OB-GYN 101

Obstetrics
Antepartum care
Intrapartum care
Postpartum care
Lactation
Abnormal Labor
Preterm labor
Premature rupture of membranes
Preeclampsia-eclampsia syndrome
Spontaneous abortion
Ectopic pregnancy
Third-trimester bleeding

Exams and Procedures
Breast Exam
Pelvic Exam
Pap Smear
Cultures
Rectal Exam
Vaginal Delivery
Wet Prep
Suturing/Stapling

Gynecology
Sexually transmitted infection
Salpingitis
Endometriosis
Normal and abnormal bleeding
Uterine leiomyomas
Disorders of the breast
Cervical disease and neoplasia
Endometrial carcinoma
Ovarian neoplasms
Pap smear and cultures
Contraception
Sterilization
Abortion
Sexual assault
Domestic violence
Climacteri

Learning objectives in obstetrics and gynecology can be written in a variety of formats and their contents may vary from institution to institution. These objectives are representative of those from a number of professional and educational institutions.

Antepartum Care

Rationale: Antepartum care promotes patient education and provides on going risk assessment and development of an individualized patient management plan.

The student will be able to cite methods to:

1. Diagnose pregnancy

2. Assess gestational age

3. Distinguish an at-risk pregnancy

The student will be able to describe

1. Appropriate diagnostic studies

2. Patient education programs

3. Nutritional needs of pregnant women

4. Adverse effects of drugs and the environment

The student will be able to

1. Perform a physical examination on obstetric patients

2. Answer commonly asked questions concerning pregnancy and labor and delivery.

Intrapartum Care

Rationale: Understanding the process of normal labor and delivery allows optimal care and reassurance for the parturient and timely recognition of abnormal events.

The student will be able to describe:

1. Characteristics of true and false labor

2. Initial assessment of the laboring patient

3. Stages and mechanism of normal labor and delivery

4. Techniques to evaluate the progress of labor

5. Pain management during labor

6. Methods of monitoring the mother and fetus

7. Management of normal delivery

8. Vaginal repair

9. Indications for operative delivery

10. Immediate postpartum care of the mother.

Postpartum Care

Rationale: Knowledge of normal postpartum events allows appropriate care, reassurance, and early recognition of abnormal events.

The student will be able to describe:

1. Normal maternal physiologic changes of the postpartum period

2. Normal postpartum care

3. Appropriate postpartum patient counseling.

Lactation

Rationale: Knowledge of the physiology and function of the breast during lactation allows appropriate counseling to the pregnant and postpartum woman.

The student will be able to:

1. List the normal physiologic and anatomic changes of the breast during pregnancy and the postpartum periods

2. Recognize and treat common postpartum abnormalities of the breast

3. Know the reasons why breast feeding should be encouraged

4. Recognize commonly used medications which are appropriate and inappropriate to use while breastfeeding

5. Counsel the lactating patient about commonly asked questions such as frequency, duration, inadequate production of milk, etc.

Abnormal Labor

Rationale: Labor is expected to progress in an orderly and predictable manner. Careful observation of the mother and fetus during labor will allow early detection of abnormalities so that management can be directed to optimize outcome.

The student will be able to list:

1. Abnormal labor patterns

2. Methods of evaluating fetopelvic disproportion

3. Fetal and maternal complications resulting from abnormal labor

4. Indications and contraindications for oxytocin administration

5. Strategies for management of abnormal fetal presentations

6. Indications for vaginal birth after cesarean delivery

7. Strategies for emergency management of breech, shoulder dystocia, and cord prolapse

Preterm Labor

Rationale: Prematurity is the most common cause fo neonatal mortality and morbidity. The reduction of preterm births remains an important goal in obstetric care. Understanding the causes and recognizing the symptoms of preterm labor provides the basis for management decisions.

The student will be able to cite:

1. Factors predisposing to preterm labor

2. Signs and symptoms of premature uterine contractions

3. Causes of preterm labor

4. Management of preterm labor, including tocolytics, steroids, and antibiotics.

Premature Rupture of Membranes

Rationale: Rupture of the membranes prior to labor is a problem for both term and preterm pregnancies. Careful evaluation of this condition may improve fetal and maternal outcome.

The student will be able to describe the following:

1. History, physical findings, and diagnostic methods to confirm rupture of the membranes

2. Factors predisposing to premature rupture of membranes.

3. Risks and benefits of expectant management versus immediate delivery

4. Methods to monitor maternal and fetal status during expectant management.

Preeclampsia-eclampsia Syndrome

Rationale: Preeclampsia-eclampsia syndrome accounts for significant morbidity and mortality in both the mother and newborn.

