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Obstetrics and Gynaecology

Code: 102937 ECTS Credits: 8

2024/2025

Degree	Type	Year
2502442 Medicine	OB	4

Contact

Name:: Antonio Gil Moreno
Email:: antonio.gil@uab.cat

Teaching groups languages

You can view this information at the end of this document.

Prerequisites

It is recommended that the student has acquired basic competences in all the preclinical subjects.

The student will acquire the commitment to preserve the confidentiality and professional secrecy

of the data that can be accessed due to the learning of health care services. Also by maintaining an attitude of professional ethics in all its actions

Objectives and Contextualisation

This subject is offered at the 4^th course of the Medicine studies when the students have already acquired the basic knowledge about the human body, as well as its structure and function.

The students are aware of the physiopathological bases of health and diseases, and some pathological aspects from medical and surgical points of view.

The main objective is acquire knowledge of the female genital tract and its physiopathological aspects, with special emphasis to the different life stages: adolescence, adulthood, menopause, and gestation.

Moreover, special emphasis on preventive medicine in pregnancy and gynecology is developed.

The specific objectives that the student has to achieve include developing skills on physical exam, and on management of the different obstetric and gynecological diseases, together with presentation and treatments.

Competences

Convey knowledge and techniques to professionals working in other fields.
Demonstrate understanding of the causal agents and the risk factors that determine states of health and the progression of illnesses.
Demonstrate understanding of the manifestations of the illness in the structure and function of the human body.
Demonstrate understanding of the structure and function of the body systems of the normal human organism at different stages in life and in both sexes.
Formulate hypotheses and compile and critically assess information for problem-solving, using the scientific method.
Organise and plan time and workload in professional activity.
Use information and communication technologies in professional practice.

Learning Outcomes

Carry out an obstetric examination and monitoring.
Convey knowledge and techniques to professionals working in other fields.
Describe the processes of contraception and fertilisation.
Explain the anatomy of the female genital system and the neuroendocrine functions that regulate it.
Explain the physiology of normal pregnancy and understand the monitoring of gestation.
Formulate hypotheses and compile and critically assess information for problem-solving, using the scientific method.
Identify a pathological postpartum and know how this is managed.
Identify the principle diseases specific to gestation.
Identify the tests that are performed during parturition.
Identify the tests that are performed during postpartum.
Identify the tests that are performed during pregnancy.
Organise and plan time and workload in professional activity.
Perform a gynaecological examination.
Recognise, diagnose and guide pathological parturition.
Recognise, diagnose and guide the management of sexually transmitted diseases.
Recognise, diagnose and guide the management of the principal benign gynaecological pathologies.
Recognise, diagnose and guide the management of the the oncological pathology that affects the female genital system.
Use information and communication technologies in professional practice.

Content

1) Physiology of pregnancy, birth and post-partum with its pathology and treatment.

2) Physiology, pathology and treatment of the organs of the female genital tract, including the breast.

3) Physiology, pathology and treatment of human reproduction.

4) Preventive, psychological and social aspects in gynecology and obstetrics.

Theory (50 hours, on site)

General Gynecology, Gynecology Oncology and Breast Pathology (from 12:00 to 13:00) Clinical cases.

1. Presentation of the subject. Anatomy of the female genital apparatus. Diseases of the vulva: degenerative and atrophic. Benign tumors. premalignant lesions. Clinical cases.

2. Diseases of the vulva: malignant tumors. Clinical cases.

3. Sexually transmitted diseases. Vulvovaginitis. Clinical cases.

4. Pelvic inflammatory disease.Tubo-ovarian abscess. Dysmenorrhea. genital tuberculosis. Clinical cases.

5. Pathology of the pelvic floor 1: Genital prolapse. Classification, types and degree of genital prolapse. Clinic and diagnosis of genital prolapse. Risk factors. Therapeutic options. Urinary fistulas. Clinical cases.

6. Pathology of the pelvic floor 2: Urinary incontinence in women. Quality of life in pelvic floor dysfunctions. Anatomy of the pelvic and urogenital diaphragm. Types of urinary incontinence. Pathophysiology. Diagnostic tests. Medical and surgical treatments. Clinical cases.

7. Benign pathology of the cervix: Cytology, colposcopy. Trauma and tumors. Dysplasia and cancer

"in situ". CIN. Clinical cases.

8. Invasive cancer of the cervix: etiology. Frequency. Pathological anatomy. Degrees of extension. Clinic and treatment. Other malignant tumors of the cervix. Clinical cases.

9. Benign and premalignant endometrial pathology. Uterine myomatosis. Other benign tumors of the uterine body. Clinical cases.

