METHODOLOGICAL INSTRUCTIONS

METHODICAL INSTRUCTION FOR STUDENTS OF THE 4 COURSE

FOREIGN STUDENT FACULTY

LESSON ¹ 2 (practical  -  6 hours)

 

THEME 1: Physiology of delivery.  Clinic and management of normal labor – 3 hours. 

THEME 2: Analgesia and anesthesia in labor – 2 hours.

THEME 3: Physiology of postpartum period. Clinical aspects and management of the  puerperium.  Physiology of infants’ period – 2 hours.

 

Aim: to learn how to estimate clinic duration of the first, second and third stages of labor, the biomechanism of labor in cephalic presentation, recognise anterior and posterior positions. To learn the main methods of analgesia and anesthesia in the first, second and third stages of labor, principles of pain relief in labor. To study the normal puerperium, to diagnose the complications of the puerperium and methods of their prevention.

 

Professional orientation of students:

Careful diagnosing and conducting of each stage of labor is important for preventing  complication in the puerperium and prevent maternal and perinatal mortality. Labor is a painful process that for the nulliparous woman may be the most painful event that she has ever experienced. Fortunately, it often proves to be the most rewarding. The relief of the pain in labor presents special problems, which may be best solved by administration of special medicines and procedures. 

 

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: 1Physiology of delivery.  Clinic and management of normal labor

Work 1. In the class-room the students review the video “Obstetric Delivery”.

Work 2. In the class-room the students work with the phantoms, to learn the perineal protective maneuvers.

Work 3. In the class-room the students work with the phantoms and dolls, to learn the primary newborn care.

Work 4. In delivery department students take part in conducting of labor – external obstetrical examination, fetal heart sounds auscultation, estimation of uterine contractions. 

Theme: 2. Analgesia and anesthesia in labor.

Work 1. In the class-room the students work with the video and slides about peridural analgesia.

Work 2. In delivery department students take part in pain relief methods in labor.

Theme 3.  Physiology of postpartum period. Clinical aspects and management of the  puerperium.  Physiology of infants’ period.

Work 1. In ultrasound cabinet the students take part in examination of postpartum patients.

Work 2. In the postpartum department students take the patient’s history, perform the external examination of postpartum women – palpation of postpartum uterus, breasts palpation, estimation of lactation function.

 

2.     Individual Students Program.

Theme: 1.  Physiology of delivery.  Clinic and management of normal labor.

1. What is labor ?

2.  Stages of labor.

3. Labor’s  expulsive forces.

4.  Mechanism of cervical  dilatation in primapara and multipara.

5.  What is lower uterine segment, contractile ring?

6.  Management of the first stage of labor.

7. Role of vaginal examinations in diagnosing the stages of labor.

8. Management of the second stage of labor.

9. Perineal protective   maneuvers.

10. Signs of placental separation.

11. Manual removal of placenta.

12. Structure of  afterbirth.

13. Blood loss during labor and its estimation.

14. Definition  of  physiological  blood loss.

15.  Theories of the cardinal moments of labor.

16.  Cardinal moments of labor in the vertex (occiput) anterior presentation.

17.  Cardinal moments of labor in the vertex (occiput) posterior presentation.

18. Importance of perineal protective maneuvers.

19.  Technique of perineal protective maneuvers (five moments).

20.  Graphic documentation of the fetal head station in the true pelvis in different types of cephalic presentation.

 

Theme 2. Analgesia and anesthesia in labor.

1. Anatomical substrate of pain in labor. Importance of cortex, conditioned reflex in the development of pain in labor.

2. Psychoprophylactic pain relief in labor.

3. Methods of analgesia and anesthesia during labor and indications for them: combination of sedation, spasmolytic and analgetic medicines; superficial anesthesia; inhalation anesthesia; acupuncture; epidural  anesthesia.

4. Structure and prescription of apparatus for anesthesia.

5. The main analgesic and anesthetic used in obstetrics: gas anesthetics; intravenous anesthetics; 3) psychotropic medicines.

6. The anesthetic technique that provides pain relief during first stage of labor.

7. The anesthetic technique that provides pain relief during second stage of labor.

8. Indications for pudendal block.

 

Theme 3. Physiology of postpartum period. Clinical aspects and management of the  puerperium.  Physiology of infants’ period

1. The definition of the puerperium. The definition of the early and late puerperium.

2.The main processes in the puerperium. Involution of the uterus.

3.What is lochia? The role of the lochia. Changening of the lochia  during puerperium.

