Obstetrics
I. Rationale
Pregnancy and childbirth are an important part of the family life cycle. The family physician, as the
provider of primary care to individuals and families, is uniquely qualified to guide and deliver
comprehensive, evidence-based maternity care to the pregnant patient and her family. The Emory
Academic Health Center and clinical affiliates expose the resident to a breadth of obstetrical experiences
with diverse patient populations.
This Family Medicine Obstetrics curriculum is offered to residents over the three years of training in both
didactic and clinical settings. The clinical phase consists of two components: the focused rotations at
Grady Memorial Hospital (PGY1) and Emory University Hospital Midtown (PGY2) in obstetrics and family
medicine inpatient service, and the longitudinal component which takes place over time in the family
medicine outpatient clinics and on other rotations where obstetric-related continuity care is provided.
The primary goal of the obstetrics curriculum is to prepare residents with the knowledge, skills, and
professional attitude to be competent in the provision of evidence-based, effective reproductive health
care to patients.
II. Competencies
Patient Care
Goals:
A. To communicate effectively and demonstrate caring and respectful behaviors interacting with
patients and their families when gathering essential and accurate reproductive health
information, counseling, and be able to apply this knowledge to the care of the individual
patient.
B. To demonstrate the ability to effectively interview and evaluate patients for reproductive
health promotion and treatment using appropriate techniques and skills to enhance the
doctor-patient relationship.
C. To demonstrate sensitivity to and knowledge of the emotional, psychosocial, and cultural
aspects of reproductive health, pregnancy, labor and delivery and parental care of the
newborn.
D. To develop and implement patient managements plans using health information technology
to support patient care decisions and patient education.
Objectives:
A. Demonstrate knowledge of and/or ability to perform:
1. New obstetric patient assessment, including history, physical, diagnostic and screening
studies and patient education
2. Estimates of gestational age
3. Risk assessment protocols
4. Routine obstetrics visits, including gestational age specific testing and anticipatory
guidance
5. Biophysical profiles
6. Pre-conceptual, anti/intra/postpartum counseling
B. Provide counseling to patients and their significant others regarding family planning,
including:
Last updated March 7, 2013
1.
2.
3.
4.
Different methods of birth control
Child spacing
Role of family members in pregnancy, delivery, and child care
Impact on family members, including spouse-spouse relations, sibling-parent
relations and sibling-sibling relations
C. Provide counseling in a non-judgmental manner to patients and their significant others
regarding various options for managing an unwanted pregnancy, recognizing that there are
multiple religious, ethical, and moral considerations in this counseling, and if unable to provide
comprehensive counseling, be able to refer to a provider who can.
D. Communicate with a family, the news of fetal loss or congenital anomaly, recognizing the
stages of grief, and appropriately scheduling the family back for follow-up.
E. Provide clear explanatory information and obtain consent on all patients undergoing
diagnostic or therapeutic procedures in a manner understandable to the patient.
F. Discuss the pregnancy, treatment plan, anticipatory guidance, and lactation issues with the
patient and her family in a manner understandable to all of them.
G. Review questions with patients and their families and elicit any concerns they may have.
Learning Activities: (check all that apply)
Attending Rounds
Research Conference
X
Multidisciplinary Rounds
Grand Rounds
Subspecialty Conference
Morning Report
X
Other (specify)
X
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Other (specify) PALS and
Neonatal Resuscitation
Course exams
Last updated March 7, 2013
X
X
X
Self-study OB Monographs
Evaluation Methods: (check all that apply)
X
Attending Evaluation
X
Directly Supervised
Procedures
Program Director
X
In-Training Exam
X Review
x
Oral Report
360° Evaluation
X
Outpatient Clinics
Case presentation
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
Faculty facilitated selfcritique of videotaped
patient encounter
X
X
Morning Report: Senior
Resident/Faculty
Supervision and Feedback
Record Review
Medical Record document
review
Medical Knowledge
Goals:
A. To provide comprehensive antepartum care, utilizing assessment tools and screening
methods for pregnant patients.
