Obstetric Course Research Articles

Discussion on the construction of MOOC course in obstetric and gynecological nursing teaching

To meet the new requirements of modern information education, and to achieve the goal of developing a new type of nursing talents with good judgment thinking ability and post competency, Chongqing Medical University explored the construction and application of nursing courses in obstetrics and Gynecology. By means of MOOC network platform, we provided students with rich teaching resources, so that students could complete their own learning, interactive discussion, examination questions and feedback, to provide the basis for teachers designing the teaching of flipped classroom. We also used the MOOC class to implement the mixed teaching, and gradually develop students' autonomous learning ability. Key words: Mooc (massive open online courses); Obstetrics and gynecology nursing; Teaching practice

Culturally Adapted Obstetrics Course for Traditional Mayan Birth Attendants

INTRODUCTION: Guatemala has the third highest maternal mortality rate in Latin America with 290 maternal deaths per 100,000 live births. Traditional Mayan birth attendants with minimal formal obstetric training provide a majority of maternity and delivery care in rural settings. We assess knowledge before and after a culturally adapted 16-week curriculum on basic obstetric practice and management of obstetric emergencies. METHODS: Twenty-three women were recruited in Santiago Atitlan through a local hospital partnership with the ministry of health. Majority had a maximum of 1 year of formal health care training. Local health care providers and Saving Mothers volunteers taught three didactic modules with 29 4-hour sessions in Spanish. On the first day of each module, participants received a pretest that was repeated the last day of that module. RESULTS: Average cumulative scores improved by 17% points between pretests and posttests (P<.001). Module 1, 2, and 3 scores improved by 16% (P=.005), 18% (P=.004), and 17% (P=.004), respectively. Before the course, only 35% of participants scored correctly in multiple basic knowledge areas such as female anatomy, pregnancy diagnosis, and pregnancy management and prenatal care. Posttest assessment improved 20–35% in these areas. Participants' strongest baseline areas were newborn assessment and care, labor and delivery, and family planning. CONCLUSION: Baseline knowledge of obstetrics and anatomy was low in this Mayan birth attendant population. A formal education led to a measurable increase in knowledge. Care should be given to create culturally appropriate educational material that leads to an increase in knowledge retention.

Tribute to a great obstetrician: in memory of Ingemar Ingemarsson.

Ingemar Ingemarsson, grew up in a rural area in Smaland in the southern part of Sweden. He studied and graduated at the Medical Faculty at Lund University and started his career in obstetrics and gynecology in 1972 at the University Hospital in Lund. He defended his PhD thesis in 1975, was appointed consultant and later became Head of the Department and Professor in Obstetrics at Lund University. In 1997 the Royal College of Obstetricians and Gynaecologists acknowledged Ingemar Ingemarsson's contributions to our speciality and honored him by the "Fellow ad eundum" award; one of seven Swedish obstetricians and gynecologists to be given that honor. This article is protected by copyright. All rights reserved.

Board #221 - Program Innovation Development of a Novel Multi-Modal Obstetric Simulation Course for Emergency Medicine Residents (Submission #8691)

ObjectivesThe management of the critically ill obstetric patient is an essential component in the training of an emergency medicine (EM) resident physician. Due to advances in the quality of perinatal care, many obstetric emergencies such as eclampsia and postpartum hemorrhage, are infrequently enco

PMM.57 Fanconi Anaemia complicating pregnancy – treatment and management of critical thrombocytopenia and anaemia

AimTo understand the underlying pathology and antenatal, intrapartum and postnatal issues associated with Fanconi anaemia, and to appreciate the importance of care planning and MDT working.DiscussionDescribed first in 1927, Fanconi...

Can laparoscopic removal of Essure device before embryo transfer correct poor reproductive outcome pattern in IVF? A case report

