Veidlapa Nr. M-3 (8)
Study Course Description

Obstetrics and Gynaecology

Main Study Course Information

Course Code
DUGK_019
Branch of Science
Clinical medicine; Obstetrics and gynaecology
ECTS
9.00
Target Audience
Medicine
LQF
Level 7
Study Type And Form
Full-Time

Study Course Implementer

Course Supervisor
Structure Unit Manager
Structural Unit
Department of Obstetrics and Gynaecology
Contacts

Riga, 45 Miera Street, Rīgas pašvaldības SIA Rīgas Dzemdību nams, dzgk@rsu.lv, +371 67293837

About Study Course

Objective

To provide students with knowledge of conception, course of pregnancy, the physiology and pathology of the birth process and the postnatal period, as well as the necessary practical skills to apply this knowledge. To provide students with knowledge of the physiology and pathology of the sexual system in different periods of a woman’s life, the main gynaecological diseases, diagnosis, differential diagnosis and treatment principles thereof, prevention of gynaecological diseases, rehabilitation of gynaecological patients, methods of family planning, as well as to teach the necessary practical skills for the application of this knowledge.

Preliminary Knowledge

Human anatomy, histology, medical cell biology, embryology, human homeostasis, physiology, medical microbiology, medical genetics, pathology, propedeutics, functional morphology, basic topographical anatomy, adaptation of body functions, internal diseases (cardiology), clinical pharmacology, introduction to surgery, radiology, tumour pathology and morphology, medical ethics.

Learning Outcomes

Knowledge

1.Knows the definitions of reproductive health and reproductive rights. Understands the principles of organisation of perinatal care, the main quality indicators of obstetric assistance (maternal mortality and perinatal mortality). Orients in Latvian legislation on reproductive health issues. Is able to describe and explain the anatomy and physiology of the female genital organs, the process of fertilisation, the development of the foetus and placenta, and the physiology of pregnancy. Knows the principles of reproductive anamnesis taking and basic gynaecological examination methods. Has good knowledge of basic antenatal care, screening of the foetus for congenital anomalies, understands normal and abnormal pregnancy: spontaneous termination of pregnancy up to week 22 of pregnancy, ectopic pregnancy, trophoblastic diseases, normal delivery, physiological postpartum period, breast feeding, preterm delivery, post-term pregnancy, multifoetal pregnancy, assessment of the foetal condition during pregnancy, TORCH infection in pregnant women, isoimmunisation during pregnancy, haemorrhage during pregnancy and the postpartum period, birth trauma to mother and foetus, hypertensive complications during pregnancy, systemic diseases during pregnancy, operative obstetrics, septic postpartum complications, adaptation of the newborn after birth and primary resuscitation, clinical pharmacology of medicinal products used in perinatal care. Understands the procedure and methods of termination of pregnancy up to week 22 of pregnancy. Understands the role of normal genital tract microflora in pregnancy and causing gynaecological pathologies: STI, endogenous and iatrogenic infection – aetiology, diagnostic methods, impact on reproductive health, treatment, including during pregnancy, pelvic inflammatory disease, septic complications in the postpartum period (endometritis, wound infection). Understands the causes of uterine bleeding: menstrual cycle disorders, endometrial precancerous diseases and endometrial cancers, principles of diagnosis and treatment thereof. Understands the possibilities of primary and secondary prevention of cervical cancer, the pathogenesis of cervical cancer, and the principles of cervical cancer diagnosis and treatment. Has good knowledge of family planning methods and principles of selection. Understands the causes of female virilisation, the diagnosis of polycystic ovary syndrome, the principles of treatment, the role of oestrogens in the female body at different periods of life and the pathogenesis of pathologies caused by oestrogen deficiency, the principles of treatment (menopause, hormone replacement therapy). Understands the pelvic floor dysfunction and infertility. Understands the main gynaecological operations and manipulations, how to prepare patients for them and how to manage the post-operative period. Has good knowledge of benign and malignant tumours of genitals – uterine fibroids and ovarian tumours, causes of chronic pelvic pain and differentiation thereof, endometriosis, primary and secondary dysmenorrhoea, premenstrual syndrome.

Skills

1.Skills to be acquired independently: 1. Bimanual examination of the uterus. 2. Cervical examination with a mirror, oncocytology smear. 3. Leopold maneuvers and uterine height measurement. 4. Neonatal resuscitation. 5. Assisting with normal birth.

