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Supervisor
Dace Rezeberga

Study Course Description

Course Description Statuss:Approved
Course Description Version:2.00
Study Course Accepted:10.04.2019
Study Course Information
Course Code:DUGK_002LQF level:Level 6
Credit Points:6.00ECTS:9.00
Branch of Science:MedicineTarget Audience:Medicine
Study Course Supervisor
Course Supervisor:Dace Rezeberga
Study Course Implementer
Structural Unit:Department of Obstetrics and Gynaecology
The Head of Structural Unit:Dace Rezeberga
Contacts:Rīga, Miera iela 45, Rīgas pašvaldības SIA Rīgas Dzemdību nams, dzgkatrsu[pnkts]lv, dzgkatrsu[pnkts]lv, +371 67293837
Study Course Planning
Full-Time - 1. Semester No.
Lectures (number)2Lecture Length (academic hours)2Total Contact Hours of Lectures4
Classes (number)14Class Length (academic hours)4Total Contact Hours of Classes56
Total Contact Hours60
Lectures (number)Lecture Length (academic hours)Total Contact Hours of Lectures0
Classes (number)15Class Length (academic hours)4Total Contact Hours of Classes60
Total Contact Hours60
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 praxis. 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, rehabilitation of gynecological patients, knowledge about family planning methods, as well as to teach practical skills to use the obtained knowledge.
Topic Layout (Full-Time)
No.TopicType of ImplementationNumberVenue
1Obstetrics and gynaecology as a speciality. Reproductive health, reproductive health indicators. Organisation of delivery care services in Latvia, legislation.Lectures1.00other
2Normal menstrual cycle, evaluation of menstrual cycle, menstrual cycle disorders.Lectures1.00E-Studies platform
3Physiological changes in women during pregnancy, complaints and symptoms associated with physiological course of pregnancy. Diagnostics of pregnancy, gestational age determination. Placenta and its functions. Fetal growth and development. The effects of teratogenic factors. Choice of medications during pregnancy and breastfeeding. Healthy nutrition during pregnancy. Restriction of noncommunicable diseases. Reproductive history.Classes1.00clinical base
4Antenatal care of pregnant women. Role of health care specialists. Investigations/ tests during normal course of pregnancy, interpretation of the results and management of pregnancy. Genetic screening. Alloimmunisation in pregnancy. Evaluation of fetal growth and wellbeing during pregnancy. Gravidogram. Social security benefits during pregnancy.Classes1.00clinical base
5Patient in obstetric ward – examination methods and their informativity. Principles of ethics in reproductive medicine. Bony pelvis in obstetrics, different types of pelvis. Birth canal. Terminology in obstetrics. Fetus lie (Leopold’s maneuvers, sonography). Biomechanics of labour.Classes1.00clinical base
6Normal labour. Management of normal labour. Fetal adaptation mechanisms to hypoxia, monitoring of fetal well-being in labour. CTG.Classes1.00clinical base
7Evaluation of a newborn after delivery. Primary resuscitation of the newborn in delivery room. Apgar score. Adaptation of the newborn.Classes1.00METC
8Simulation of labour.Classes1.00METC
9Physiological puerperium, observation of patient (early warning score). The most frequent complications in puerperium, workup, management. Physiology of lactation. Postpartum depression.Classes1.00clinical base
10Labour dystocia. Instrumental deliveries nowadays – c.section, forceps, vacuum extraction, indications. Ways of reducing the rate of c.section. Comparison of vaginal delivery and c.section risk profile. Breech presentation: management of pregnancy and choosing the way of delivery, external cephalic version. Maternal birth trauma. Genital trauma repair. Venous thromboembolism – prophylaxis before and after delivery. Uterotonics – oxytocin, methylergometrine, misoprostol, use in obstetrics.Classes1.00clinical base
11Frequent complaints in gynaecology (vaginal discharge, abdominal pain, abnormal uterine bleeding, pelvic mass). Reproductive anamnesis. Examination methods and those value: clinical examination, breast examination, palpation of regional lymph nodes. Examination of small pelvis (external genitalia visual examination and palpation, examination per speculum and per vaginam, per rectum, bimanual palpation), office based examinations (taking Pap smear (cytology).Classes1.00clinical base
12Vaginal bleeding in the first trimester of pregnancy - spontaneous abortion, missed abortion, ectopic pregnancy. Pregnancy termination in case of a woman’s request – legislation in Latvia. Methods of termination.Classes1.00clinical base
