Maternity and Gynecological Health
General competencies
1. Perform a comprehensive women’s health assessment, with special
consideration to reproductive health
2. Use available women’s health care resources from local, national, and
international agencies
3. Emphasize disease prevention, and health promotion
4. Communicate effectively with the patient and her family, caregivers, especially
in the context of differing cultural and belief barriers surrounding women’s
health
Topic Areas
Gynecology
1. Female development, normal and variants vs pathological
2. Physiology of menstruation
3. Physiology of menopause
4. Pelvic pain
5. Abnormal uterine bleeding
6. Diseases of the female reproductive and urinary systems
7. Neoplasms of the female reproductive system (including breast, ovaries,
fallopian tubes, uterus, cervix, vagina)
8. Cervical lesions
9. Diseases of the breast
10. Sexually transmitted infections
11. Sexual Assault
12. Domestic violence
Obstetrics
1. Family planning
2. Counselling/prescribing appropriate form of contraceptive
3. Risk assessment for pregnancy
4. Fertility problems
5. Physiologic changes of pregnancy
6. Pre-natal care
7. Initial pregnancy visit
8. Hyperemesis Gravidarum
9. Gestational hypertension
10. Gestational diabetes
11. Indications for referral to obstetrician/sub-specialist /high risk center
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Voluntary termination of pregnancy
Fetal assessment during pregnancy and delivery
Ectopic pregnancy
Physiology of labour, delivery
Analgesia/anaesthesia for labour and delivery
Intra-partum problems (i.e. hypertension, pre-eclampsia, fever, infection, fetal
status, shoulder dystocia, placental abruption/accreta)
Pre-term labour
Induction of delivery
Caesarian section
Obstetric emergencies
Neonatal resuscitation
Post-partum care
Post-partum hemorrhage, endometritis, etc.
Lactation
Effective use of multi-disciplinary team (nutritionist, midwife, nurse, lactation
consultant, etc.)
Care of the normal newborn, and common neonatal problems
For each topic area
1. Epidemiology
2. Anatomy
3. Pathophysiology/Etiology
4. Risk factors
5. History and physical exam
6. Diagnostic Tests
7. Differential diagnosis
8. Management
9. Psychosocial implications
Highlighted teaching points
1. Anatomy
a. Normal anatomy and variants of female reproductive and urinary
systems
b. Normal anatomy and variants of pregnancy (placental anatomy, fetal
development)
2. History and physical exam
a. Gynecology: Screening physical exam , breast exam, pelvic exam
b. History/physical exam for suspicion of sexual assault/domestic violence
c. Obstetrics
3.
4.
i.
Initial pregnancy visit
ii.
Fetal assessment during pregnancy and delivery
iii.
Physical exam of the newborn
Diagnostic tests (including indication for):
a. Gynecology
i.
Vaginal and cervical cytology
ii.
Colposcopy
iii.
Cervical biopsy
iv.
Endometrial biopsy
v.
Microscopic diagnosis of urine and vaginal smears
b. Diseases of the breast
i.
Mammography
ii.
Breast lump aspirate/biopsy
c. Obstetrics
i.
Diagnosis of pregnancy (b-HCG – urine/blood)
ii.
Fertility problem work-up
iii.
Ectopic pregnancy: ultrasound, serial b-HCG
d. Fetal monitoring
i.
Ultrasound
ii.
Non-stress test
Management (including indications for)
a. Cervical polypectomy
b. Endometrial biopsy
c. Cryosurgery and cautery for benign disease
d. Bartholin duct cyst management
e. Family planning and contraception
i.
Oral contraceptive counseling and prescribing
ii.
Intrauterine contraceptive device counseling, insertion and
removal
iii.
Diaphragm fitting and counseling
iv.
Insertion and removal of subcutaneous contraceptive implants and
counseling
v.
Injectable long term contraceptives and counseling
f. Pregnancy
i.
Pre-conceptual counseling
ii.
Initial pregnancy visit
iii.
Risk assessment
g. Management of labor
i.
Pudendal and local block anesthesia
ii.
Induction of labor
iii.
iv.
5.
Internal fetal monitoring and amnioinfusion
Common intrapartum problems (e.g., hypertension, mild preeclampsia, fever, infection, nonreassuring fetal status,
unanticipated shoulder dystocia, manual removal of placenta)
v.
Normal cephalic delivery (including use of vacuum extraction and
outlet forceps)
vi.
Episiotomy and repair (including third-degree lacerations)
vii.
Emergency breech delivery
viii.
Common postpartum problems (e.g., hemorrhage, endometritis)
ix.
Caesarian section
x.
Vaginal delivery after previous Caesarian section
h. Neonatal resuscitation
Psychosocial implications of gynecological/ maternity health
a. Special consideration to sexual abuse and domestic violence
References:
1. American Academy of Family Physicians. (2008). Recommended Curriculum
Guidelines for Family Medicine Residents, Maternity and Gynecologic Care
(Reprint No. 278), Leawood, Kansas.