High-Risk Obstetrics Rotation

By the end of the rotation, the fellow will be able to:

Describe the normal pregnancy and the physiological changes during pregnancy
Describe various placental pathologies, both gross and histological
Cite methods of assessing fetal growth and fetal well being
Obtain a comprehensive maternal history, citing specific historical risk factors for an adverse maternal or fetal outcome
Describe methods of antepartum fetal assessment, including fetal movement counts, non-stress and stress testing biophysical profiles, Doppler flow studies and amniotic fluid assessment
Assess fetal condition during labor, including the evaluation of fetal heart rate tracings and using techniques to further evaluate fetal distress
Obtain a basic genetic history, citing specific risks for Trisomy 21, neural tube defects and hemoglobinopathies
Discuss the etiology, clinical significance and management of intrauterine growth restriction
Discuss various antenatal high-risk pregnancies and the anticipated fetal effects
Describe the differential diagnosis and management of hypertensive disorders during pregnancy and the expected fetal effects
List the indications for procedures like amniocentesis, PUBS, and chorionic villous sampling

Antenatal Rounds: Antenatal Rounds begin at 7 a.m. in the Antepartum Unit and continue at 8 a.m. in 2C Conference Room. All the Antenatal High-Risk patients will be presented by the residents, discussed by the fellow, and moderated by the attending. Prior to this, the fellow will discuss any interesting obstetric topics. This session ends at 8 a.m. Reading about the fellow’s topic one day prior is recommended.
Labor and Delivery Rounds: All the patients on the Labor and Delivery Board will be discussed by the OB resident on call for about 30 minutes.
Management Rounds: Once a week, on Wednesdays at 4 pm, the entire OB Faculty participates in Management Rounds.

FDC Clinic (Tuesdays and Fridays): All Level I and Level II ultrasounds will be conducted. This is an extremely useful clinic especially to identify high-risk patients and to discuss the Neonatal perspective with the mother.
Diabetic Clinic (Monday mornings): This clinic is useful for identifying DM patients, participate in their management, and talk with them about the effect on the fetus.
High-Risk Clinic (Wednesday mornings): Fellows will get a chance to see a wide variety of high-risk pregnancy mothers and their management.
Mother and Child Dependency Clinic (Wednesday): Multi-disciplinary High-Risk Clinic where fellows have opportunity to see drug (including opioid) dependent pregnant mothers.

PUBS: Discuss with MFM fellows about when they have PUBS scheduled to observe this procedure.
Amniocentesis and CVS

Non-Stress Test (NST): Attending one session is very useful and informative
OCT and BPP
Placental Pathology: Fellow will meet with the Pathology Director, to set-up several days to work with his team. It is better to see the gross placentas in the morning at surgical pathology and look at the placenta slides in the afternoon with any of the staff pathologists.

Reading List Topics

Physiology and physiologic changes in lab values in pregnancy
Role of placenta in gas exchange and placental transport
Maternal immunologic disease and its effect on the fetus
Maternal Diabetes Mellitus and Hypertension and its effect on the fetus
Effect of maternal bacterial and viral infections, including HIV, GBS, and CMV
Maternal cardiac disease and its effect on the fetus
Significance and management of maternal seizures
Post-term pregnancy and its risk to the fetus
Effects of maternal substance abuse on the fetus
Antenatal screening
Amniocentesis and PUBS
Doppler velocimetry and fetal well-being
Tocometry and fetal heart rate monitoring – significance, interpretation, and management.
Diagnosis and management of fetal-maternal blood group incompatibility
Approach to fetal dysrhythmia
Diagnosis and management of IUGR
Testing and interpretation of fetal lung maturity
Diagnosis, management and significance of abnormal amniotic fluid volume
Normal physiology of labor and the factors causing preterm labor
Diagnosis and management of maternal/fetal blood loss
Significance and management of meconium stained amniotic fluid
Approach to PROM and PPROM
Birth trauma
Pathophysiology and management of maternal sepsis
Management and complications of abnormal presentation