reproductive module phase ii - University of Sri Jayewardenepura

REPRODUCTIVEMODULEPHASE IIFaculty of Medical SciencesUniversity of Sri JayewardenepuraGangodawilaNugegodaReproductive module – Phase II Page 2

COMMITTEE MEMBERSChairman:Dr.Ramya PathirajaConvener:Dr. R.C. FernandopulleMembersDr. S.A. JayarathneDr. D. GunasekeraDr. B.M.H.A. BannehekaDr. C.S.E. GoonewardenaDr. R.C. FernandopulleDr. K.C.D.P. SilvaDr.Sharaine FernandoDr. T.A.N. FernandoDr. Kamani GunasekaraReproductive module – Phase II Page 3

GENERAL OBJECTIVESOn completion of the Reproductive Module, the graduate should be able to:1. Apply the knowledge on the anatomical, physiological and other biologicalphenomena, to understand the congenital anomalies in the genital tract in the maleand the female.2. Diagnose and manage the diseases that affect the breast.3. Apply the principles of pathology to understand the disease process that affect thereproductive system.4. Diagnose and manage infections that affect the reproductive system and developmanagement protocols.5. Describe the reproductive health concept.6. Provide the basic care at primary (care at home and at field clinics) and secondarylevel in pregnant women.7. Manage pregnant women and pregnancy related complications, when theypractice on their own after qualifying.8. Manage uncomplicated labour, recognize complications of labour, lactation andnormal and abnormal puerperium.9. Care of the normal neonate.10. Recognize and manage neonatal problems.11. Understand the concepts and methods available to diagnose gynaecologicalproblems when they practice on their own after qualifying12. Understand the role of contraception in promoting reproductive health.13. Understand the causes and management of infertility.Reproductive module – Phase II Page 4

IntroductionThe reproductive module is a five weeks module that you will follow during phase two of yourmedical curriculum. This module will help you to develop a deeper understanding andknowledge of the disorders related to the reproductive system . You are expected to learn aboutclinical features of reproductive disorders, and how to arrive at a diagnosis, the clinical course,treatment, follow up and the expected out come. Further more this module will introduce you tothe management of important neonatal conditions and child health.This module should be considered as a guide to the relevant topics but not as a comprehensivecoverage of whole subject area. Therefore the emphasis should be on active learning and selfstudy by you using the module as a guide.Teaching of this module will be in the form of lectures , tutorials, problem based learning,practicals and teacher-student seminars. The teaching will be conducted jointly by clinical &paraclinical departments of the faculty.The assessment will be in the form of an end of term module exam (MCQ) and an end of yearsummative assessment.Reproductive module – Phase II Page 5

Main content areasReproductive embryologyBreast diseasesDiseases of the reproductive systemDiagnosis and management of the diseases that affect the reproductive systemReproductive health conceptMaternal and child health careAnte partum, Intra partum and post partum careContraceptionInfertilityReproductive module – Phase II Page 6

OBJECTIVE 1Intermediate ObjectivesDetailed contentsMethod ofTeachingDurationDepartment1. Recall the reproductive embryology A. GametogenesisFertilizationEarly fetal developmentSex differentiationDevelopment of femaleAnd male genitaliaSeminar 45 min PhysiologyAnatomy2. Diagnose Intersex and implications onreproductive healthB. Chromosomal abnormalitiesGonadal aberrationsEnd organ resistanceFemale intersex3. Female reproductive System A. Gonadal abnormalitiesCongenital anomalies of thegenital tractUterine abnormalitiesFLM 45 mins Obstetrics &Gynaecology4. Male reproductive system A. Scrotal lumpsHerniaHydroceleLecture 45 min SurgeryReproductive module – Phase II Page 7

OBJECTIVE 2Intermediate ObjectivesDetailed ContentsMethod ofTeachingDurationDepartment1. Know w the initial steps to be carried out ina patient presenting with symptoms related tobreast diseasesA. Common presentationsHistory taking from a patientpresenting with breast diseasePBL 45 min SurgeryB. The technique of examination of apatient presenting with a breast lumpGroup activitySkills lab45 min Surgery2.Diagnose and manage the diseases thataffect the breastA. Pathophysiology of common benignand malignant breast diseasesLecturePractical45 min PathologyB. Investigations and treatment optionsof benign breast diseasesManagement of commonpresentations / when to referLecture 45 min Surgery-Do-C. Malignant breast diseasesRisk factorsPreventionPresentationInvestigationsStagingTumour markersTreatment optionsScreeningBreast reconstructionComplications of breast surgeryFollow up patients with breast cancerLectureTutorial45 min45 minSurgeryPathologyReproductive module – Phase II Page 8

