Obstetrics and Gynaecology

Core Generalist#

Knowledge#

CG.K.1#

Describe knowledge of relevant anatomy, physiology, pathology

CG.K.2#

Identify aetiology of urinary tract infections and urethral syndrome and outline appropriate management

CG.K.3#

Discuss principles in the prevention and management of incontinence

CG.K.4#

Identify indications for investigations for diseases of the breast and outline appropriate management

CG.K.5#

Detail contraception options and relative advantages and disadvantages of each option

CG.K.6#

Demonstrate an understanding of the physical and emotional issues associated with infertility and be able to outline investigations and treatment options

CG.K.7#

Discuss antenatal problems of specific high-risk groups including:

  • Aboriginal and Torres Strait Islander women
  • migrant women
  • women with a disability
  • women with a drug addiction and
  • women over 35 years of age

CG.K.8#

Identify available community facilities/resources and means of access including:

  • local antenatal classes
  • breastfeeding support services
  • midwife services

CG.K.9#

Describe the management of miscarriages

CG.K.10#

Describe the types of terminations available in Australia (surgical and medical) and the differences between them

CG.K.11#

Understand lactation and manage associated problems

CG.K.12#

Describe normal antenatal and postnatal care

CG.K.13#

Describe preventative health screening tests for women including mammography and cervical screening

Skills#

CG.S.1#

Apply diagnostic reasoning to arrive at one or more provisional diagnoses, considering common gynaecological conditions including:

  • urinary tract infections
  • genital tract infections
  • abnormal cervical screening results
  • endometriosis
  • pelvic pain
  • pelvic inflammatory disease
  • Bartholin’s cysts/abscess
  • ovarian cysts
  • uterine fibroids
  • cervical and uterine polyps and
  • pelvic organ prolapses
  • post-menopausal bleeding

CG.S.2#

Diagnose and manage common menstrual problems including:

  • heavy menstrual bleeding (menorrhagia)
  • no menstrual bleeding (amenorrhea)
  • bleeding between periods (intermenstrual bleeding)
  • dysmenorrhea (painful menstrual periods)
  • premenstrual syndrome (PMS)
  • premenstrual dysphonic disorder (PMDD)

CG.S.3#

Recognise and provide advice and treatment to women experiencing menopause in relation to:

  • the immediate symptoms of the menopause
  • long term risks of the menopause
  • management options, including lifestyle, hormonal and non-hormonal
  • risks and benefits of the use of hormone replacement therapy (HRT)
  • HRT options, combinations, delivery methods and appropriate investigation, if required
  • alternative options to HRT

CG.S.4#

Educate patients about choice of contraceptive methods and negotiating safe sex

CG.S.5#

Perform the following procedures:

  • conduct a pelvic exam
  • insert and remove implanon
  • insert and remove contraceptive intrauterine devices
  • pregnancy testing
  • fundal height assessment
  • foetal heart sound detection using a Doppler or ultrasound

CG.S.6#

Undertake a pre-pregnancy consultation including health assessment that includes rubella immunity, consideration of cervical screening, genetic screening, determination of blood group and blood group antibodies, smoking, alcohol avoidance, listeria risk reduction and CMV, folate preconception

CG.S.7#

Provide non-directive advice and counselling for patients presenting with an unplanned pregnancy

CG.S.8#

Work within state legislation and relevant cost, availability and accessibility of services for termination of pregnancy

CG.S.9#

Undertake an initial antenatal assessment including a detailed obstetric history and antenatal examination to identify women who are at high risk of complications

CG.S.10#

Undertake routine antenatal screening including testing for anaemia, Group B streptococcus, HIV, hepatitis B, rubella, syphilis, asymptomatic bacteriuria, dating ultrasound, chromosomal testing

CG.S.11#

Order and interpret routine screening tests and other investigations as necessary including:

  • ultrasound +/- first trimester screening with NT
  • Non-Invasive Prenatal Testing (NIPT)
  • amniocentesis
  • chorion villus sampling (CVS)

CG.S.12#

Identify those who should be offered genetic counselling

CG.S.13#

Recognise the signs and symptoms of patients who require multi-disciplinary care including referral to specialised antenatal care

CG.S.14#

Provide lifestyle counselling for pregnancy including alcohol use, drug use, smoking, nutrition, exercise, folate supplementation, safe sex, avoiding listeria prone foods, reducing risk of toxoplasma and CMV infections

