Marcello PERSICO | OBSTETRIC AND GYNECOLOGICAL EMERGENCIES

cod. 1012400025

OBSTETRIC AND GYNECOLOGICAL EMERGENCIES

	1012400025
	DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY "SALERNITANA MEDICAL SCHOOL"
	EQF6
	MIDWIFERY
	2025/2026

PERCORSO STUDY PATHWAY IN COMMON IN OBSTETRICS

	OBBLIGATORIO
	YEAR OF COURSE 3
	YEAR OF DIDACTIC SYSTEM 2013
	AUTUMN SEMESTER

TEACHING UNITS

	SSD	CFU	HOURS	ACTIVITY	TYPE OF ACTIVITY
1	URGENZE ED EMERGENZE OSTETRICO GINECOLOGICHE - MOD. CHIRURGIA GENERALE
	MED/18	1	12	LESSONS	BASIC COMPULSORY SUBJECTS
2	URGENZE ED EMERGENZE OSTETRICO GINECOLOGICHE - MOD. ANESTESIOLOGIA
	MED/41	1	12	LESSONS	BASIC COMPULSORY SUBJECTS
3	URGENZE ED EMERGENZE OSTETRICO GINECOLOGICHE - MOD. MEDICINA INTERNA
	MED/09	1	12	LESSONS	COMPULSORY SUBJECTS, CHARACTERISTIC OF THE CLASS
4	URGENZE ED EMERGENZE OSTETRICO GINECOLOGICHE - MOD. SCIENZE INFERMIERISTICHE OSTETRICO-GINECOLOGICHE
	MED/47	3	36	LESSONS	COMPULSORY SUBJECTS, CHARACTERISTIC OF THE CLASS
5	URGENZE ED EMERGENZE OSTETRICO GINECOLOGICHE - MOD. GINECOLOGIA
	MED/40	1	12	LESSONS	COMPULSORY SUBJECTS, CHARACTERISTIC OF THE CLASS

PROFESSORS

	MARCELLO PERSICO3 T Curriculum
	-5421

	Objectives
	At the end of the course the student will have to know the pathologies that determine the onset of an obstetric emergency and their management. Define, identify risk factors and symptoms, manage obstetric emergencies/urgencies. Knowledge and understanding At the end of the course the student will know and understand: - the application circumstances of general anaesthesia, loco-regional anaesthesia, post-operative and labour analgesia, maternal-infant resuscitation. - the conditions of urgency and emergency including first aid; - the values, theories and models of Midwifery for the assessment of the health status of the assisted person and the application of good obstetric practice in labour-delivery and puerperium assistance and in obstetric, neonatological and gynaecological assistance; Applying knowledge and understanding At the end of the course, the student will know and be able to: - apply the knowledge related to the use of family planning methods and techniques necessary to identify useful strategies to promote conscious and responsible procreation, taking into account the values and preferences of the woman or couple; - develop appropriate communication skills (verbal, non-verbal and written) with users of all ages and with their families within the care process and/or with other professionals in the multi-professional team; - collect, analyse and interpret, in compliance with the scientific methodology, the data of the clinical-care area for the purposes of research and evaluation of the results of the care provided; - use the knowledge to read the organizational model, resources and care processes of the health services responsible for promoting gender health protection, in the birth process and in developmental age; - answer for one's actions during the professional exercise in accordance with the professional profile and the code of ethics in compliance with current regulations; - to perform, in case of emergency, a breech birth; - to perform emergency interventions in pathological pregnancies or difficult births; - to participate in innovative and traditional surgical procedures performed in collaboration with medical specialists and other healthcare personnel; Making judgements At the end of the course the student will be able to: - take responsibility for decisions and answer for their actions during professional practice in accordance with the profile, the code of ethics and ethical and legal standards; - make decisions through a scientific approach to solving patient problems through the evaluation of available scientific studies and in compliance with the quality of care provided using research tools; - make decisions during obstetric care by personalizing their choices based on the similarities and differences of the people assisted with respect to values, ethnicity and socio-cultural practices; - use critical thinking skills to provide personalized obstetric care in safety. Learning ability At the end of the course the student will have acquired the skills of: -teaching and learning for specific informative or educational interventions aimed at individual users, families, groups, other professionals such as support staff, midwifery students, nursing students, applying clear and orderly communication of their mental synthesis; -managing conflicts arising from different positions by negotiating solutions and communicating effectively with the care team to agree on operating methods and implement the application and development of protocols and guidelines; -to search for the information needed to resolve problems or uncertainties in professional practice, critically selecting secondary sources (guidelines, systematic reviews) and primary sources (research studies). Learning ability At the end of the course, students will have developed the following skills: - learning necessary to undertake further studies with a high degree of autonomy; - evaluating their performance on the basis of professional practice standards and organizational criteria; - cultivating doubts and tolerating uncertainties arising from study and practical activity; - asking questions about the exercise of their activity, relevant in time, place and interlocutors; - continuously seeking opportunities for self-learning, collaborative learning and self-assessment within work teams; - demonstrating the ability to share knowledge.

