||
| Assessment | |||||||||
| Unaided Work: | Independent learning of manipulations and manipulation video capturing. Preparation of clinical case exercises in e-studies for disc ussion during the practical classes. Self-tests in e studies. Students should fill out the study course survey questionnaire (for an example, see the video: https://panopto.rsu.lv/Panopto/Pages/Viewer.aspx?id=9558208…). | ||||||||
| Assessment Criteria: | Attendance at lectures and classes; Acquisition of independent skills and evaluation of video manipulation recording with "passed" or "failed" during the VII semester; In the last class of each semester (14th class) one manipulation will be evaluated with a mark according to the lottery principle and learned topic. It will make - up 20% of the total evaluation of the course of Obstetrics and gynaecology. Obtaining of the patient's reproductive history at the end of the VIII semester and receiving grade; The evaluation of the VII semester consists of - 20% analysis of clinical case. The evaluation of the VIII semester consists of - 10% reproductive anamnesis + 20% manipulation evaluation; 50% multiple-choice exam grade. Total annual assessment consists - (20% analysis of clinical case + 10% reproductive anamnesis + 20% manipulation evaluation) + 50% multiple-choice exam grade. | ||||||||
| Final Examination (Full-Time): | Exam | ||||||||
| Final Examination (Part-Time): | |||||||||
| Learning Outcomes | |||||||||
| Knowledge: | The student understands the principles of perinatal care organisation, indicators of quality of care, Latvian legislation of reproductive health, is able to explain anatomy and physiology of the female reproductive system, the process of fertilisation, development of the fetus and placenta, physiology of pregnancy. Knows principles of obtaining reproductive anamnesis and basic methods of the gynecologic examination of women. Can define the basic antenatal care programme, screening of genetic and other diseases, understands the course of normal and pathological pregnancy: spontaneous interruption of pregnancy till 22 weeks of gestation, ectopic pregnancy, trophoblastic disease, normal labour, delivery, physiologic postpartum period, breastfeeding, dystocia during labour and delivery, pre-term and post-term delivery, twin pregnancy, intrauterine growth retardation, fetal antenatal testing, TORCH infections during pregnancy, isoimmunisation during pregnancy, bleeding during pregnancy, delivery and postpartum, birth trauma in mother and newborn, hypertensive disorders during pregnancy, extra-genital pathologies during pregnancy, operative delivery, postpartum septic complications, physiology and pathology of newborns, primary care of newborn and resuscitation. Understands clinical pharmacology of medications used during perinatal care. Knows the regulations and methods of termination of pregnancy till 22 weeks of pregnancy. Understands the role of normal microflora of the genital tract in context of reasons of gynecologic and obstetric pathology: STI, endogen and iatrogenic infection – etiology, diagnostic methods, impact on reproductive health, treatment (also during pregnancy), pelvic inflammatory disease, septic postpartum complications (endometritis, wound infection). Understands the reasons of uterine bleeding: disorders of the menstrual cycle, endometrial precancerous lesions, endometrial cancer, principles of diagnosis and treatment. Understands options of primary and secondary prophylaxis of cervical cancer, pathogenesis and progression of cervical cancer, principles of diagnostics and treatment of cervical cancer. Knows family planning methods and principles of their choice. Understands reasons of female virilization, diagnostics and treatment principles of polycystic ovary syndrome, understands role of estrogens in female body in different periods of woman’s life, pathogenesis of estrogen deficiency and principles of treatment (menopause, hormone replacement therapy). Understands about subspecialties of gynecology – urogynecology, human embryology and reproduction and associated problems – pelvic floor dysfunction, and infertility. Understands main gynecologic operations and manipulations, knows how to prepare the patient, how to manage postoperative period. Understanding about benign and malignant tumors of genitals – uterine myoma, ovarian tumors, reasons of chronic pelvic pain and options of differentiation, endometriosis, primary and secondary dysmenorrhea, premenstrual syndrome. | ||||||||