13Menstrual cycle disorders, classification, differential diagnosis and management. PCOS – impact on women health, reproductive health, management.Classes1.00clinical base
14Abnormal uterine bleeding, etiology, examination methods, differential diagnosis and treatment. Pre-cancerous lesions of endometrium, classification, methods of examination and treatment. FIGO classification. Premenstrual syndrome.Classes1.00clinical base
15Precancerous 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.Classes1.00clinical base
16Infections of the reproductive tract: STD, endogenous and iatrogenic infections – etiology, diagnostic methods, impact on reproductive health, treatment (also during pregnancy). Pelvic inflammatory disease.Classes1.00clinical base
17Pregnancy complications caused by reproductive tract infections (intrauterine infection, GBS). TORCH infections: toxoplasmosis, rubella, herpes, syphilis, Cytomegalovirus, HIV, herpes zoster virus, hepatitis B, prophylaxis of vertical transmission of TORCH infections. Immunisation during pregnancy.Classes1.00clinical base
18Preterm delivery. Prolonged pregnancy, induction of labour. Post-term pregnancy. Assessment of fetal well-being in case of prolonged pregnancy.Classes1.00clinical base
19Antepartum haemorrhage (placental abruption, placenta praevia, etc.), intrapartum haemorrhage (abnormally attached placenta) and early postpartum haemorrhage. The principles of blood loss replacement. Uterotonics, their dosage, use in obstetrics.Classes1.00METC
20Hypertensive disorders during pregnancy. Twin/ multi-fetal pregnancy.Classes1.00clinical base
21Systemic medical diseases and pregnancy – cardiovascular diseases, renal diseases (including asymptomatic bacteriuria, acute pyelonephritis), anemia, antiphospholipid syndrome (AFLS), deep venous thrombosis (DVT), pulmonary embolism (PE), medications and side effects.Classes1.00clinical base
22Endocrine diseases (gestational diabetes, diabetes mellitus, thyroid diseases), neurological disorders (epilepsy, headache), abdominal pain in pregnancy, differential diagnosis, respiratory diseases (bronchial asthma, tuberculosis, pneumonia), depression in pregnancy and after pregnancy, acute surgery in pregnancy. Medication, side effects. Risk assessment in early pregnancy, minimising risk, multidisciplinary approach.Classes1.00clinical base
23Menopausal transition. Menopause: natural, induced, premature; hormonal changes, signs and symptoms, impact on women`s health (urogenital, cardiovascular, bone system, cognitive functions). Hormonal replacement therapy (menopause hormonal treatment): types, indications, contraindications, risks.Classes1.00clinical base
24The meaning of family planning, contraception methods, effectiveness (Pearl index), principles of assessing of possible side effects and contraindications for use. WHO medical eligibility criteria for contraceptive use – contraceptive tool (wheel). Contraception in postpartum period.Classes1.00METC
25Pelvic floor dysfunction. Vaginal and uterine prolapse, etiopathogenesis, classification, diagnostic methods, differential diagnosis, principles of treatment. Urinary incontinence, classification, diagnostic principles, treatment principles. Urogynecology as a subspecialty of gynecology.Classes1.00clinical base
26Uterine fibroids, etiopathogenesis, classification, diagnostics, differentialdiagnosis and management. Uterine sarcoma. Surgical treatment options.Classes1.00clinical base
27Ovarian tumors: etiology, classification, diagnostics, differential diagnosis and treatment. Acute abdomen in gynecology – possible reasons, differential diagnosis, treatment plan.Classes1.00clinical base
28Endometrial, cervical and ovarian cancer: diagnostics, treatment, prophylaxis. Genetic predisposition of ovarian and breast cancer.Classes1.00clinical base
29Chronic pelvic pain. Endometriosis – etiology, pathogenesis, stages, principles of examination and treatment. Primary and secondary dismenorrhoea.Classes1.00clinical base
30Infertility, principles of examination of infertile couple, modern treatment possibilities.Classes1.00clinical base
31Presentation of the report. Clinical exercises about topics in Obstetrics and Gynecology.Classes1.00clinical base
Assessment
Unaided Work:
Clinical simulations and manipulation video uploading; Clinical case history in gynecology or clinical case history in obstetrics; Clinical case exercises in e-studies; Presentation on chosen topic in gynecology or obstetrics.
