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Knowledge Area 7 – Management of labour

Capability in practice (CiP)

  • 1: The doctor is able to apply medical knowledge, clinical skills and professional values for the provision of high-quality and safe patient-centred care
  • 6: The doctor takes an active role in helping self and others to develop
  • 10: The doctor is competent in recognising, assessing and managing emergencies in obstetrics

 

Summary Knowledge Requirements

PART 1 MRCOG

  • Physiology, biochemistry and endocrinology of parturition, including maturation of the fetal endocrine system, the influence of hormones on signalling pathways in the myometrium and the biochemistry of myometrial contractility
  • Principles of tocolysis and stimulation of uterine contraction
  • Fetal physiology in late pregnancy
  • Fetal assessment in late pregnancy and labour, and how to interpret the results
  • Placentation and the implications of infection on labour, and the optical therapeutic options

PART 2 MRCOG

  • Have the knowledge, skills, understanding and judgement to be capable of initial management of intrapartum problems, including knowledge and understanding of normal and abnormal labour, data and investigation interpretation, clinical judgement and prioritisation, management of a team, communication skills, insights and knowing one’s limits, emotional and cultural awareness, and appropriate use of protocols and guidelines

PART 3 MRCOG

  • Have the knowledge, skills, understanding and judgement to be capable of initial management of intrapartum problems without direct supervision, including knowledge and understanding of normal and abnormal labour, data and investigation interpretation, clinical judgement and prioritisation, management of a team, communication skills, insights and knowing one’s limits, emotional and cultural awareness, and appropriate use of protocols and guidelines

 

Detailed Knowledge Requirements

  • Mechanisms of normal labour and delivery
  • Induction and augmentation of labour
  • Drugs acting upon the myometrium
  • Structure and use of partograms
  • Fluid balance in labour
  • Blood products
  • Regional anaesthesia, analgesia and sedation
  • Fetal wellbeing and compromise
  • Prolonged labour
  • Emergency policies/maternal collapse/haemorrhage
  • Pre-term labour/ premature rupture of membranes
  • Cervical cerclage
  • Multiple pregnancy in labour
  • Severe pre-eclampsia and eclampsia
  • In-utero fetal death (IUFD), including legal issues
  • Acute abdominal pain
  • Mechanisms of normal and abnormal labour
  • Mechanism of spontaneous vaginal delivery
  • Methods of induction of labour; indications, contraindications and complications
  • Methods of augmentation of labour; indications, contra-indications and complications
  • Drugs acting upon the myometrium and cervix
  • Structure and use of partograms
  • Fluid balance in labour
  • Transfusion
  • Types and methods of action of regional anaesthesia including epidural (lumbar, caudal), spinal, pudendal nerve block; indications and contra-indications
  • Types and methods of action of analgesia and sedation including narcotics, hypnotics, psychotropics, non-steroidal anti-inflammatory drugs; indications, contra-indications
  • Complications of anaesthesia and analgesia including cardiac arrest, respiratory arrest, aspiration, drug reactions
  • Assessment of fetal wellbeing using fetal heart rate monitoring, acid/base balance, and fetal scalp blood sampling
  • Causes and management of fetal compromise including cord prolapse and intra-uterine fetal death
  • IUFD – legalities regarding registration and disposal of fetal tissue
  • Causes and management of prolonged labour
  • Causes and management of maternal collapse including massive haemorrhage, cardiac problems, pulmonary and amniotic embolism, drug reactions, trauma
  • Emergency guidelines and procedures
  • Ante andintra partum haemorrhage including, placenta praevia, vasa praevia, ruptured uterus, coagulation defects, iatrogenic causes
  • Causes, mechanisms of action and complications of pre-term labour/ premature rupture of membranes including fetal pulmonary maturity, infection risks
  • Preterm labour including therapy (antibiotics, steroids, tocolysis), consultation with neonatologists, in-utero transfer, methods of delivery (induction of labour, timing, mode), outcomes, risks
  • Role and types of cervical cerclage
  • Multiple pregnancy in labour
  • Severe pre-eclampsia and Eclampsia
  • Placental abruption