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Knowledge Area 9 – Postpartum problems

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 and structural changes in the neonate
  • Physiology of lactation, uterine involution and the pathology and management of puerperal sepsis and infection
  • Common puerperal complications, including mental health issues
  • Postpartum contraception and other drugs used postpartum and during lactation

PART 2 MRCOG

  • Understand and demonstrate appropriate knowledge, skills and attitudes in relation to postpartum problems, including dealing with the resuscitation of both mother and baby and the ability to manage birth trauma and other birth complications
  • Understand and be able to manage neonatal problems at birth

PART 3 MRCOG

  • Understand and demonstrate appropriate knowledge, skills and attitudes in relation to postpartum problems, including dealing with the resuscitation of both mother and baby and the ability to manage birth trauma and other birth complications
  • Display empathy, counselling skills and an understanding of the role of other professionals
  • Understand and be able to manage neonatal problems at birth, and be able to discuss these with parents

 

Detailed Knowledge Requirements

  • Normal and abnormal postpartum period
  • Techniques for the control of postpartum haemorrhage
  • Appropriate use of blood and blood products
  • manual removal of placenta
  • bimanual compression of uterus
  • exploration of genital tract
  • cervical laceration (identification and repair)
  • drug management of haemorrhage
  • balloon tamponade of uterus
  • laparotomy including B Lynch stitch
  • radiological embolisation
  • ligation of internal iliac arteries
  • caesarean hysterectomy
  • Perineal surgery
  • Repair of episiotomy, second- third- fourth- degree laceration
  • Retained placenta
  • Postpartum and postoperative complications
  • Epidemiology, aetiology, pathogenesis, recognition, diagnosis, prevention, management, complication, prognosis regarding: uterine involution, bleeding including placenta accreta, atonic uterus, retained placenta, retained products of conception, pyrexia, infections, maternal collapse including massive haemorrhage, cardiac problems, pulmonary and amniotic embolism, drug reactions, trauma, thromboembolism, lactation (inadequate, suppression), medical disorders (diabetes mellitus, renal disease, cardiac disease)
  • postnatal review
  • contraception
  • Postpartum and postoperative complications, including pathophysiology, diagnosis, management and prognosis in puerperal psychological disorders (blues, depression), mood disorders, reactions to pregnancy loss
  • Perperal sepsis, mastisis, urinary tract infection
  • Breast cancer
  • Sequelae of obstetric events: antenatal, intrapartum
  • Recognition of normality: postnatal management, clinical evaluation
  • Resuscitation of newborn: collapse, primary apnoea, secondary apnoea, ventilation, effect of maternal drugs, cardiac massage, umbilical catheterisation, volume replacement, temperature control, acid/base status
  • Common problems of the neonate (aetiology, management sequelae): respiratory distress, hyperbilirubinaemia, infection, seizures, hypoglycaemia, hypothermia, heart disease, intracranial haemorrhage, necrotizing enterocolitis, the preterm infant, the growth restricted infant, congenital anomalies, syndromes, cerebral palsy
  • Feeding: breast (advantages, promotion, techniques), artificial (formulae, techniques)