| Skills: | Upon completion of the course the student is able to apply the following practical skills: 1. Bimanual pelvic examination; 2. Cervical examination in speculum, obtaining Pap smear; 3. Leopold manoeuvres and fundal height measurement; 4. Newborn resuscitation; 5. Physiological labour management. 6. Usage of WHO contraception eligibility criteria during family planning consultation. | ||||||||
| Competencies: | Obtaining reproductive history. Clinical examination for pregnant women and gynecological patients.Determination of the due date (delivery date). Understanding the physiological course of childbirth and the principles of childbirth management. Demonstrate manual techniques in physiological delivery and neonatal care. Assess the condition of the fetus - ausculatiom of the fetal heartbeat with a fetal doppler. Student lists and describes the parameters theat have to be assess in newborn after birth, knows how to provide a safe environment for the newborn and understands if any support is needed. Undersatands the evidedence based principles of antenatal care, can recognize the most frequent high risk pregnancies: fetal genetic abnormalities, asymptomatic bacteriuria, gestational diabetes, iron deficiency anemia, hypertensive disorders, abnormal fetal growth, twin pregnancy, TORCH infections et c. Can explain the principles of primary and secondary prevention of cervical cancer, explains how to take cervical cancer screening examinations and interprets the results of cervical cancer screening. Can consult a woman on the choice and application of family planning methods. Can mention the main symptoms of gynecological diseases, the application of differnt examination methods, understands the informativity of examination methods, describes prevention of reprductive tract diseases and main treatment modalities. Understands the principles of drug selection during pregnancy and lactation. | ||||||||
| Clinical Skills: | |||||||||
| No. | Skill | Level | |||||||
| 1 | Bimanual uterine examination | A - Beginner level | |||||||
| 2 | Bimanual uterine examination | B1 - Basic level | |||||||
| 3 | Bimanual uterine examination | B2 - Intermediate level | |||||||
| 4 | Due date estimation | A - Beginner level | |||||||
| 5 | Fundus uteri identification | A - Beginner level | |||||||
| 6 | Fundus uteri identification | B1 - Basic level | |||||||
| 7 | Leopold maneuvers | A - Beginner level | |||||||
| 8 | Leopold maneuvers | B1 - Basic level | |||||||
| 9 | Newborn primary resuscitation | B1 - Basic level | |||||||
| 10 | Physiological labor | A - Beginner level | |||||||
| 11 | Physiological labor | B1 - Basic level | |||||||
| 12 | Physiological labor | B2 - Intermediate level | |||||||
| 13 | Prevention of the postpartum haemorrhage (PPH) | B1 - Basic level | |||||||
| 14 | Primary care of the neonate in physiological labor | A - Beginner level | |||||||
| 15 | Reproductive hystory of gynecological patient | C1 - High level | |||||||
| 16 | The cord cutting | A - Beginner level | |||||||
| 17 | The cord cutting | B1 - Basic level | |||||||
| 18 | The cord cutting | B2 - Intermediate level | |||||||
| 19 | Use of contraceptive tool during consultation about contraception | C1 - High level | |||||||
| Bibliography | |||||||||
| No. | Reference | ||||||||
| Required Reading | |||||||||
| 1 | Lekcijas un metodiskais materiāls e studijās | ||||||||
| 2 | M. Pilmane, G.H. Šūmahers. Medicīniskā embrioloģija. Rīgas Stradiņa universitāte, 2006. | ||||||||
| 3 | Dzemdniecība. D. Rezebergas redakcijā. Nacionālais apgāds, 2016. | ||||||||
| 4 | Ginekoloģija. J.Žodžikas redakcijā. RSU tipogrāfija, 2022. | ||||||||
| Additional Reading | |||||||||
| 1 | Latvijas ginekologu un dzemdību speciālistu asociācijas vadlīnijas mājas lapā | ||||||||
| 2 | Williams Obstetrics, atkārtoti izdevumi, pieejams RSU bibliotēkas e resursos | ||||||||
| 3 | Williams Gynecology,atkārtoti izdevumi, pieejams RSU bibliotēkas e resursos | ||||||||
| 4 | LR likumdošana | ||||||||
| 5 | Piemērots uzturs, plānojot grūtniecību un grūtniecības laikā, — veselīga dzīves sākuma pamats, Ieteikumi veselības aprūpes speciālistiem, 2017 | ||||||||
| Other Information Sources | |||||||||
| 1 | PVO resursi | ||||||||
| 2 | www.pubmed.com | ||||||||
| 3 | Perinatālā perioda aprūpes algoritmi, pieejami Slimību profilakses un kontroles centra mājas lapā | ||||||||
| 4 | pieejams RSU bilbiotēkas e resursos | ||||||||
