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Study-Unit Description
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CODE MDS4018

 
TITLE Obstetrics and Gynaecology 1

 
LEVEL 04 - Years 4, 5 in Modular UG or PG Cert Course

 
ECTS CREDITS 12

 
DEPARTMENT Faculty of Medicine and Surgery

 
DESCRIPTION The theoretical teaching programme during the fourth year of studies is covered by a series of lectures and tutorials delivered throughout the two semesters. The study-unit will deal with six subsections:
1. Maternal Medicine - Medical and surgical disorders in the obstetric patient
2. Normal and abnormal pregnancy
3. Foetal medicine
4. Physiological and structural disorders of the female reproductive system
5. Pathological disorders of the female reproductive system
6. Oncology of the female reproductive system

This study-unit builds up on the assumption that prior objectives have been reached in previous study-units [MDS1009 - Reproduction & Genetics Units.] There is in addition a clinical component incorporating two three-week clinical attachments [total six weeks]. The student is required to keep a portfolio reflecting this clinical assignment. The portfolio assessment will be incorporated with the final MDS4026 assessment.

Study-unit Aims:

The obstetrics sections of this study-unit will provide a clear understanding of the normal and abnormal aspects of pregnancy as it relates to the antenatal, intrapartum and postpartum periods. It will further concentrate on the maternal problems that affect pregnancy and its outcome; and review the foetal development and its abnormalities together with the measures available for its assessment. This study-unit will also concentrate on the foetal problems that occur during pregnancy, labour and the neonatal period.

The gynaecology sections of this study-unit will concentrate on issues related to reproductive health function in the female and the male at various stages of the life cycle. It will review the pathology of the reproductive system in the female in relation to structure and function; and the pathology and management of malignant lesions affecting the reproductive tract.

Learning Outcomes:

1. Knowledge & Understanding:

By the end of the study-unit the student will be able to:
- Discuss topics relating to the maternal and foetal systems in normal and abnormal pregnancies.
- Outline the requirement related to antepartum care including its aims and method of implementation.
- Describe the normal and abnormal intrapartum process as the student will be presented with clear criteria of management in these situations.
- Identify the problems of the postpartum period and puerperium.
- Explain the anatomical and physiological changes that occur during pregnancy, and the role these play in incidental disease states.
- Describe the clinical, biophysical and biochemical assessment for foetal wellbeing in relation to congenital abnormalities and placental insufficiency.

The learning outcomes of the gynaecology section of the taught component will attempt to present the students with the opportunity to:
- Demonstrate a practical knowledge of the reproductive hormonal function in the female detailing the abnormalities that can occur.
- Outline the causes, investigations and management of infertility.
- Discuss issues related to contraception.
- Define the pathology and management of the various lesions affecting the lower and upper genital tract caused by infective organisms and neoplasia.
- Detail the conditions affecting the urinary system in relation to incontinence and trauma.
- Demonstrate knowledge of the different types of gynaecological tumours in relation to their epidemiology, aetiology, diagnosis and management.

2. Skills:

By the end of the study-unit the student will be able to:
- Diagnose and institute the antenatal care of the pregnant woman.
- Identify and manage the specific problems and pathologies that occur during the three trimesters of pregnancy.
- Monitor the foetus during the antenatal period, labour and delivery.
- Identify the onset of foetal distress and hypoxia.
- Identify postpartum and puerperal problems, and be familiar with their management.
- Safely prescribe hormonal treatment in the management of the gynaecological patient.
- Explain to a patient in a professional and sensitive manner the correct use of the methods available for family control.
- Detail the basic principles related to gynaecological surgery including preoperative assessment and informed consent, postoperative care, possible associated surgical complications and their prevention.
- Manage professionally and sensitively the prblems of the postpartum period and puerperium
- Diagnose pregnancy clinically and biochemically, and calculate gestational age.
- Identify and be able to manage the specific problems and pathologies that occur in the 1st and 2nd trimesters of pregnancy - e.g. miscarriage; hyperemesis; molar pregnancy and choriocarcinoma; ectopic pregnancy.
- Identify and be able to manage the specific problems and pathologies that occur in the 3rd trimester of pregnancy which may have consequences for the mother and/or fetus - e.g. Antepartum haemorrhage; hypertensive disorders; premature labour; multiple pregnancy; rhesus isoimmunization.
- Identify and manage the medical and surgical conditions that affect the pregnant woman - e.g. cardiovascular, respiratory, genitourinary, gastrointestinal, endocrine, psychiatric, etc.
- Monitor the foetus during labour and delivery including basic interpretation of cardiotocographs (CTGs), and identify the onset of foetal distress and hypoxia.
- Explain to a patient the principles a lower segment Caesarean section operation.
- Identify postpartum and puerperal problems, and be familiar with their management.
- Assess for foetal wellbeing in relation to congenital abnormalities [particularly Down's syndrome, cystic fibrosis, neural tube defects and congenital cardiac defects] and placental insufficiency.
- Safely prescribe the oestrogen-progesterone combine contraceptive showing a understanding of the pharmacology, risks and benefits, and drug interactions of these medications.
- Explain to a patient in a professional and sensitive manner the correct use of the methods available for family control.
- Detail the basic principles related to gynaecological surgery including:
    - the concept of preoperative assessment and informed consent,
    -postoperative care, and
    -possible associated surgical complications and their prevention.
- Explain to a patient the basic principles of surgical procedures including:
    -uterine curettage and evacuation,
    -colposcopy, hysteroscopy and laparoscopy,
    -laparotomy and hysterectomy +/- salpingo-oophorectomy,
    -genital prolapse surgery including anterior & posterior repair and vaginal hysterectomy, and
    -colposuspension and urethral buttressing for stress incontinence.

