<p> Key: Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies</p><p>Core Module 10: Management of Labour</p><p>Learning outcomes: . To understand and demonstrate appropriate knowledge, skills and attitudes in relation to labour</p><p>Professional Evidence/assessmen Knowledge criteria Clinical competency skills and Training support GMP GMP GMP t attitudes</p><p>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</p><p>1</p><p>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</p><p>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 </p><p>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-</p><p>2</p><p>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</p><p>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</p><p>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</p><p>3</p><p>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</p><p>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</p><p>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 </p><p>4</p><p>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</p><p>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</p><p>5</p><p>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</p><p>Appendix to Module 10: Management of Labour </p><p>. 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</p><p>6</p><p>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</p><p>7</p><p>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</p><p>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</p><p>Manage delay in first labour</p><p>Manage delay in second stage of labour</p><p>Advise on pain relief</p><p>Interpret CTG</p><p>Perform fetal blood sampling</p><p>Manage fetal acidaemia</p><p>Manage preterm labour and delivery</p><p>Manage labour after previous caesarean section</p><p>Management of the breech in labour (excluding delivery)</p><p>Management of transverse lie in labour (excluding delivery) OM</p><p>8</p><p>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</p><p>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</p><p>Manage severe pre-eclampsia in labour</p><p>Manage eclampsia in labour</p><p>Manage HELLP in labour OM</p><p>Manage obstetric antepartum haemorrhage</p><p>Safe use of blood products</p><p>Manage obstetrical collapse OM</p><p>Manage intrauterine infection</p><p>Prioritise labour ward problems</p><p>Evaluate clinical risk</p><p>Coordinate and run labour ward</p><p>9</p><p>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</p><p>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</p><p>Manage in utero transfer</p><p>Manage in utero fetal death</p><p>Date Title Eclampsia drill</p><p>Drill for obstetric collapse</p><p>ALSO/MOET or similar</p><p>Resilience training; Step-up course (or equivalent)</p><p>Authorisation of signatures (to be completed by the clinical trainers)</p><p>Name of clinical trainer (please print) Signature of clinical trainer</p><p>10</p><p>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</p><p>Authorisation of signatures (to be completed by the clinical trainers)</p><p>Name of clinical trainer (please print) Signature of clinical trainer</p><p>OSATS Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off</p><p>Date Date Date</p><p>Fetal blood sampling Signat Signature Signature ure</p><p>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</p><p>11</p><p>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</p><p>12</p><p>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</p>