At the end of the course the student will have to know the pathologies that determine the onset of an obstetric emergency and their management. Define, identify risk factors and symptoms, manage obstetric emergencies/urgencies.

Knowledge and understanding
At the end of the course the student will know and understand:
- the application circumstances of general anaesthesia, loco-regional anaesthesia, post-operative and labour analgesia, maternal-infant resuscitation.
- the conditions of urgency and emergency including first aid;
- the values, theories and models of Midwifery for the assessment of the health status of the assisted person and the application of good obstetric practice in labour-delivery and puerperium assistance and in obstetric, neonatological and gynaecological assistance;

Applying knowledge and understanding
At the end of the course, the student will know and be able to:
- apply the knowledge related to the use of family planning methods and techniques necessary to identify useful strategies to promote conscious and responsible procreation, taking into account the values and preferences of the woman or couple;
- develop appropriate communication skills (verbal, non-verbal and written) with users of all ages and with their families within the care process and/or with other professionals in the multi-professional team;
- collect, analyse and interpret, in compliance with the scientific methodology, the data of the clinical-care area for the purposes of research and evaluation of the results of the care provided;
- use the knowledge to read the organizational model, resources and care processes of the health services responsible for promoting gender health protection, in the birth process and in developmental age;
- answer for one's actions during the professional exercise in accordance with the professional profile and the code of ethics in compliance with current regulations;
- to perform, in case of emergency, a breech birth;
- to perform emergency interventions in pathological pregnancies or difficult births;
- to participate in innovative and traditional surgical procedures performed in collaboration with medical specialists and other healthcare personnel;

Making judgements
At the end of the course the student will be able to:
- take responsibility for decisions and answer for their actions during professional practice in accordance with the profile, the code of ethics and ethical and legal standards;
- make decisions through a scientific approach to solving patient problems through the evaluation of available scientific studies and in compliance with the quality of care provided using research tools;
- make decisions during obstetric care by personalizing their choices based on the similarities and differences of the people assisted with respect to values, ethnicity and socio-cultural practices;
- use critical thinking skills to provide personalized obstetric care in safety.

Learning ability
At the end of the course the student will have acquired the skills of:
-teaching and learning for specific informative or educational interventions aimed at individual users, families, groups, other professionals such as support staff, midwifery students, nursing students, applying clear and orderly communication of their mental synthesis;
-managing conflicts arising from different positions by negotiating solutions and communicating effectively with the care team to agree on operating methods and implement the application and development of protocols and guidelines;
-to search for the information needed to resolve problems or uncertainties in professional practice, critically selecting secondary sources (guidelines, systematic reviews) and primary sources (research studies).

Learning ability
At the end of the course, students will have developed the following skills:
- learning necessary to undertake further studies with a high degree of autonomy;
- evaluating their performance on the basis of professional practice standards and organizational criteria;
- cultivating doubts and tolerating uncertainties arising from study and practical activity;
- asking questions about the exercise of their activity, relevant in time, place and interlocutors;
- continuously seeking opportunities for self-learning, collaborative learning and self-assessment within work teams;
- demonstrating the ability to share knowledge.

	Prerequisites
	To understand and be able to apply most of the topics covered in the course, it is necessary to have passed the preparatory exam in Pathology of Childbirth and Puerperium.