B. To identify common antepartum complications and know how to manage these
complications.
C. To deliver appropriate intrapartum care for pregnant patients.
D. To identify common intrapartum complications and know how to manage these
complications.
E. To provide appropriate postpartum care for pregnant patients.
F. To identify postpartum complications and appropriately manage these complications.
G. To provide effective care of the normal newborn.
H. To perform neonatal resuscitation.
I. To recognize ectopic pregnancies and manage them effectively.
Objectives:
A. Demonstrate knowledge of and assist in the performance of:
1. New obstetric patient assessment, including history, physical, diagnostic and
screening studies and patient education
2. Estimates of gestational age
3. Risk assessment protocols
4. Routine obstetrics visits, including gestational age specific testing and anticipatory
guidance
5. Biophysical profiles
6. Pre-conceptual, anti/intra/postpartum counseling
B. Demonstrate knowledge of the following ante partum complications and their managements,
assisting in the management of those that present in the clinical setting:
1. First trimester bleeding
2. Third trimester bleeding
3. Gestational diabetes
4. Pregnancy-induced hypertension, pre-eclampsia, eclampsia
5. IUGR / macrosomia
6. Premature rupture of membranes
7. Pre-term labor
8. Abdominal trauma
9. Advanced maternal age
10. Abnormal AFP
11. Anemia
12. Abdominal pain
13. Sexually transmitted infections
14. UTI/ pyelonephritis
15. Positive group B strep
16. Oligohydramnios
17. Polyhydramnios
18. Abnormal lie
19. Hyperemesis gravidarum
20. Post-date pregnancy
21. Size-date discrepancy
Last updated March 7, 2013
C. Demonstrate knowledge of and/or ability to perform under faculty supervision:
1. Pudendal/local block anesthesia
2. Normal vaginal delivery
3. Placement of Fetal scalp electrode
4. Placement of intrauterine pressure catheter
5. Vacuum/forceps delivery
6. Episiotomy and repair
7. External fetal monitoring
8. Analgesia during pregnancy
9. Determination of rupture of membranes
10. Leopold maneuvers
11. Determination of cervical dilatation, effacement, presentation, station
12. Use of Ultrasound to determine presentation
13. Stages of labor, and normal labor curve
14. First person assist in Cesarean Section
D. Demonstrate knowledge of the following intrapartum complications and their managements,
managing or assisting in the management of those that present in a clinical setting under
faculty supervision:
1. Prolonged rupture of membranes
2. Abnormal presentation, position
3. Fever
4. Active herpes
5. Labor disorders
6. Meconium
7. Vaginal/cervical lacerations and repair
8. Vacuum delivery
9. Breech delivery
10. Retained placenta
11. Shoulder dystocia
12. Abnormal fetal tracking
E. Demonstrate knowledge and display skills under faculty supervision to perform:
1. Manual extraction of placenta
2. First assist of tubal ligation and hysterectomy
F. Demonstrate knowledge and displays skills in the management of post-epidural complications
under faculty supervision for:
1. postpartum hemorrhage
2. postpartum infection
3. postpartum PIH
4. amniotic fluid embolism
G. Demonstrate knowledge of care of the normal newborn including:
1. Estimating gestational age by Dubowitz criteria
2. Initial physical examination
3. Initial prophylactic medications
4. Initial feeding of the infant in the delivery room
5. Ability to perform circumcisions under faculty supervision
H. Demonstrate knowledge of and skills in neonatal resuscitation by passing the course and
performing correctly in the clinical setting.
Last updated March 7, 2013
I. Describe typical signs and symptoms, the work-up, and management of an ectopic pregnancy.
Learning Activities: (check all that apply)
x
Attending Rounds
Research Conference
x
x
Multidisciplinary Rounds
Grand Rounds
Subspecialty Conference
Morning Report
Other (specify)
Self study Ob modules
x
x
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Ambulatory Care Clinic
Evaluation Methods: (check all that apply)
X
Attending Evaluation
X
Directly Supervised
Procedures
Program Director
X
In-Training Exam
X Review
x
Oral Report
360° Evaluation
X
Other (specify) PALS and
Neonatal Resuscitation
Course exams
X
Outpatient Clinics
x
x
x
X
X
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
Neonatal Resuscitation
and PALS courses
Morning Report: Senior
Resident/Faculty
Supervision and Feedback
Record Review
Medical Record document
review
Case presentation
Practice-Based Learning and Improvement
Goals:
A. To understand the need for and engage in continuing self-education about updates in
obstetrics using information technology and other modes for learning evidence-based care.