CG.S.15#

Recognise and manage important first trimester conditions including early bleeding, miscarriage, anembryonic or "missed miscarriage", molar pregnancy and ectopic pregnancy, hyperemesis

CG.S.16#

Provide advice on the treatment of minor antenatal problems such as:

  • nausea
  • vomiting
  • urinary frequency
  • cramps
  • Braxton Hicks
  • syncope
  • musculoskeletal pain
  • intercurrent infections (respiratory, urinary and vaginal)
  • recommend appropriate vaccinations in pregnancy eg influenza and pertussis

CG.S.17#

Work with parents, families and other healthcare providers to develop mutually acceptable birthing plans

CG.S.18#

Recognise and manage late trimester complications including:

  • pre-eclampsia
  • eclampsia
  • foetal growth restriction
  • elevated blood pressure
  • threatened pre-term labour
  • antepartum haemorrhage
  • placental complications
  • gestational diabetes

CG.S.19#

Manage normal labour and delivery under emergency circumstances in consultation with Rural Generalist or Specialist Obstetrician or retrieval as appropriate

CG.S.20#

Recognise and participate in the management of birthing complications including:

  • haemorrhage
  • pre-eclampsia
  • eclampsia
  • placental complications
  • failure to progress in labour
  • analgesia requirements
  • fever
  • amnionitis
  • malpresentations such as breech, occipito-posterior (OP)
  • shoulder dystocia

CG.S.21#

Perform the following procedures in an emergency:

  • Cardiotocography (CTG) interpretation
  • catheterise the urethra
  • manage shoulder dystocia
  • episiotomy
  • repair of small perineal tear and genital trauma

CG.S.22#

Recognise and respond early to the deteriorating condition of a woman or baby during labour and post-partum, including:

  • inadequate uterine contractions
  • abnormal bleeding
  • high blood pressure
  • obstructed labour

CG.S.23#

Provide definitive emergency resuscitation and management of primary and secondary post-partum haemorrhage and endometritis and sepsis in keeping with clinical need, own capabilities and local context and resources

CG.S.24#

Perform routine neonatal assessment

CG.S.25#

Provide ongoing care for common neonatal problems including:

  • respiratory distress, secondary apnoea
  • meconium aspiration
  • asphyxia, cyanosis
  • hypoglycaemia
  • hypothermia
  • vomiting
  • failure to pass meconium
  • physiological and non-physiological jaundice
  • intrapartum and neonatal infection
  • seizures
  • maternal infection including syphilis, hepatitis B and C and HIV
  • feeding problems
  • drug withdrawal

CG.S.26#

Provide advice and support regarding conditions affecting breast feeding including:

  • inverted and cracked nipples
  • mastitis
  • breast engorgement
  • misconceptions regarding lactation, supply and demand
  • decreased supply
  • drug contraindications

CG.S.27#

Provide advice and counselling on the physical and emotional issues experienced by women in their first 12 months following childbirth including:

  • tone of pelvic floor and other muscles
  • mastitis
  • urinary tract infection (UTI)
  • perineal wound infections
  • sexuality after childbirth
  • stress and social demands
  • depression
  • contraceptive options while lactating

CG.S.28#

Recognise, support and manage post-natal depression

CG.S.29#

Undertake a six-week post-natal check for both mother and infant

CG.S.30#

Provide initial counselling for families experiencing:

  • perinatal death, still born or neonatal death
  • child born with abnormalities

CG.S.31#

Work within National and state legislation relating to women’s health including legal responsibilities regarding notification of disease, birth, death and autopsy relevant to the state concerned

Attributes#

At.6#

Compassion

At.13#

Pragmatism

At.17#

Resourcefulness

Advanced Specialised (based on DRANZCOG Advanced Curriculum)#

Knowledge#

AS.K.1#

Discuss the principles and use of regional analgesia, including the principles of management of complications of regional anaesthesia

AS.K.2#

Describe the principles of

  • management of first and second trimester termination of pregnancy
  • elective breech delivery
  • twin delivery
  • 3rd and 4th degree tear repair
  • repair of torn bladder
  • repair of lacerated cervix

AS.K.3#

Discuss the principles of medical and operative management of postpartum haemorrhage, including uterine balloon tamponade, emergency hysterectomy, bilateral uterine and internal iliac artery ligation and uterine brace sutures