	Contents
	The course is divided into 5 modules: Gynaecology (1 credit - 12 hours), Obstetric-gynaecological nursing sciences (3 credits - 36 hours), General surgery (1 credit - 12 hours), Anaesthesiology (1 credit - 12 hours) and Internal medicine (1 credit - 12 hours). Gynaecology Module (MED 40, 1 cfu – 12 hours) Procidence and prolapse of the umbilical cord: classification and etiopathogenesis, diagnosis of procidentia or prolapse of the umbilical cord, acute fetal distress and hypoxia: differences (2 hours). Pathologies of the umbilical cord: absolute and relative brevity (1 hour). Haemorrhage of the first trimester: ectopic pregnancy, spontaneous abortion (2 hours). Haemorrhage of the second and third trimester: premature placental abruption, placenta previa (2 hours). Uterine rupture: Epidemiology and etiopathogenesis, pathogenesis and classification (2 hours). CTG (1 hour) Abnormalities of placentation (1 hour). Abnormalities of the amniotic fluid, meconium-stained (1 hour) Obstetric-gynaecological Nursing Sciences Module (MED 47, 3 cfu - 36 hours) Definition of urgency and emergency (1 hour). Obstetric triage Emergency room procedure (phases), colour code attribution scales, attribution of colour codes to pregnant women with EG >, < 20 WKS, to puerperal women or gynaecological patients, Hub and Spoke locations, STAM and STEN (2 hours) Communication (1 hour). Clinical risk, definition of error, adverse event, sentinel event, reporting systems, clinical audits (1 hour). Blood transfusions, blood groups and Rh factor, blood components: GRC and PFC, informed consent, request procedure, administration and monitoring of the patient (2 hours). Obstetric responsibility, regulatory framework of the obstetric profession, professional profile, Ministerial Decree 740/94, law 42/1999, Gelli Bianco law, civil liability (contractual and extra-contractual), criminal liability, characteristics of clinical documentation (2 hours). Cardiotocography, general information: graphic representation, methods of detecting BCF and ACU, archiving, characteristics of the baseline: tachycardia and bradycardia, variability: reduced, increased, accelerations, decelerations: early, late, variable and mild variable with worsening criteria, prolonged, sinusoidal pattern (2 hours). Trace classification: ACOG 2009, FIGO 2015 and RCOG 2001. Cardiotocography in the 2nd stage of labour and classification. Analysis of 4 scenarios: interpretation and action (2 hours). Third trimester metrorrhagia: general classification, management algorithms, clinical management of placenta previa and DIPNI (2 hours). Postpartum haemorrhage (PPH): classification and estimation of blood loss, risk factors in pregnancy, labour/delivery, communication and practical interventions for PPH (2 hours). Preeclampsia and eclampsia: pre-conceptional risk factors, pregnancy-related risk factors, classification, clinical management, timing of delivery of the various forms (algorithms) (2 hours). HELLP: diagnosis and treatment (1 hour). Breech birth: types of breech presentations, physiological mechanism, intrapartum management manoeuvres (2 hours). Manual seconding: risk factors, complications, execution techniques and subsequent monitoring (2 hours). Shoulder dystocia: diagnosis and classification, risk factors, clinical management, 1st, 2nd and 3rd level manoeuvres, complications (2 hours). Obstetric vacuum extractor: application and degree of risk, contraindications, traction mechanism (2 hours). Pathologies of the umbilical cord: procidentia and prolapse, classification, risk factors and causes, case management (2 hours). Structural anomalies of the umbilical cord, anomalies of insertion of the umbilical cord, anomalies of the umbilical cord resulting from fetal movements (2 hours). Uterine rupture: classifications, predisposing and determining causes, pathogenesis, differential diagnosis, prognosis and therapy (2 hours). Uterine inversion: epidemiology, pathophysiology, diagnosis and treatment (2 hours). General Surgery Module (MED 18, 1cfu - 12 hours) Acute abdomen: causes, diagnosis and treatment (3 hours). Digestive bleeding in pregnancy: upper and lower tract bleeding (3 hours). Haemorrhoids (2 hours). Gall lithiasis and obstructive jaundice (2 hours). Intestinal obstruction in pregnancy (ILEO) (2 hours). Anaesthesiology Module (MED 41, 1cfu - 12 hours) Pharmacology and physiology: general anaesthesia, physiological alterations of pregnancy, aesthetic drugs used in obstetrics, uteroplacental transfer of drugs and teratogenic effects (2 hours). Labor and expulsive phase: labour pain, labour analgesia, analgesic techniques chosen from perimedullary anaesthesia and local anaesthetic, impact of analgesia on the outcomes of labour and delivery, anaesthesia for caesarean labour, management of difficult airways in pregnant women (2 hours). Obstetric emergencies: management of haemorrhagic shock, cyanotic asphyxia and pallor (2 hours). BLS-D and neonatal resuscitation (2 hours) Pathological conditions: hypertensive disorders in pregnant women, cardiac arrest, thrombophilia and coagulopathies (2 hours). Recommendations for safety in the operating room (2 hours). Internal Medicine Module (MED 09, 1cfu - 12 hours) Ischemic heart disease: aetiology, risk factors, angina pectoris (1 hour). ECG and acute coronary syndromes (1 hour). Angina pectoris (1 hour). Acute myocardial infarction (1 hour). Arterial hypertension: definition, classification, how to measure blood pressure, symptoms and complications, diagnosis and treatment. Portal and pulmonary hypertension (1 hour). Diabetes Mellitus (1 hour). HELLP Syndrome (1 hour). Polycystic Ovary Syndrome (1 hour). Hypertensive crisis: Hypertensive emergencies and urgencies (1 hour). Anaemias: etiopathogenetic classification, anamnesis, signs and symptoms and treatment (1 hour). Respiratory failure: AGE, main causes, diagnosis and treatment (1 hour). Acute pulmonary oedema (1 hour).

