Daniela MELIS | PHYSIOLOGICAL childbirth AND PUERPERIUM: MECHANISM AND ASSISTANCE

cod. 1012400012

PHYSIOLOGICAL CHILDBIRTH AND PUERPERIUM: MECHANISM AND ASSISTANCE

	1012400012
	DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY "SALERNITANA MEDICAL SCHOOL"
	EQF6
	MIDWIFERY
	2024/2025

PERCORSO STUDY PATHWAY IN COMMON IN OBSTETRICS

	OBBLIGATORIO
	YEAR OF COURSE 2
	YEAR OF DIDACTIC SYSTEM 2013
	AUTUMN SEMESTER

TEACHING UNITS

	SSD	CFU	HOURS	ACTIVITY	TYPE OF ACTIVITY
1	IL PARTO E IL PUERPERIO FISIOLOGICI: MECCANISMO ED ASSISTENZA- MOD. GINECOLOGIA E OSTETRICIA
	MED/40	2	24	LESSONS	COMPULSORY SUBJECTS, CHARACTERISTIC OF THE CLASS
2	IL PARTO E IL PUERPERIO FISIOLOGICI: MECCANISMO ED ASSISTENZA - MOD. PEDIATRIA GENERALE E SPECIALISTICA
	MED/38	2	24	LESSONS	COMPULSORY SUBJECTS, CHARACTERISTIC OF THE CLASS
3	IL PARTO E IL PUERPERIO FISIOLOGICI: MECCANISMO ED ASSISTENZA - MOD. SCIENZE INFERMIERISTICHE OSTETRICO-GINECOLOGICHE
	MED/47	3	36	LESSONS	COMPULSORY SUBJECTS, CHARACTERISTIC OF THE CLASS

PROFESSORS

	DANIELA MELIS2 T Curriculum
	MAURIZIO RINALDI1 Curriculum
	ROSA ORO3 Curriculum

EXAMS

Exam	Date	Session
IL PARTO E IL PUERP FIS: MECCANISMO DI A	10/03/2025 - 09:00	SESSIONE ORDINARIA
IL PARTO E IL PUERP FIS: MECCANISMO DI A	10/03/2025 - 09:00	SESSIONE DI RECUPERO
IL PARTO E IL PUERP FIS: MECCANISMO DI A	26/03/2025 - 09:00	SESSIONE ORDINARIA
IL PARTO E IL PUERP FIS: MECCANISMO DI A	26/03/2025 - 09:00	SESSIONE DI RECUPERO
IL PARTO E IL PUERP FIS: MECC DI ASS	19/06/2025 - 09:00	SESSIONE ORDINARIA
IL PARTO E IL PUERP FIS: MECC DI ASSIST	03/07/2025 - 09:00	SESSIONE ORDINARIA