OBJECTIVE 3,4,11Intermediate ObjectivesDetailed contents1. Menstrual disorders Physiology of puberty andMenstrual cycleMethod ofTeachingDurationDepartmentTutorial 45 min Physiology2. Infections of genitaltractAmenorrhoea-Primary-secondaryDysmenorrhoea- Primary- secondaryDysfunctional uterine bleeding (DUB)MenorrhagiaPathological aspect of menstrual abnormalitiesEndometrial HyperplasiaUpper and lower genital tract infectionsAll Sexually Transmittd Infections(STI)HIV/ AIDSTrichomonasLecture 45 min Obstetrics &GynaecologyLecture 45 min Obstetrics &GynaecologyTutorial 45 min Obstetrics &GynaecologyLecture 45 min PathologyPractical3 Lectures 45 minx3 MicrobiologySeminarMicro, Obstetrics &GynaecologyFamily MedicineSTISpecimen collection & transportIdentification of organismsPractical 45 min MicrobiologyIReproductive module – Phase II Page 9

Intermediate Objectives3. Tumours of femalegenital tractDetailed contentBenign and malignant tumours ofUterusOvaries and tubesVulva and vaginaMethod of Teaching Duration Department2 Lectures 45 min x 2 Pathology4. Tumours of malegenital tractBenign and malignant tumours2 LecturesPracticalTutorial45 min x 2 SurgeryPathology5. Problems in postreproductive lifeUtero vaginal prolapse PBL 45 min Obstetrics &GynaecologyReproductive module – Phase II Page 10

OBJECTIVE 5, 6Intermediate ObjectivesDetailed content1. Describe Reproductive Health (RH) concept Definition of RHComponents of RHFamily Health program inSri Lanka- objectives & strategiesSafe motherhoodMethod ofTeachingDurationDepartmentLecture 45 min CommunityMedicine2. Organization and delivery of maternal & childhealth services of Sri LankaThe need for maternal & child careThe role of MOH, PHN & PHMPre conceptual counselingAntenatal careLecture 45 min CommunityMedicine3. Describe maternal & child health services provideat the field levelClinical activitiesInvestigationsVitamin & Mineral supplementationTetanus toxoidMaintenance of records & returnsScreening for high risk conditions &referralNatal careImportance of hospital deliveryThe need for trained assistance forhome deliveriesLectureClerkship45 min CommunityMedicineReproductive module – Phase II Page 11

4. Describe infant & child healthservices5. Describe activities of the wellbaby clinic6. To be able to describe methodsof minimizing childhoodmortalityChild health services-Institutional & fieldRole of public health staff in deliveryof child health servicesOrganizationFacilities available and delivery ofservicesCauses of infant and childhoodmortalityMethods/ strategies to minimizeLectureClerkship45 min Community MedicineLecture 45 min PaediatricsLecture 45 min Community MedicineDescribe the school healthservicesSchool health programme:-objectives- components- deficienciesClerkshipCommunity Medicine7. Adolescent Health ImportanceHealth, social and mental problemsNutrition8 Describe measures ofpreventing maternal deathsDefine maternal deathCauses of maternal mortality /morbidity in SL & global situationFactors contributing to declinematernal mortality in SLFurther reduction of deathsInvestigation of maternal deathInterpretation of autopsy findingsSeminar 45 min Community MedicineObstetrics &GynaecologyPaediatricsFamily MedicineLecture 45 min Community MedicineClerkshipForensic MedicineReproductive module – Phase II Page 12

9. Describe activities of wellwomen clinicObjectivesActivitiesClerkshipCommunity Medicine10 Describe monitoring andevaluation of maternal and childhealth servicesImportance of monitoring andevaluation of antenatal and postnataland outcome indicatorsClerkshipCommunity MedicineReproductive module – Phase II Page 13

