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METHODICAL INSTRUCTION FOR STUDENTS OF THE 5-th COURSE

FOREIGN STUDENT FACULTY

LESSON ¹ 3 (PRACTICAL – 6 HOURS)

 

Theme: Pregnancy and labor at extragenital diseases.

 

Aim: to study the methods of diagnostics, treatment and rehabilitation of pregnant women with extragenital pathology (heart and vessels diseases, kidney diseases, anemia, diabetes, tuberculosis, hepatitis, cholecystitis, appendicitis).

 

Professional orientation of students: Extragenital diseases complicate the duration of the normal pregnancy, increase the for most systemic  illnesses, the physiologic and anatomic changes inherent in normal pregnancy influence the symptoms, signs and laboratory values to a considerable degree. Physicians providing obstetric care must have a thorough understanding of the effect of pregnancy on the natural course of a disorder on a pregnancy and the change in management of the pregnancy and /or disorder caused by their coincidence.

 

1.    Methodology of Practical Class (9.00-12.00).

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

While working with patients, students must comply with the rules of communication:

History taking in pregnant women and woman after labor

- Say hello and call yourself;

- The friendly facial expression, gentle tone of conversation.

- Clarify how to address to the patient, to make contact;

- Correct the survey, especially regarding intimate details history;

- End conversation, thank for communicating, to wish successful completion of the course and pregnancy.

Physical examination methods

- Explain the necessity examination, its purpose.

- Explain the details of examination, their safety, possible sense of them.

- Wash your hands, wear gloves. Before external obstetric examination - warm hands.

- Carry out inspection

- Report completed survey.

Post survey results

- Explain what analysis you will interpret what it is about can testify.

- Tell-result analysis, in an accessible way to explain it.

- In the case of pathological changes reassure the patient, inform future actions.

- Ensure about change and favorable prognosis if all medical recommendations will be done.

Work 1. Students work in prenatal care center, pathologic pregnancy unit, maternity unit, operative room (take obstetric history, exam a pregnant woman).

Work 2. Estimate the results of additional methods of examination.

Work 3. Conduct a differentiation diagnostics with other illnesses, which have a similar clinical symptoms, interpret the results of laboratory research.

 

2.         Individual Students Program.

1.     Cardiovascular diseases:

a)     congenital heart diseases (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

b)    arterial hypertension (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

c)     arterial hypotension (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk).

2.     Disorders of Gastro-Intestinal Tract:

a)     disorders of biliary ducts (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

b)    appendicitis and pregnancy. Acute pancreatitis and pregnancy (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk).

3.     Kidney disorders:

a)     acute and chronic pyelonephritis (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

b)    acute and chronic glomerulonephritis (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

c)     urolithiasis glomerulonephritis (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk).

4.     Disorders of the respiratory system:

a)     tuberculosis (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

b)    bronchial asthma (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

c)     chronic bronchitis (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk).

5.     Endocrine disorders:   

a)     diabetes (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

b)    thyroid disorders (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

c)     adrenal disorders (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk).

6.     Blood diseases (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk).

7.     Anomalies of female genital organs and pregnancy.

8.     Nervous and psychic diseases:

a)     epilepsy (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk);

b)    disseminated sclerosis (clinical symptoms, diagnostics, tactics of handling pregnancy and delivery, estimation of labor risk).

 

3.    Seminar discussion of theoretical issues (12.30-14.00).

 

4.    Test evaluation and situational tasks.

1.     Which of the following is No characteristic of Willebrand’s disease?

A - Decreased factor VII;

B - Decreased factor VIII;

C - Family history of the disease;

D - Prolonged bleeding time.

E - All of the above.

2.     The appropriate management for a pregnant patient with asymptomatic bacteriuria is:

A - No treatment;

B - Antibiotics ;

C - Dietary alterations;

D - Changes of sexual behavior.

E - All of the above.

3.     Infants born to mothers with insulin-dependent diabetes are at higher risk for:

A - Neonatal hyperbilirubinemia;

B - Neonatal hypoglycemia;

C – Hypocalcemia;

D – Polycythemia;

E - All of the above.

4.     In the well-controlled diabetic with no complications, induction of labor is often undertaken at how many weeks’ gestation?

A - 40-42;

B - 38-40;

C - 36-38;

D - 34-36;

E - 32-34.

5.     A 23-year-old pregnant woman is seen at 8 week’s gestational age for obstetric care. She complains on sickness, and says that has diabetes from childhood. Ophtalmologic conclusion is diabetes retinopathy. She has two pregnancies that finished with stillbirth. Blood glucose – 15 mmoll/l. Vaginal examination shows: uterus enlarged till 8 weeks. What would be the most appropriate diagnosis and 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.     Student should know:

1.     Basic hemodynamic indicators during pregnancy.

2.     Pathomorphological changes of organs by cardiovascular diseases, kidney diseases, anemia, diabetes, tuberculosis, hepatitis, cholecystitis, appendicitis, blood diseases.

3.     Classification of cardiovascular diseases, their diagnostics and treatment (congenital heart diseases, arterial hypertension, hypotension).

4.     Diabetes, diagnostics and treatment.

5.     Tuberculosis, diagnostics and treatment.

6.     Diagnostics and treatment of liver troubles.

7.     Clinical symptoms, diagnostics and treatment of blood diseases.

8.     Pharmacodynamics and prescriptions of drugs for heart and vessel diseases, kidney diseases, anemia, diabetes, tuberculosis, hepatitis, holecystitis, appendicitis.

9.     Normal indicators of laboratory research methods.

 

7. Student should be able to:

1.     To take obstetric history, to examine a pregnant woman.

2.     To estimate the results of additional methods of examination.

3.     To conduct a differentiation diagnostics with other illnesses which have a similar clinical symptoms.

4.     To interpret the results of laboratory research.

 

8. Correct answers of test evaluations and situational tasks:

1.     B.

2.     B.

3.     E.

4.     B.

5.     Third pregnancy, 8 week’s gestational age, diabetes mellitus, type 1, diabetes retinopathy. It is indicate the medical abortion.

 

9. References:

À – Basic:

1.     Lecturer notes (handouts).

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 labor at extragenital diseases

 

 – 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 ¹ 901 from 27.12.2006 «Postdate pregnancy».

8.Order ¹ 900 from 27.12.2006 «Fetal distress at pregnancy  and during births».

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

10.Order  ¹ 716 from 14.11.2007 “Prevention of HIV transmission from mother to infant” .

11.National program “Bases of transplantology”

 

Methodical instruction has been worked out by: I.Ya. Kuziv

 

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

__________20__. Minute ¹ __