Competences

1.Takes reproductive anamnesis. Performs a general examination on a pregnant woman and a gynaecological patient. Determines the gestational age. Understands the process of physiological birth and the principles of birth management. Demonstrates manual techniques in assisting with physiological birth and care for the newborn. Knows how to assess the state of the foetus – listening to the foetal heartbeat with a foetal doppler. Knows what parameters to assess in a newborn after birth to decide on the state of health of the newborn, knows how to provide a safe environment for the newborn after birth and understands if any support is needed. Knows how to prescribe and explain the need for examinations and interpret the results during antenatal care in case of a physiologically normal pregnancy, is able to identify abnormalities and understand the following tactical steps in case of major pregnancy pathologies: risk of foetal genetic abnormalities, asymptomatic bacteriuria, gestational diabetes mellitus, iron deficiency anaemia. Knows how to explain the nature of primary and secondary prevention of cervical cancer, explain how to collect cervical cytology and interpret cervical cytology results. Is competent to advise women on the choice and use of family planning methods. Is able to explain to a woman the symptoms of gynaecological diseases, the possibilities of examination and the informativeness of the methods of examination, and the possibilities of prevention and treatment of diseases.

Assessment

Individual work

Title
% from total grade
Grade
1.

Individual work

-
-
Independent learning and video recording of practical manipulations. Clinical history of gynaecology or obstetrics. Assignments in the e-environment. A report on a topic in gynaecology. Students must fill in the study course questionnaires.

Examination

Title
% from total grade
Grade
1.

Examination

-
-
Attendance of lectures and classes. Tests and tasks in classes. Acquisition of independent skills and assessment of a video recording. Demonstration of a practical manipulation for a grade. An exam based on clinical cases (multiple-choice test).

Study Course Theme Plan

FULL-TIME
Part 1
  1. Lecture

Modality
Location
Contact hours
On site
Auditorium
2

Topics

Obstetrics and gynaecology – introduction to the specialty. The concept and indicators of reproductive health. Procedure of organisation of childbirth assistance in Latvia, legislation.
  1. Lecture

Modality
Location
Contact hours
Off site
E-Studies platform
2

Topics

Normal menstrual cycle, methods of examining it, menstrual cycle disorders.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Preconception period. Physiological changes in a woman’s body during pregnancy, complaints and symptoms related to the physiological course of pregnancy. Diagnosis of pregnancy. Placenta, functions thereof. The growth and development of a foetus. Effects of teratogenic factors. Choosing medicinal products during pregnancy and lactation. Healthy nutrition during pregnancy. Limiting the spread of non-communicable diseases. Reproductive history.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Antenatal care of pregnant women, the role of medical practitioners, examinations during antenatal care, justification thereof, interpretation of results and possible tactics. Genetic screening. Isoimmunisation during pregnancy, diagnosis, tactics, prevention. Assessment of the growth and well-being of the foetus during pregnancy. Gravidogram. Social guarantees for families in Latvia.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

A patient in the obstetric clinic – specifics of examination, examination methods and informativeness thereof, observance of ethical principles. Pathways of birth. Bony pelvis in the obstetric sense. The foetus as the object of birth. Terminology of obstetrics. Foetal position, options for detecting it. The biomechanics of birth.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Normal birth. Partogram. Management of physiological birth. Foetal adaptation mechanisms to hypoxia during birth, foetal monitoring during birth. Cardiotocography.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Assessment of the newborn after birth. Apgar score. Adaptation of and care for a newborn. Primary resuscitation of a newborn in the delivery room.
  1. Class/Seminar

Modality
Location
Contact hours
On site
-
4

Topics

Simulating birth – management of physiological birth (situational tasks).
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

The most common complaints of gynaecological patients. Physical examination of women: general examination, breast examination, abdominal palpation, palpation of regional lymph nodes, pelvic examination, outpatient diagnostic procedures. Radiological examination methods. Uterine cavity abrasion, culdocentesis, diagnostic laparoscopy. Laboratory examination methods. Screening programmes for early detection of cervical, breast and colorectal cancer.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Precancerous conditions of the cervix: aetiology, screening, interpretation of cytology test results, role of colposcopy, histological examination, principles of treatment and follow-up. Primary and secondary prevention of cervical cancer.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Menstrual cycle disorders, classification, differential diagnosis and treatment principles thereof. PCO syndrome – the impact thereof on women’s reproductive and general health, principles of therapy.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Pathological uterine bleeding, causes, differential diagnosis, examination methods and treatment principles. FIGO classification. Precancerous endometrial conditions, classification, examination methods, treatment principles. Premenstrual syndrome.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Genital tract infections: STI, endogenous and iatrogenic infection – diagnostic methods, impact on reproductive health, treatment, including during pregnancy. Pelvic inflammatory disease.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Physiological postpartum period, patient monitoring, early warning score. The most common complications of the postpartum period, diagnosis thereof and tactics. Physiology of lactation. Postpartum depression.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Concept: obstetric dystocia. The place of operative delivery in modern obstetrics: caesarean section, operative vaginal delivery, indications thereof. Comparison of the risk profile of caesarean section and vaginal delivery. Foetal position in the pelvis: principles of pregnancy and labour management tactics, external cephalic version. Maternal birth trauma. Risk assessment and principles of prevention of venous thromboembolism in the postpartum/postoperative period. Uterotonics.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Semester test: demonstration of a randomly selected manipulation for assessment.
Total ECTS (Creditpoints):
4.50
Contact hours:
60 Academic Hours
Final Examination:
Exam (OSCE)
Part 2
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Pregnancy complications caused by genital infections (intrauterine infection, GBS). TORCH infections during pregnancy (toxoplasmosis, rubella, syphilis, herpes, cytomegalovirus, HIV, chickenpox), options for prevention of vertical transmission of TORCH infections.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Preterm birth. Prolongation of pregnancy, post-term pregnancy, induction of labour. Assessment of the condition of the foetus in case of prolonged pregnancy.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Bleeding during pregnancy (placental abruption, placenta previa, etc.), during birth (placental attachment abnormalities, etc.) and the early postnatal period. Principles of restoring lost blood volume. Uterotonics, dosage thereof, use in obstetrics.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Multifetal pregnancy. Hypertensive states in obstetrics.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Systemic diseases and pregnancy – cardiovascular diseases, kidney diseases (including asymptomatic bacteriuria, acute pyelonephritis), anaemia, antiphospholipid syndrome, deep vein thrombosis, pulmonary embolism, medicinal products and the side effects of use thereof. Risk assessment in antenatal care, risk mitigation strategy, multidisciplinary approach.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Systemic diseases and pregnancy – endocrine system diseases (gestational diabetes, diabetes mellitus, thyroid pathology), nervous system diseases (epilepsy, headaches), depression, lung diseases (bronchial asthma, tuberculosis, pneumonia), surgical pathology, medicinal products to be used, side effects thereof. Risk assessment in antenatal care, risk mitigation strategy, multidisciplinary approach.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Menopausal transition. Menopause: natural, iatrogenic, early; hormonal changes, physical changes. Impact on quality of life and organ systems – genitourinary, cardiovascular, bone tissue system, cognitive function. Hormone replacement therapy: types, indications, contraindications, risks.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

The concept of family planning, contraception methods, effectiveness thereof and medical criteria for use.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Pelvic floor dysfunction. Vaginal and uterine prolapse, aetiopathogenesis, classification, principles of diagnosis, differential diagnosis and therapy thereof. Urinary incontinence, classification, principles of examination, principles of treatment. Urogynaecology as a subspecialty of gynaecology.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Bleeding in the first half of pregnancy – spontaneous abortion, missed abortion, ectopic pregnancy. Termination of pregnancy at the woman’s request, legislation in Latvia, methods.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Uterine myoma, symptoms, diagnosis, principles of therapy. Ovarian formations, symptoms, diagnosis, complications. Principles of treatment. Surgical treatment methods in gynaecology. Acute abdomen in gynaecology – causes, differential diagnosis, treatment.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Endometrial, cervical and ovarian cancer: diagnosis, treatment. Genetic predisposition to ovarian and breast malignancies.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Chronic pelvic pain. Endometriosis – aetiology, pathogenesis, stages, examination and treatment principles. Primary and secondary dysmenorrhoea.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Infertility, principles of examination of an infertile couple, modern treatment options.
  1. Class/Seminar

Modality
Location
Contact hours
On site
Specialized room
4

Topics

Presentation of a report on gynaecology. Submitting anamnesis.
Total ECTS (Creditpoints):
4.50
Contact hours:
60 Academic Hours
Final Examination:
Exam (OSCE)

Bibliography

Required Reading

1.

Lekciju materiāls.

2.

M.Pilmane, G.H. Šūmahers Medicīniskā embrioloģija, Rīgas Stradiņa universitāte 2006. (akceptējams izdevums)

3.

Dzemdniecība, D. Rezebergas redakcijā, Nacionālais apgāds, 2016.

4.

Ginekoloģija, I. Vībergas redakcijā, Nacionālais apgāds, 2013.

5.

Williams Gynecology, atkārtoti izdevumi, 2021

6.

Ārvalstu studentiem/For international students:

7.

Williams Gynecology, atkārtoti izdevumi, 2021

Additional Reading

1.

Latvijas ginekologu un dzemdību speciālistu asociācijas vadlīnijas.

2.

Williams Obstetrics, atkārtoti izdevumi, 2022

3.

LR likumdošana, MK 611. noteikumi

4.

Jaundzimušo reanimācijas rokasgrāmata, American Heart Association, American Academy of Pediatrics, 2004.

5.

Ārvalstu studentiem/For international students:

6.

Williams Obstetrics, atkārtoti izdevumi, 2022

Other Information Sources

1.

Ilona Auziņa. Bērnu un pusaudžu ginekoloģija, Rasa ABC, 2004.

2.

RSU bibliotēkas resursi.

3.

www.pubmed.com

4.

Ārvalstu studentiem/For International students:

5.

www.pubmed.com

6.

RSU library resources.