OBJECTIVE 7Intermediate Objectives1. Describe maternal physiologicalchanges in pregnancyDevelopment of fetus & itsadaptation at birth2. Manage bleeding in pregnancySeptic conditions in pregnancy3. Manage medical disorders inpregnancy-do-Detailed contentsNormal changes in pregnancyFetal developmentAntepartum haemorrhageEctopic pregnancyTrophoblastic diseaseMiscarriagesSeptic miscarriagesHypertensive / renal disordersDiabetes & endocrine disordersCoagulation disordersAnaemiaHeart diseaseInfectionsNutritionPsychiatric & neurologicaldisordersLiver disorders (will bediscussed in GIT module)Method ofTeachingDuration DepartmentSeminar 45 min Obs tetrics&GynaecologyAnatomyPhysiology3 Lectures 45 min x 3 Obstetrics &GynaecologySeminar (phase III) 45 min5 LecturesPBLSeminar45 min x 545 min45 minMedicineObstetrics&GynaecologyCommunitymedicinePsychiatryPrinciples in prescribing Seminar 45 min PharmacologyObstetrics &GynaecologyFamily medicineReproductive module – Phase II Page 14

4. Describe & manage problems inpregnancy affecting fetal outcomeIntrauterine growthretardation(IUGR)Multiple pregnancyPreterm labourAbnormal presentations (PBL)Past dates (lecture)Fetal distress (PBL)Antenatal management of fetalcongenital anomalies (lecture)Intrauterine death (PBL)Rh isoimmunization (tute)4 Lectures5 PBLSeminar (phase 111)45 min x 445 min x 545 minObstetrics &GynaecologyReproductive module – Phase II Page 15

OBJECTIVE 8Intermediate Objectives1.Management of normal labourDetailed contentsDiagnosis of labourComponents of natural labourMaintenance of labourMaintenance of partogramMethod ofTeachingDurationDepartmentLecture 45 min Obstetrics &GynaecologyOxytocic drugs Seminar 45 min PharmacologyObstetrics &Gynaecology2.Management of abnormal labour Malposition & malpresentation PBL 45 min Obstetrics &GynaecologyDiagnosis & management of maternal injuriesrelated to child birthObstetric operations & proceduresSeminar( phase III)45 min Obstetrics &GynaecologyForceps, vacuum & caesarian sectionsVBAC( Vaginal Birth After CaesarianSection)Obstetric emergenciesLecture 45 min Obstetrics &GynaecologySeminar(phase III)45 min Obstetrics &GynaecologyReproductive module – Phase II Page 16

3.Normal & abnormal puerperiumPhysiology of puerperiumComplications of puerperiumThird stage of labour & its complicationsPPHRetained placentaLectureSeminar( phase III)45 min Obstetrics &Gynaecology4.Lactation5.Infant feedingPhysiology of lactationEstablishment of lactationProblems associated with lactationBaby friendly hospital initiativeTen steps to successful breast feedingBreast feeding:Composition of breast milkAdvantages- mother & infantContraindicationsAssessment of adequacyFormula feeding:Concepts of formula I, II, IIISpecial formulae:Advantages & disadvantagesAbsolute indicationsComplementary feeding(CF) :Concept of CFPlanning to CFValue of different weaning foods (CF),Kanji, fruit juices, home made CF,commercial CFComposition, constitution, frequency,problems/misconceptionsSeminar 45 min CommunityMedicineLectureClerkshipPaediatricsFamily Medicine45 min PaediatricsReproductive module – Phase II Page 17

OBJECTIVE 9, 10Intermediate Objectives1.Care of the newborn includingcommon problemsDetailed contentsManagement of a term neonate atdelivery & the immediate neonatalperiodNeonatal screeningIdentify & manage :Umbilical sepsis, eye infections,pustulesMethod ofTeachingDurationDepartmentLecture 45 min Paediatrics2.Diagnosis & management ofneonatal problemsNeonatal infections Seminar 45 min PaediatricsFamily MedMicrobiologyPrematurity/IUGR/Large for dates baby 3 Lectures45 minx3 PaediatricsNeonatal sepsisNeonatal jaundicePBLBirth asphyxiaNeonatal convulsionsSeminarDiagnosis & management of respiratoryDistressSurfactant deficiencyCongenital pneumoniaMeconium aspirationTransient Tachypnoea inNewborn(TTN)Birth asphyxia & meconium aspirationReproductive module – Phase II Page 18

