Obstetrics/Gynecology | Advocate Health Care

Externs are expected to make rounds with the obstetrical service on antepartum, postpartum and labor and delivery patients, prior to perinatal rounds, starting at a time to be determined by the chief obstetrical resident.

Following Perinatal Service Rounds, externs are expected to participate in the care of and delivery of patients in labor and delivery, under the supervision of residents on the obstetrical service. This experience will hopefully include:

Admitting patients to labor and delivery
Management of patients during the labor process and those with pregnancy complications
Participation in the delivery of patients
Assisting in the cesarean delivery of patients
Other procedures as determined by senior resident staff

Weekday afternoons:
Tuesday and Friday afternoons:
Externs are expected to participate in the resident high-risk obstetrical clinic in the Maternal-Fetal Medicine Office.

Wednesday afternoons:
Participation in the resident lecture series is recommended

Monday and Thursday afternoons:
Participation in Maternal-Fetal Medicine attending staff office sessions and/or observation of obstetrical ultrasounds in the Maternal Fetal Medicine office is expected.

Call schedule:
While not mandatory it is recommended that participants in the maternal fetal medicine rotation choose one night per week for in-house call on the labor and delivery unit. The day for call should be predetermined after discussions with the senior obstetrical resident. The schedule for the student on the day after call should be in accordance with guidelines of the particular school the student attends.

Presentation:
It is expected that the externs will give a presentation to the obstetrical service on the last Friday of the rotation. The topic of this presentation should be one of interest and significant to the high-risk obstetrical rotation. Overheads and or slides would enhance the presentation but are not mandatory. An outline or handout of the presentation should be available for participants. The presentation should last approximately 10 minutes and should highlight the presenters understanding of the topic, and ability to organize the topic/presentation appropriately.

Maternal-Fetal Medicine Rotation Objectives:
The following objectives are given to enhance participant’s abilities to organize the studies regarding the high-risk obstetrics rotation. These objectives are not all-inclusive and participants should strive to cover these topics at a minimum along with other topics relating to patients under their care. For recommendations on books to use during this rotation please check with senior obstetrical residents or Maternal-Fetal Medicine attending physicians.

A) Maternal-Fetal Physiology
The student will demonstrate knowledge of the following:

Maternal physiologic changes associated with pregnancy
Physiologic functions of the placenta and fetus
Effect of pregnancy on common diagnostic studies

B) Antepartum Care
The student will demonstrate knowledge of the following:

Medical conditions such as diabetes mellitus,chronic hypertensive vascular disease,and heart disease
Recurrent pregnancy loss
History of genetic abnormalities
Maternal age over 35
Substance Abuse
Assessment of gestational age
Assessment of fetal growth, well being, and maturity

The student will demonstrate the following skills:

Performing a physical examination on obstetric patients
Answering commonly asked questions concerning pregnancy, labor and delivery

C.) Intrapartum Care
The student will demonstrate knowledge of the following:

Characteristics of true and false labor
Initial assessment of the laboring patient
Stages and mechanism of normal labor
Techniques to evaluate the progress of labor
Pain management during labor
Methods of monitoring the mother and fetus
Management of normal delivery and episiotomy repair
Indications for operative delivery
Postpartum care of the mother

D.) Medical and Surgical Conditions in Pregnancy
The student will demonstrate knowledge of the following conditions in pregnancy:

Anemia
Diabetes mellitus
Urinary tract disorders

Infectious diseases, including:

Herpes
Group B Beta strep
HIV
Hepatitis B
Cardiac disease
Asthma
ETOH, tobacco, and other substance abuse
Acute abdominal symptoms

E.) Pre-eclampsia-Eclampsia Syndrome
The student will demonstrate knowledge of the following:

Definitions and classifications of hypertension in pregnancy
Pathophysiology of preeclampsia-eclampsia syndrome
Symptoms, physical findings and diagnostic methods
Approach to management
Maternal and fetal complications

F.) D-Isoimmunization
The student will demonstrate knowledge of the following:

Antigens of the Rh system
Use of immunoglobulin prophylaxis during pregnancy
Clinical circumstances under which D-isoimmunization is most likely to occur
Methods to determine severity of fetal involvement

G.) Multifetal Gestation
The student will demonstrate knowledge of the following:

Etiology of monozygotic, dizygotic and multizygotic gestation
Altered physiologic state with multifetal gestation
Symptoms, physical findings and diagnostic methods
Approach to antepartum, intrapartum and postpartum management

H.) Abnormal Labor
The student will demonstrate knowledge of the following:

Various abnormal labor patterns
Methods of evaluating feto-pelvic disproportion
Fetal and maternal complications resulting from abnormal labor
Indications and contraindications for oxytocin use and administration
Management of abnormal fetal presentations
Vaginal birth after cesarean section

I.)Third Trimester Bleeding
The student will demonstrate knowledge of the following:

Approach to the patient who presents with third trimester bleeding
Symptoms, physical findings, and diagnostic methods that differentiate patients with placenta previa and abruption placenta from those with other causes of third trimester bleeding
Complications of placenta previa and abruptio placenta

J.) Preterm Labor
The student will demonstrate knowledge of the following:

Impact of preterm labor and delivery on neonatal morbidity and mortality
Factors predisposing to preterm labor
Signs and symptoms of premature uterine contractions
Causes of preterm labor
Principles of tocolysis

K.) Premature Rupture of Membranes
The student will demonstrate knowledge of:

History, physical findings and diagnostic methods to confirm premature rupture of membranes
Conditions favoring expected to management vs. timely delivery
Methods to monitor maternal and fetal status in expectant to management

L.) Intrapartum Fetal Distress
The student will demonstrate knowledge of the following: Techniques of intrapartum fetal surveillance including

Ascultation
Electronic fetal monitoring
Fetal scalp sampling
Fetal pulse oximetry
Reassuring fetal heart rate patterns
Recognition and management of non-reassuring fetal heart patterns

M.) Postpartum Hemorrhage
The student will demonstrate knowledge of the following:

Risks associated with postpartum hemorrhage

Immediate management of the patient with postpartum hemorrhage including:

Inspection for laceration
Use of and types of uterine contractile agents

N.) Postpartum Infection
The student will demonstrate knowledge of the following:

Risk factors for postpartum infection
Infectious organisms
Evaluation and management of the patient with postpartum infection
Use of prophylactic antibiotics

O.) Mortality
The student will demonstrate knowledge of the following

Maternal death
Fetal death
Neonatal death
Perinatal death

P.) Postterm Pregnancy
The student will demonstrate knowledge of the following:

Normal period of gestation
Risks of post maturity
Antepartum fetal surveillance
Management of prolonged gestation
Methods and agents for cervical ripening

Q.) Fetal Growth Anomalies
The student will demonstrate knowledge of the following:

Definitions of macrosomia and fetal growth retardation
Etiologies of abnormal growth
Methods of detection of fetal growth abnormalities
Associated morbidity and mortality