METHODICAL INSTRUCTIONS

METHODICAL INSTRUCTIONS

TO PRACTICAL LESSON VI YEAR STUDENTS FOR TEACHERS

FACULTY OF FOREING STUDENTS

 

LESSON 1 (PRACTICAL  - 6 HOURS)

 

THEME 1: Physiology of pregnancy,  labor, and postpartum period.

THEME 2: Perinatal care of the fetus.

THEME 3: Pharmacotherapy in obstetrics. Medical ethics and deontology.

AIM: To learn physiological duration of pregnancy, appreciate beginning, clinical course of partum; to master principles direction of partum. To learn peculiarities of course and direction of partum when there are extensional presentations and multiple pregnancy. To learn biomechanism of partum when there are different variants of cephalic presentations, physiological duration of postpartum period, to learn perinatal care of fetus; pharmacotherapy in obstetrics.

 

Professional orientation of students: Each physician should assist in physiological birth. So it must be able to ascertain their origin, to assess progress, to know the methods of anesthesia, as well as own methods of " perineal protecting manuvers." Biomekhanism delivery is an important component of the maternity act. Ability to determine the progress of the fetal head through the birth canal provides an estimate obstetric situation and to use the event to correct deviations from the normal course of labor. Proper diagnosis stage of labor, good management of their reduces maternal and perinatal mortality, the number of puerperal complications. Therefore, timely diagnosis, the correct decision on the mode of delivery, the ability to provide expert assistance in childbirth is an important reserve for reducing perinatal mortality, birth trauma.
On the mechanism of puerperal pain affects between subcortical violation neurodynamic processes and the functional state of the cerebral cortex, as well as individual characteristics of mothers, her emotional state to the future of motherhood. All these features determine the need of an individual approach with respect to pain relief during labor.
Postpartum is a very responsible due to the significant changes taking place at this time in the genitals, breasts and all over the woman's body. Normal course of uterine involution, lactation, and the general state of health of the woman is highly dependent on proper treatment in the postpartum period. It is important to diagnose early signs of complications of puerperium and prevent the disease. Neonatal period is a very responsible transition from fetal to post-uterine existence of the child's primary adaptation to environmental conditions.
Perinatal system of the fetus and newborn include the knowledge and ability to identify factors  risk to the fetus and newborn, their prevention , more rational organization of prenatal care, if necessary, to improve it, successful labor and providing adequate medical newborn care ¬ Nome.
Most important to the use of medicines (drugs) during pregnancy. A significant number of complications during pregnancy, and often occurring extragenital diseases require the use of drug therapy, sometimes multi. The main problem with this drug therapy is to determine the correct ratio of the degree of the risks and potential benefits of a particular drug.
Of particular importance in the medical profession acquire such universal communication standards such as the ability to respect and listen carefully to the interlocutor, to demonstrate the interesting
in the content of conversation and patient opinion, correct and affordability of the re-chi. Also important and external tidy kind of medical personnel: a clean gown and cap, removable shoes, manicured hands with short fingernails.

 

1.Methodology of Practical Class from 9.00 till 12.00.

THEME 1: Physiology of pregnancy,  labor, and postpartum period.

Work 1. To make external obstetrical examination, auscultation of pregnant woman.

Work 2. Determine presence of labor activity, give its appreciation.

Work 3. Using case records draw parthogramme.

Work 4. Demonstrate perineum protection on phantom.

Work 5. To perform primary care of infant

Work 6. Appreciate presence of signs of placental separation .

Work 7. Calculation of hemorrhage in partum.

Work 8.Student under the guidance of a teacher is working with, conducts palpation of the uterus and mammary glands, and the toilet holds the newborn. Evaluate the postpartum period. Holds a conversation about health postpartum.

Work 9. Evaluation of fetal well-being, evaluation of the newborn according to Apgar score.

 

2. Individual Students Program.

 

