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Selectives - OB/GYN

Maternal Fetal Medicine Selective

Selective Number: (Oasis - S52k) 1912

Rotation Supervisor: Dr. Christian Chisholm

Duration: 2 weeks

Available: TBA

Report to: Chief Resident on Obstetrics service

Time to Report: 7:50 am

Place to Report: Labor and Delivery, 8 East University Hospital

Typical Day: 8:00 am - 5:00 pm

Suggested preparatory reading: ACOG Practice Bulletins: 4: Prevention of Rh(D) Alloimmunization; 12: Intrauterine Growth Restriction; 22: Fetal Macrosomia; 27: Prenatal Diagnosis of Fetal Chromosomal Abnormalities; 43: Management of Preterm Labor; 56: Multiple Gestation; 60: Pregestational Diabetes Mellitus; 64: Hemoglobinopathies in Pregnancy

Number of students per rotation: 2

Course Description: Triage assessments in Labor and Delivery and admission history and physicals on high risk obstetrics patients, assisting in the operating room, writing orders, counseling families, evaluation and management of new and return clinic patients.

Each antepartum inpatient should be seen daily by the selective student and should be presented to the team orally in morning report.

A selection of readings in various high risk obstetrics topics is listed above as required reading; additional reading will be patient-focused from standard texts of obstetrics. Each selective student will be required to complete five case studies (either web-based or paper-based) from the library of choices provided by the selective supervisor.

The student will be able to:

  • take a complete history and physical for a new ambulatory high risk obstetrics patient, including formulation of an appropriate plan of care
  • make appropriate triage assessments of patients presenting to Labor and Delivery with pregnancy-relate complaints other than normal labor.

Medical and surgical conditions in pregnancy: The student will be able to counsel patients regarding potential consequences of the following conditions in pregnancy:

  • anemia
  • diabetes mellitus
  • urinary tract disorders
  • infectious diseases, including:
    • herpes
    • rubella
    • group B streptococcus
    • hepatitis
    • human immunodeficiency (HIV), human papillomavirus (HPV) and other sexually transmitted infections
    • cytomegalovirus (CMV)
    • toxoplasmosis
    • varicella and parvovirus
  • cardiac disease
  • asthma
  • surgical abdoment

Isoimmunization: The student will demonstrate knowledge of the following:

  • red blood cell antigens
  • use of immunoglobulin prophylaxis during pregnancy
  • clinical circumstances under which D isoimmunization is likely to occur
  • methods used

Multifetal gestation: The student will be able to describe:

  • etiology of monozygotic, dizygotic and multizygotic gestation
  • altered physiologic state with multifetal gestation
  • symptoms, physical findings and diagnostic methods
  • approach to antepartum, intrpartum and postpartum management

Third trimester bleeding: The student will be able to:

  • describe the approach to the patient with third-trimester bleeding
  • compare symptoms, physical findings and diagnostic methods that differentiate patients with placenta previa, abruptio placenta and other causes of third-trimester bleeding
  • describe complications of placenta previa and abruptio placenta
  • describe immediate management of shock secondary to third-trimester bleeding
  • describe components of the various blood products and indications for their use

Preterm labor: The student will be able to cite:

  • factors predisposing to preterm labor
  • signs and symptoms of premature uterine contractions
  • causes of preterm labor
  • management of preterm labor, including:
    • tocolytics
    • steroids
    • antibiotics

Fetal growth abnormalities: The student will be able to:

  • define macrosomia and fetal growth restriction
  • describe etiologies of abnormal growth
  • cite methods of detection of fetal growth abnormalities
  • cite associated morbidity and mortality

Prenatal diagnosis: The student will be able to state:

  • indications for genetic counseling and prenatal diagnosis testing
  • relative risks and benefits of different prenatal diagnostic and screening tests
  • inheritance patterns of conditions commonly encountered in prenatal diagnosis centers