RCOG Curriculum Consultation 2009

Key: Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Core Module 10: Management of Labour

Learning outcomes: . To understand and demonstrate appropriate knowledge, skills and attitudes in relation to labour

Professional Evidence/assessmen Knowledge criteria Clinical competency skills and Training support GMP GMP GMP t attitudes

Mechanisms of normal 1,2 Manage: 1,2 Demonstrat 1,2 CTG training Meetings labour and delivery . in-utero transfer e the attended . intrauterine fetal appropriate Eclampsia drill – Induction and death (IUFD) use of simulation** Case reports augmentation of labour . women who decline protocols blood products and Drill for Audit project Drugs acting upon the . obstetric guidelines obstetrical myometrium haemorrhage** 3,4 collapse and Annual Review . severe pre- Demonstrat obstetric Structure and use of eclampsia/eclampsia** e the ability haemorrhage - Logbook partograms . obstetric collapse** to prioritise 3 simulation/drills* cases and * Reflective diary Fluid balance in labour Prioritise labour ward problems have the skills to Communication OSATS- Fetal Blood products Evaluate clinical risk supervise 3,4 in an blood sampling the emergency – Regional anaesthesia, Liaise with other staff workload on role MRCOG Part analgesia and sedation a labour play/simulation One Interpret a CTG ward

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust Key: Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Professional Evidence/assessmen Knowledge criteria Clinical competency skills and Training support GMP GMP GMP t attitudes Fetal wellbeing and Breaking bad MRCOG Part compromise Manage: Respect news study Two . induction of labour cultural/relig 1,3 session – role Prolonged labour . delay in labour ious play MRCOG Part . labour after a differences Three Emergency previous lower segment in attitudes 1,4 Labour ward policies/maternal caesarean section to childbirth team drills (as collapse/haemorrhage . preterm labour used for CNST Practice training) which Pre-term labour/ premature Perform and interpret a fetal effective include aspects rupture of membranes blood sample liaison with of colleagues team-working, Cervical cerclage Prescribe blood products in other leadership and appropriately disciplines, situational Multiple pregnancy in clinical and judgment labour Advise on pain relief 3,4 non-clinical awareness

Severe pre-eclampsia and Removal of cervical suture Demonstrat Perinatal eclampsia e the ability mortality and Counsel and consent for fetal to deal morbidity In-utero fetal death (IUFD), post-mortem in cases of sensitively meetings including legal issues intrauterine fetal death with the issues StratOG.net: Acute abdominal pain Manage abdominal pain regarding Management of intrauterine Labour and Clinical skills essential for: fetal death delivery e-

Professional Evidence/assessmen Knowledge criteria Clinical competency skills and Training support GMP GMP GMP t attitudes o Common clinical skills-delivery of twins tutorials fetal bradycardia and ventouse delivery, malposition at full dilatation Recognise personal Resilience limitations training; Step-up and the course (or need to equivalent) refer appropriatel Disposal of fetal y parts

Keep RCOG Good accurate Practice contempora Guideline: neous Disposal records following pregnancy loss Ensure before 24 weeks prompt of gestation. post- RCOG website. incident report is Courses such completed as ALSO and MOET Confident in stepping up The from ST2 to Obstetrician and

Professional Evidence/assessmen Knowledge criteria Clinical competency skills and Training support GMP GMP GMP t attitudes ST3 Gynaecologist journal Increase responsibilit y and promote patient safety

Non-clinical skills essential for: o Understan ding of senior midwife coordinato r expectatio ns of an ST3 on delivery suite o Best practice in telephone consultati ons and referral o Coping and dealing

Professional Evidence/assessmen Knowledge criteria Clinical competency skills and Training support GMP GMP GMP t attitudes with serious untoward incidents including debriefing and feedback. o Improving resilience –looking after yourself

Appendix to Module 10: Management of Labour

. Mechanisms of normal and abnormal labour . Mechanism of spontaneous vaginal delivery . Methods of induction of labour; indications, contraindications and complications . Methods of augmentation of labour; indications, contra-indications and complications . Drugs acting upon the myometrium and cervix . Structure and use of partograms . Fluid balance in labour . Transfusion . Types and methods of action of regional anaesthesia including epidural (lumbar, caudal), spinal, pudendal nerve block; indications and contra-indications . Types and methods of action of analgesia and sedation including narcotics, hypnotics, psychotropics, non-steroidal anti- inflammatory drugs; indications, contra-indications . Complications of anaesthesia and analgesia including cardiac arrest, respiratory arrest, aspiration, drug reactions . Assessment of fetal wellbeing using fetal heart rate monitoring, acid/base balance, and fetal scalp blood sampling . Causes and management of fetal compromise including cord prolapse and intra-uterine fetal death . IUFD – legalities regarding registration and disposal of fetal tissue . Causes and management of prolonged labour . Causes and management of maternal collapse including massive haemorrhage, cardiac problems, pulmonary and amniotic embolism, drug reactions, trauma

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust Key: Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies . Emergency guidelines and procedures . Ante andintra partum haemorrhage including, placenta praevia, vasa praevia, ruptured uterus, coagulation defects, iatrogenic causes . Causes, mechanisms of action and complications of pre-term labour/ premature rupture of membranes including fetal pulmonary maturity, infection risks . Preterm labour including therapy (antibiotics, steroids, tocolysis), consultation with neonatologists, in-utero transfer, methods of delivery (induction of labour, timing, mode), outcomes, risks . Role and types of cervical cerclage . Multiple pregnancy in labour . Severe pre-eclampsia and Eclampsia . Placental abruption

Competence level Basic level Intermediate level Advanced level Not required Core Module 10 Logbook Level 2 Level 3 Signature Date Signature Date Signature Induce labour

Manage delay in first labour

Manage delay in second stage of labour

Advise on pain relief

Interpret CTG

Perform fetal blood sampling

Manage fetal acidaemia

Manage preterm labour and delivery

Manage labour after previous caesarean section

Management of the breech in labour (excluding delivery)

Management of transverse lie in labour (excluding delivery) OM

Competence level Basic level Intermediate level Advanced level Not required Core Module 10 Logbook Level 2 Level 3 Signature Date Signature Date Signature Cord prolapse

Manage severe pre-eclampsia in labour

Manage eclampsia in labour

Manage HELLP in labour OM

Manage obstetric antepartum haemorrhage

Safe use of blood products

Manage obstetrical collapse OM

Manage intrauterine infection

Prioritise labour ward problems

Evaluate clinical risk

Coordinate and run labour ward

Competence level Basic level Intermediate level Advanced level Not required Core Module 10 Logbook Level 2 Level 3 Signature Date Signature Date Signature Liaise with other staff

Manage in utero transfer

Manage in utero fetal death

Date Title Eclampsia drill

Drill for obstetric collapse

ALSO/MOET or similar

Resilience training; Step-up course (or equivalent)

Authorisation of signatures (to be completed by the clinical trainers)

Name of clinical trainer (please print) Signature of clinical trainer

Authorisation of signatures (to be completed by the clinical trainers)

Name of clinical trainer (please print) Signature of clinical trainer

OSATS Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off

Date Date Date

Fetal blood sampling Signat Signature Signature ure

COMPLETION OF MODULE 10 I confirm that all components of the module have been successfully completed: Date Name of educational supervisor Signature of educational supervisor

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust