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HUMAN DEVELOPMENT: Obstetrics and Gynaecology

Index

• General Outcomes for Obstetrics and Gynaecology
• Menstrual Disorders
• Puberty
• Contraception
• Fertility and Infertility
• Antenatal Care and Fetal Screening
• Pregnancy
• Fetal development
• Labour and Delivery
• Puerperium and Lactation
• The Menopause (inc. HRT)
• Gynaecological Oncology
• Pelvic Floor Dysfunction
• Sexually Transmitted Infections and Pelvic Inflammatory Disease
• Therapeutics in O&G
• Ovarian Disorders
• Uterine Disorders
• Vulval Disorders

• General Outcomes for Obstetrics and Gynaecology
  • Medical knowledge: ANATOMY
    • Female Pelvis and Reproductive System
      1. Describe the anatomy of the vagina and cervix and their clinical examination (HD2)
      2. Identify the female reproductive organs (O&G4)
      3. Understand the relationships between the gynaecological organs and the bony pelvis, pelvic floor muscles, ligaments and other non-gynaecological pelvic and abdominal structures (O&G4)
      4. Understand the anatomical support of the uterus and vagina (O&G4)
      5. Identify the components of the pelvic floor and the perineal body (O&G4, O&G4)
      6. Basic knowledge on the vasculature and nerve supply of the pelvic organs (O&G4)
  • Medical knowledge: PHYSIOLOGY
    • Female Reproductive Physiology
      1. Be able to explain the normal ovarian cycle (HD1)
      2. Explain the endocrinology and physiology of the menstrual cycle (HD1, O&G4)
      3. Describe the lifetime changes of the uterus (HD2)
    • Physiology of Growth and Puberty
      1. Understand the physiology of puberty and the associated physical changes (11/12 Arch, CH4, HD1, HD1, HD1, O&G4)
    • The Hormones of Reproduction
      1. Carry out analyses, present and interpret findings (HD1)
    • Adaptation of Fetus to Neonate - General
      1. 1. Understand the difference between embryonic and fetal periods of development and the clinical significance to organ development and growth. (HD1)
  • Clinical skills: HISTORY and EXAMINATION
    • O&G Examination
      1. Describe the anatomy of the vagina and cervix and their clinical examination (HD2)
      2. Be able to perform a bimanual pelvic examination and taking genital swabs (O&G4)
      3. Be able to perform an obstetric examination (O&G4)
  • Clinical skills: INVESTIGATION
    • Sexual Health Investigations
      1. Be able to take microbiological and virological swabs from ano-genital sites which are appropriate to the patient's symptoms and risk factors, and which are appropriate to the medical setting (general practice, A&E, the ward, outpatient clinics) (O&G4)
  • Clinical skills: DIAGNOSTIC PROCEDURES
    • General Procedures
      1. Be able to take a cervical smear and perform a full sexual health screen (O&G4)
• Menstrual Disorders
  • General Outcomes for Menstrual Disorders
    1. Know the different types of menstrual disorders and be able to differentiate between them (O&G4)
    2. Outline the theories of causation, pathological features and complications of endometriosis and adenomyosis (HD2, O&G4)
    3. Outline an appropriate plan for investigations and management of menstrual disorders (O&G4)
    4. Understand the clinical presentation, causes, management and complications of fibroids, endometriosis and adenomyosis (O&G4)
    5. Be able to list the causes of endometrial hyperplasia; discuss the relationship to endometrial carcinoma. (O&G4, O&G4)
    6. Be able to list the causes of endometrial hyperplasia; discuss the relationship to endometrial carcinoma. (O&G4, O&G4)
• Puberty
  • General outcomes for puberty
• Contraception
  • General Outcomes for Contraception
    1. Understanding the different methods of contraception, including the rhythm method, spermicide, barrier method, and IUDs, regarding their mechanism of action, risks/benefits, contraindication, efficacy and ethical considerations (O&G4)
    2. Be able to obtain a contraceptive and reproductive health history to assess contraceptive need and to discuss contraceptive choices to enable patients to make informed decisions on those choices (I&I 4)
    3. Be able to distinguish between the following terms and conditions: Rhythm method; Spermacide; Barrier method; Intra-uterine device (IUD) (HD1)
    4. To explain principles of safer sex and risk reduction and be able to demonstrate correct condom technique (I&I 4)
    5. To manage under supervision or refer as appropriate the contraceptive needs of a client presenting with a medical condition which may contraindicate the method s/he is currently using. (I&I 4)
