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Obstetrics

bulletRCGP RCOG Joint Statement
bulletWest Midlands

RCGP RCOG Joint Statement competency based

Vocational training in obstetrics and gynaecology should help future general practitioners to acquire the knowledge, skills and values that will enable them to provide a broad range of service for women and to an acceptable standard.

Training should concentrate particularly on those conditions and activities that are common in general practice with particular emphasis on the normal and the prompt recognition of the abnormal.

Programmes should prepare general practitioners to undertake intrapartum care if they wish to do so.

Shared Antenatal and Postnatal Care

The doctor should:

  1. appreciate the preventive role, and understand the significance of all routine procedures used in modern antenatal care;

  2. have a thorough understanding of the epidemiology of maternal and perinatal morbidity and mortality;

  3. be able to undertake the initial management of common and life-threatening emergencies in early pregnancy;

  4. know when pregnant women require referral for specialist opinion or care and which are suitable for shared care or full care by the general practitioner;

  5. understand the principles of counselling a woman faced with possible or real problems of fetal malformation;

  6. know the methods by which congenital 1 malformation of the fetus may be detected;

  7. be aware of the methods of, and provision for, education for pregnancy, childbirth and care of the newborn;

  8. understand the importance of social and emotional factors in pregnancy and childbirth;

  9. understand their own role and that of different members of the health team in this field;

  10. understand the management of common conditions for which pregnant women are admitted to hospital e.g. premature labour, pre-eclampsia, multiple pregnancy, fetal growth retardation, antepartum haemorrhage, maternal disease etc;

  11. be able to recognise the signs and symptoms of the onset of labour;

  12. understand the principles and methods of the current management of labour;

  13. understand the importance of accurate and detailed records in all aspects of obstetric care and recognise the value of such records in clinical audit;

  14. be able to carry out routine examination of the newborn infant;

  15. understand the normal development of the newborn;

  16. recognise common diseases arising in the newborn;

  17. recognise congenital abnormalities in the newborn;

  18. understand how breast feeding is established and maintained;

  19. recognise and understand the management of physical and psychological problems of the mother in postnatal period e.g. puerperal depression;

  20. understand the normal involutional processes in the postpartum period;

  21. understand the indications for maternal immunisation with anti D and rubella vaccine and the importance of confirming their efficacy;

  22. be able to advise and provide suitable methods of family planning.

Intranatal Care

The doctor should:

  1. be able to conduct a normal delivery in a way that is based on an understanding of the physical and psychological processes of childbirth;

  2. understand the indications and contra­ indications for the induction of labour;

  3. understand the physiology of uterine activity and the advantages and disadvantages of the use of oxytoxics to augment vaginal delivery;

  4. know the principles and practice of continuous fetal heart rate and acid-base monitoring and their implications;

  5. recognise the abnormalities that may occur in labour necessitating transfer to specialist care e.g. fetal distress, haemorrhage, delay in labour, abnormal presentation, etc;

  6. be able to:
    bullet

    induce labour where appropriate.

    bullet

    provide obstetric analgesia and local

    bullet

    anaesthesia including pudendal block.

    bullet

    carry out a low forceps delivery.

    bullet

    resuscitate a shocked mother.

    bullet

    resuscitate a shocked baby.

  7. understand the management of other abnormalities of labour e.g. shoulder dystocia, breech, twins;

  8. be able to manage the third stage of labour including the immediate management of postpartum haemorrhage and retained placenta;

  9. be able to suture episiotomies and lacerations;

  10. be aware of special arrangements needed for home confinements;

  11. be able to communicate with women in labour in order to become aware of their particular wishes and fears concerning its conduct so that they can be active participants in the decisions concerning its management, and so that they can understand the procedures proposed for their own safety and that of their babies;

  12. understand the local arrangements for intrapartum care in the setting of general practice.

Source:
RCGP & RCOG General Practitioner Vocational Training In Obstetrics & Gynaecology 1998;

West Midlands

Learning experience in the subject

Antenatal care 

bulletUnderstand the nature of ANC. Appreciate anticipatory care role.
bulletBe able to counsel patients about screening for foetal abnormality.
bulletBe able to advise about maternity benefits.
bulletUnderstand the role of the professionals involved in ANC
bulletKnow when to book a patient for shared care or for GP care: Risks and benefits of home confinements. Local arrangements.
bulletPre-conception advice

Complications in Pregnancy 

bulletBleeding in early pregnancy.
bulletMiscarriage
bulletEctopic pregnancy
bulletHyperemesis.
bulletPremature labour
bulletPre eclampsia & hypertension
bulletMultiple pregnancy
bulletFoetal growth retardation
bulletBleeding in later pregnancy
bulletMaternal disease
bulletGestational diabetes

Intra-partum care 

bulletRecognise the onset of labour.
bulletManagement of labour
bulletRecognise the complications of labour
bulletExamine a new born baby
bulletBe able to resuscitate a newborn baby.

Post-natal care 

bulletManage complications of the puerperium
bulletCarry out a postnatal examination.
bulletAdvise on family planning.
bulletAdvise a patient about breastfeeding.

Procedures (observe, assist or perform) 

bulletFoetal monitoring
bulletForceps delivery
bulletBreech Delivery
bulletAssist with a LSCS
bulletAssist with a twin delivery
bulletManually remove a placenta.
bulletCarry out an evacuation of uterus

 

Source: D Rapley Surviving GP Training (Download Word version)

 

 

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