B. To identify gaps in obstetrics knowledge and skills and set learning and self
improvement goals.
C. To develop a vision for whether obstetrics may be part of future practice.
Objectives:
A. Discuss the value of including Obstetrics in the practice of Family Medicine.
B. Accept and respond positively to constructive feedback for self- improvement.
C. Construct an educational experience that allows for additional training in obstetrics as
indicated, based on self-identified personal knowledge and skills gaps to be prepared for on
anticipated future practice including obstetrics. If obstetrics are not to be part of a future
practice, describe how the family physician may interact with the pregnant patient and her
family to help ensure the most gain from the experience.
D. Participate in a quality improvement/practice management project to assess the degree of
compliance with an evidence-based or best practice clinical guideline related to Obstetrics,
and report the findings and plans for improvement.
E. Identify sources to which residents may turn for more information or continuing education on
family-centered obstetrics.
Last updated March 7, 2013
Learning Activities: (check all that apply)
Attending Rounds
Research Conference
Multidisciplinary Rounds
Grand Rounds
Subspecialty Conference
Morning Report
Other (specify)
X
Outpatient Clinics
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Portfolio development
Evaluation Methods: (check all that apply)
X
Directly Supervised
Attending Evaluation
Procedures
Program Director
In-Training Exam
Review
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
QI Project
Morning Report
X
Faculty Supervision and
Feedback
Quality Improvement
Project presentation
Other (specify)
Interpersonal and Communication Skills
Goals:
A. To learn to communicate efficiently and effectively with obstetric patients and their families,
the health care team and obstetric consultants.
B. To communicate and document clearly and completely using written and verbal methods.
C. To demonstrate sensitivity to patient and family cultural, lifestyle, race, gender, age,
disability issues.
D. To develop effective interpersonal and teaching skills for participation in the healthcare team
and for support of maternity patients and their families including use of language translators.
Objectives:
A. Prepare a consultant referral form which contains a complete and succinct summary of the
patient’s diagnosis, accurate description of the problem, the question for the consultant, and
other information pertinent to the referral.
B. Utilize, and facilitate the communication of accurate information effectively with other
members of the health care team, patients and their families in a timely manner.
C. Present patient cases accurately and effectively.
D. Effectively, accurately, efficiently document obstetric patient encounters in the medical
record.
E. Communicate effectively with obstetric patients and their families.
F. Communicate effectively verbally and in writing with community healthcare partners.
Learning Activities: (check all that apply)
x
Attending Rounds
Research Conference
Multidisciplinary Rounds
Last updated March 7, 2013
Ethics/Comm Conference
Outpatient Clinics
x
Direct Patient Care
Grand Rounds
Subspecialty Conference
Morning Report
Other (specify)
Videotape patient encounter
and self-critique
x
Specialty Conference
Noon Conference
Faculty Supervision
Ambulatory Care Clinic
x
Evaluation Methods: (check all that apply)
x Attending Evaluation
x Directly Supervised Procedures
Program Director Review
x
In-Training Exam
360° Evaluation
x
Other (specify)
x
Checklist evaluation of Patient
interaction videotaped
performance
Patient surveys
Other (specify)
x
Resident Seminar
Journal Club
Critical Appraised Topics
Focused observation of
faculty professional role
models
Morning Report:
x
Supervision and Feedback
Senior Resident/Faculty
Videotape review of patient
encounter
Professionalism
Goals:
A. To develop a commitment to carrying out professional responsibilities
B. To adhere to ethical principles
C. To develop sensitivity to a diverse patient populations
Objectives:
A. Displays behavior that is patient-centered, team-oriented, compassionate, ethical and
sensitive to patient culture and beliefs.