10. Malignant pathology of the uterine body. Endometrial cancer. Clinical cases.

11. Sarcomas in Gynecology. Vaginal tumors. rare tumors.

12. Benign ovarian tumors, adnexal mass, diagnosis and therapeutic scheme.

13. Molecular bases of gynecological cancer.

14.Ovarian tumors I: Classification. Pathological anatomy. Clinical cases.

15.Ovarian tumors II: Evolution. Clinic. complications. Diagnosis. Treatment of ovarian tumors. Tubal and primary peritoneal cancer. Clinical cases.

16. Breast Pathology I. Anatomy of the breast and the armpit. Physiology of the breast. breast hypertrophy. Mastodinia. Adenosis and fibrocystic breast disease. Benign tumors of the breast.

Clinical cases.

17. Breast Pathology II. breast cancer Epidemiology. Risk factors. Clinic. Classification.

18. Breast Pathology III. Diagnosis and treatment. Clinical cases.

19. Medical Oncology in Oncological Gynecology and Breast Pathology. Treatment.

Gynecological endocrinology. Reproductive Medicine

20. Sexual determinism and sexual differentiation. Embryology of the genital apparatus. Different sexual development.

21. Hypothalamic-pituitary amenorrhea. hyperprolactinemia. Ovarian and uterine amenorrhea. Diagnostic diagram. Clinical cases.

22. Puberty. Menarche. Pathology of puberty. Adolescence. Clinical cases.

23. Climacteric. Menopause. Pathology of the climacteric. Clinical cases.

24. Abnormal uterine bleeding/heavy menstrual bleeding. Clinical cases.

25. Virilization and hirsutism. Polymicrocystic ovary syndrome. Clinical cases.

26. Family Planning. barrier methods. Hormonal. IUD. irreversible methods. Clinical cases.

27. Premenstrual syndrome. Pain related or not with the cycle. Endometriosis. Adenomyosis.

Clinical cases.

28 .Marital sterility and infertility. Assisted reproductive techniques.

Physiology of pregnancy

29.-Gametogenesis. Fertilization. Transportation and nesting. early stages of its development. Placentation. Trophoblast growth and development.

30.-Placental circulation. ovular membranes. Umbilical cord. Amniotic fluid. Fetal circulation. Feto-placental unit: exchanges at the level of the placenta. Endocrinology of the feto-placental unit. Normal and pathological placentation and its implications in Obstetrics (PE, IUGR, accreta...)

31.Pregnancy diagnosis. Physiological modifications of the maternal organism in gestation.

32. Complementary techniques in pregnancy: means to control the evolution of normal and pathological pregnancy. Clinicians. Ultrasound. RM. Amniocentesis (not prenatal dx). Antenatal cardiotocographic records.

33.Prenatal diagnosis. Diagnostic techniques. Clinical cases.

34.Duration of gestation. Start of labor. childbirth periods. Clinical cases.

35.Labor induction. Indications and current methods. Delivery. Normal puerperium. Breast-feeding.

Pregnancy pathology

36.Abortion: different types. Etiology. recurrent abortion. Therapeutic approach to recurrent abortion. Clinic. Clinical cases.

37. Ectopic gestation. Ultrasound diagnosis of ectopic pregnancy. Medical and surgical management. Indications. Clinical cases.

38.Trophoblastic disease. Cytogenetics. Clinic. Diagnosis and treatment.

39. Gestation and multiple childbirth. Clinical cases.

40.Hypertensive disease. Concept. Preeclampsia. Pathophysiology of PE. Diagnosis. Prediction and prevention. Treatment. Chronic hypertension and gestational hypertension. Clinical cases.

41. Preterm birth. Etiology. Diagnosis. Prevention and therapeutics. Lung maturation and neuroprotection. Route of delivery in the preterm fetus. Clinical cases.

42.- Premature rupture of the ovular membranes. Chorioamnionitis. Clinical cases.

43.Intrauterine growth retardation. Causes, diagnosis and follow-up. Early and late IUGR. Decision of the moment of delivery. Way of birth. PEG fetus. Clinical cases.

44. Isoimmunization. Hydrops fetalis. Post-term delivery. Antepartum fetal death.

45. Maternal diseases that complicate pregnancy I. Diabetes. Thyroid diseases. Clinical cases.

46. Maternal diseases that complicate pregnancy II. Anemia. Most common autoimmune diseases. Venous thromboembolic disease. Clinical cases.

47.Maternal diseases that complicate pregnancy III. Pregnancy in elderly women. Infectious diseases and their impact on the embryo, the fetus and the baby. TORCH syndrome: urinary tract infections (asymptomatic bacteriuria, recurrent UTI in pregnant women and PNA). Clinical cases.