Objective: This report describes a successful surgical approach to multiple in vitro fertilization (IVF) failures in the setting of hydrosalpinges, which had been previously treated with Essure inserts. Materials and Methods: A non-smoking 33-year-old Caucasian G2 P0020 (body mass index: BMI = 22) attended for second opinion. Her history was significant for bilateral hydrosalpinges having been noted on hysterosalpingogram two years earlier. This was managed by hysteroscopic placement of Essure inserts bilaterally. One year later, and now with Essure in situ, the patient completed three IVF cycles elsewhere. Her first and third IVF attempts resulted in biochemical pregnancy, while human chorionic gonadotropin (hCG) was negative after the second cycle. Upon presentation at the authors’ center and before beginning a fourth IVF cycle, further testing and surgical removal of the Essure devices was recommended. Results: Repeat hysteroscopy was unremarkable; laparoscopic bilateral salpingectomy and extirpation of Essure implants was accomplished without difficulty. Following menses, the patient initiated IVF with three embryos transferred. At day 60, a single intrauterine pregnancy was identified with positive cardiac activity (rate >100/min). Her obstetrical course was uneventful; a healthy 4,195 gram male infant was delivered (breech) by Cesarean at 40 weeks’ gestation. Conclusion: Essure inserts comprise inner fibers of polyethylene terephthalate, a stainless steel coil, and a nickeltitanium coil. The product received FDA approval as a contraceptive in 2002 although its use for hydrosalpinx remains off-label. While successful outcomes with IVF following Essure placement have been reported, this is the first description of pregnancy and delivery from IVF after Essure removal. Essure may be considered for sterilization when laparoscopy is contraindicated, but experience with its use specifically for treating hydrosalpinges before IVF is limited. This observed association between prior poor IVF outcomes and Essure with subsequent delivery after surgical Essure removal is the first of its kind to be reported, and warrants further investigation.

Perceived changes in the knowledge and confidence of doctors and midwives to manage obstetric emergencies following completion of an Advanced Life Support in Obstetrics course in Australia

The Advanced Life Support in Obstetrics (ALSO) course is an internationally recognised interprofessional course to support health professionals to develop and maintain the knowledge and skills to manage obstetric emergencies. This study investigated changes in confidence and perceived changes in the knowledge of doctors and midwives to manage specific obstetric emergency situations following completion of an ALSO course in Australia. A prospective repeated-measures survey design was used to survey 165 course attendees from four Australian states pre- and postcourse and at six weeks (n=101). Data were analysed using a Friedman two-way repeated-measures analysis of variance and the Wilcoxon signed rank test. There was a significant improvement in confidence and perceived knowledge of the recommended management of all 17 emergency situations immediately postcourse (P<0.001) and at six weeks postcourse (P<0.001) when compared to precourse levels for both groups of health professionals. However, a significant decrease in knowledge and confidence for many emergency situations from immediately postcourse to six weeks postcourse (P<0.05) was also observed in both groups. Completion of the Australian ALSO course in Australia has a positive effect on the confidence and perceived knowledge of doctors and midwives to manage obstetric emergencies. However, there needs to be some means of reinforcing the effects of the course for longer term maintenance of knowledge and confidence.

Critique of the pre-hospital obstetric emergency training course: ALSG

Pre-hospital obstetric incidents account for a significant number of emergency calls to the ambulance service, with obstetric emergencies being one of the most challenging situations that pre-hospital practitioners encounter. The mortality associated to obstetric emergencies has shown significant decline over recent years due to improved obstetric education, advances in surgery and improved maternal care. Additionally, the development of the Confidential Enquiry into Maternal and Child Health (CEMACH) has identified patterns of sub-optimal practice and has provided recommendations on how to improve the maternity services and obstetric care available to all pregnant patients. One of the most influential recommendations to come out of this document was the apparent need to improve education of basic, intermediate and advanced life support in obstetric emergencies, which lead to the introduction of advanced obstetrics and gynaecology becoming compulsory elements within the paramedic curriculum. The need for organisation and ambulance trusts to provide specialist training into obstetric emergencies was also identified within this enquiry (Confidential Enquiry into Maternal and Child Health, 2007; Advanced Life Support Group, 2010). In order facilitate the development of prehospital obstetric education; several programmes have been written which allowed for paramedics to maintain their continuous personal development through the competition of a short ‘crash course’ in obstetric care. One of the most successful courses of this type available to prehospital clinicians is the pre-hospital emergency training course (POET) delivered by the advanced life support group. Within this article, a review of this course will take place in order for readers to gain an understanding into the course content and the benefits of undertaking such course as part of the clinician’s continuous personal development. The authors of this article have recently completed the POET course, held in Manchester, which was the inspiration for this piece.

