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Course syllabus for acute gynaecology and early pregnancy ATSM

The acute gynaecology and early pregnancy ATSM course syllabus below lists the minimum requirements for a course to be suitable for the theoretical component of this module. The course should last 2 days.

Any times given or descriptions of activities within a course are given for guidance and as an example only. To establish whether a course is suitable, please compare this syllabus and the syllabus of a course on offer and take advice from your ATSM Preceptor. Please also read our general guidance on ATSM courses.

The College can’t offer advice or information relating to the suitability of courses except for courses run by the RCOG or jointly run by the RCOG and specialist societies.

Course syllabus – lecture topics and timings

ATSM in acute gynaecology and early pregnancy (30 minutes)

  • Rationale for having this ATSM
  • Role of consultants in the provision of acute gynaecological care
  • Explanation of theoretical and practical training, availability and certification

Early pregnancy units – organisational aspects (30 minutes)

  • Setting up units
  • Necessary facilities
  • Staffing
  • Laboratory support
  • Managing patient flow
  • Management algorithms
  • Protocols
  • Patient information leaflets
  • Facilities for outpatient and inpatient treatment

Epidemiology and aetiology of miscarriage and ectopic pregnancy (30 minutes)

  • Causes of early miscarriage and ectopic pregnancy
  • Age-related risk of miscarriage
  • Effects of assisted conception and various medical conditions on miscarriage rates
  • Epidemiology of miscarriage and ectopic pregnancy, including clinically detectable and subclinical losses
  • Use of epidemiological figures when planning local services for the management of early pregnancy complications

Diagnosis and conservative management of miscarriage (30 minutes)

  • Ultrasound criteria for diagnosis of miscarriage
  • Role of serum biochemistry in early pregnancy failure
  • Effectiveness of expectant and medical treatment of miscarriage
  • Summary of randomised clinical trials
  • Diagnosis and initial management of trophoblastic disease

Diagnosis and conservative management of tubal ectopic pregnancies (30 minutes)

  • Ultrasound diagnosis of tubal ectopic pregnancy
  • Role of serum biochemistry when ultrasound findings are inconclusive
  • Selection criteria for expectant and medical management
  • Methotrexate protocols (emphasis on safety and adverse effects)

Differential diagnosis and management of non-tubal ectopic pregnancies (30 minutes)

  • Differential diagnosis of ectopic pregnancies
  • Aetiology, epidemiology and management of each type of non-tubal ectopic pregnancy

Surgical management of early pregnancy complications (30 minutes)

  • Surgical options to treat miscarriage, including outpatient local anaesthetic evacuation of retained products of conception
  • Laparoscopic diagnosis of ectopic pregnancy
  • Relative merits of salpingectomy and salpingotomy, including variations in surgical techniques

Recurrent miscarriage – current concepts in investigations and treatment (30 minutes)

  • Up-to-date information about management of recurrent miscarriage, including advice on setting up a dedicated recurrent miscarriage clinic

Counselling women following early pregnancy loss (30 minutes)

  • Importance of emotional support and counselling within the early pregnancy unit
  • Arrangements for providing psychological support to those particularly badly affected by pregnancy loss
  • Information about other sources of support, e.g. Miscarriage Association, Ectopic Pregnancy Trust, etc.

How to organise care for women with acute gynaecological problems (30 minutes)

  • Reasons for providing dedicated acute gynaecology units
  • Organisational issues
  • Staffing
  • Protocols
  • Role of imaging and laboratory support
  • Admission procedures and access to operating theatres

Differential diagnosis of acute pelvic pain (30 minutes)

  • Various gynaecological causes of pelvic pain, including:
    • Clinical presentation
    • Laboratory tests
    • Role of ultrasound and other imaging methods in reaching a correct diagnosis

Abnormal vaginal bleeding – diagnosis and management (30 minutes)

  • Causes of abnormal bleeding, including postmenopausal bleeding
  • Diagnostic work-up
  • Role of ultrasound
  • Endometrial biopsy and outpatient hysteroscopy
  • Management of cervical lesions
  • Endometrial hyperplasia
  • Polyps and submucous fibroids
  • Problems with intrauterine contraceptive devices

Pelvic inflammatory disease – current concepts in screening and outpatient management (30 minutes)

  • Up-to-date information about the value of opportunistic screening for chlamydia and how it should be implemented in clinical practice
  • Management of asymptomatic chlamydial infection
  • Contact tracing
  • Role of genitourinary medicine clinics and development of joint protocols
  • Principles of outpatient management of presumed and mild pelvic inflammatory disease

Management of severe pelvic infection (30 minutes)

  • Clinical, ultrasound and laboratory features of severe pelvic infections
  • Principles of antibiotic therapy
  • Pain management and general support
  • Ultrasound-guided drainage of pelvic abscess
  • Indications for surgical treatment of severe pelvic inflammatory disease

Diagnosis and management of haemorrhagic and septic shock (30 minutes)

  • Pathophysiology of shock
  • Diagnostic work-up
  • Principles of treatment and monitoring

Acute appendicitis and other non-gynaecological causes of pelvic pain (30 minutes)

  • Overview of various non-gynaecological causes of pelvic pain
  • Principles of diagnosis and treatment

Role of minimally invasive surgery in the diagnosis and treatment of acutely ill women (30 minutes)

  • Specific issues which need to be considered when planning surgery on acutely ill women, with particular reference to:
    • Haematoperitoneum
    • Management of functional haemorrhagic cysts
    • Ovarian torsion
    • Adhesions and unexpected findings
    • Other abnormalities, e.g. significant pelvic endometriosis

Elsewhere on the site

Assessment of training
Information about sign-off of competencies, workplace-based assessments, ARCPs and more
Resources and support for trainees
Training guidelines, advice, useful resources and sources of support for trainees