48. Maternal diseases that complicate pregnancy IV. Digestive diseases: hyperemesis gravidarum, inflammatory bowel diseases. Some infectious diseases and their impact on the embryo, the fetus and the baby. HIV, Zika, Hepatitis, Chagas disease.

Pathology of childbirth and the puerperium

49. Placental retention. uterine inversion. Postpartum hemorrhage. placenta accreta. Clinical cases.

50.Pathology of the puerperium. Puerperal infection: urinary tract infections, mastitis, endometritis, surgical wound infection in cesarean section. Septic pelvic thrombophlebitis. Clinical cases.

Specialized seminars (20 hours)

SEMINARS OF 4TH YEAR MEDICINE DEGREE

GYNECOLOGY (from 3:00 p.m. to 4:00 p.m.) Clinical cases.

1. Clinical history of gynecology. Major gynecological syndromes. Clinical history and general gynecological examination. Questioning as a basis for diagnosis. Complementary explorations.

2. Menstrual disturbances. Differential diagnosis. Study scheme. Amenorrhea.

3. Early diagnosis of genital cancer. Prevention. Cytology and colposcopy. HPV and cervical cancer. Vulvoscopy.

4.Infections in gynecology. MTS and vulvovaginitis. vaginal infections Flow study. Fresh examination.

5. Gynecological surgery. The hysterectomy. The adnexectomy. Basics of vaginal surgery

6. Minimally invasive surgery techniques in Gynecology and Gynecology Oncology. General concepts and bases. Indications. robotics

7. Clinical cases of breast pathology.

8. Gynecological urology. Urodynamic studies.

9. Contraception. intrauterine devices. Tubal occlusion. Emergency or postcoital contraception.

10. Clinical cases in Gynecological Oncology.

OBSTETRICS (from 3:00 p.m. to 4:00 p.m.) Clinical cases.

1. Clinical history of obstetrics. Outpatient prenatal care protocol (number of visits / clinical / analytical / complementary examinations). Clinical cases.

2. Sterility and infertility. Functional scheme.

3. Basic ultrasound and its purpose in pregnancy. Indications according to the trimester. Fetoplacental Doppler. Why is it useful? Biophysical profile. Clinical cases.

4. Reproductive counseling. Voluntary termination of pregnancy.

5. Fetal medicine. Current and future aspects. Clinical cases.

6. Drugs and pregnancy.

7. Control of intrapartum well-being. Fetal suffering. Biophysical and biochemical monitoring in childbirth. FHR control. Fetal pH control. Diagnosis and treatment. Clinical cases.

8. Emergency situations during pregnancy. Maternal emergency criteria. Fetal emergency criteria. General Approach. Clinical cases.

9. Assistance to normal childbirth. Dystocic labor. Breech presentation and instrumental delivery. Surgery in obstetrics. Vacuum, spatulas and forceps. Indications and contraindications. Complications: Obstetric sprains. Uterine rupture. the caesarean section Techniques. Indications. complications. Clinical cases.

10. Congenital and acquired heart disease. Obesity and pregnancy.

Healthcare clinical practices (20 hours)

The practices will basically be carried out in the Gynecology and Obstetrics dispensaries, in the operating theaters of the Maternal and Child Hospital and in the operating rooms of the General Hospital, hospitalization rooms and delivery rooms, as well as in the emergency rooms (2 on-call joining the guard teams, in groups of 2 students).

During the guards they must carry out:

- A gynecological/obstetric medical history

- Gynecological and obstetric examination (Leopold maneuvers, fetal auscultation, vaginal examination to

                                   check cervical dilation, fetal presentation, pelvic assessment).

- Help to practice a normal childbirth.

This is how they will spend in groups, for two weeks, and for each of the following areas:

- General Gynecology and Pelvic Floor Dispensary

- Gynecological Endoscopy Dispensary (Laparoscopy/Hysteroscopy)

- Dispensary of Oncological Gynecology and Pathology of the Lower Genital Tract (LAC)

- Breast Pathology Dispensary

- High Obstetric Risk Dispensary

- Prenatal Diagnosis Clinic

- Gynecological and obstetric ultrasound cabinets

- Operating theaters other than Gynecology

- Family planning and endocrinology dispensary

- Sterility dispensary

- Hospitalization room

Activities and Methodology

Title	Hours	ECTS	Learning Outcomes
Type: Directed
CARE PRACTICUM WITHOUT GUIDELINES	20	0.8
Specialized seminars (SEM)	20	0.8
THEORY (TE)	50	2
Type: Autonomous
READING ARTICLES /REPORTS OF INTEREST	10	0.4
SELF-STUDY	70	2.8	3, 2, 4, 5, 13, 1, 6, 7, 11, 9, 10, 8, 12, 17, 15, 16, 14, 18
works delivery	20	0.8

This Course Guide details the context, the contents, the methods and norms of the subject according to the current study plan. Final organization of the subject with different groups,

calendar and exam dates and evaluation criteria will be decided in each Teaching Unit of each Hospital, and will be specified in their web pages and in the first day of the subject lesson.

