METHODOLOGICAL INSTRUCTIONS

METHODICAL INSTRUCTION FOR STUDENTS OF THE 4 COURSE

FOREIGN STUDENT FACULTY

LESSON ¹ 4 (practical  -  6 hours)

 

THEME 1. Pregnancy and births contracted pelvis  

THEME 2. Macrosomia in obstetrics, pregnancy and delivery. Multifetal gestation. Pregnancy in polyhydramnios, oligihydramnios 

 

Aim: be able to diagnose anatomically contracted pelvis, to make a plan of labor management in different types of contracted pelvis. to learn the peculiarities of pregnancy duration in polyhydramnios, multifetal pregnancy, to diagnose the main complications in labor in macrosomic fetus, multifetal gestation, and in polyhydramnios.

 

Professional orientation of students:

Learning the main types and peculiarities of labor in contracted pelvis gives a possibility to prevent the main obstetric complications, perinatal and maternal death. In fact, pregnancies with multiple fetuses pose significant medical risks for both the mother and her offspring. Special care is necessary to achieve an optimal outcome. In general, all potential complications with twin pregnancies are somewhat more frequent and more serious as the number of fetuses increases. 

 

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. Pregnancy and births contracted pelvis  

Work 1. In the pathology of pregnancy department the students measure the external pelvic sizes, plan the root of delivery in different degrees of pelvis contraction.

Students work with the pelvis and doll learning the biomechanism of delivery in case of contracted pelvis

 Theme: 2.  Macrosomia in obstetrics, pregnancy and delivery. Multifetal gestation. Pregnancy in polyhydramnios, oligihydramnios 

Work 1. In ultrasound cabinet the students take part in examination of pregnant in late terms of pregnancy, recognize the macrosomia, maltifetal gestation, polygydroamnion.

Work 2. In the class-room the students work with the video and slides about  maltifetal delivery, delivery in case of macrosomia.

 Work 3. In the department of pregnancy pathology students take the patient’s history, perform the external obstetrical examination of pregnant women – Leopold’ maneuvers, measuring pelvic sizes, fetal heart biting auscultation, plan the method of delivery in case of maltifetal pregnancy, macrosomia.

 

2.     Individual Students Program.

Theme 1.  Pregnancy and births contracted pelvis  

1.  Pelvic classification according to form of contractions.

2. Anatomically and clinically contracted pelvis.

3.  Diagnosis of contracted pelvis.

4. Pelvic classification according to degree of contraction.

5. Often occurred contracted pelvis: generally contracted pelvis, flat pelvis: simple flat pelvis, flat rachitic pelvis, generally contracted flat pelvis.

6. Principles of pregnancy management in contracted pelvis.

7. Principles of labor management in contracted pelvis.

8. Cardinal moments of labor in different types of contracted pelvis.

9. Vasten’s and Cagenmayster’s sign.

 

Theme 2. Macrosomia in obstetrics, pregnancy and delivery. Multifetal gestation.

1.                 Fetal weight and height at interm pregnancy.

2.                 Which fetuses are called as “large” and “giant”?

3.                 Percularities of delivery in case of macrosomia.

4.                 Signs of multifetal pregnancy.

5.                 Peculiarities of pregnancy duration in multiple gestation.

6.                 Peculiarities of labor duration in multiple gestation.

7.                 Management of labor in multiple gestation.

8.                 Differential diagnosis of monochorionic and dichorionic twins.

9.                 Etiology and diagnosis of polyhydramnios, oligihydramnios.

10.            Peculiarities of pregnancy duration polyhydramnios, oligihydramnios

11.      Peculiarities of labor duration and its management in polyhydramnios, oligihydramnios .

 

 

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

 

4.     Test evaluation and situational tasks.

1. Third degree of pelvic contraction is associated with :

A – True conjugate is 11-9 cm;

B - True conjugate is 9 – 5, 5 cm;

C - True conjugate is 7,5 – 5, 5 cm;

D - True conjugate is 5-6 cm;

E – True conjugate is 12 cm.

2. Which statement is true about simple flat pelvis ?

A -  Shortening of  anteroposterior diameters at all levels of true pelvis;

B – Shortening of  anteroposterior diameters of the pelvic inlet;

C – Shortening of  anteroposterior diameters of the pelvic outlet;

D – Diminution of all true pelvic diameters (anteroposterior, transverse, and oblique);

E –  Diminution of all transverse pelvic  diameters.

3. An indications for cesarean section in contracted pelvis are:

A – First degree of pelvic contraction;

B – Clinically contracted pelvis;

C – Third degree of pelvic contraction;

D – Obliquely contracted pelvis;

E – Spondylolisthetic pelvis.

4. A 24-year-old woman in labor has pushing efforts during 1 hour. Pelvic sizes: 26,  28, 30, 20 cm. Fetal head is fixated to the pelvic inlet (- 2 station). Probable featal weight is 4900 grams. fetal heart rate is 130 beats per minute. Positive Vasten’s sign. Vaginal examination reveals full dilation of the cervix, absence of the amniotic sac, and edema of the fetal scalp (caput succedaneum). Sagittal  suture located in transverse position of the pelvic inlet. What would be the most probable diagnosis? What should be and adequate management?  

 

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.     Classification of the contracted pelvis.

2.     Cardinal moments of labor in contracted pelvis.

3.     Management of the pregnancy and labor in contracted pelvis.

4.     Signs of multiple gestation.

5.     Peculiarities of pregnancy duration in multiple gestation.

6.     Management of labor in multiple gestation.

7.     Differential diagnosis of monochorionic and dichorionic twins.

8.     Diagnosis of polyhydramnios.

9.     Peculiarities of pregnancy and labor duration in polyhydramnios.

10.      Which fetuses are called as “large” and “giant”?

11.      Diagnosis of pregnancy with macrosomic fetus.

12.      Complications in labor with macrosomic fetus.

13.      Management of labor with macrosomic fetus.

 

7.     Students should be able:

14.      To take the female history, to measure the external and internal pelvic sizes.

15.      To evaluate the results of additional methods of pelvic measurement.

16.      To make a diagnosis.

17.      To make a differential diagnosis between different types of contracted pelvis.

18.      To make a plan of investigation and management of pregnancy and labor in different types of contracted pelvis.

19.      To diagnose polyhydramnios, to prescribe treatment and to make a plan of labor in polyhydraamnios.

20.      To differentiate monochorionic and dichorionic twins.

21.      To diagnose multifetal pregnancy, to make a plan of labor.

22.      To determine the probable fetal weight and to diagnose “large” fetus.

23.      To make a plan of labor in “large” fetus.

 

8.     Correct answers of test evaluations and situational tasks:

1.C.

2.A

3. B, C, D, E.

4. First interm labor, second stage of labor, cephalic presentation. Clinically contracted pelvis. Cesarean section should  be administrated.

 

9.     References:

À – 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. PREGNANCY AND BIRTHS CONTRACTED PELVIS

 – 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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