B. Demonstrate personal responsibility for compliance with residency program policies and
procedures, for responsible management of patient records, follow-up on diagnostic study
results, patient phone requests for information, clarification, and medication.
C. Displays behavior that reflects initiative, punctuality, dependability and responsibility.
D. Completes charting in a timely manner, and maintains up-to-date duty hour, delivery volume
and obstetric procedure documentation.
E. Demonstrate attention to detail and appearance that reflects respect for self, the profession,
patients and families.
Learning Activities: (check all that apply)
Attending Rounds
Research Conference
Multidisciplinary
Rounds
Grand Rounds
Morning Report
Other (specify)
Prepare an EBM Case
Last updated March 7, 2013
Ethics/Comm Conference
x
Outpatient Clinics
x
Direct Patient Care
Specialty Conference
Noon Conference
Resident Seminar
Journal Club
Faculty Supervision
Critical Appraised Topics
Review
Self critique patient
interaction videotape
x
Observe behavior of
faculty role models
Evaluation Methods: (check all that apply)
X
Attending Evaluation
X
Directly Supervised
Procedures
Program Director
Review
X
X
Other(specify)
360° Evaluation
In-Training Exam
Morning Report
X
Faculty Supervision and Feedback
Portfolio
Other(specify)
Videotape review and
facilitated critique
Systems-Based Practice
Goals:
A. To understand the value of obstetrical care in the practice of family medicine and the positive
impact on patients and families.
B. To identify and utilize community and system resources to support effective and efficient
maternity care.
C. To learn to bill appropriately for services and procedures.
D. To utilize a team approach to patient care and quality improvement practices.
Objectives:
A. Participated effectively in team-based, patient-centered approach to comprehensive health
care for female patients and their families
B. Meet patient needs or arrange for the comprehensive reproductive health promotion and
management services
C. Fully utilize community and system resources to optimize high quality reproductive health
management.
D. Demonstrated the interest in teaching less experienced learners how to provide high quality,
patient centered obstetrical care within the healthcare system and community.
E. Utilize appropriate coding and billing procedures and clinic resources for efficient, effective,
patient centered reproductive health services and practice management.
F. Demonstrate sensitivity to cost containment, patient safety, best practices guidelines, and
comparative effectiveness in clinical decisions.
G. Compare and contrast the patient satisfaction, provider satisfaction, practice cost/revenue
and obstetric patient health outcomes in Family Physician practices that offer or choose not
to offer obstetrical services
H. Participate in a practice management project on a healthcare systems topic.
Learning Activities: (check all that apply)
x
Attending Rounds
Research Conference
Multidisciplinary
Last updated March 7, 2013
Ethics/Comm Conference
x
Outpatient Clinics
x
Direct Patient Care
Rounds
Grand Rounds
Subspecialty
Conference
Morning Report
x
x
Specialty Conference
Noon Conference
x
x
Resident Seminar
Journal Club
Faculty Supervision
x
Critical Appraised Topics
Other (specify)
Practice Management
project
Evaluation Methods: (check all that apply)
Attending Evaluation
Directly Supervised
Procedures
x
Program Director Review
In-Training Exam
Other(specify)
Other(specify)
Morning Report
x
Faculty Supervision and
Feedback
Portfolio
Project presentation
III. Instructional Strategies (see above)
A. Observation of obstetrics preceptor role models and upper level resident’s assessment
of actual patients in labor and delivery
B. Management of actual patients in continuity clinic case discussions
C. Ambulatory care conference and core obstetric readings
D. Associated rotations: family medicine, pediatrics, and newborn nursery
IV. Evaluation Strategies (see above)
A. Observation of resident by obstetric preceptor (PC, K, PBL, CS, P, SBP)
B. Observation of resident clinical performance and medical record documentation by
clinic preceptor (PC, K, CS, P)
C. Procedure/diagnosis documentation. (PC, K, CS, P)
D. End of rotation evaluation (forms: all competencies)
E. Performance on the Obstetrics section of the in-training exam and mini-quizzes (K)
F. Evaluation of case presentation PC, K, PBL, CS, P, SBP)
V. Implementation Methods
The PGY1 resident is scheduled for the Obstetric core rotation at Grady Memorial Hospital, where
he/she joins the team of an OB intern and an OB PGY3 resident, who assumes responsibility for the
team under the supervision of OB/GYN faculty. The team is responsible for the triage area. The Family
Medicine resident and the OB intern share responsibility for seeing all patients coming through the triage
area, and all patients are signed out to the OB PGY3 resident. The Family Medicine resident primarily
sees term patients (=/> 37 weeks gestation), except when the OB intern is unable to handle the volume
of pre-term patients and beginning the patient evaluation to rule out the need for emergency measures.