A atuação dos enfermeiros egressos do curso de especialização em obstetrícia no nordeste do Brasil: da proposta à operacionalização

Com o objetivo de detalhar a atuação de enfermeiros após especialização em Obstetrícia na Região Nordeste do Brasil e os benefícios dessa atuação consubstanciados em premiações para a instituição em que trabalhavam, procedeu-se a estudo transversal, descritivo, exploratório, entre maio de 2006 e março de 2007, em duas fases: a primeira com entrevista estruturada para 127 (67,2%) dos 345 egressos da especialização, residentes em nove estados do Nordeste, e a segunda com contato telefônico via web a 56 (98,2%) enfermeiros. Constatou-se que 114 (90,5%) egressos atuavam na assistência, 50 (39,7%) na administração e 47 (37,3%) na docência de enfermagem. Só em Pernambuco, os egressos lecionavam a residentes de enfermagem. Predominou a concessão da premiação pelo Ministério da Saúde a instituições com egressos. Concluiu-se que cursos de especialização em enfermagem obstétrica, financiados pelo Ministério, ensejaram ganhos a egressos e instituições, permitindo melhor assistência, resultando em premiações pela implantação de novos modelos assistenciais.

Management of a Klippel–Trenaunay syndrome in pregnant women with mega‐cisterna magna and splenic and vulvar varices at birth: A case report

Klippel-Trenaunay syndrome (KTS) is a rare, sporadic and complex malformation characterized by the clinical triad of: (i) capillary malformation (port-wine stain); (ii) soft tissue and bone hypertrophy or occasionally, hypertrophy of one lower limb; and (iii) atypical lateral varicosity. The maternal and fetal risks associated with pregnancy in women with KTS are proportional to disease severity, which can be exacerbated by pregnancy. Complications include bleeding, disseminated intravascular coagulation, thromboembolic events and pain. Here, we report the case of a pregnant woman with KTS who had an uneventful pregnancy, labor and postpartum course, but had splenic and large vulvar vein varices. The obstetrical course of women with KTS varies. Management is largely conservative and multidisciplinary approaches form the mainstay for managing these patients based on their symptoms.

Kidney injury during pregnancy: associated comorbid conditions and outcomes

To investigate the characteristics of women who have kidney injury during pregnancy. Medical records of all women who gave birth at our institution between January 1, 2005, and December 31, 2010, were retrospectively reviewed electronically. We identified those who incurred a kidney injury [defined by modified Acute Kidney Injury Network (AKIN) criteria: serum creatinine (sCr) increase ≥0.3mg/dL] during pregnancy or within 30days postpartum. Identified case records were reviewed in detail. During the study period, 54 women had a kidney injury (0.4% estimated incidence) with a mean (SD) increase in sCr of 0.46 (0.29) mg/dL; most injuries were AKIN stage 1 with transient increases in sCr. Most of the women (n=48, 87.3%) had substantial preexisting or pregnancy-associated comorbid conditions (e.g., kidney disease, hypertension, diabetes), complications (e.g., preeclampsia, HELLP syndrome), or a complicated obstetric course (hemorrhage, infections) that could have contributed to the development of a kidney injury. Two patients had AKIN stage 3 injuries: a previously healthy patient who had a massive hemorrhage during cesarean delivery, and a patient with a renal transplant who had deterioration and eventual postpartum failure of her transplanted kidney. The majority of pregnancy-associated kidney injuries were transient and occurred in women with substantial comorbid conditions or complicated pregnancies.

Vasectomy: a survey of attitudes, counseling patterns and acceptance among Nigerian resident gynaecologists.

Previous Nigerian studies show widespread ignorance and low acceptance of vasectomy among the male population. The objectives of this study were to determine the level of knowledge of, attitudes to, counselling pattern and acceptance of vasectomy among Nigerian Resident Gynaecologists. A cross-sectional questionnaire based survey. Resident Doctors attending a national update course in obstetrics and gynaecology. Most of the doctors had good knowledge of Vasectomy. More than four-fifth of the doctors were convinced that the average Nigerian male will not accept vasectomy when indicated while more than three-fifth consider BTL a more appropriate option for permanent contraception in our setting. Forty one point three percent of the doctors will opt for vasectomy or urge their husbands to. Reasons for opposition to vasectomy were socio-cultural (21.3%), religious (13.1%) and psychological (41.0%), 24.6% had no specific reasons. While 89.4% of the doctors counselled often for BTL only 5.8% did for vasectomy. The Doctors showed good knowledge of vasectomy but most were poorly disposed towards use of vasectomy. The findings suggest a need for effective national training programmes targeted at resident doctors to enhance their knowledge of vasectomy as well as break barriers to personal use of, and counselling for vasectomy.

William Mackintosh Mackean

Bill Mackean seemed to want to keep to surgery hours from the moment he came into the world, in the family house at 55 Shaw Street, Everton, on 20 July...