    6. To describe to a client methods of emergency contraception and indications and guidance for use (I&I 4)
    7. Be able to discuss the pros and cons of commonly used methods of family planning with a patient (HD1)
    8. Apply "BRAINS & AIMS" when choosing, giving and monitoring the following medications: Progestrone Only Contraceptive Pills (POP), Combined Oral Contraceptive Pills (COCP), Injectable progestogens, Copper IUD, Progestogen containing IUD, Contraceptive patc (O&G4)
    9. Outline the advantages and disadvantages of each of the methods of contraception including post-coital contraception and its dangers (HD1)
    10. To demonstrate basic knowledge of currently available contraceptive methods and be able to communicate to clients the mechanism of action and failure rate (I&I 4, O&G4, O&G4)
    11. To describe to a client methods of emergency contraception and indications and guidance for use (O&G4)
    12. Be able to discuss methods of contraception with a breast feeding mother (O&G4)
    13. New development in contraception (O&G4)
• Fertility and Infertility
  • General Outcomes for Fertility, Implantation and Infertililty
    1. Be able to discuss the pros and cons of commonly used methods of family planning with a patient (HD1)
    2. Define primary and secondary subfertility (O&G4)
    3. Describe the essential ingredients for fertilisation (HD1)
    4. List of causes for male and female subfertility (O&G4)
    5. Explain the normal processes which occur from fertilisation to implantation (HD1)
    6. Summarise the important features of implantation and placentation (HD1)
    7. General screening for subfertile male and female (O&G4)
    8. Indicate how there is maternal recognition of pregnancy (HD1)
    9. Clinical features of Polycystic Ovarian Syndrome (PCOS), endocrine abnormalities and varied presentations (HD2, O&G4)
    10. Management of PCOS, Endometriosis, Fibroids, Chronic PID - including investigations, lifestyle changes, and medical & surgical treatment recommended (O&G4)
    11. Investigations of causes of subfertility (O&G4)
    12. Principles of management including assisted reproduction techniques, including their potential risks (O&G4)
• Antenatal Care and Fetal Screening
  • General Outcomes for Antenatal Care and Fetal Screening
    1. Understand the principles of antenatal care and screening for maternal problems in pregnancy. (O&G4, O&G4)
    2. Know the common genetic and congenital abnormalities and their screening and management options. (O&G4)
    3. Be able to distinguish between giving information or advice and non-directive counselling when assisting patients to explore the implications of screening for fetal abnormalities. (O&G4)
    4. Future of screening in pregnancy (O&G4)
• Pregnancy
  • General Outcomes for Pregnancy
    1. Be able to describe the physiology of pregnancy and the associated physical changes (HD1)
    2. Be able to perform and interpret near patient pregnancy testing
    3. To understand factors which lead to unwanted pregnancy
    4. 1. Describe the physiological changes in pregnancy, with particular reference to maternal cardiovascular, respiratory, haematological and endocrine systems. (HD1)
    5. 6. Outline the role of the main glycoproteins involved in reproductive physiology including maternal recognition and maintainance of pregnancy (HD1)
    6. 2. Explain the physiological changes prior to parturition. (HD1)
    7. Describe implantation and development of the placenta and establishment of the feto-maternal circulation (HD1)
    8. Describe the physiological changes in pregnancy with particular reference to maternal cardiovascular, respiratory, haematological and endocrine systems (HD1)
    9. Describe the adaptive processes in maternal physiology to pregnancy, parturition and puerperium (O&G4)
    10. Explain the function of the placenta in supporting fetal development and maternal adaptation to pregnancy (HD1)
    11. To provide information and support decision making for women facing an unplanned pregnancy (O&G4)
    12. Explain the changes to the cervix in pregnancy (HD2)
    13. Describe the different sites of placentation (HD2)
  • Multiple Pregnancy
    1. Definition of multiple pregnancy (O&G4)
    2. Epidemiology of multiple pregnancy (O&G4)
    3. Complications of multiple pregnancy (O&G4)
    4. Antenatal care, intrapartum care and special considerations for multiple pregnancy (O&G4)