The Family Medicine resident is expected to attend morning report, the Grady OB/Gyn didactic sessions,
and will participate in the labor, delivery and C-section activities. Each Family Medicine resident should
have the goal of doing and documenting at least 30 vaginal deliveries by the end of this rotation.
Last updated March 7, 2013
The obstetric curriculum has several components. During all training years, the didactic teaching
sessions includes obstetrics-related presentations. In the PGY-1 year the resident rotates through the
Ob-Gyn department of Grady Memorial Hospital for four weeks. The resident is responsible for triage
of all patients that present to this clinic along with the OB intern. In addition the resident will be called
to all deliveries during the shift. The rotation consists of 12 hour shifts (7pm-7am) Monday through
Friday. The resident is required to read the following monographs (pregnancy care and
medical conditions of pregnancy) and to score >90% on the written exam. It is required that
on at least three occasions during this rotation that the supervisor rechecks the examination of the
cervix to document competency in cervical examination.
In the PGY-2 year the resident rotates through the Emory University Hospital Midtown delivery suite for
a six week rotation. The FM resident is responsible for triage and management of labor under the
supervision of the Ob-Gyn attending physicians. In addition the resident is first assist on all C-sections
that occur during the residents shift. The rotation consists of Monday to Friday shifts of 7:00 AM to 7:00
PM with call in the family medicine service every fourth night. The resident is taught and expected to
memorize and use the pneumonic DR C BRAVADO for interpreting rhythm strips.
Throughout the residency, residents follow their own obstetric patients in their continuity clinic. These
patients are scheduled into the Family Medicine Clinic beginning in their intern year. They are followed
solely by each individual resident under the supervision of Family Medicine faculty. These patients
deliver at Emory University Hospital Midtown. The resident is expected to perform vaginal deliveries and
assist the OB department faculty in C-sections of their continuity patients. Residents are expected to
manage and deliver at least 10 continuity OB patients prior to graduation.
Contact Information:
Jessica Arluck, MD
Pic # 10382
Chiefs: Tara Cleary tcleary@emory.edu
Martina Badell mbadel@emory.edu
Emory University Hospital Midtown
550 Peachtree Street, NE
Atlanta, GA 30308
(404) 686 8121 ofc
(404) 778 3527 fax
VI. Suggested Readings
Articles:
Labor Analgesia, AFP, March 1, 2012 Steven D. Schrock, MD, and Carolyn Harraway-Smith, MD.
Managing Adverse Birth Outcomes: Helping Parents and Families Cope Van Dinter MC, Graves
L Am Fam Physician. 2012 May 1; 85(9):900-904.
Office Management of Early Pregnancy Prine LW, MD, Macnaughton, H, MD Am Fam
Physician. 2011 Jul 1; 84(1):75-82.
Umbilical Cord Blood: A Guide for Primary Care Physicians MARTIN P., Kurtzburg J., Hesse B. Am
Fam Physician. 2011 Sep 15; 84(6):661-666.
