A. Maternal Physiology

1. The medical student will be able to describe the physiologic changes associated with pregnancy in the following organ systems:

• cardiovascular system
• hematologic system
• -espiratory system
• renal and urinary tract system
• gastrointestinal system
• skin
• musculoskeletal system
• breasts
• endocrine system with particular reference to changes in carbohydrate metabolism throughout pregnancy
• immune system

2. The student will be able to describe the physiologic functions of the placenta and fetus.

3. The student will be able to describe how these maternal physiologic changes result in the common symptoms experienced by pregnant women.

4. The student will be able to recognize the normal changes in laboratory tests that are seen during pregnancy.

B. Psychosocial Issues in Pregnancy:

1. When providing care for the pregnant woman the student will be able to apply their knowledge of normal physiologic changes in pregnancy, and communication skills acquired during their training to:

2. Discuss the common fears relating to pregnancy, labor and delivery with the pregnant woman.

3.. Identify the special needs of working women, single parents, adolescents, immigrant women and aboriginal women.

4. Describe how culture, race and religion can affect a woman's experience during her pregnancy.

5. Discuss issue of sexuality in pregnancy and the puerperium with the pregnant woman.

6. Assist the pregnant woman where necessary to access assistance for social, financial and emotional support for herself and her child.

C. Antepartum Care:

The student will be able to:

1. Discuss the methods used to diagnose pregnancy and establish gestational age.

2. Describe the methods of initial and on-going risk assessment for the mother to distinguish the normal from the high-risk pregnancy.

3. Advise the patient about issues including the following:

• early vaginal bleeding
• nutrition
• use of prescribed, over-the-counter and illicit drugs
• use of alcohol
• use of tobacco
• sexual and physical activity
• occupational exposure
• immunization
• travel
• breast feeding
• circumcision
• radiation during pregnancy
• prenatal education
• genetic testing including amniocentesis and chorionic villous sampling

4. Participate in provision of prenatal education by the physician and community resources.

5. List the appropriate laboratory investigations and be able to interpret them.

6. List the indications for ultrasound and biophysical profile scoring in pregnancy.

7. Describe the signs and symptoms of the onset of labor.

8. Perform the basic technical skills required to provide initial and continuing examination of the pregnant patient including a pelvic examination, cytological screening, and blood pressure monitoring and fundal height measurements.

D. Intrapartum period:

The student will be able to:

1. List the four stages of labor and describe them.

2. Outline the seven mechanisms of normal labor.

3. Describe how to evaluate the strength and timing of uterine contractions.

4. Describe the progress of normal labor in the primiparous and multiparous laboring patient and be able to recognize when the progress is abnormal

5. List the different modes of analgesia and anaesthesia available.

6. Explain the importance of early diagnosis of maternal and fetal complications in labor.

7. Describe the steps in management of normal delivery.

8. Describe the management of the third stage of labor including episiotomy repair and techniques to avoid episiotomy.

9. Recognize and classify obstetric tears as first degree, second degree, third degree and fourth degree.

10.Discuss the principles of family-centered care and the merit of whenever possible respecting the parent's unique desires about their labor and delivery.

11. Give the standards of monitoring in labor, using clinical and electronic monitoring.

12. Describe alternate positions for birth.

13. List the indications for consultation during labor and delivery.

E. Postpartum Period

The medical student will be able to:

1. Outline the normal recovery from the physiologic changes of pregnancy.

2. Discuss the importance of breast-feeding and breast care.

3. Describe the normal and abnormal states of postpartum bleeding, pain and fever.

4. Describe the appropriate emotional and social support for the patient and family.

5. Discuss when normal sexual activity can be resumed and counsel regarding and problems commonly encountered.

6. Provide counseling regarding family planning for the post-partum patient.

7. Outline the principles for perineal, bowel and bladder care in the post-partum period.

F. The Normal Newborn

1. Assign an apgar score to the newborn

2. List the critical steps in providing care for the newborn infant.

3. Perform an examination of the newborn and be able to recognize abnormalities on examination.

4. Discuss the risks and benefits of newborn circumcision.