The student will be able to explain:

1. Definition(s) and classification of hypertension in pregnancy

2. Pathophysiology of preeclampsia-eclampsia syndrome

3. Symptoms, physical findings and diagnostic methods

4. Approach to management

5. Maternal and fetal complications

Spontaneous Abortion

Rationale: Bleeding is common in early pregnancy. A logical approach to its evaluation may not only affect the outcome of the pregnancy, but also will help to reassure the patient.

The student will be able to:

1. Develop a differential diagnosis for first-trimester bleeding

2. Distinguish the types of spontaneous abortion

3. Define recurrent abortion

4. Recognize the signs of a missed abortion

5. List complications of spontaneous abortion

6. List causes and complications of septic abortion.

Third Trimester Bleeding

Rationale: Bleeding in the third trimester requires immediate patient evaluation. Thoughtful, prompt evaluation and management is necessary to reduce the threat to the lives of the mother and fetus.

The student will be able to:

1. Describe the approach to the patient with third-trimester bleeding

2. Compare symptoms, physical findings, and diagnostic methods that differentiate patients with placenta previa and abruptio placenta

3. Describe complications of placenta previa and abruptio placenta

4. Describe immediate management of shock secondary to third-trimester bleeding

5. Describe components of the various blood products and indications for their use.

Pap Smear and Cultures

Rationale: The Pap smear is one of many screening methods used in medicine. Proper technique in performing the Pap smear and obtaining specimens for microbiologic culture will improve accuracy.

The student will demonstrate the ability to:

1. Perform an adequate Pap smear

2. Obtain specimens to detect sexually transmitted diseases

3. Handle specimens properly to improve diagnostic accuracy

4. Provide an explanation to the patient regarding the purpose of these tests.

Contraception

Rationale: An understanding of the medical and personal issues involved in decisions regarding contraceptive methods is necessary to adequately advise patients requesting contraception.

The student will be able to explain:

1. Physiologic or pharmacologic basis of action

2. Effectiveness

3. Benefits and risks

4. Financial considerations of the various methods of contraception.

Climacteric

Rationale: Women spend as much as one-third of their lives in the postmenopausal years. Understanding the physical and emotional changes caused by estrogen depletion is important for all physicians who provide health care for women.

The student will be able to describe:

1. Physiologic changes in the hypothalamic-pituitary-ovarian axis.

2. Symptoms and physical findings associated with hypoestrogenism

3. Management, including hormone therapy, nutrition and exercise, and non-hormonal therapeutic options.

4. Risks and benefits of hormone replacement therapy.

Sterilization

Rationale: In the process of deciding whether to have a sterilization procedure, men and women often seek the advice of their physicians. Providing accurate information will allow patients to make an informed decision regarding this elective surgery.

The student will be able to list:

1. Methods of male and female surgical sterilization

2. Risks and benefits of procedures

3. Factors needed to help the patient make informed decisions, including potential surgical complications, failure rates and reversibility.

4. Financial considerations

Abortion

Rationale: Induced abortion is a reproductive option considered by some patients. Regardless of one's personal views, the practitioner should be aware of the techniques, management, and complications of induced abortions.

The student will be able to list:

1. Surgical and non-surgical pregnancy termination methods

2. Potential complications of abortion, such as hemorrhage and infection.

3. Psychosocial considerations of abortion.

Sexually Transmitted Infection

Rationale: To prevent sexually transmitted infections and minimize their impact on health, the physician should understand their basic epidemiology, diagnosis and management.

The student will be able to list organisms and methods of transmission, symptoms, physical findings and evaluation and management of each of the following::

1. Gonorrhea

2. Chlamydia

3. Herpes simplex virus

4. Syphilis

5. Human papillomavirus infection

6. Human Immunodeficiency virus (HIV) infection

7. Hepatitis B virus infection.

The student will be able to list the public health concerns, including:

1. Screening programs

2. Costs

3. Prevention and immunizations

4. Partner evaluation and treatment

Salpingitis

Rationale: The potential impact of acute or chronic salpingitis is significant. Early recognition and optimal management may help prevent the long-term sequelae of tubal disease.