Last updated March 7, 2013
Usta J., Antoun,J, Ambuel B, Khawaja M. Involving the Health Care System in Domestic Violence:
What Women Want Ann. Fam. Med 2012 10:213-220; doi:10.1370/afm.1336
Moos M , Dunlop AL et al Healthier women, healthier reproductive outcomes: recommendations
for the routine care of all women of reproductive age American Journal of Obstetrics &
Gynecology Volume 199, Issue 6, Supplement B , Pages S280-S289, December 2008
The clinical content of preconception care: women with chronic medical conditions
Anne L. Dunlop, MD, MPH; Brian W. Jack, MD; Joseph N. Bottalico, DO et al
ACOG, 2008, Vol 199, # 6
Liver Disease in Pregnancy - February 15, 1999 - American Academy of Family Physicians
http://www.aafp.org/afp/990215ap/829.html
Medical Options for Early Pregnancy Termination August 1997, AFP
http://www.aafp.org/afp/970800ap/abortion.html
Urinary Tract Infections During Pregnancy February 1, 2000 American Academy of Family
Physicians http://www.aafp.org/afp/20000201/713.html
Obstetric Care in Patients with HIV Disease
117.
Krist A.., Am Fam Physician 2001 Jan 1; 63(1):107-
Neonatal Herpes Simplex Virus Infections Rudnick CM Hoekzema GS Am Fam
Mar 15; 65(6):1138-1142.
Physician. 2002
Management of Vaginitis Owen M Clenney TL Am Fam Physician. 2004 Dec 1; 70 (11):21252132.
Screening and Treatment for Sexually Transmitted Infections in Pregnancy Majeroni BA and
Ukkadam S. Am Fam Physician. 2007 Jul 15; 76 (2):265-270.
Screening for Bacterial Vaginosis in Pregnancy to Prevent Preterm Delivery Lin KW
LoBrano MB Am Fam Physician. 2009 Apr 15; 79 (8):697-698.
Screening for Genital Herpes Putting Prevention into Practice Am Fam Physician. 2005
72(01):135-136.
Jul 1;
Epilepsy in Pregnancy - October 15, 1997 - American Family Physician
http://www.aafp.org/afp/971015ap/rochest.html
Safety of Radiographic Imaging During Pregnancy April 1, 1999 American Academy of Family
Physicians http://www.aafp.org/afp/990401ap/1813.html 04/01/99,
NHBPEP Report on High Blood Pressure in Pregnancy: A Summary for Family Physicians - July 15,
2001 - American Family Physician http://www.aafp.org/afp/20010715/263.html 07/18/01
Intrauterine Growth Restriction: Identification and Management - August 1998 - American
Academy of Family Physicians http://www.aafp.org/afp/980800ap/peleg.html 11/16/00,
Pyelonephritis in Pregnancy: Is Hospitalization Necessary? - March 15, 2000 - American Academy
of Family Physicians http://www.aafp.org/afp/20000315/tips/25.html 12/01/00
Last updated March 7, 2013
Diagnosing and Managing Ectopic Pregnancy - February 15, 2001 - American Family
Physician http://www.aafp.org/afp/20010215/tips/11.html 02/20/01
Evaluation of Pregnant Women Exposed to Respiratory Viruses - May 15, 2000 - American
Academy of Family Physicians http://www.aafp.org/afp/20000515/3065.html 07/10/00
Emergency Postcoital Contraception - November 15, 2000 - American Family Physician
http://www.aafp.org/afp/20001115/2287.html 11/21/00
Case Studies in Partner Violence - December 1, 1999 - American Academy of Family Physicians
http://www.aafp.org/afp/991201ap/2569.html 12/01/99
Current Trends in Cervical Ripening and Labor Induction - August 1999 - American Academy of
Family Physicians http://www.aafp.org/afp/990800ap/477.html 07/31/99
HELLP Syndrome: Recognition and Perinatal Management - September 1, 1999 - American
Academy of Family Physicians http://www.aafp.org/afp/990901ap/829.html
External Cephalic Version - September 1, 1998 - American Academy of Family Physicians
http://www.aafp.org/afp/980901ap/coco.html 08/24/01
Interpretation of the Electronic Fetal Heart Rate During Labor - May 1, 1999 - American Academy
of Family Physicians http://www.aafp.org/afp/990501ap/2487.html
Common Peripartum Emergencies - November 1, 1998 - American Academy of Family Physicians
http://www.aafp.org/afp/981101ap/morrison.html
Management of Suspected Fetal Macrosomia - January 15, 2001 - American Family Physician
http://www.aafp.org/afp/20010115/302.html
Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: part I. General
prenatal care and counseling issues. Am Fam Physician 2005; 71:1307-16. Review.
Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: part II. Third-trimester care
and prevention of infectious diseases. Am Fam Physician 2005; 71:1555-60. Review
ACOG Obstetrics Guidelines
#263 August 2011 Policy Statement Maternity Leave in Normal Pregnancy
#236 Nov 2009
Clinical Practice Guideline Immunization in pregnancy
Replaces #220 (Dec 08)
#235 Oct 2009 Clinical Practice Guideline Active management of the third stage of labour:
prevention and treatment of postpartum hemorrhage
Replaces #88 (April 2000)
#214 Sept 2008
to 42+0 weeks
Clinical Practice Guideline Guidelines for the management of pregnancy at 41+0
Replaces #15 (Mar 1997)
# 206 Mar 2008 Clinical Practice Guideline Diagnosis, evaluation and management of the
hypertensive disorders of pregnancy
# 203 Feb 2008 Clinical Practice Guideline Rubella in Pregnancy
Last updated March 7, 2013
# 197 Sept 2007 Clinical Practice Guideline Fetal Health Surveillance: Antepartum and
Intrapartum Consensus Guideline
Replaces #130 (July 2003), #90 (June 2000); #112 (March 2002); and # 112 (April 2002)
#190 April 2007 Policy Statement Pospartum Maternal and Newborn Discharge Replaces #56
(Oct 1996)
# 006538 NGC Feb.2008 Asthma in pregnancy. American College of Obstetricians and
gynecologists
Vaginal Birth after Previous Cesarean 2010 National Guideline Clearinghouse
http://guideline.gov/content.aspx?id=23853
Diabetes in pregnancy. Management of diabetes and its complications from pre-conception to the
postnatal period. 2008 Mar. NGC: 007192 National Collaborating Centre for Women’s and Children’s
Health - National Government Agency
http://guideline.gov/content.aspx?id=14324&search=pregnancy
Hypertension in pregnancy. The management of hypertensive disorders during pregnancy. 2010
Aug. NGC: 008073 National Collaborating Centre for Women’s and Children’s Health - National
Government Agency http://guideline.gov/content.aspx?id=24122&search=pregnancy
Practice parameter update: management issues for women with epilepsy—focus on pregnancy (an
evidence-based review): teratogenesis and perinatal outcomes. Report of the Quality Standards
Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of
Neurology and American Epilepsy Society. 2009 July NGC: 007263 American Academy of
Neurology http://guideline.gov/content.aspx?id=14680&search=pregnancy
VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention
of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice
guidelines. 2001 Jan (revised 2012 Feb). NGC: 008939 American College of Chest Physician
http://guideline.gov/content.aspx?id=35275&search=pregnancy
Thromboembolism in Pregnancy: Clinical Guidelines - February 1, 2001 - American Family Physician
http://www.aafp.org/afp/20010201/tips/7.html 02/06/01
Management of Pre-term Birth, Obstetrics and Gynecology Clinics, Vol 39, Issue 1, March 2012
US Preventive Services Task Force Neural Tube defects: Folic Acid for Prevention
Recommendations, May, 2009 http://www.uspreventiveservicestaskforce.org/uspstf/uspsnrfol.htm
FP Practice Endorsed Guidelines and Policies
Trial of Labor After Cesarean (TOLAC), Formerly Trial of Labor Versus Elective Repeat Cesarean
Section for the Woman With a Previous Cesarean Section, March 2005 A Review of the Evidence
and Recommendations by the American Academy of Family Physicians. Available at:
http://www.aafp.org/online/en/home/clinical/clinicalrecs/ob/tolac.html
and
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/clin_recs/tolacpolicy.Par.0001.F
ile.tmp/clinicalrec_tolac.pdf
