(1.09) Severe early onset fetal growth restriction (1.10) Late onset fetal growth restriction (1.11) Twin pregnancy with growth discordance (1.12) Twin-twin transfusion syndrome (1.13) Suspected preterm ruptured membranes (1.14) Polyhydramnios (1.15) Low lying placenta (1.16) Ultrasound guided procedures: ECV for Breech 1,2 1,2 1,2 1,2 1,2 1,2 1,2 1,2 Understand how MCA vMax is used to monitor for signs of anaemia (1.08) Cervical length: transcervical measurement of cervical length, the criteria for accurate and reproducible measurement. Recognises when cervical length should be offered. (1.09-1.10) Management of growth restriction according to National Guidelines. When to refer to the Tertiary Centre. (1.11-1.12) Multiple pregnancies: able to recognise and manage growth discordance. Understand the influence of chorionicity. For monochorionicity to be able to monitor for signs of TTTS and refer to the tertiary centre in accordance with local guidelines. Aware of the ultrasound features of TRAP (Twin reverse arterial perfusion sequence) and conjoined twins. (1.13) Aware of the role and limitations of ultrasound in the management of suspected preterm ruptured membranes. 1,2 1,2 1,2 1,2 1,2 1,2 1,2 (1.09-1.16) Able to formulate a suitable management plan, liaising where appropriate and always considering the individuals hopes and expectations for the pregnancy. pregnancies in the antenatal period. RCOG Green top guideline N0.51 Monochorionic twin pregnancy. STRATOG Advanced, Clinical Case Studies eLearning: Management of the SGA fetus (2016). abnormal values and explore the antenatal management. These are common findings and should be based upon direct patient care. OSAT CBD Reflective Practice 1,2,3
Clinical competency Knowledge criteria GMP Professional skills and attitudes Training support Evidence/ assessment Substance misuse (7.01) Current alcohol misuse (7.02) Obstetric management for current opiate misuse (7.03) Obstetric management for current stimulant misuse. (7.04) MDT assisted conversion to an opiate replacement programme 1,2 (7.01-7.03) Know the incidence, pharmacology, obstetric, medical & neonatal complications and legal consequences for the abuse of: alcohol, cannabis, opiates, cocaine and crack cocaine, heroin, benzodiazepines, amphetamines, LSD, phencyclidine (angel dust), solvent misuse and not forgetting cigarette smoking. Know their interactions with prescribed drugs and analgesia during labour. Understand the organization of dependency services and links with psychiatric and social services; the theories of addiction and self-harming behaviours prevalence of psychiatric and its detection. (7.01-7.04) Manage cases of alcohol or substance abuse in pregnancy; arrange and interpret appropriate maternal & fetal investigations refer, where appropriate, for further assessment. (7.02-7.03) Knowledge of the law regarding class A and class B drugs. 1,2 1,2 1,2 1,2,3 1,2 1.2 (7.01-7.03) Provide sympathetic support. Respect confidentiality. Recognise if there are issues relating to child protection and where to seek advice. Achieve harm minimisation in partnership with women. Take an appropriate history and examination. Plan pregnancy, delivery and postnatal care within a team. Talk to the drug dependency team, psychiatrists, social services, pharmacists, midwives and neonatologists understand their services and your role in supporting the care they deliver. Counsel appropriately about: drinking / drug cessation maternal, fetal and neonatal risks: long-term health implications, viral and other infections breast-feeding / 1,2,3 1,2,3 1,2,3 (7.01-7.04) RCOG Statement 5 (Alcohol consumption and the outcomes of pregnancy). (7.01-7.04) Record of attendance at drug / alcohol abuse clinic or relevant psychiatry clinic. Work alongside drug liaison midwife or community team. OSAT CBD Reflective Practice 1,2,3 1,2,3 1,2,3
Knowledge of the local and national strategies for reduction in drug and alcohol misuse. (7.04) Knowledge of neonatal management and outcome (incl. management of withdrawal and long term effects). 1,2 contraception, effects of risk taking behaviour. (7.02) Be able to explain the features of neonatal withdrawal. Teach the parents how to recognise signs of neonatal withdrawal. Care of the Pregnant Teenager (7.05) Mother <18 years Social vulnerability (7.06) Care plan for recent arrival to the UK 1,2 1,2 (7.05 - 7.06) Know the incidence, associated obstetric, medical & neonatal complications and legal consequences of social disadvantage with respect to: domestic violence, teenage pregnancy and asylum seekers. Understand the influence of ethnic & religious background on obstetric expectations and outcome. Knowledge of the law in relation to seeking asylum. 1,2 1,2 1,2 (7.05) Ability to effectively communicate and respond to the hopes and concerns of pregnant teenagers. (7.06) Understand when and how to use the different agencies involved in processing claims for asylum status and meeting their practical needs (Police, Home Office, Social Services). Be sensitive to the potential for psychological and emotional traumas previously experienced by many asylum seekers. Reflect upon the consequences of being displaced from home, community and country. (7.06) NICE guideline CG110. (2010) Pregnancy and complex social factors Obesity (BMI >40) 1,2 1,2,3 1,2,3 1,2,3