  • Antenatal care and screenings for maternal and fetal problems
    1. Antenatal care, intrapartum care and special considerations for multiple pregnancy (O&G4)
  • Bleeding in Early Pregnancy
    1. Understanding the different causes of bleeding in early pregnancy, including miscarriage, ectopic pregnancy, gestational trophoblastic disease, etc. (O&G4)
    2. Diagnosis and causes of early pregnancy loss (O&G4)
    3. Basic knowledge on the different types of miscarriages (O&G4)
    4. Describe the presenting features and management of ectopic pregnancy (O&G4)
    5. Management - both conservative and surgical - of the various causes of early pregnancy loss (O&G4)
  • Medical Disorders of Pregnancy
    1. Describe the effect of the following complications upon the mother and the fetus: hypertension/PET; miscarriage; placenta praevia/abruption; ectopic pregnancy; twins; trophoblastic disease (HD2)
    2. Discuss the pathogenesis and presentation of diabetes, anaemia and non-viral infections in pregnancy (HD2)
    3. Factors contributing to maternal and perinatal morbidity and mortality, and strategies to minimise them (O&G4)
    4. List the viruses and other organisms that can harm a pregnancy; describe the main fetal abnormalities resulting from each of these infections (HD2)
    5. Describe the effects of these complications on the mother and the fetus (HD2)
    6. Impact of pre-existing medical conditions on the pregnancy (O&G4)
    7. Discuss the ethical issues raised by infections during pregancy eg fetal abnormality as a result of infection (HD2)
    8. Explain the effect of the following complications on perinatal mortality and morbidity (HD2)
    9. Discuss the management of the following complications of pregnancy: diabetes, anaemia, non-viral infections (HD2)
    10. Understand the rationale behind pre-conception counselling (O&G4)
    11. Describe the protective measures taken to prevent infections in pregnancy and the treatment options available (HD2)
    12. Pathophysiology, presentation, diagnosis and treatment of common disorders complicating pregnancy with specific reference to hypertension, diabetes, fetal growth retardation, thrombo-embolic disease, bleeding disroders, epilepsy and psychiatric illnesses (O&G4)
  • Termination of Pregnancy
    1. Know the indications for termination of pregnancy and the regulations under which it is performed in the UK (O&G4)
    2. Know the methods of termination of pregnancy, including mechanism of action, risks and sequelae. (O&G4)
    3. To provide information regarding different methods of termination of pregnancy (ToP) and legal procedures relating to referral for ToP (O&G4)
    4. Clinical examination and investigations prior to TOP (O&G4)
• Fetal development
  • General Outcomes for fetal development
• Labour and Delivery
  • General Outcomes for Labour and Delivery
    1. Define the stages of normal labour, including associated anatomical and physiological changes at each stage (HD2, O&G4)
    2. Describe the signs of labour (HD1)
    3. 3. Describe the stages of normal labour resulting in the delivery of the fetus and placenta. (HD1)
    4. 1. Describe the signs of labour. (HD1)
    5. 2. Explain the physiological processes involved in parturition. (HD1)
    6. Explain the physiological processes involved in parturition (HD1)
    7. Explain the physiological changes prior to parturition (HD1)
    8. Principles of intrapartum fetal monitoring and interpretations of CTGs and other assessments (O&G4)
    9. Explain the consequences of injury to the pelvic floor during childbirth (HD2)
    10. Methods of induction and augmentation in labour (O&G4)
    11. Prevention and management of pre-term labour (O&G4)
    12. Describe the anatomy relevant to childbirth and Caesarian section (HD2)
  • Complications of Labour and Delivery
    1. Discuss the complications of Stage 1: failed induction, primary and secondary arrest, fetal distress (HD2)
    2. Discuss the complications of Stage 2: failure to progress, maternal and fetal distress, operative delivery (HD2)
    3. Discuss the complications of Stage 3: post-partum haemorrhage, uterine inversion, amniotic fluid embolism (HD2)
    4. Management of fetal malpresentations such as breech, twins, etc. (O&G4)
    5. Discuss the pharmacology relevant to the complications of labour (HD2)
    6. Management of obstetric emergencies such as fetal distress, maternal haemorrhage, cord prolapsed and shoulder dystocia (O&G4)
