Obstetrics Block

Two-week rotation on the in-patient services which combines daytime work and night on-call responsibilities (work rounds, teaching rounds, admissions, following laboring patients and participating in deliveries and postpartum care). All on Obstetrics block will attend daily morning and evening Labor and Delivery unit team rounds. The Chief Resident will release the student on night call to home after morning rounds. Each student will be scheduled on-call 3 weeknights and one weekend night. Two students will be expected to attend work/teaching rounds on Saturday and Sundays, and if not on-call that day will be off for the rest of the day when rounds have been completed. The Labor and Delivery Attending “Rounder” on service will make daily student work assignments (labor and delivery, Ultrasound clinic, high risk OB clinic) keeping in mind the expectation that while on this 2 week block, UNMC students should spend at least 1½ days in ultrasound and one ½ day seeing high risk OB patients (either in MFM or High Risk OB clinic). A similar arrangement will be set-up at Methodist Hospital.

Learning Objectives for Obstetrics Block:

Cognitive: Students should become familiar with the following topics:
     Normal Obstetrics-
          Preconception Counseling
          Diagnosis of Pregnancy
          Physiology and Maternal Adaptation of Pregnancy
          Antepartum Care including Prenatal Diagnosis
          Labor and Delivery including induction of labor
          Obstetric Analgesia and Anesthesia
          The Puerperium

     Abnormal Obstetrics-
          Bleeding in Pregnancy- second and third trimester
          Fetal Death in Utero
          Dystocia
          Breech
          Cesarean section and VBAC
          Hypertensive Disorders in Pregnancy- Preeclampsia
          Isoimmunization
          Multiple Gestation
          Intrauterine Growth Restriction
          Premature Rupture of Membranes
          Preterm Labor
          Postpartum hemorrhage
          Puerperal Fever
          Medical and Surgical Complications of Pregnancy:
             Anemia, Cardiac Disease, Diabetes, Pyelonephritis,
             other
          Counseling on Male Circumcision

Ultrasound Clinic:

Students will have exposure to ultrasound and prenatal diagnosis in pregnancy by spending time with the High Risk Obstetricians (MFM) and ultrasound technicians during ultrasound clinic. Students should focus on the following goals while spending time in ultrasound clinic:

1) Understand the components of an anatomic obstetric survey
2) Be familiar with 1st trimester screening

3) Be familiar with the QUAD screen testing and how normal or abnormal results affect counseling and testing at time of ultrasound
4) Understand the types of antenatal surveillance (such as NST (non-stress test), AFI (amniotic fluid index), BPP (biophysical profile) available; understand indications for these tests

Some students will get to see some unusual ultrasound findings and it would be expected that the student would perform extra research into that anomaly.

Knowledge and Skills Expectations:

By the end of the Obstetrics block students will be expected to competently:

1) Obtain, present, and document a relevant history on patients being evaluated or admitted; examinations will be done with supervising resident/ faculty
2) Interpret and document fetal heart rate monitoring strips
3) Assess and document labor course in patients, postpartum assessments
4) Write appropriate post-delivery orders (vaginal and C/S)
5) Understand the normal hospital course for the patient after a normal vaginal delivery or operative C/S delivery

Directed studying recommendations:

Students have only 6 weeks to cover a wide range of clinical problems seen by Ob/Gyns. It is important that students use “down-time” for directed studying. On the Obstetrics block, activities aimed at directed studying include:

Ultrasound Images link: http://www.obgyn.net/us/img_gal.htm

OB ultrasound link: http://www.cpdx.com/

FHT Tracing link:
http://www.aafp.org/afp/990501ap/2487.html

Learning about Nurse Midwifery
http://www.acnm.org/focus/thinking/index.cfm

Breastfeeding Information
http://www.askdrsears.com/html/5/T020100.asp

Virtual Hospital (patient education on OB topics)
www.vh.org

2) Reviewing Obstetric-related sample test questions and answers to prepare for NBME shelf examination.
(Binder of sample questions available through Clerkship Coordinator)

3) Reading the assignments for that week’s Wednesday faculty teaching sessions. References listed on student web site and copies available through Clerkship Coordinator.

Last Update: August 23, 2007