TOLAC Shared Patient Provider decision tool:
Last updated March 7, 2013
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/patient_ed/tolaccolor.Par.0001.File.tmp/TOLAC-color.pdf
Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC,
2010 (endorsed by AAFP with reservations) Available at:
http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/clin_recs/cdcgbs.Par.0001.File.t
mp/MMWRGroupBStreptococcaldisease11192010.pdf
Circumcision: Position Paper on Neonatal Circumcision
Board Approved: August 2007 Reaffirmed Available at:
http://www.aafp.org/online/en/home/clinical/clinicalrecs/guidelines/Circumcison.html
Immunizations in Pregnancy from CDC (updated Oct, 2011). Chart and flyer available at:
http://www.cdc.gov/vaccines/pubs/downloads/f_preg_chart.pdf and
http://www.cdc.gov/vaccines/pubs/downloads/f_preg.pdf
AAFP: FP Essentials Monographs and Policies
Genetics Update May 2012 (#396)
http://www.aafp.org/online/en/home/cme/selfstudy/fpe/fpeissues.html
Care of the Pregnant Patient, 2011 (#382)
Society for Maternal/Fetal Medicine: Maternal Fetal Medicine Monograph, High Risk Pregnancy Care 2009
https://www.smfm.org/attachedfiles/SMFMMonograph3.1.pdf
Finley BJ, Harnisch DR. Women’s Genitourinary Conditions. (# 314) AAFP Home Study. Leawood, Kan:
American Academy of Family Physicians, 2005.
Soldat LG, Batra CP, Murad E. Medical Conditions in Pregnancy. (#316) AAFP Home Study. Leawood,
Kan: American Academy of Family Physicians, 2005.
Pauwels J, Olifer L, Huntington J, Church L. Reproductive Health Update. (#340), AAFP Home Study.
Leawood, Kan: American Academy of Family Physicians, 2007.
Texts:
Cunningham F, Williams JW. Williams Obstetrics. 23nd ed. New York, N.Y.: McGraw-Hill Medical,
2010. Available Books at Ovid at Emory HS Library
Gibbs R, Kirlan B et al Danforth’s Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott
Williams & Wilkins, 2008. Available Books at Ovid at Emory HSC Library
American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for
Perinatal Care. 6th ed, Elk Grove Village, Ill.: American Academy of Pediatrics, 2007.
Creasy RK, Resnik R, Iams JD. Maternal-Fetal Medicine: Principles and Practice. 6th ed. Philadelphia,
Pa.: Saunders, 2009. (Via MD Consult at Emory Health Sciences Library)
Weiner: Drugs for Pregnant and Lactating Women, 2nd ed, 2009.
(MD Consult thru Emory HSc Library)
Brunt, B Evidence-Based Competency Management for the Obstetrics Unit, 2nd ed, 2008
(R2 Library)
Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia,
Pa.: Churchill Livingstone/Elsevier, 2012.
(Available at MD Consult)
Last updated March 7, 2013
Speroff L, Fritz MA. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia, Pa.:
Lippincott Williams & Wilkins, 2011. (Books at OVID)
Websites:
The Center for Disease Control and Prevention
http//:www.cdc.gov/reproductivehealth/MaternalInfantHealth/
(revised 1/19/12)
http//:www.cdc.gov/women/ (modified, 2012)
http://www.womenshealth.gov/ http://www.womenshealth.gov/publications/ourpublications/breastfeeding-guide/(Breast feeding)
http://www.womenshealth.gov/publications/our-publications/pregnancy-dos-donts.pdf (Pregnancy)
http://www.womenshealth.gov/publications/our-publications/pregnancy_food_donts.pdf Nutrition)
Association of Maternal and Child Health Programs
http://www.amchp.org
American College of Obstetricians and Gynecologists
http://www.acog.org
National Guideline Clearinghouse
http:/www.guideline/index.aspx
American Pregnancy Association (Tools and Pt Ed)
http://www.americanpregnancy.org/
Last updated March 7, 2013