    7. Discuss haematology relevant to the complications of labour (HD2)
    8. Methods of operative delivery including forceps, ventouse and Caesarean delivery (O&G4)
    9. Assessment of the neonate at birth using the APGAR score (O&G4)
    10. Understand the role of MDT in the intrapartum care (O&G4)
  • Stillbirth and Perinatal Loss
• Puerperium and Lactation
  • General Outcomes for Puerperium and Lactation
    1. Normal physiological changes following childbirth (O&G4)
    2. 3. Describe the nature and control of processes associated with lactation. (HD1)
    3. 1. Demonstrate the normal physiological and anatomical changes associated with the puerperium. (HD1)
    4. 3. Describe the physiological changes in preparation for lactation (HD1)
    5. Demonstrate the normal physiological and anatomical changes associated with the puerperium (HD1)
    6. Management of the postnatal period (O&G4)
    7. Describe the establishment of breast feeding and its physiological and anatomical advantages to the mother and infant (HD1)
    8. Understand factors preventing the establishment of breast feeding (HD1)
    9. Describe the physiological changes in preparation for lactation (HD1)
    10. Principles of presecribing during lactation (O&G4)
    11. Basic knowledge on drugs that inhibit lactation and their mechanism of action: Bromocriptine; Oestrogens; Thiazides (O&G4)
    12. Basic knowledge on common drugs that should not be taken while breast feeding, including: Aspirin; Ergotamine; Antibacterials; Benzodiazipines; Lithium; Anti-thyroid drugs and iodine; Suphonylureas; and anti-neoplastic drugs (O&G4)
    13. Understand the precautions necessary when using glucocorticoids if breast feeding (O&G4)
  • Maternal Post-partum Disorders
    1. Explain the main risks and problems associated with the puerperium (HD2)
    2. Describe the definition, aetiology, investigation and management of post-partum haemorrhage (HD2)
    3. Describe the aetiology, investigation and management of pregnancy associated thrombo-embolism (HD2)
    4. Describe the aetiology, investigation and management of psychiatric problems in the puerperium (HD2)
  • Breast Feeding - General
    1. 2. Describe the establishment of breast feeding, and its physiological and anatomical advantages to the mother and infant. (HD1)
    2. 3. Understand factors preventing the establishment of breast-feeding (HD1)
    3. Be aware of conditions when breastfeeding is not advisable e.g. HIV, certain medications, breast abscesses, etc. (O&G4)
• The Menopause (inc. HRT)
  • General Outcomes for the Menopause and HRT
    1. To describe the physiology of the menopause and the associated physical changes (HD1, O&G4)
    2. 7. Understand the changes in levels of the main glycoproteins at the menopause (HD1)
    3. 3. Outline the options available to treat the symptoms of the menopause (HD1)
    4. 2. Describe what investigations can be performed to diagnose the menopause (HD1)
    5. 1. Describe the normal physiological and anatomical changes at the menopause. (HD1)
    6. Describe what investigations can be performed to diagnose the menopause (HD1)
    7. Outline the options available to treat the symptoms of the menopause (HD1)
    8. Define the physiology of the menopause and identify the clinical features of the normal and abnormal features of the climacteric and menopause (O&G4)
    9. Understanding postmenopausal disorders including irregular bleeding, urinary incontinence, genital tract atrophy and dyspareunia (O&G4)
    10. Non-pharmacological treatments for menopausal symptoms (O&G4)
    11. Pharmacological treatments for menopausal symptoms, including indications and contraindications, side effects and complications (O&G4)
• Gynaecological Oncology
  • General Outcomes for Gynaecological Cancer
    1. Describe various malignancies of the breast and female reproductive tract, and their incidence (HD2)
    2. Differential diagnosis of a pelvic mass (O&G4)
    3. Discuss the principles of screening for and prevention of malignancies of the cervix, breast and ovary (HD2)
    4. Explain the aetiology, pathogenesis, risk factors, presenting symptoms, main investigative procedures employed and prognosis of, the various cancers (HD2)
    5. Principles of investigation including colposcopy, ultrasound/CT/MRI scanning, and tumour marker biochemical screening of pelvic mass (O&G4)
    6. Explain the broad principles of the management of the more common malignancies in women (breast, cervix, endometrium and ovaries) (HD2)
