Key:

Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Core Module 8: Antenatal care

Learning outcomes:
 To understand and demonstrate appropriate knowledge, skills and attitudes in relation to antenatal care

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment
ANTENATAL CARE
Preconception care 1 Undertake pregnant and non-pregnant abdominal 1,2 Have the skills to liaise with midwives 3,4 Appropriate MRCOG Part2
examination and other health professionals to postgraduate
Purposes and practice of antenatal care optimise care of the woman education courses Logbook
Take obstetric history and make relevant referral including CTG
Recognition of signs of domestic violence as a result of domestic violence Demonstrate the skills to empower and interpretation courses Local meetings attended
inform women to make appropriate
Problems of teenage pregnancy 1,3 Conduct booking visit and arrange appropriate choices for themselves and their Perinatal morbidity Case reports
investigations. Understand the positive and families in pregnancy and childbirth and mortality
Awareness of drug and alcohol misuse negative effects of screening on the individual meetings Audit project
1,3 Show awareness of the need to
Management of normal pregnancy, birth Conduct follow-up visits identify and deal appropriately with Risk assessment Certificate of completion
and puerperium domestic violence and have a working meetings of CTG training package
Manage: knowledge of child protection issues as (e.g. K2)
Placental abnormalities and diseases  growth restriction they relate to the practice of obstetrics StratOG Antenatal
 mode of delivery after caesarean section and gynaecology Care e-tutorials MSF (TO1/TO2)
Genetic modes of inheritance, common  multiple pregnancy
genetic conditions the importance of  antepartum haemorrhage Demonstrate an ability to explain National Institute for CbD
screening and the diagnosis thereof.  malpresentation correctly and place in context for the Clinical Excellence.
 preterm prelabour rupture of the fetal woman: Mini CEX
Epidemiology, aetiology, pathogenesis, membranes  detection rates and Scottish
diagnosis, prevention, management,  reduced fetal movements limitations of anomaly Intercollegiate Log of experience
delivery, complications of:  prolonged pregnancy screening Guidelines Network
 Pregnancy-induced hypertension  drug and alcohol abuse in pregnancy  principles of screening for website Reflective learning
 haemorrhage neural tube defects, Down
 preterm premature rupture of Assess fetal wellbeing by interpretation of CTG syndrome and Scottish Health on Roleplay
membranes haemoglobinopathies the Web website
 multiple pregnancy: Observe:  genetic disorders and their MRCOG Part One
 malpresentation  External cephalic version (ECV) inheritance with examples The Obstetrician and
 fetal growth retardation:  cervical cerclage such as Tay-Sachs disease, Gynaecologist journal MRCOG Part Two
 fetal haemolysis: cystic fibrosis and
 prolonged pregnancy: Counsel about: thalassaemia Access female MRCOG Part Three
 congenital malformation  Screening for Down syndrome  effects upon fetus and genital mutilation
 Social and cultural factors:  genetic disease neonate of infections during training video.
 fetal abnormality pregnancy, including HIV, www.fgmnationalgrou
Immunology and immunological disorders  haemolytic disease measles, chickenpox, p.org (password
affecting pregnancy  infection rubella, cytomegalovirus, detailed within e
 mode of delivery parvovirus and portfolio)
1,2  defibulation in cases of female genital toxoplasmosis
mutilation

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

Appendix to Module 8 – details of knowledge criteria:

Preconception care: Immunology:

 Sources of detailed information accessed by patients  Immunological pregnancy tests

 Effect of pregnancy upon disease  Rhesus and other isoimmunisation
 Effect of disease upon pregnancy  Auto-immune diseases
 Principles of inheritance of disease
 Teratogenesis Preterm premature rupture of membranes:
 Drugs and pregnancy
 Fetal pulmonary maturity
Purposes and practice of antenatal care:  Therapy (steroids, antibiotics, tocolytics)
 Infection (risks, management)
 Arrangements for and conduct of booking visit  Delivery (induction of labour, timing, mode)
 Arrangements for and conduct of follow-up visits
 Use of imaging techniques Haemorrhage:
 Screening for abnormality
 Health education  Placental abruption
 Liaison between health professionals  Placenta praevia
 Recognition of domestic violence  Vasa praevia
 Placenta accreta
Physiology and management of normal:  Trauma

 Pregnancy Multiple pregnancy:

 Childbirth, including delivery outside specialist unit
 Puerperium, including lactation  Zygosity
 Neonate, including feeding  Impact of assisted reproduction techniques
 Placentation
Placental:  Diagnosis
 Management (antenatal, intrapartum, postnatal)
 Abnormalities (shape, size, implantation)  Special procedures (prenatal diagnosis, monitoring)
 Chorioamnionitis  Feeding
 Infarcation  Higher order multiple pregnancies (counselling, community care)
 Chorioangioma
 Multiple pregnancy Malpresentation:
 Intrauterine growth retardation
 Cord abnormalities  Types (breech, brow, face, shoulder, variable lie)
 Trophoblastic disease  Diagnosis
 Management (antenatal, intrapartum)
 Mode of delivery

Fetal growth restriction: Hypotensive disorders:

 Aetiology (maternal, placental, fetal)  Hypovolaemia

 Diagnosis (clinical, imaging, biochemical, genetic)  Sepsis

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

 Monitoring (ultrasound, cardiotocography)  Neurogenic shock

 Delivery (timing, method)  Cardiogenic shock
 Prognosis (fetal, neonatal)  Anaphylaxis
 Trauma
Genetic:  Amniotic fluid embolism
 Thromboembolism
 Modes of inheritance (Mendelian, multifactorial)  Uterine inversion
 Cytogenetics
 Phenotypes of common aneuploidies (Down syndrome, Edward syndrome, Patau syndrome, Fetal haemolysis:
Turner syndrome, Klinefelter syndrome, triple X, multiple Y)
 Translocation  Relevant antigen-antibody systems
 Miscarriage  Prevention
 Molecular genetics (DNA transcription, DNA translation, DNA blotting techniques, gene  Fetal pathology
amplification techniques, principles of gene tracking)  Diagnosis
 Counselling (history taking, pedigree analysis)  Assessment of severity
 Population screening (genetic disease, congenital malformations)  Intrauterine transfusion (indications, techniques, referral)
 Antenatal diagnosis (chromosomal defects, inborn errors of metabolism, neural tube defects,  Delivery (timing, method)
other major structural abnormalities)  Counselling
 Management [referral to specialist team, antenatal intervention, delivery, neonatal investigation,
neonatal care (medical, surgical)] Prolonged pregnancy:

Epidemiology, aetiology, pathogenesis, diagnosis, prevention, management, delivery,  Risks

complications, prognosis with regard to the following:  Fetal monitoring
 Delivery (indications, methods)
Pregnancy induced hypertension:

 Definitions
 Aetiological theories
 Prophylaxis
 Assessment of severity
 Consultation
 Therapy
 Delivery (timing, method)
 Complications (eclampsia, renal, haemorrhagic, hepatic, fetal)

Congenital malformation:

 Screening
 Amniotic fluid volume (polyhydramnios, oligohydramnios)
 Management: diagnosis, consultation, viability, delivery (time, place, method), counselling
 Specific abnormalities:
 Head (anencephaly, microcephaly, encephalocele, hydrocephalus, hydranencephaly,
holoprosencephaly)
 Skeleton (spina bifida, phocomelia, chondrodysplasia, intrauterine amputation)
 Heart (major defects, other defects)

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

 Lungs (pulmonary hypoplasia)

 Urinary (renal agenesis, polycystic kidneys, urinary tract obstruction)
 Genital (intersex, genital tract abnormalities, ovarian cyst)
 Gastro-intestinal (abdominal wall defects, oesophageal atresia, duodenal atresia,
diaphragmatic hernia, bowel obstruction)
 Other (cystic hygroma)
 Other fetal disorders:
 Non-haemolytic hydrops fetalis
 Tumours
 Pleural effusion
 Fetal bleeding

Social and cultural factors:

 Effect upon pregnancy outcome

 Single parenthood
 Teenage motherhood
 Parent-baby relationships (factors promoting, factors interfering)
 Bereavement counselling
 Counsel women appropriately about defibulation

Techniques of fetal anomaly scanning and non-invasive fetal diagnosis:

 Use of nuchal translucency measurements to identify fetuses at high risk of Down’s syndrome
 Combination of ultrasound and other risk markers to create an individualised risk profile for
each patient

Invasive procedures:
 Amniocentesis
 Chorionic villus sampling
 Placentesis
 Cordocentesis

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

Competence level Basic level Intermediate level Advanced level Not required
Core Module 8 Logbook
Level 1 Level 2 Level 3
Date Signature Date Signature Date Signature
Conduct a booking visit

Conduct a follow up visit

Arrange appropriate investigations

Assess fetal wellbeing by interpretation of:

Maternal history

CTG

Ultrasound assessment

Manage:

Oligohydramnios/polyhydramnios

Growth restriction

Multiple pregnancy

Malpresentation

Reduced fetal movements

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

Competence level Basic level Intermediate level Advanced level Not required
Core Module 8 Logbook
Level 1 Level 2 Level 3
Date Signature Date Signature Date Signature

Care of woman diagnosed with a stillbirth

Prolonged pregnancy

Drug and alcohol problems in pregnancy

Common infections in pregnancy (UTI, parvovirus,

varicella)

Rarer infections (e.g. HIV, CMV)

Preterm premature rupture of the membranes

Antepartum haemorrhage

External cephalic version

Insertion of cervical cerclage OM

Counsel about:

Screening for Down syndrome

Screening for other fetal abnormalities

Able to discuss risks of stillbirth

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

Competence level Basic level Intermediate level Advanced level Not required
Core Module 8 Logbook
Level 1 Level 2 Level 3
Date Signature Date Signature Date Signature
Haemolytic disease of the newborn

Mode of delivery after caesarean section

Cervical cerclage

Defibulation as appropriate in cases of OM

female genital mutilation

Training Courses or sessions

Date
Title Signature of educational supervisor
CTG Interpretation

Basic obstetric ultrasound theoretical course

Authorisation of signatures (to be completed by the clinical trainers)

Name of clinical trainer (please print) Signature of clinical trainer

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

Authorisation of signatures (to be completed by the clinical trainers)

Name of clinical trainer (please print) Signature of clinical trainer

COMPLETION OF MODULE 8
I confirm that all components of the module have been successfully completed:
Date Name of educational supervisor Signature of educational supervisor

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