4. Hygiene of the female reproductive organs in pueperants.

5. Care of the pueperants after episiotomy.

6. Function of breasts in puerperium. Fissures of the nipples. Treatment and prevention.

7. The rules of  breast feeding.

8. The management of the puerperium.

9. Ultrasonic estimation of uterine involution.

10. Patients  discharge from the hospital after delivery.

 

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

 

4.     Test evaluation and situational tasks.

1. During  second stage of labor in the absence of  electronic fetal monitoring, fetal heart rate auscultation should be performed after:

A - Each uterine contraction;

B - Every other uterine contraction;

C - Every third uterine contraction;

D - Every contraction generating more than 15-20 mm Hg pressure.

2. It is customary to wait approximately how many minutes for spontaneous extrusion of the placenta?

A – 10;

B – 20;

C – 30;

D – 40;

E – 50.

3. All of the following are necessary for the diagnosis of true labor EXCEPT:

A - Rhythmic contractions ;

B - Cervical dilatation;

C - Cervical effacement;

D - Bloody show.

4. Woman with in-time pregnancy. Bears  down during 40-45 seconds with intervals 1-2 minutes. The rupture of the membrane has occurred 10 minutes ago. Vaginal examination: fetus head is on the pelvic floor. Saggital suture is in anterior-posterior diameter of pelvic outlet. Amniotic sac is absent. What is the stage of labor?

5. The bleeding began right after childbirth. The blood loss is 300 ml. There aren’t the signs of the placental separation. What is the diagnosis?  What you have to do?

 

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. Stages of labor.

2. Clinic  and management of 1 stage of labor.

3. Clinic  and management of 2 stage of labor.

4. Clinic and management of 3 stage of labor.

5. Methods of removal of separated placenta.

6. Estimation of blood lost during labor.

7. The cardinal movements of labor in anterior occiput presentation.

8. The cardinal movements of labor in posterior occiput presentation.

9.   The definition of synclitism and asynclitism.

10.  Anatomical substrate of pain in labor.

11.  Methods of analgesia and anesthesia during the first and second stages labor.

12.  The main analgesic and anesthetic agents used in obstetrics.

13.  Regime of the postpartum unite.

14.  Methods of prevention of complication in puerperal period.

15.  Management of physiological puerperal period.

16.  Principles of breast-feeding.

 

7.     Students should be able to:

1.To diagnose true labor.

2. To estimate the character of uterus contractions.

3. To estimate fetal station.

4. To estimate of fetal well-being.

5. To choose the analgesic and anesthetic agents.

6. To perform perineal protective   maneuvers.

7. To perform primary newborn care.

8. To estimate the maternal vital signs.

9. To show the cardinal movements of labor in anterior and posterior occiput presentation on phantom.

10. To determine the suture and fontanels on the fetal head.

11. Determine the importance of administration of anesthesia during labor.

12. Give the prescriptions of analgesia and anesthetic agents in a correct doses. Determine the sites for pudendal block.

13. Organize a psychoprophylactic lesson with pregnant.  

14. Perform the palpation of postpartum uterus.

15. Examine the external genitalia, estimate the character of lochia.

14. Estimate the breast and nipple care, to diagnose crafted nipples.

 

8.     Correct answers of test evaluations and situational tasks:

1. A.

2. C.

3. D.

4. Second – pelvic stage of labor.

5. Placenta accreta. Manual removal of the placenta.

 

9.     References:

À – Basic:

1.                Williams Obstetrics. Williams & Wilkins Waverly Company. – 21 Edition. – 2004. – P 31 – 54, 175-177.

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.PHYSIOLOGY OF DELIVERY

 

 – Additional:

1. Order ¹ 503 from 28.12.2002 «Improvement of ambulatory obstetric-gynecological help».

2. Order ¹ 582 from 15.12.2003 «Clinical protocols from the obstetric and gynecological help».

3. Order ¹ 620 from 29.12.2003 «Organization of grant of stationary obstetric-gynecological and neonatal manuals».

4. Order ¹ 676 from 31.12.2004 «Clinical protocols from the obstetric and gynecological help».

5. Order ¹ 782 from 29.12.2005 «Clinical protocols from the obstetric and gynecological help».

6. Order ¹ 234 from 10.05.2007 «Instruction of organization bacteriological laboratories in the infectious checking system in obstetric permanent establishments».

7. Order ¹ 899 from 27.12.2006 «Breech presentations ».

8 Order ¹ 906 from 27.12.2007 the «Perinatal infections».

9. Order ¹ 901 from 27.12.2006 «Postdate pregnancy».

10. Order ¹ 900 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  ¹ 716 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 ¹ 13

Methodical instruction was reviewed and adopted at the Department sitting

24.05.2012. Minute ¹ 13

Methodical instruction was discussed and adopted at the Department sitting

23.05.2013. Minute ¹ 10

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute ¹ __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute ¹ __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute ¹ __

Methodical instruction was adopted and reviewed at the Department sitting

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