  1. Delivery, causes of beginning,  regulation of partum.
  2. Biological readiness of organism to delivery.
  3. Labor forces. Changing in uterus (lower uterine segment, contractional ring, mechanism of opening neck of the uterus in primapara and multipara). Periods of labor.
  4. Biomechanism of labor in  occipitoposterior and occipitoanterior presentations.
  5. Biomechanism of labor in deflexed presentations.
  6. Clinical course of first period of partum.
  7. Direction of first period of partum. Aseptic and antiseptic in obstetrician.
  8. Methods of registration labor activity. Monitoring of delivery.
  9. Modern methods of appreciation  fetus status.
  10.  Course and duration of second period of partum.
  11. Giving obstetric care after delivery of the fetus.
  12. Appreciation of newborn status.
  13. Primary toilet of newborn, processing of umbilical cord, prophylaxis of ophthalmoblenorrhea.
  14.  Course direction of third period of labor.
  15. Signs of placental  separation.
  16. External methods of placenta removal.
  17. Appreciation of afterbirth.
  18. Physiologic and pathological postpartum hemorrhage. Calculation of hemorrhage.
  19. Deposition for operative delivery when there is multiple pregnancy.
  20. Painless of labor: psychoprophylactic, medicamental and unmedicamental.
  21. Changing in women organism in postpartum period. Appreciation of uterus involution, nature of lochia.
  22. Hygiene in postpartum period. Care of women in postpartum period.
  23.  Care of mammary gland. Prophylaxis of hypogalactia, mastitis.
  24.  Anatomical and physiological characteristics of the neonatal period. Y and feeding infants.
  25.  Organization of the Department of newborns.
  26.  Determination of risk to the fetus by prenatal factors.

     27. Classification of drugs according to their permeability through the placental                  barrier.

     28 The meaning of the main ethical principle of medicine.

3. Seminar discussion of theoretical issues from 12.30-14.00 (90 minutes).

4. Test evaluation and situational tasks

 

1. How many points of biophysical profile is considered to be normal?

A – 1-2

B – 3-4

C – 5-6

D – 7- 8

E – 8 - 10

 

2. Cordocentesis – is:

A – puncture of amniotic sac

B -  percutaneous umbilical blood sampling

C – skin sample

D – chorionic villus sampling

E – fetoscopy

 

       3. Most important diameter of pelvis during labour is -

A. Interspinal diameter

B. Oblique diameter of inlet

        C. AP diameter of oulet

        D. Intertubercular diameter

E. none


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. A student should know:

1.     Definition of labor, causes of beginning partum, regulation of labor activity.

2.     Biological readiness of organism to partum.

3.     Forerunners of partum, preliminary period.

4.     Changing in uterus (lower uterine segment, contractional ring), mechanism of opening neck of the uterus in primapara and multipara.

5.     Clinical course of 1-th, 2-end, 3-d   period of partum.

6.     Peculiarities course of partum when there is multiple pregnancy.

7.     Direction of  1-th, 2-end , 3-d   period of partum

8.     Signs of placental detachment.

9.     External methods of ablation placenta.

10.           Course and direction of postpartum period.

11.           Peculiarities course and direction of partum when there are different variant of cephalic presentation.

12.           Biomechanism of partum when there are different variant of cephalic presentation.

13. The principles of active management of the postpartum period. Criteria and deadlines discharge from the hospital clinic. (Order ¹ 503 of 28.12.2002). 163 p.)
14. Anatomical and physiological characteristics of the neonatal period. Y and feeding infants. Organization of the Department of newborns.
15. Determination of risk to the fetus by prenatal factors
16. Classification of drugs according to their permeability through the placental barrier.

17. The meaning of the main ethical principle of medicine.

 

7. A student should be able:

1.     To make external obstetrical examination.

2.     Auscultative pappitation of fetus.

3.     Determine presence of labor activity, give its appreciation, to put plan of delivery.

4.     Motivate necessity of painless of labor, choose adequate methods of painless.

5.     Using case records draw parthogramme.

6.     Demonstrate perineum protection on phantom.

7.     If the child born appreciates him by Apgar scale.

8.     To make processing of umbilical cord on phantom.

9.     Appreciate presence of signs of placental detachment.

10.                        Motivate necessity to use external methods of ablation placenta.

11.                        Look and appreciate afterbirth.

12.                       Calculation of hemorrhage in partum.

13. To show the biomechanism of childbirth (on a phantom).

14. To make a plan of delivery.

15. To manage the I period of childbirth, to reveal complications.

16. To substantiate indications for Cesarean section.

 

8. Correct answers of test evaluations and situational tasks

1. E, 2.B, 3.A.

9. References:

A – Basic: 1. Obstetrics. – Edited by Ventskivska. – Kyiv “Medicine” – 2008. – 336p.

2.Obstetrics and gynaecology. Williams & Wilkins Waverly Company. – Third Edition.-2001-980ð.

2. Essentials of obstetrics and gynecology. – W.B. Saunders Company. – Third edition – Neville F. Hacker, M.D., J. George More, M.D. – 737p.

3PHYSIOLOGY OF PREGNANCY.

 

B – 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”

 

 

 

Prepared by Stelmakh O.Y.

 

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 __