AS.K.4#

Describe the changes in the neonate at birth

AS.K.5#

Describe the requirements of the sick neonate prior to transfer

AS.K.6#

Discuss the principles of

  • management of ectopic pregnancy
  • management of corpus luteum (CL) cyst, ruptured/torsion ovarian cyst
  • pathological conditions of the cervix
  • management of uterine contraceptive device complications
  • performing female sterilization at the time of Caesarean section Skills

AS.S.1#

Manage pregnancies in women with pre-existing or current medical conditions such as haematological disorders, diabetes mellitus, renal disease, cardiac disease, gastrointestinal disease or epilepsy

AS.S.2#

Diagnose and provide immediate management of pregnancy-induced disorders, including hyperemesis gravidarum, pre-eclampsia, cholestasis, fibroid complications and ovarian cysts

AS.S.3#

Diagnose and provide immediate management of obstetric complications including isoimmunisation, and multiple pregnancy

AS.S.4#

Manage first trimester miscarriage, including ERPOC

AS.S.5#

Perform marsupialisation of Bartholin’s cyst/abscess

AS.S.6#

Diagnose and manage women with hyperemesis gravidarum

AS.S.7#

Manage antepartum haemorrhage

AS.S.8#

Manage women with pre-eclampsia

AS.S.9#

Manage women with cholestasis, fibroid complications, diet controlled gestational diabetes, abnormal foetal growth, premature rupture of membranes

AS.S.10#

Manage preterm labour, prolonged pregnancy, abnormal presentation, poor progress of labour, obstructed labour

AS.S.11#

Manage normal labour and delivery, including third stage

AS.S.12#

Assess and chart the progress of labour; manage poor progress

AS.S.13#

Counsel a woman regarding pain management in labour

AS.S.14#

Prescribe appropriate analgesia in labour

AS.S.15#

Assess fetal wellbeing in labour by electronic fetal monitoring

AS.S.16#

Manage fetal compromise during labour

AS.S.17#

Manage women with eclampsia

AS.S.18#

Manage maternal collapse

AS.S.19#

Manage retained placenta including manual removal

AS.S.20#

Perform induction and augmentation of labour

AS.S.21#

Perform episiotomy and repair and repair of perineal and vaginal tears

AS.S.22#

Manage intrapartum sepsis

AS.S.23#

Perform instrumental delivery, both vacuum and forceps

AS.S.24#

Manage shoulder dystocia

AS.S.25#

Manage undiagnosed vaginal breech delivery

AS.S.26#

Perform a Caesarean delivery, both elective and emergency

AS.S.27#

Manage postpartum haemorrhage, including operative management (eg, uterine balloon tamponade, laparotomy and uterine brace sutures)

AS.S.28#

Provide basic life support to a sick neonate

AS.S.29#

Resuscitate a neonate, including endotracheal intubation

AS.S.30#

In consultation with a specialist be able to:

  • recognise, provide immediate management, stabilise and arrange transfer as appropriate of sick neonates, including those with sepsis, respiratory distress, hypoglycaemia and failure to thrive
  • evaluate a perinatal death in accordance with PSANZ guidelines
  • perform basic grief counselling, including counselling parents after a perinatal death

AS.S.31#

Examine a neonate, recognize abnormalities requiring paediatric review (eg congenital dislocation of the hips, oesophageal atresia, cardiac murmurs) and perform appropriate management and testing of the neonate

AS.S.32#

Manage neonatal jaundice

AS.S.33#

Manage maternal problems arising in the puerperium, including primary and secondary post-partum haemorrhage, pyrexia, thrombo-embolism, depression, perineal complications, disorders of lactation, breast complications

AS.S.34#

Provide postnatal contraception advice

AS.S.35#

Perform post-natal review of mother

AS.S.36#

Perform a pelvic laparotomy, eg for ectopic pregnancy or ovarian cyst complication

AS.S.37#

Perform a hysteroscopy

AS.S.38#

Manage first trimester termination of pregnancy and/or miscarriage

AS.S.39#

Manage and perform uterine evacuation following second trimester pregnancy loss and/or mid trimester termination

AS.S.40#

Perform basic first trimester scanning, including localization, dating, viability and plurality of pregnancy, both transvaginal and transabdominal

AS.S.41#

Perform late pregnancy scanning, including presentation of fetus, placental localization, basic fetal biometry and amniotic fluid volume

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