(7.07) Assessment of maternal risks and counselling at booking. (7.08) Fetal assessment. (7.09) Intrapartum obstetric and anaesthetic care plan. (7.07 -7.09) Know the incidence, associated obstetric, medical & neonatal complications of the pregnant obese patient. Understand the endocrinology of obesity Understand the place of weight reduction strategies and appropriate nutrition in managing the pregnant obese patient. Understand the management of obesity and its complications during pregnancy. Conduct a booking risk assessment and plan follow up visits and care. Undertake antenatal (fetal and maternal) assessment of the obese patient. Arrange and interpret appropriate investigations including screening for gestational diabetes. Recognise and manage health risks associated with maternal obesity; the place of weight reduction strategies and nutrition 1,2 1,2 1,2 1,2 1,2 (7.07-7.09) Liaise with midwives and other health professionals to optimise patient management. Provide care with sensitivity and empathy. Provide specific practical advice to reduce the maternal and fetal risks of obesity during pregnancy and birth. Use appropriate referral pathways and local protocols. 1,2,3 1,2 (7.07-7.09) CMACE/RCOG Joint Guideline (2010) Management of women with obesity in pregnancy. Scientific impact paper No.18 Nutrition in pregnancy. NICE Guideline Intrapartum Care for High Risk Women (in development 2017). Domestic violence (7.10) History taking and MDT care plan (7.10) Knowledge of the role of different agencies (Social Services, Police, 1,2 (7.10) Recognise the impact of domestic violence on the 1,2 (7.10) STRATOG Core training: (2016) 1,2,3 1,2,3
Voluntary groups) in the investigation of suspected domestic violence and the protection of vulnerable women and children. Knowledge of the law in relation to physical and sexual assault, bodily harm and rape. 1,2 physical, psychological and emotional health of women and their families. Be able to describe the role of support agencies and encourage engagement if appropriate. Domestic abuse and substance misuse. Women who decline blood products (7.11) Care-plan specific to individual circumstances, for example Jehovah’s Witness. 1,2 (7.11) Understand those Religious beliefs and customs that may affect healthcare or consent for medical interventions. Knowledge of the alternatives to blood transfusion. Be familiar with the set up and use of cell-salvage during surgery. 1,2 1,2 1,2 (7.11) Assist in the construction of an advanced directive detailing the acceptability or not of blood and blood products and their use in acute circumstances. (7.11) (No blood: blood management and avoidance) RCOG Green top guideline No. 47 Blood transfusion in Obstetrics. 1,2,3 1,2,3
(8.08) Previous or suspected cervical incompetence (8.09) Suspected preterm rupture of the membranes (8.10) Previous shoulder dystocia (8.11) Recurrent antepartum haemorrhage Explain correctly and put into the clinical context the ultrasound & Doppler findings. Use other fetal tests (e.g. CTG) and maternal tests (e.g. blood investigations) in an appropriate fashion and be able to recognise deteriorating trends, which mandate action such as the need for delivery. (8.08) No. 60 Cervical cerclage. (8.06-8.09) NICE Guideline NG25 (2015) Preterm labour and birth. (8.07-8.09) No 1b Preterm labour and tocolytic drugs. No.44 Preterm prelabour rupture of membranes. RCOG Scientific impact paper No.33 Preterm labour antibiotics and cerebral palsy. (8.10) Green top guideline No.42 Shoulder dystocia (8.11) Green top guideline No. 63. Antepartum haemorrhage. 1,2,3
ASM 9 Effective Communication and Clinical Governance Skills for High-Risk Pregnancy Clinical competency Knowledge criteria GMP Professional skills and attitudes Training support Evidence/ assessment Effective Communication (9.01) Explain any implications for the pregnancy and childbirth for strongly held parental beliefs. (9.02) High risk for Fetal Genital Mutilation. (9.03) Early or pre-pregnancy counselling for on-going substance misuse. (9.04) Early or pre-pregnancy counselling for on-going maternal alcohol misuse. (9.01-9.04) How to conduct an interview with a patient to identify their prior beliefs, expectations, comprehension, priorities and fears. How to lead a non-directive discussion of medical facts and explore the patient’s responses and feelings to achieve joint decision-making. How to break bad news and discuss difficult issues or uncertainty. Bereavement processes and behaviour. (9.02) Knowledge of the UK and international laws and directives regarding Female Genital Mutilation (FGM). Understanding of the various FGM procedures and their consequences, including for pregnancy and delivery. 