Contents

The course is divided into 5 modules: Gynaecology (1 credit - 12 hours), Obstetric-gynaecological nursing sciences (3 credits - 36 hours), General surgery (1 credit - 12 hours), Anaesthesiology (1 credit - 12 hours) and Internal medicine (1 credit - 12 hours).

Gynaecology Module (MED 40, 1 cfu – 12 hours)
Procidence and prolapse of the umbilical cord: classification and etiopathogenesis, diagnosis of procidentia or prolapse of the umbilical cord, acute fetal distress and hypoxia: differences (2 hours).
Pathologies of the umbilical cord: absolute and relative brevity (1 hour).
Haemorrhage of the first trimester: ectopic pregnancy, spontaneous abortion (2 hours).
Haemorrhage of the second and third trimester: premature placental abruption, placenta previa (2 hours).
Uterine rupture: Epidemiology and etiopathogenesis, pathogenesis and classification (2 hours).
CTG (1 hour)
Abnormalities of placentation (1 hour).
Abnormalities of the amniotic fluid, meconium-stained (1 hour)

Obstetric-gynaecological Nursing Sciences Module (MED 47, 3 cfu - 36 hours)
Definition of urgency and emergency (1 hour).
Obstetric triage Emergency room procedure (phases), colour code attribution scales, attribution of colour codes to pregnant women with EG >, < 20 WKS, to puerperal women or gynaecological patients, Hub and Spoke locations, STAM and STEN (2 hours)
Communication (1 hour).
Clinical risk, definition of error, adverse event, sentinel event, reporting systems, clinical audits (1 hour).
Blood transfusions, blood groups and Rh factor, blood components: GRC and PFC, informed consent, request procedure, administration and monitoring of the patient (2 hours).
Obstetric responsibility, regulatory framework of the obstetric profession, professional profile, Ministerial Decree 740/94, law 42/1999, Gelli Bianco law, civil liability (contractual and extra-contractual), criminal liability, characteristics of clinical documentation (2 hours).
Cardiotocography, general information: graphic representation, methods of detecting BCF and ACU, archiving, characteristics of the baseline: tachycardia and bradycardia, variability: reduced, increased, accelerations, decelerations: early, late, variable and mild variable with worsening criteria, prolonged, sinusoidal pattern (2 hours).
Trace classification: ACOG 2009, FIGO 2015 and RCOG 2001. Cardiotocography in the 2nd stage of labour and classification. Analysis of 4 scenarios: interpretation and action (2 hours).
Third trimester metrorrhagia: general classification, management algorithms, clinical management of placenta previa and DIPNI (2 hours).
Postpartum haemorrhage (PPH): classification and estimation of blood loss, risk factors in pregnancy, labour/delivery, communication and practical interventions for PPH (2 hours).
Preeclampsia and eclampsia: pre-conceptional risk factors, pregnancy-related risk factors, classification, clinical management, timing of delivery of the various forms (algorithms) (2 hours).
HELLP: diagnosis and treatment (1 hour).
Breech birth: types of breech presentations, physiological mechanism, intrapartum management manoeuvres (2 hours).
Manual seconding: risk factors, complications, execution techniques and subsequent monitoring (2 hours).
Shoulder dystocia: diagnosis and classification, risk factors, clinical management, 1st, 2nd and 3rd level manoeuvres, complications (2 hours).
Obstetric vacuum extractor: application and degree of risk, contraindications, traction mechanism (2 hours).
Pathologies of the umbilical cord: procidentia and prolapse, classification, risk factors and causes, case management (2 hours).
Structural anomalies of the umbilical cord, anomalies of insertion of the umbilical cord, anomalies of the umbilical cord resulting from fetal movements (2 hours).
Uterine rupture: classifications, predisposing and determining causes, pathogenesis, differential diagnosis, prognosis and therapy (2 hours).
Uterine inversion: epidemiology, pathophysiology, diagnosis and treatment (2 hours).

