Basic Practical Skills in Obstetrics and Gynaecology

Description:

This handbook is designed to introduce trainee obstetricians and gynaecologists to safe surgical techniques and obstetric skills in a structured workshop environment. It is the course manual for the Basic Practical Skills in Obstetrics and Gynaecology course offered by the Royal College of Obstetricians and Gynaecologists, successful completion of which is mandatory to obtain an ST3 post. The manual consists of modules covering basic open general surgical techniques (such as instrument handling, suturing and knot tying); basic obstetric skills (such as pelvic anatomy, instrumental delivery and shoulder dystocia); and basic gynaecological procedures, including hysteroscopy and laparoscopy. This revised and fully updated edition is in line with the latest course, and includes new sections on human factors and basic ultrasound. The course and the manual provide a valuable early step towards building safe and sound surgical and obstetric skills, giving trainees a firm foundation for their future careers in obstetrics and gynaecology.

Table of Contents:

Basic Practical Skills in Obstetrics and Gynaecology Pioneer Working Group

Acknowledgements

Introduction

Outline of the course

Day one

Day two

Module 1 Basic open general surgical techniques

Introduction

Preparation for the course

Principles of safe surgery and good theatre etiquette

The theatre team

Preparation for surgery

Patient positioning

Ensure good views

Patient and staff safety

Protective clothing and hand washing

Asepsis and hygiene

Gown

Gloves

Suture materials and needles

Suture characteristics

Types of suture material

Suture selection

Selection of appropriate needles

Round-bodied needles

Cutting needles

Needle size, shape and gauge

Handling instruments

The scalpel

Scissors

Dissecting forceps

Artery forceps (haemostats)

Needle holder

PRACTICAL EXERCISE

Knot tying

General principles of knot tying

The square knot (reef knot)

The instrument tie

The surgeon’s knot

Tying at depth

Principles of suturing

Interrupted sutures

PRACTICAL EXERCISE

Continuous sutures

PRACTICAL EXERCISE

Mattress sutures

Subcuticular sutures

Anatomy of the anterior abdominal wall

Blood supply of the anterior abdominal wall

The nerve supply

Abdominal wall muscles (Figure 1.20)

Surgical incisions into the abdomen

Midline incision

PRACTICAL EXERCISE

Suprapubic incision

PRACTICAL EXERCISE

Abdominal wall incisions for laparoscopic surgery

Practical exercises

Opening the abdomen

Closing the abdomen

Haemostasis

PRACTICAL EXERCISE

OSATS

Module 2 Obstetric skills

Introduction

Female pelvic anatomy

The pelvic floor

The urogenital diaphragm

The perineal body

The ischiorectal fossae

The pudendal nerve

Relative dimensions of the female pelvis and the fetal head

Spontaneous vaginal birth

Flexion

Internal rotation

Extension

Restitution

External rotation

Delivery of the shoulders

Scenario 1

Phase 1

Case presentation

Ventouse delivery

Ventouse delivery technique

PRACTICAL EXERCISE

Phase 2

Case presentation (continued)

PRACTICAL EXERCISE

Manual removal of placenta

Phase 3

Case presentation (continued)

Episiotomy

Right mediolateral episiotomy technique

Episiotomy repair technique

PRACTICAL EXERCISE

Scenario 2

Phase 1

Case presentation

Pudendal block technique

Non-rotational forceps

PRACTICAL EXERCISE

Phase 2

Case presentation (continued)

Shoulder dystocia

Management of shoulder dystocia

PRACTICAL EXERCISE

Phase 3

Case presentation (continued)

PRACTICAL EXERCISE

Postpartum haemorrhage

Prediction and prevention of postpartum haemorrhage

Management of major PPH

Tone

Tissue

Trauma

Thrombin

Blood transfusion

Recombinant factor VIIa

Scenario 3

Phase 1

Case presentation

PRACTICAL EXERCISE

PRACTICAL EXERCISE

CTG interpretation

Phase 2

Case presentation (continued)

PRACTICAL EXERCISE

Fetal scalp blood sampling technique

PRACTICAL EXERCISE

Phase 3

Case presentation (continued)

PRACTICAL EXERCISE

Grade the urgency in caesarean section

Consent

Documentation of consent

Operation note

Scenario 4

Phase 1

Case presentation

PRACTICAL EXERCISE

PRACTICAL EXERCISE

Phase 2

Case presentation (continued)

PRACTICAL EXERCISE

PRACTICAL EXERCISE

Case presentation (continued)

Phase 3

Module 3 Gynaecological procedures, hysteroscopy and laparoscopy

Basic gynaecological examination and basic procedures

Position of the patient

Equipment required

Inspection

Speculum examination with Cuscoe speculum

Digital bimanual pelvic examination

Speculum examination with Sims speculum

Taking a cervical cytology specimen (cervical smear)

Taking vaginal and endocervical swabs

Insertion of an intrauterine device

Uterine evacuation

PRACTICAL EXERCISES

The use of electrical energy in surgery

Priniciples of electrosurgery

Cut

Coagulate

Monopolar diathermy

Bipolar diathermy

Frequency of surgical current

Waveform

Manipulation of the electrode

Risks of using electrosurgical energy

Unintended burns

Electrosurgery with laparoscopy

Capacitative coupling

Insulation failure

Direct coupling

Basic laparoscopy and hysteroscopy

Equipment for endoscopic surgery

Operating table

Television monitors

Video cameras

Light source and cable

Electrosurgical unit

Hysteroscopy

Equipment used for hysteroscopy

Speculum

Hysteroscope

Hysteroscope sheath

Fluid infusion system

Hysteroscopy procedure

Laparoscopy

Equipment used for laparoscopy

Laparoscope

Rapid-flow insufflator

Irrigation/suction system

Insertion of the primary ports

Position the patient

Camera etiquette

Closed-entry technique for laparoscopy

Introduction of the pneumoperitoneum

Insertion of the primary trocar

Open entry for laparoscopy

Alternative entry site

Insertion of secondary ports

Laparoscopic exit techniques

Laparoscopy scenarios

Closed laparoscopic entry and optimisation of equipment

Index