1,3,4 1,3,4 1,2 (9.02) Be able to explain the UK law as it relates to female genital mutilation. (9.03-9.04) Respect confidentiality. Liaise effectively with the MDT. Be able to discuss risk taking behaviour and harm minimisation in an informative, helpful but non-judgemental manner. 4 (9.01) (No blood: blood management and avoidance) (9.02) RCOG Statement 3 (Female Genital Mutilation) RCOG Green top guideline N0.53 (2015) FGM and its management. Department of Health factsheet: FGM in the serious crime Act 2015. (9.04) NICE Guideline (2011) CG115. Alcohol use disorders, diagnosis assessment and management of (9.01-9.0) These are communication skills and the evidence should demonstrate this. Suitable evidence is: Reflective practice OSATS CBD Evidence of eLearning These are relatively common scenarios and your evidence should be based on your direct clinical experience. 1,2,3 1,2,3 1,2,3 1,2,3 1,2,3 1,2,3
harmful drinking and alcohol dependence. (9.05) Communication of the risks of morbid obesity during pregnancy and childbirth. (9.05) Knowledge of the risks associated with increased BMI in pregnancy and postpartum and how these may be minimised. Knowledge of the steps that can be taken pre-pregnancy to reduce the risks of morbid obesity during pregnancy. 1,2 1,2 (9.05) Ability to quantify the risks during the pregnancy and minimise risks through use of thromboprophylaxis and support services. Able to discuss harm minimisation constructively and provide accurate and accessible information. Construct an individualised care pathway for labour and delivery. (9.05) CMACE/RCOG Joint Guideline (2010) Management of women with obesity in pregnancy. RCOG Patient information (2011) Why your weight matters during pregnancy and after birth. STRATOG Advanced, Generic Skills Case Studies eLearning: Female obesity in obstetrics and gynaecology a primary care perspective (2015). 1,2,3 1,2,3 1,2,3 1,2,3
(9.08) Discuss child protection concerns within MDT. 1,2,3 (9.08) Liaise with midwives and other health professionals to optimise patient management. Empower and inform women to make appropriate choices for herself and her family in pregnancy and childbirth. Achieve minimization of harm in partnership with women. Identify and deal appropriately with domestic violence and child protection issues. Use appropriate referral pathways and local protocols. (9.08) Knowledge of the law relating to protection of children. Knowledge of the role of different agencies in the care of children and investigation of concerns for their welfare (Social Services, Health Visitors, Police, GPs, Community Paediatricians, Community Psychiatric practitioners). 1,2,3 1,2 1,2 (9.08) Make relevant referral as a result of domestic violence. Use interpreting services appropriately. Conduct booking and follow up visits. Arrange and interpret appropriate investigations. Recognise health risks arising from previous / current social problems. Engage in organisation & running of multidisciplinary pregnancy services to encompass the needs of socially disadvantaged groups. Act as local obstetric liaison for groups with particular needs and social requirements. Engage in organisation & running of child protection procedures. 1,2 1,2,3 1,2,3 (9.08) NICE Clinical guideline CG.89 (2009) When to suspect child maltreatment. (9.08) Achieve a minimum of level 1 child protection competence. Reflective practice within ePortfolio.
Governance (9.09) Demonstrate effective reflective practice across a range of scenarios (attach supporting evidence). (9.10) Produce a relevant Audit, Guideline or other Quality Improvement Project (attach supporting evidence). (9.11) Lead Risk Management case review. (9.12) Work effectively within the MDT. (9.13) Know when and how to refer to support services (such as psychiatric, medical, social services, counselling) (9.14) Demonstrate awareness of own limitations, when to refer and how best to share care and monitoring. 1,2 (9.09) Understand the definition of reflective practice, and those models that may be used to support reflection (9.11-9.14) Knowledge of team working: Team dynamics, with different roles and responsibilities for individual members. Influences, both positive and negative, on team development. Understand the principles of delivering effective support, mentoring and motivation. Implementing changes and progressing as a team. Leadership styles and behaviours. 1,2 1,3 (9.09) Ability to use reflective practice to demonstrate positive changes learnt as a consequence of challenging clinic encounters. (9.09-9.14) RCOG Clinical Governance Advice No.1c Producing a clinical practice guideline. No.2 Improving patient safety. Risk management for maternity and gynaecology. No.5 Understanding Audit. No.6 Obtaining valid consent. GMC Leadership and Management for all doctors (2012) GMC Good Medical Practice (2013). (9.09-9.14) Reflective practice. Relevant Audit or other Quality Improvement Project. Log of risk management cases.