Medicine

METHODOLOGICAL INSTRUCTIONS

METHODICAL INSTRUCTION FOR STUDENTS OF THE 4 COURSE

FOREIGN STUDENT FACULTY

LESSON № 1 (practical  -  6 hours)

 

THEME 1. Female pelvis. Fetus as object of delivery.

THEME 2. Physiology of pregnancy. The perinatal care of the fetus.

THEME 3. Obstetrics Terminology. Methods of Examination of Pregnant Women.

 

Aim: be acquainted with the stages of embryonic development, to know the critical periods in the conceptus development and teratogenic influence in its development. To learn the pelvic structure, to measure pelvis sizes, to learn the structure of pelvic floor, sizes of fetus head. To study the obstetrical terminology and methods of examination of pregnant women.

 

Professional orientation of students:

The learning about the female reproductive anatomy and the main function of the female sex organs, structure and development of the embryos and fetus is the scientific basis of obstetrics and gynecology. Life of a new individual begins after egg’s fertilization. From this moment genetically predisposing factor occurs that stimulating fetus to growing and development. Learning of the embryo’s and fetus’ development stages, influence of teratogenes factors in the critical periods of the embryo’s development have considerable scientific and practical importance. Careful history taking and physical examination of pregnant women is important for the basis for patient evaluation and clinical management in obstetrics.

 

1.     Methodology of Practical Class - from 09.00 till 12.00.

Algorithm of students’ communication with patients with pathology in subject (communication skills) (for clinical department):

Algorithm of practical work:

Theme: 1. Female pelvis. Fetus as object of delivery 

Work 1.  In the class-room the students work with the pelvis and doll learning the pelvic and fetal head structure and sizes. Students measure the pelvic sizes.

Theme: 2. Physiology of pregnancy. Perinatal fetal care.

Work 1. In the class-room the students work with the video and slides about fertilization and embryo’ development.

Work 2. In ultrasound cabinet the students take part in examination of pregnant in early terns of pregnancy, recognize the embrio’ membranes.

Theme 3. Obstetrics Terminology. Methods of Examination of Pregnant Women.

Work 1. In ultrasound cabinet the students take part in examination of pregnant in late terns of pregnancy.

Work 2. In the class-room the students work with the phantoms, to learn  methods of examination of pregnant women – Leopold’ maneuvers.

Work 3. In the class-room the students learn the speculum examination and bimanual examination on phantoms.

Work 4. In the department of pregnancy pathology students take the puerpera or woman in labor for curation: take patient’s history, perform the external obstetrical examination of pregnant women – Leopold’ maneuvers, measuring pelvic sizes, fetal heart biting auscultation.

 

2.     Individual Students Program.

Theme: 1. Female pelvis. Fetus as the object of labor.

1.  What bones does the pelvis consist of?

2.  Differences between female and male pelvis.

3.  The main landmarks of the female pelvis.

4.  Planes of pelvis and their sizes.

5. Main and additional external pelvis sizes.

6.  Methods of estimation of true conjugate.

7. Solovjov’ index. Its  significance for estimation of  internal  pelvic sizes.

8. Mikhaelis’ rhomb. Its significance for estimation of result of labor.

9.  Structure of pelvic floor.

10. tructure and sizes of fetal head.

11. Body sizes of in-term fetus.

12. Sutures and fontanels and their significance for diagnosing the situation of fetal head

13. Definition of «large segment» of fetal head.

14. Relationship of fetal head to pelvic planes.

 

 Theme 2. Physiology of pregnancy. Perinatal fetal care.

 1. Fertilisation. Stages of embryonic development. Embryonic formation and fetal development in different periods of pregnancy.

2. Implantation.

3.  Placenta structure.

4.  Amniotic fluid.

5.  Conceptus structure in the end of pregnancy.

6.  The signs of the fetus maturity and gestation.

7.  Fetal sizes in different periods of its development.

8.  Physiological paculiarities of the fetus in different stages of its development.

 

Theme 3. Obstetrics Terminology. Methods of Examination of Pregnant Women.

1.   Definition of the obstetrics terms: attitude (habitus),  lie, presentation, position, variety (visus).

2.   Definition of the terms: axis of fetus,  axis of uterus, axis of pelvis.

3.   Engagement (synclitic and asynclitic).

4.   Auscultation of fetal heart sounds.

5.   Vaginal examination.

6.   Speculum examination.

7.   Examination of abdomen ( Leopold Maneuvers).

8.   Methods of pregnancy diagnosis: presumptive signs of pregnancy, probable signs of pregnancy, positive signs of pregnancy.

9.   Signs of early pregnancy: Hegar’s, Piskachek’s,  Henter’s, Snegirov’s.

10.   Tests for pregnancy. Tests with Chorionic Gonadotropin.

11.   Diagnosis of late terms of  pregnancy.

12.  Sizes of uterus in different terms of pregnancy.

 

3.     Seminars’ discussion of theoretical questions and practical work: from 12.30 till 14.00

 

4.     Test evaluation and situational tasks.

1. During normal pregnancy, the uterus first becomes palpable in the lower abdomen at:

A – 8 weeks;

B –  12 weeks;

C –  16 weeks;

D – 20 weeks;

E –  24 weeks.

2. Average length gain in a in-term fetus should be:

A – 35 cm.;

B –  40 cm.;

C –  45 cm.;

D – More than 48 cm.;

E –  More than 25 cm.

3. Conceptus in the end of pregnancy should include for all of the following EXCEPT:

A – Placenta;

B – Amniotic fluid;

C – Umbilical cord;

D – Fetus;

E – Fetal membranes;

F – Uterus.

4. A male fetus was born with such characteristics, as length - 44 cm., weight – 2320 g. Skin is pink, sutures and fontanels are wide, bones of the head are thin and soft, testes are not palpable in the scrotum. To determine the gestation age of the fetus and its maturity.