The student will be able to describe:

1. Pathogenesis

2. Common organisms

3. Signs and symptoms

4. Methods of diagnosis

5. Treatment

6. Sequelae, including tuboovarian abscess, chronic salpingitis, ectopic pregnancy, and infertility.

Endometriosis

Rationale: Endometriosis is a common problem of women of reproductive age, which may result in pelvic pain, infertility and menstrual dysfunction.

The student will be able to describe:

1. Theories of pathogenesis

2. Symptoms and physical findings

3. Common sites of implants

4. Methods of diagnosis

5. Non-surgical and surgical management

Normal and Abnormal Bleeding

Rationale: The occurrence of bleeding at times other than expected menses is a common event. Accurate diagnosis of abnormal uterine bleeding is necessary for appropriate management.

The student will be able to:

1. Describe endocrinology and physiology of the normal menstrual cycle

2. Distinguish abnormal uterine bleeding from dysfunctional uterine bleeding

3. List causes of abnormal uterine bleeding

4. Evaluate and diagnose abnormal uterine bleeding

5. Describe therapeutic options.

Uterine Leiomyomas

Rationale: Uterine leiomyomas represent the most common gynecologic neoplasm and are often asymptomatic.

The student will be able to describe the following:

1. Prevalence of uterine leiomyomas

2. Symptoms and physical findings

3. Methods to confirm the diagnosis

4. Indications for medical and surgical treatment

Ectopic Pregnancy

Rationale: Ectopic pregnancy is a leading cause of maternal morbidity and mortality in the Unites States. Early diagnosis and management may not only save lives, but may also preserve future fertility.

The student will be able to:

1. Develop a differential diagnosis of first-trimester bleeding

2. List risk factors predisposing patients to ectopic pregnancy

3. Describe symptoms and physical findings suggestive of ectopic pregnancy

4. Understand methods and test used to confirm the diagnosis of ectopic pregnancy

5. Explain treatment options

Disorders of the Breast

Rationale: Every physician should understand the basic approach to evaluating the common symptoms associated with the breast.

The student will be able to describe:

1. Standards of surveillance of an adult woman, including breast self-examination, physical examination and mammography.

2. Diagnostic approach to a woman with the chief complaint of breast mass, nipple discharge, and breast pain.

The student will be able to describe the history and physical findings that might suggest the following abnormalities:

1. Intraductal papilloma

2. Fibrocystic changes

3. Fibroadenoma

4. Carcinoma

5. Mastitis

The student will be able to teach a woman how to perform breast self-examination.

Cervical Disease and Neoplasia

Rationale: Detection and treatment of preinvasive lesions reduces the medical and social costs of, as well as the mortality associated with, carcinoma of the cervix.

The student will be able to describe:

1. Risk factors of cervical disease and neoplasia

2. Indications for screening.

3. Symptoms and physical findings of cervicitis and neoplasia

4. Evaluation and management of the patient with an abnormal pap smear.

5. Impact of staging on management and prognosis

Endometrial Carcinoma

Rationale: Endometrial carcinoma is the most common gynecologic malignancy.

The student will be able to describe:

1. Risk factors for endometrial carcinoma

2. Symptoms and physical findings

3. Management of the patient with postmenopausal bleeding

4. Methods to diagnose endometrial carcinoma

5. Impact of staging on management and prognosis

6. Management of the patient with endometrial cancer

Ovarian Neoplasms

Rationale: Adnexal masses are a common finding in both symptomatic and asymptomatic patients. Management is based on determining the origin and character of these masses.

The student will be able to describe:

1. Evaluation of the patient with an adnexal mass

2. Characteristics of ovarian neoplasms

3. Evaluation and management of carcinomas of the ovary

4. Symptoms and physical findings

5. Risk factors

6. Histologic classification

7. Impact of staging on management and prognosis

Sexual Assault

Rationale: Individuals who are the victims of sexual assault often have significant physical and emotional sequelae.

The student will be able to explain the medical, forensic, psychological evaluation and treatment and followup of::

1. Child sexual assault victim

2. Adult sexual assault victim

3. Acquaintance rape

Domestic Violence

Rationale: Domestic violence affects a significant proportion of the U.S. population in all economic classes and walks of life. All physicians should screen for the presence of domestic violence.

The student will be able to:

1. Cite prevalence and incidence of violence against women, elder abuse, child abuse.

2. Assess the involvement of any patient in domestic violence situations.

3. Counsel patients for short term safety.

4. Counsel patients regarding local support agencies for long term management and resources.

5. Counsel patients requiring resources for batterers and perpetrators of domestic violence.