OBJECTIVE 12Intermediate Objectives1.Discribe different family planningmethods available in SLDescribe the fertility control policyin S LDetailed contentsHormonal contraceptivesBarrier methodsDevicesMeasures of fertilityGoals, Targets & objectivesList advantages of family planning(FP)Contraceptive prevalence & FP indicatorsUnmet need of family planning(FP)CounselingMethod ofTeachingSGD (clerkship)DurationDepartmentCommunityMedicine2.Educate the people & promote theuse of contraceptivesThe role of hospital doctor, MOH, PHN,and midwife in the hospital setting & inthe fieldSeminar 45 min CommunityMedicineFamily MedicineObstetrics &Gynaecology3.Types of oestrogens &progesteronepreparations(RECALL)Parentral & oral contraceptivesIndications for their use, mechanisms ofactions, clinical uses, method ofadministration and adverse effects &contraindicationsDifferent types of oral contraceptive pills(OCP) preparationsMechanism of action, adverse effects,precautions, contraindications &interactionsPrescribing, CounselingNon contraceptive benefits of OCPSGDPharmacologySeminar 45 min PharmacologyFamily MedicineReproductive module – Phase II Page 19

4.Describe the other differenttypes of methods used byfemales & males includingsurgical methods5.Emergency contraceptivesRhythm methodMethods of use, benefits &advantages of the different devicesIndicationsContraindicationsDifferent preparations availableHow & when to use themAdverse effects, precautions &contraindications for their useFLM45 minObstetrics &GynaecologyPharmacologyFamily MedReproductive module – Phase II Page 20

OBJECTIVE 13Intermediate Objectives1.Background diagnosis &counseling in infertility2.Management of Infertility3.Traetment of infertility &complicationsDetailed contentsIntroductionPrevention of infertilityPlanning a pregnancyInvestigating infertilityCounselingFemale- causesCoital problems, uterine causes,problems with ovulation, cervicalfactorsMale – causesCoital problemsAbnormalities in sperm count rmortalitySexual dysfunctionUnexplained infertilityInvestigation of infertilityOvulation inductionAssisted reproductive techniqueIntra Uterine Insemination(IUI)Gamete intra fallopiantransfusion(GIFT)In Vitro fertilization (IVF)OHSSMultiple pregnancyMethod ofTeachingDurationDepartmentSeminar(phase III) 45 min Obstetrics&GynaecologyLectureTutorial (phase III)Seminar (phase III)45 min45 min45 minPsychiatryObstetrics&GynaecologyObstetrics&GynaecologyPsychiatryLecture 45 min Obstetrics&GynaecologyReproductive module – Phase II Page 21

Reading MaterialPaediatrics1. Illustrated text book of PaediatricsProf Tom Lissaur & GrahamClayden2. Essential Paediatrics – Ghai3. Paediatrics – Anthony de Milner & David HullAnatomy & Physiology1. Langman2. Emery’s element of Mdical Genetics –Student notes in Genetics – Young and Muller3. Review of Medical Physiology –William F. Ganong 21 st Edition4. An aid to clinical surgery – Williamson Waxman scottReferences1. Moors – developing Embryo2. Before we are born – Essetials of Embryology and birth defectsKeith L. Moore, Vid Persand3. Human Genetics – concepts and applications Ricki Lewis4. ABC in GeneticsObstetrics & Gynaecology1. Text book of Gynaecology - D.C. Dutta5 th Edition2. Text book of Obstetrics - D.C. Dutta5 th Edition3. Gynaecology by Ten teachers – Stuart Campbell, Ash Monga17 th Edition4. Obstetrics by Ten teachers – Stuart Campbell, Christopher Less17 th EditionReproductive module – Phase II Page 22

Parasitology1. Basic Clinical Parasitology – 6 th EditionFranklin A. Neva, Harold BrownMicrobiollgy1. Microbiology in clinical practice – D.C. Chanson2. Medical Microbiology – edited by Cedric A Mimms, John H.L.Play fair,Ivan M. Roitt, Derek Wakelin, Rosamind Williams3. Medical Microbiology – 16 th EditionDavid Greenwood, Richard C.B. SluckPathology1. Robbins and Cotran – Pathological basis of diseaseKumar, Abbas, Fausto2. Muir’s textbook of PathologyMcSween, Whaley3. Textbook of PathologyHarsh Mohen4. Concise PathologyChandrasoma, TaylorReproductive module – Phase II Page 23