General Surgery Module (MED 18, 1cfu - 12 hours)
Acute abdomen: causes, diagnosis and treatment (3 hours).
Digestive bleeding in pregnancy: upper and lower tract bleeding (3 hours).
Haemorrhoids (2 hours).
Gall lithiasis and obstructive jaundice (2 hours).
Intestinal obstruction in pregnancy (ILEO) (2 hours).

Anaesthesiology Module (MED 41, 1cfu - 12 hours)
Pharmacology and physiology: general anaesthesia, physiological alterations of pregnancy, aesthetic drugs used in obstetrics, uteroplacental transfer of drugs and teratogenic effects (2 hours).
Labor and expulsive phase: labour pain, labour analgesia, analgesic techniques chosen from perimedullary anaesthesia and local anaesthetic, impact of analgesia on the outcomes of labour and delivery, anaesthesia for caesarean labour, management of difficult airways in pregnant women (2 hours).
Obstetric emergencies: management of haemorrhagic shock, cyanotic asphyxia and pallor (2 hours).
BLS-D and neonatal resuscitation (2 hours)
Pathological conditions: hypertensive disorders in pregnant women, cardiac arrest, thrombophilia and coagulopathies (2 hours).
Recommendations for safety in the operating room (2 hours).

Internal Medicine Module (MED 09, 1cfu - 12 hours)
Ischemic heart disease: aetiology, risk factors, angina pectoris (1 hour).
ECG and acute coronary syndromes (1 hour).
Angina pectoris (1 hour).
Acute myocardial infarction (1 hour).
Arterial hypertension: definition, classification, how to measure blood pressure, symptoms and complications, diagnosis and treatment. Portal and pulmonary hypertension (1 hour).
Diabetes Mellitus (1 hour).
HELLP Syndrome (1 hour).
Polycystic Ovary Syndrome (1 hour).
Hypertensive crisis: Hypertensive emergencies and urgencies (1 hour).
Anaemias: etiopathogenetic classification, anamnesis, signs and symptoms and treatment (1 hour).
Respiratory failure: AGE, main causes, diagnosis and treatment (1 hour).
Acute pulmonary oedema (1 hour).

	Teaching Methods
	The course includes lectures and laboratory exercises lasting 84 hours. Attendance at classroom lessons and laboratory exercises is mandatory. To take the final exam, the student must have attended at least 75% of the hours required by the course. Attendance will be verified using the EasyAcademy software.

	Verification of learning
	The achievement of the teaching objectives is certified by passing an oral exam with a grade of thirtieths. The final grade is awarded in thirtieths and is calculated considering the weighted average of the grades of the individual modules. Honors requires achieving the maximum grades in all the modules of the teaching. The test allows to ascertain both the ability to know and understand, and the ability to apply the skills acquired, and the ability to present, and the ability to learn and develop solutions in autonomous judgment. The oral exam will verify theoretical knowledge, with particular reference to the procedures for intervention in obstetric-gynaecological emergency situations; the basics of anaesthesia and resuscitation and the criteria for therapeutic choice in obstetrics and gynaecology; the physio pathological bases and the systematic treatment of diseases of the various organs and systems; the characteristics of care for the surgical patient and the responsibilities of the midwife during the perioperative phase.

Verification of learning

The achievement of the teaching objectives is certified by passing an oral exam with a grade of thirtieths. The final grade is awarded in thirtieths and is calculated considering the weighted average of the grades of the individual modules. Honors requires achieving the maximum grades in all the modules of the teaching. The test allows to ascertain both the ability to know and understand, and the ability to apply the skills acquired, and the ability to present, and the ability to learn and develop solutions in autonomous judgment. The oral exam will verify theoretical knowledge, with particular reference to the procedures for intervention in obstetric-gynaecological emergency situations; the basics of anaesthesia and resuscitation and the criteria for therapeutic choice in obstetrics and gynaecology; the physio pathological bases and the systematic treatment of diseases of the various organs and systems; the characteristics of care for the surgical patient and the responsibilities of the midwife during the perioperative phase.

	Texts
	Giarratano et al, Fondamenti di Anestesia, medicina perioperatoria e medicina critica, Piccin 2024 Mario Lise Chirurgia per infermieri - Piccin 2016 MEDICINA INTERNA- SCIENZE INFERMIERISTICHE- MCGRAW HILL EDUCATION; VI ED. 2019 ELEMENTI DI PATOLOGIA GENERALE & FISIOPATOLOGIA GENERALE. G.M. PONTIERI (ED. PICCIN) HANDOUTS

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Marcello PERSICO | OBSTETRIC AND GYNECOLOGICAL EMERGENCIES