In the current exceptional circumstances, at the discretion of the teachers and also depending on the resources available and the public health situation, some of the theoretical classes, practicals and seminars organized by the Teaching Units may be taught either in person or virtually.

This guide describes the framework, contents, methodology and general rules of the subject, according to the current study plan. The final organization of the subject with regard to the number and size of groups, distribution in the calendar and exam dates, specific evaluation criteria and review of exams, will be specified in each of the Hospital Teaching Units (UUDDHH), which They will make it explicit through their web pages and on the first day of class for each subject, through the teacher responsible for the subject at the UUDDHH.

For the 2022-2023 academic year, the professors designated by the Departments as responsible for the subject at the Faculty and UUDDHH level are:

Department(s) responsible: Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health. Head of Faculty: Antonio Gil-Moreno: agil@vhebron.net / antonioimma@yahoo.es (tef: 3217, 3066)

UDHVH (Vall d'Hebron): Antonio Gil-Moreno: antonio.gil@vallhebron.cat / antonioimma@yahoo.es (tel: 3217/3066)

Secretary: Juan José López: jjlopez@vhebron.net
UDH Tria i Pujol: Miguel Angel Luna
UDH Sant Pau: Juan José Espinós
UDH Parc tauli: Ramón Costa

Annotation: Within the schedule set by the centre or degree programme, 15 minutes of one class will be reserved for students to evaluate their lecturers and their courses or modules through questionnaires.

Assessment

Continous Assessment Activities

Title	Weighting	Hours	ECTS	Learning Outcomes
Attendance and active participation in class and in seminars, works	20%	2	0.08	3, 2, 4, 5, 13, 1, 6, 7, 11, 9, 10, 8, 12, 17, 15, 16, 14, 18
Objective tests: Multiple choice test	80%	8	0.32	3, 2, 4, 5, 13, 1, 6, 7, 11, 9, 10, 8, 12, 17, 15, 16, 14, 18

The evaluation system for the acquisition of skills for this subject is organized into two modules:

• Theoretical module:

-Assessment system: first and second partial multiple choice, and final test (written in the form of short questions and/or multiple choice). Partial theoretical exams of an eliminatory nature will be scheduled when the grade obtained is higher than 5.

 This subject/module does not provide for the single assessment system

-Weight in the overall rating: 80%

• Expository module of works, seminars and practical part.

According to the particularities of each Teaching Unit and subject, the practices/seminars can be evaluated continuously. The continuous evaluation will be specified in the program of each UUDDHH.

- Continuous evaluation: Seminars, class attendance and practices (10%) (and approx. 20% of the questions in the test of the exams): Multiple choice tests and/or development questions about the cases worked on in the seminars (questions incorporated into midterm and final exams).

-Works (10%): Evaluation of the quality and expository clarity.

Practices: Attendance at practices is mandatory to access the exams.

Each student must:

                  -Write a medical history

                  - Perform a gynecological examination:

                       ● Visualization with speculum

                       ● Vaginal touch

                       ● Breast examination

                  - Being an assistant in a small intervention:

                       ● Curettage

                       ● Laparoscopy

                       ● Debridement of Bartholinitis, etc.

                  - Being an observer / participant of at least one major intervention:

                       ● Hysterectomy

                       ● Mastectomy

                       ● Oncologic surgery

                       ● Vaginal plastias, etc.

At the end of the internship period, the student must write a report with the history and the exploration that he himself will have done, as well as a summary of his activity, which will be confirmed by his tutor. The delivery of the summary is mandatory to be ableto access the exam of the subject.

Final score

The final grade is the weighted average of the theoretical knowledge (80%) and the clinical evaluation, such as continuous evaluation: attendance at theoretical classes, seminars and practicals10%) and presentation of a practical work (10%).

The student who has not passed the partial exams and/or has not passed the practices may take the final test, but attendance at the practices is required for this.

This subject/module does not provide for the single assessment system

Evaluation activities (5%= 10 hours)

Activity	Weight	Hours	ECTS	Learning outcomes
Theoretical exams	80%	5		Partial theoretical exams of an eliminatory nature will be scheduled when the grade obtained is higher than 5.
Seminars	20% (of the previous 80% total)	2		Individual presentation of a clinical case and assessment by the tutor and a teacher. Anamnesis, diagnostic guidance, complementary examinations, treatment and detection of medical and affective needsby the patient.
Work	10%	2
Clinical evaluation as attendance at theoretical classes, seminars and practices	10%	1