Teaching pelvic examination technique using professional patients: a controlled study evaluating students' skills

To compare the skills in pelvic examination technique between students who have had training with professional patients and a control group of students trained using clinical patients. Prospective controlled study. University hospital. Students attending three consecutive courses in obstetrics and gynecology at Karolinska University Hospital. A study group of 53 students received training in pelvic examination with professional patients and was compared with a control group of 34 students who were trained using clinical patients. The students' skills in pelvic examination technique were examined by teachers in a practical test. Students' skills were also evaluated by the students themselves and by the patients who participated in the examination. Students who had training with professional patients were more skilled in performing a pelvic examination and better prepared to examine their own patients than students trained using clinical patients. Training with professional patients is more effective in teaching pelvic examination technique than training with clinical patients. We recommend that the use of professional patients is considered in the training of medical students.

Similaridades entre semiologias na metodologia da aprendizagem baseada em problemas

O Programa de Aprendizagem de Ginecologia e Obstetrícia da PUC-PR adota a aprendizagem baseada em problemas como metodologia de aprendizagem. Neste programa, são executados diversos casos clínicos que compõem seu conteúdo. Para cada caso clínico, os professores definem uma semiologia principal e as respectivas semiologias secundárias, a fim de definir o conjunto de ações ou procedimentos que os alunos devem executar. Visando à inserção das tecnologias da informação e comunicação no aprendizado dos alunos, foi desenvolvido um sistema que permite obter, passo a passo, as ações e procedimentos executados pelos alunos. O objetivo geral deste trabalho é conceber um modelo matemático e computacional que permita obter índices de similaridade entre as semiologias definidas pelos professores e as executadas pelos alunos.

Modern simulation-based training in obstetrics

Dear Editor Management of obstetric emergencies is difficult. Managing a rarely occurring obstetric emergency would be challenging, even for a very experienced accoucheur. This highlights the importance of obstetric emergency management courses. In most of these courses, for example, advanced life support in obstetrics (ALSO) and managing obstetric emergencies and trauma (MOET), simulation-based training is provided. Such training with the use of novel simulators appears very productive and perhaps, ideal.

Pre-hospital risks of the reconfiguration of obstetric services

The increasing centralization and reconfiguration of obstetric services demands insight into the pre-hospital (and inter-hospital) risks of emergency obstetric care. This applies to emergency admissions from home, to transfer of women who encounter problems during home delivery and also to inter-facility transfers from stand-alone midwifery-led units, without the facilities for obstetric emergency intervention, to place of safety consultant obstetric units, as well as transfers from obstetric units to network tertiary centres with neonatal intensive care facilities and for definitive treatment of the critically-ill woman. This article discusses the risks of reconfiguration including the balance between safety and accessibility. The planned reconfiguration of obstetric services must always take into account the need for high quality pre-hospital and inter-hospital care of obstetric emergencies. This requires well-trained and experienced paramedics as full members of the obstetric team. The Pre-Hospital Obstetric Trauma course of the Advanced Life Support Group will become the standard for high quality care.

Frank Wright

<h3>Aim</h3> To understand the underlying pathology and antenatal, intrapartum and postnatal issues associated with Fanconi anaemia, and to appreciate the importance of care planning and MDT working. <h3>Discussion</h3> Described first...

Pregnancy complicated with Alport syndrome: A good obstetric outcome and failure to diagnose an infant born to a mother with Alport syndrome by umbilical cord immunofluorescence staining

Alport syndrome is a familial progressive nephritis. The most frequent type is X-linked Alport syndrome, caused by genetic abnormalities in the alpha 5 chain of type IV collagen. Skin biopsy is a useful tool for diagnosing this disease. It is not well known how this syndrome affects pregnancy and how it is affected by pregnancy, or whether the umbilical cord may provide material for detecting this collagen abnormality. We report a primigravida with Alport syndrome with mild proteinuria who gave birth abdominally to a term male infant without deteriorating renal function during pregnancy. The umbilical cord from not only this infant but also from an Alport (-) control infant showed negative immunofluorescence staining for the alpha 5 chain of type IV collagen. Women with Alport syndrome without renal dysfunction may follow an uneventful obstetrical course until term. The cord may not be suitable for diagnosing Alport syndrome with immunofluorescence staining.

O1000 The advanced life support in obstetrics (ALSO) course in Moshi, Tanzania: A cost analysis

O1000 The advanced life support in obstetrics (ALSO) course in Moshi, Tanzania: A cost analysis