5. A primagravida visit an obstetrician. Gestational age of the pregnancy is 29 weeks. What is an average length and weight of the fetus  according to Gaaze formula?

 

5.     Student's individual work from 14.15 till 15.00.

Students, who have not passed control in «MOODLE» system, should stay for individual work and write test control. Students work with thematic training tables, train in computer class, work with license examination test "KROK" and the department database tests, in-depth study of topics according to an individual study program, etc.

 

6.           Students should know:

1.  Physiological process of fertilisation, conceptus’ formation.

2.  Critical periods of the embryo’and fetus’ development.

3. Conceptus structure in different stages of its development.

4.  Embryo’ and fetus’ alteration by toxic substances.

5.  Signs of fetus maturity and gestation.

6. Placenta structure and its functions.

7.   Antropomethrical dates of the fetus in different gestational periods of the pregnancy.

8.   Structure of  female pelvis.

9.   Planes of true pelvis and their sizes.

10. Main and additional sizes of pelvis.

11.  Structure of interm fetus head.

12.  Obstetrics terminology.

13.  Examination of the abdomen ( Leopold’s maneuvers).

14.  Pelvic examination.

15. The signs of pregnancy.

16.  Diagnostic methods of pregnancy.

17.  Tests for pregnancy

 

7.      Students should be able to:

1.  To evaluate the female reproduction function.

2.  To assess anterpartum fetal surveillance.

3.  To determine fetus sizes in different gestational periods of the pregnancy.

4. To determine fetus mass in the second half of pregnancy.

5.  Determination of the “interm fetus” and to assess its maturity.

6.  To measure of pelvic sizes.

7.  To measure diagonal conjugate.

8. To measure true conjugate.

9. To measure Solovjovs’ index and to apply it for estimation of internal sizes of pelvis.

10. To take the patient’s history.

11. To perform objective examination of pregnant woman.

12. To perform Leopold’s maneuver.

13. To identify the lie, position and presentation of the fetus.

14. To perform the auscultation, vaginal and speculum examination.

15. To diagnose early terms of pregnancy.

16.  To perform objective examination of pregnant woman

17. To diagnose the late terms of pregnancy.

 

8.     Correct answers of test evaluations and situational tasks:

1. B.

2. D.

3. F.

4. Fetus is pre-term and immature.

5. Length – 35 cm., weight – 1000g.

 

9.      References:

А – Basic:

1.     Williams Obstetrics. Williams & Wilkins Waverly Company. – 21 Edition. – 2004.

2.     Obstetrics. – Edited by Ventskivska. – Kyiv “Medicine” – 2008. – 336p.

3.     Gynecology  – Edited by Ventskivska. – Kyiv “Medicine” – 2008. – 340p.

4.     Danforth’s Obstetrics and gynaecology. - Seventh edition.- 1994. – 1118p.

5.     Obstetrics and gynaecology. Williams & Wilkins Waverly Company. – Third Edition.- 1998. – 980p.

6.     Basic Gynecology and Obstetrics. – Norman F. Gant, F. Gary Cunningham. – 1993. -  398p.

7.     Obstetrics and gynecology. – Pamela S.Miles, William F.Rayburn, J.Christopher Carey. – Springer-Verlag New York, 1994. – 226p.

8.     Gynecology. Second edition - Stephan Khmil, Zina Kuchma, Lesya Romanchuk. – Ukrmedknyha. – Ternopil.- 2006.  – 384p.

9.     Obstetrics and gynecology. – Pamela S.Miles, William F.Rayburn, J.Christopher Carey. – Springer-Verlag New York, 1994. – 218p.

10. FEMALE PELVIS

В – Additional:

1. Order № 503 from 28.12.2002 «Improvement of ambulatory obstetric-gynecological help».

2. Order № 582 from 15.12.2003 «Clinical protocols from the obstetric and gynecological help».

3. Order № 620 from 29.12.2003 «Organization of grant of stationary obstetric-gynecological and neonatal manuals».

4. Order № 676 from 31.12.2004 «Clinical protocols from the obstetric and gynecological help».

5. Order № 782 from 29.12.2005 «Clinical protocols from the obstetric and gynecological help».

6. Order № 234 from 10.05.2007 «Instruction of organization bacteriological laboratories in the infectious checking system in obstetric permanent establishments».

7. Order № 899 from 27.12.2006 «Breech presentations ».

8 Order № 906 from 27.12.2007 the «Perinatal infections».

9. Order № 901 from 27.12.2006 «Postdate pregnancy».

10. Order № 900 from 27.12.2006 «Fetal distress at pregnancy  and during births».

11. National program for prevention HIV- infection, treatment care and supporting HIV – patients in 2009-2013years – adopted 19.02.2009.

12. Order  № 716 from 14.11.2007 “Prevention of HIV transmission from mother to infant” .

13. National program “Bases of transplantology”

14. Danforth’s Obstetrics and gynaecology. - Seventh edition. – 1994.

15. Basic Gynecology and Obstetrics. – Norman F. Gant, F. Gary Cunningham. – 1993.

16. Obstetrics by ten teachers. Stuart Campbell and Christoph Lees. - 17th edition. – London, 2000.

17. The Text Book of Obstetrics. D.C. Dutta. – 6th edition, 2006.

 

 

Methodical instruction has been worked out by: prof. Heryak S.N.

 

Methodical instruction was discussed and adopted at the Department sitting

27.05.2011. Minute № 13

Methodical instruction was reviewed and adopted at the Department sitting

24.05.2012. Minute № 13

Methodical instruction was discussed and adopted at the Department sitting

23.05.2013. Minute № 10

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute № __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute № __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute № __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute № __