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Curriculum for Subspecialty Training in Maternal and Fetal Medicine

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Curriculum for Subspecialty Training in Maternal and Fetal Medicine Maternal and Fetal Medicine Curriculum Curriculum for Subspecialty Training in Maternal and Fetal Medicine Module 1 Medical Complications of Pregnancy Module 2 Genetics Module 3 Structural Fetal Abnormalities Module 4 Antenatal Complications Module 5 Intrapartum Complications Module 6 Infectious Diseases 1 Last updated February 2013 Maternal and Fetal Medicine Curriculum Module 1 Medical complications of pregnancy 1.1 Hypertension Objectives Manage a case of chronic hypertension, including: Counsel regarding fetal and maternal risks 1. To be able to carry out appropriate assessment (including long-term health implications. and management of women with chronic hypertension. Arrange appropriate investigations. 2. To be able to carry out appropriate assessment institute and modify drug therapy. and management of women with pregnancy- Plan delivery and postnatal care. induced hypertension, pre-eclampsia and Refer, where appropriate, for further assessment associated complications. and treatment. Chronic hypertension Professional skills and attitudes Knowledge criteria Ability to take an appropriate history and conduct an examination to screen for secondary causes and Definition and diagnosis: complications of chronic hypertension. Measurement of blood pressure in pregnancy, including validated devices. Ability to perform and interpret appropriate Impact of pregnancy on blood pressure. investigations. Superimposed pre-eclampsia. Prevalence (primary and secondary causes). Ability to formulate, implement and, where appropriate, modify a multidisciplinary management Pathophysiology: plan. Acute hypertension. Chronic hypertension (including end-organ Ability to manage antihypertensive drug therapy in damage). antenatal and postnatal periods. Management: Ability to liaise with primary care and physicians in Screening for common causes of secondary management of hypertension. hypertension. Ability to counsel women about: Pregnancy management, including fetal monitoring. maternal and fetal risks Maternal and fetal risks. safety of antihypertensive therapy Contraception. contraception Pharmacology, including adverse effects: Training support Anti-adrenergics (e.g. propranolol, labetalol, Observation of and discussion with senior oxprenolol). medical staff. Calcium channel blockers (e.g. nifedipine). Appropriate postgraduate courses Vasodilators (e.g. hydralazine). (e.g. ICL/RCP/BMFMS Maternal Complications ACE inhibitors (e.g. lisinopril). in Pregnancy). Attendance at maternal medicine and Outcome: long-term and cardiovascular risks. hypertension clinics. Attachments in: Clinical competency o obstetric anaesthesia Take an appropriate medical history from a woman o intensive care unit/high-dependency unit with pre-existing hypertension: Personal study. family history secondary causes of chronic hypertension Evidence complications of chronic hypertension Log of experience and competence. outcomes of previous pregnancies Mini-CEX. drug therapy. Case-based discussions. Perform an examination to screen for: secondary causes of hypertension complications of hypertension. 2 Last updated February 2013 MFM Curriculum Pre-eclampsia Knowledge criteria Professional skills and attitudes Definition and diagnosis: Ability to take an appropriate history and conduct an pregnancy-induced hypertension (PIH) examination to assess a woman with pre-eclampsia. proteinuria prevalence. Ability to perform and interpret appropriate investigations. Pathophysiology: placental pathology Ability to formulate list of differential diagnoses. endothelial dysfunction and systemic manifestations Ability to formulate, implement and, where oxidative stress. appropriate, modify a multidisciplinary management plan. Prediction (see 4.2). Ability to manage antihypertensive drug therapy in Management of severe pre-eclampsia: antenatal and postnatal periods. maternal and fetal risks maternal monitoring, including indications for Ability to liaise with primary care and physicians in invasive monitoring) management of hypertension. fetal monitoring management of complications Ability to counsel women about: HELLP syndrome maternal and fetal risks Eclampsia, including differential diagnosis safety of anti-hypertensive therapy convulsions, altered consciousness (see 1.18) recurrence risks and future management (see cerebrovascular accident (see 1.9) 4.2) pulmonary oedema, acute respiratory distress contraception. syndrome (see 1.5) contraception. Training support Observation of and discussion with senior Pharmacology, including adverse effects: medical staff. magnesium sulphate Appropriate postgraduate courses (e.g. frusemide. ICL/RCP/BMFMS Maternal Complications in Pregnancy). Outcome, including long-term cardiovascular risks. Attachments in: o obstetric anaesthesia Clinical competency o intensive care unit/high-dependency unit. Take an appropriate medical history from a woman Personal study. with pre-eclampsia: RCOG Green-top Guideline Management of family history Severe Pre-eclampsia/Eclampsia (No. 10A). symptoms of severe disease. Evidence Perform an examination to screen for complications in a woman with pre-eclampsia. Log of experience and competence. Mini-CEX. Manage a case of complex pre-eclampsia (or PIH) Case-based discussions. with: (a) HELLP, (b) severe hypertension, (c) eclampsia and (d) pulmonary oedema: counsel regarding fetal and maternal risks arrange and interpret appropriate investigations institute and modify drug therapy plan delivery and postnatal care refer, where appropriate, for further assessment and treatment. Manage a case of pre-eclampsia with acute renal failure: counsel regarding fetal and maternal risks arrange and interpret appropriate investigations refer to for further assessment and treatment. 3 Last updated February 2013 MFM Curriculum 1.2 Renal disease Objectives Manage a case of CRD: counsel regarding fetal and maternal risks 1. To be able to carry out, under supervision, appropriate assessment and management of arrange and interpret appropriate investigations women with pre-existing renal disease and renal institute and modify drug treatment transplants. plan delivery and postnatal care 2. To be able to carry out appropriate assessment refer where appropriate, for further assessment and management of women with pregnancy- and treatment. induced renal disease. Manage a case of renal transplant or ARF: Knowledge criteria counsel regarding fetal and maternal risks arrange and interpret appropriate investigations The kidney in normal pregnancy: refer for further assessment and treatment. anatomical changes, including hydronephrosis) functional changes Professional skills and attitudes interpretation renal function tests fluid and electrolyte balance. Ability to take an appropriate history and conduct an examination to assess a woman with CRD. Pre-existing renal disease (CRD): reflux nephropathy, glomerulonephritis, polycystic kidney Ability to perform and interpret appropriate disease (PKD): investigations. pathology Ability to formulate list of differential diagnoses. prevalence prepregnancy assessment Ability to formulate, implement and, where pregnancy management appropriate, modify a multidisciplinary management outcome (including genetic implications). plan. Renal transplant recipients: Ability to manage antihypertensive drug therapy in prepregnancy assessment antenatal and postnatal periods. diagnosis rejection pregnancy management Ability to liaise with nephrologists and intensivists in long term considerations the management of acute and CRD. pharmacology (including adverse effects) cyclosporine, tacrolimus Ability to counsel women about maternal and fetal azathioprine (see 1.10) risks, inheritance, recurrence risks, contraception. corticosteroids (see 1.5, 1.6, 1.10). Training support Acute renal failure (ARF) in pregnancy and the puerperium: Observation of and discussion with senior aetiology and diagnosis, including differential medical staff. diagnosis of abnormal renal function (see 1.18) Appropriate postgraduate courses (e.g. management and outcome ICL/RCP/BMFMS Maternal Complications in Pregnancy). indications for and principles of renal support. Attendance at renal medicine clinic. Urinary tract infection (see 6.15): differential Attachment in intensive care unit/high- diagnosis proteinuria (see 1.18). dependency unit. Personal study. Clinical competency Evidence Take an appropriate history from a woman with CRD: family history Log of experience and competence. complications Mini-CEX. outcome of previous pregnancies Case-based discussions. drug therapy. Perform an examination to screen for complications of CRD. 4 Last updated February 2013 MFM Curriculum 1.3 Cardiac disease Objectives Clinical competency 1. To be able to carry out, under supervision, Take an appropriate history from a woman with appropriate assessment and management of cardiac disease: women with pre-existing cardiac disease. family history previous operations/procedures 2. To be able to carry out, under supervision, complications of cardiac disease appropriate assessment and management of drug therapy. women with pregnancy-induced cardiac disease. Perform an examination to assess cardiac disease. Knowledge criteria The heart in normal pregnancy: Manage a case of congenital and acquired heart anatomical and functional changes, including disease in pregnancy: differential diagnosis heart murmur (see 1.18) counsel regarding fetal and maternal risks ECG, echocardiography and assessment of arrange and interpret appropriate investigations cardiac function. refer to
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