Main Text/s and any supplementary readings:

- Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology (Paperback) by Jeremy N. Oats (Author), Suzanne Abraham (Author). Elsevier Health Sciences (United Kingdom), 2004, ISBN 9780723433293.
- Clinical Obstetrics and Gynecology [Illustrated] (Paperback) by James Drife (Author), Brian A. Magowan (Author). Bailliere Tindall (United Kingdom), 2004, ISBN 9780702017759.
- Review of Obstetrics and Gynecology (Paperback) by Victor Y. Fujimoto, and others. McGraw-Hill/Appleton & Lange (U.S.A.), ISBN 9780838503232.

Main Texts related to Pathology:

Recommended Systematic Pathology (and Haematology):

- Muir’s Textbook of Pathology, Ed by DA Levison, R Reid, AD Burt, DJ Harrison, S Fleming, 14th Edition, ISBN 9780340740620, Hodder Arnold, 2008.
and
- General and Systematic Pathology, P Bass, S Burroughs, N Carr, C Way, 3rd Ed, Master Medicine, ISBN 9780080451299, Churchill Livingstone, 2009.

Microbiology:

- Medical Microbiology and Infection, Tom Elliott et al, 4th Ed, ISBN 1405129329, Blackwell, 2007.
and
- Clinical Oriented Cases in Microbiology, Hilary Humphreys & William Irving, 2nd Ed, ISBN 0198515855, Oxford University Press, 2004.
and
- Basic Concepts of Infection Control: www.theific.org

Alternative texts:

- General and Systematic Pathology, JCE Underwood, 4th Edition, ISBN 0443073341, Churchill Livingstone.
or
- Robbins Basic Pathology, V Kumar, A K Abbas, N Fausto, R Mitchell, 8th Edition ISBN1416029737, Saunders.
and
- Notes on Medical Microbiology (Paperback), MC Timbury, C McCartney, B Thakker, KN Ward, ISBN 0443071640 or latest edition, Churchill Livingstone.

Additional Resources:

- Pathology Illustrated, Robin Reid & Fiona Roberts, 6th Ed, ISBN 0 443 073368, Churchill Livingstone, 2005.
- Robbins and Cotran Review of Pathology, EC Klatt, V Kumar, 3rd Edition, ISBN9781416049302, Saunders, Elsevier, 2010.

Reference Texts:

- Robbins and Cotran Pathologic Basis of Disease, V Kumar, A K Abbas, N Fausto, 7th Edition ISBN 0721601871, Saunders.
- Medical Microbiology, Greenwood D, Slack RCB, Peutherer JF, Barer MR, 17th Edition, ISBN 0443102090, Churchill Livingstone, 2007 (or latest edition).

Various Internet Resources are available for pathology: See http://library.med.utah.edu/WebPath/webpath.html

Recommended Clinical Pharmacology text books:

- Humphrey P. Rang HP, Dale MM, Ritter JM, Flower R. Rang & Dale's Pharmacology. Churchill Livingstone. 6th Ed.
- Grahame-Smith D, Aronson J. Oxford Textbook of Clinical Pharmacology and Drug Therapy. Oxford University Press. 3rd Ed.
- Bennett PN, Brown MJ. Clinical Pharmacology. Churchill Livingstone. 10th Ed.
- British National Formulary. Pharmaceutical Press.

Reference/Additional:

- Brunton L, Lazo J, Parker K. Goodman & Gilman's The Pharmacological Basis of Therapeutics. McGraw-Hill Medical. 11th Ed.
- Waller DG, Renwick AG, Hillier K. Medical Pharmacology and Therapeutics. Saunders. 3rd Ed.
- Guidelines for Medical Students – A Maltese Aid by E. Cassar [author]. Department of Obstetrics and Gynaecology, UMMS, Malta, 2013, +78p.
http://www.um.edu.mt/_data/assets/pdf_file/0010/181639/CPG_medical_students_Maltese.pdf

Lecture notes:

- Reid JL, Rubin PC, Walters MW. Clinical Pharmacology and Therapeutics (Lecture Notes). Blackwell. 7th Ed.
- Neal MJ. Medical Pharmacology at a Glance. Wiley-Blackwell. 6th Ed.

 
STUDY-UNIT TYPE Lecture, Independent Study, Placement & Tutorial

 
METHOD OF ASSESSMENT
Assessment Component/s Resit Availability Weighting
Examination (3 Hours) Yes 100%

 
LECTURER/S Christopher Barbara
Mark P. Brincat
Johann Craus
James Degaetano
Mark Formosa
Raymond P. Galea
Yves Muscat Baron
Ian Said
Isabel Saliba
Mark Sant
Charles Savona Ventura (Co-ord.)
Albert Paul Scerri
John Thake
Alberto Vella

 
The University makes every effort to ensure that the published Courses Plans, Programmes of Study and Study-Unit information are complete and up-to-date at the time of publication. The University reserves the right to make changes in case errors are detected after publication.
The availability of optional units may be subject to timetabling constraints.
Units not attracting a sufficient number of registrations may be withdrawn without notice.
It should be noted that all the information in the study-unit description above applies to the academic year 2017/8, if study-unit is available during this academic year, and may be subject to change in subsequent years.
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