    7. Clinical features of common gynaecological cancer (O&G4)
    8. Understands the principles of the cervical screening program and the intended outcomes (O&G4)
    9. Be able to explain the results of both normal and abnormal cervical cytology (O&G4)
    10. Staging and management of common gynaecological cancers, including surgery, chemotherapy and radiotherapy (O&G4)
  • Screening for Gynaecological Cancer
  • Ovarian Cancer
  • Endometrial Cancer
    1. Be able to list the causes of endometrial hyperplasia; discuss the relationship to endometrial carcinoma. (O&G4, O&G4)
  • Cervical Cancer
  • Vulval Carcinoma
• Pelvic Floor Dysfunction
  • General Outcomes for Pelvic Floor Dysfunction
    1. Define pelvic floor dysfunction (O&G4)
    2. List the risk factors for pelvic floor dysfunction and uterovaginal prolapse (O&G4)
    3. List the causes of pelvic floor dysfunction, including the effect of pregnancy and childbirth on the integrity of the pelvic floor (O&G4)
    4. Classification of utero-vaginal prolapse (O&G4)
    5. Clinical presentations associated with pelvic floor dysfunction, including urinary and bowel symptoms (O&G4)
    6. Investigations for urinary symptoms, including urodynamics (O&G4)
    7. Management options for patients with urinary incontinence and uterovaginal prolapse, including behavioural techniques, physiotherapy, pharmacological and surgical treatments (O&G4)
• Sexually Transmitted Infections and Pelvic Inflammatory Disease
  • General Outcomes for Pelvic Pain and Infection
    1. Be able to perform competently female genital examinations including speculum and pelvic examination (O&G4, O&G4)
    2. Discuss the main features of sexually transmitted infections including aetiology, clinical presentation and treatment of: HIV; genital warts; chlamydia; gonorrhoea; herpes (HD2, O&G4)
    3. Understand the relationship between STIs and pregnancy (O&G4)
    4. Understand the pathogenesis, diagnosis and management of Pelvic Inflammatory Disease (I&I 4, O&G4)
    5. Understand the relationship between STIs and fertility (O&G4)
    6. Understand the relationship between HIV and pregnancy, and principle of management of HIV before, during and after pregnancy (O&G4)
    7. List of differential diagnosis of pelvic pain in women - gynaecological, non-gynaecological, psychological and psychosexual (O&G4)
    8. Management of common causes of gynaecological pelvic pain - endometriosis, pelvic infection, fibroids and ovarian pathology (O&G4)
    9. Strategies for management of unexplained chronic pelvic pain (O&G4)
• Therapeutics in O&G
  • General outcomes for therapeutics in obstetrics
    1. General prescribing in Pregnancy (O&G4)
    2. Effect of pregnancy on pharmacokinetics (O&G4)
    3. Understanding teratogens and pre-pregnancy preparation (O&G4)
    4. Effects of drugs of abuse on foetal development (O&G4)
    5. Use of vaccines in pregnancy (O&G4)
    6. Drugs of choice in pregnancy for common conditions, including epilepsy, diabetes mellitus, UTI, hypertension and hyperthyroidism (O&G4)
    7. Obstetric drugs used during delivery, including oxytocin, prostaglandins, ergot alkaloids, opiates/other analgesics, and tocolytics (O&G4)
    8. Drugs used for the suppression of lactation (O&G4)
  • General outcomes for therapeutics in gynaecology
    1. Therapeutic management of menstrual disorders (O&G4)
    2. To demonstrate basic knowledge of currently available contraceptive methods and be able to communicate to clients the mechanism of action and failure rate (I&I 4, O&G4, O&G4)
    3. Understanding the treatment of subfertility (O&G4)
    4. Understanding the treatment of genital tract infections including STIs (O&G4)
    5. Outline the therapeutic management of genitourinary disturbance (O&G4)
    6. Understanding Hormone Replacement Therapy (HRT) and the principles of prescribing (O&G4)
    7. Understanding rationale for commonly used chemotherapies in gynaecological cancer (O&G4)
• Ovarian Disorders
  • General Outcomes for Ovarian Disorders
• Uterine Disorders
  • General Outcomes for Uterine Disorders
• Vulval Disorders
  • General Outcomes for vulval disorders
    1. Commonly presenting Vulval symptoms e.g. itching, pain, soarness, dyspareunia and their causes (O&G4)
    2. Dermatological conditions affecting the vulva e.g. lichen disorders, and other dermatoses (O&G4)
    3. Neoplastic conditions (benign and malignant) affecting the vulva (O&G4)
    4. Vulval Pain Syndrome (O&G4)

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