Assessment Criteria:
Attendance of lectures and seminars; Completion of exercises and tasks during seminars; Simulation and video evaluation; Clinical case exam (multi-choice Q&A).
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 maneuvers and fundal height measurement; 4. Newborn resuscitation.
Competencies:Obtaining reproductive history; Clinical examination for pregnant woman and gynaecological patient; Determination of gestational age, maternity leave regulations; Anatomy of bony pelvis - planes and measurements; Fetal head anatomy and measurements; Mechanism of labour for occipital anterior and posterior presentation; Correct use of hands and perineum support during labour; Fetal heart auscultation using stethoscope, CTG interpretation; Newborn assessment - APGAR score; Student knows what tests and exams to order during physiological pregnancy, knows how to interpret them and what findings are abnormal; Risk factors in pregnancy - genetic abnormalities; asymptomatic bacteriuria, gestational diabetes, iron deficiency anemia; Interpretation of Pap smear results; Cervical examination in speculum - obtaining bacteriological smears; Can provide consultation for family planning and correct use of different contraceptives; Student is able to use their knowledge in explaining etiology and pathogenesis of female gynecological disorders, to examine a gynaecologic patient, diagnostics, to provide treatment and prophylaxis of gynecological diseases.
Clinical Skills:
No.SkillLevel
1Bimanual uterine examinationA - Theoretical
2Bimanual uterine examinationB1 - Pre-clinical (training equipment)
3Bimanual uterine examinationB2 - Pre-clinical (simulation scenario)
4Fundus uteri identificationA - Theoretical
5Fundus uteri identificationB1 - Pre-clinical (training equipment)
6Leopold maneuversA - Theoretical
7Leopold maneuversB1 - Pre-clinical (training equipment)
8Physiological laborA - Theoretical
9Physiological laborB1 - Pre-clinical (training equipment)
10Physiological laborB2 - Pre-clinical (simulation scenario)
Bibliography
No.Reference
1Lekciju materiāls.
2M.Pilmane, G.H. Šūmahers Medicīniskā embrioloģija, Rīgas Stradiņa universitāte 2006.
3Dzemdniecība, D. Rezebergas redakcijā, Nacionālais apgāds, 2016.
4Ginekoloģija, I. Vībergas redakcijā, Nacionālais apgāds, 2013.
1Latvijas ginekologu un dzemdību speciālistu asociācijas vadlīnijas mājas lapā www.ginasoc.lv
2Williams Obstetrics, atkārtoti izdevumi, pieejami RSU e resursos
3Williams Gynecology,atkārtoti izdevumi, pieejami RSU e resursos
4LR likumdošana
5Jaundzimušo reanimācijas rokasgrāmata, American Heart Association, American Academy of Pediatrics, 2004.
1RSU bibliotēkas resursi.
2www.pubmed.com
3Ilona Auziņa. Bērnu un pusaudžu ginekoloģija, Rasa ABC, 2004.