	Objectives
	At the end of the course, the student will have acquired complementary obstetric training aimed at acquiring the necessary knowledge to design and implement effective and appropriate care interventions for the management of pregnancy, childbirth, and the puerperium. The student will have an in-depth understanding of the process of assisting in normal childbirth in its various stages and the ability to early detect any abnormalities in these stages to ensure maternal and fetal well-being; they will be able to detect deviations from normal physiology (abnormal presentations and positions). Management of the second stage of labor, perinatal emergencies, and obstetric emergencies in the delivery room. Knowledge and Understanding At the end of the course, the student will know and understand: The values, theories, and models of Midwifery for assessing the health status of the patient and applying good obstetric practices in the management of labor, childbirth, and puerperium, as well as obstetric, neonatal, and gynecological care. The historical and evolutionary processes of the profession and obstetric care. The principles necessary for identifying psycho-emotional aspects related to adolescence, pregnancy, and menopause. Ability to Apply Knowledge and Understanding At the end of the course, the student will apply knowledge and understanding to: The theories and principles of Midwifery care-cure-education, behavioral and social sciences for recognizing the health needs of women in various stages of reproductive life and the couple, in their social context, and the neonate up to the first year of life. Obstetric care models that support the self-determination of women/couples and the normal evolution of physiological processes of pregnancy, childbirth, puerperium, newborn adaptation, and breastfeeding. Assisting in normal births with personal responsibility and applying hygiene standards for newborn care and prophylaxis of risk factors and neonatal diseases. Collaborating in the care of neonates who require sub-intensive care. Judgment Autonomy At the end of the course, the student will be able to: Gain progressive autonomy in managing and implementing diagnostic-therapeutic procedures aimed at the health of women, newborns, and the couple, in team-based care, and at different levels of care intensity. Make professional decisions in different phases of the care process, be able to verify their effectiveness, and make decisions for future planning. Decide on care priorities for groups of patients they are responsible for. Make appropriate care decisions considering legal, political, geographical, economic, ethical, and social influences. Take responsibility for decisions and be accountable for their actions during professional practice in accordance with the profile, code of ethics, and legal and ethical standards. Make decisions using a scientific approach to problem-solving based on available scientific studies and ensure the quality of care delivered using research tools. Make decisions during obstetric care, customizing choices based on similarities and differences among the patients, including values, ethnicity, and socio-cultural practices. Demonstrate judgment autonomy in applying assessment tools to measure the effectiveness of preventive interventions. Communication Skills At the end of the course, the student will have developed the ability to: Conduct interpersonal interviews with patients of all ages and their families within the care process and/or with other healthcare professionals appropriately, conducting effective negotiations and methodological rigor. Support and encourage patients to make health choices, strengthening coping skills, self-esteem, and enhancing available resources. Manage communication skills for national and international exchanges. Apply teaching and learning principles for informational or educational interventions aimed at individual patients, families, groups, and other professionals such as support staff, midwifery students, nursing students, using clear and organized communication. Assess the application of research findings through written, oral, and electronic communication strategies to improve organizational quality. Learning Ability At the end of the course, the student will have developed the ability to: Study independently. Continuously self-assess educational needs in relation to the nature and complexity of the problems to be faced and the strategic and operational management required. Cultivate doubts and tolerate uncertainties arising from study and practical activity. Reflect on their professional activity, being relevant in terms of timing, locations, and interlocutors. Continuously seek opportunities for self-learning, collaborative learning, and self-assessment within the work teams.

At the end of the course, the student will have acquired complementary obstetric training aimed at acquiring the necessary knowledge to design and implement effective and appropriate care interventions for the management of pregnancy, childbirth, and the puerperium. The student will have an in-depth understanding of the process of assisting in normal childbirth in its various stages and the ability to early detect any abnormalities in these stages to ensure maternal and fetal well-being; they will be able to detect deviations from normal physiology (abnormal presentations and positions). Management of the second stage of labor, perinatal emergencies, and obstetric emergencies in the delivery room.

Knowledge and Understanding

At the end of the course, the student will know and understand:

The values, theories, and models of Midwifery for assessing the health status of the patient and applying good obstetric practices in the management of labor, childbirth, and puerperium, as well as obstetric, neonatal, and gynecological care.
The historical and evolutionary processes of the profession and obstetric care.
The principles necessary for identifying psycho-emotional aspects related to adolescence, pregnancy, and menopause.
Ability to Apply Knowledge and Understanding

At the end of the course, the student will apply knowledge and understanding to:

The theories and principles of Midwifery care-cure-education, behavioral and social sciences for recognizing the health needs of women in various stages of reproductive life and the couple, in their social context, and the neonate up to the first year of life.
Obstetric care models that support the self-determination of women/couples and the normal evolution of physiological processes of pregnancy, childbirth, puerperium, newborn adaptation, and breastfeeding.
Assisting in normal births with personal responsibility and applying hygiene standards for newborn care and prophylaxis of risk factors and neonatal diseases.
Collaborating in the care of neonates who require sub-intensive care.
Judgment Autonomy

At the end of the course, the student will be able to:

Gain progressive autonomy in managing and implementing diagnostic-therapeutic procedures aimed at the health of women, newborns, and the couple, in team-based care, and at different levels of care intensity.
Make professional decisions in different phases of the care process, be able to verify their effectiveness, and make decisions for future planning.
Decide on care priorities for groups of patients they are responsible for.
Make appropriate care decisions considering legal, political, geographical, economic, ethical, and social influences.
Take responsibility for decisions and be accountable for their actions during professional practice in accordance with the profile, code of ethics, and legal and ethical standards.
Make decisions using a scientific approach to problem-solving based on available scientific studies and ensure the quality of care delivered using research tools.
Make decisions during obstetric care, customizing choices based on similarities and differences among the patients, including values, ethnicity, and socio-cultural practices.
Demonstrate judgment autonomy in applying assessment tools to measure the effectiveness of preventive interventions.
Communication Skills

At the end of the course, the student will have developed the ability to:

Conduct interpersonal interviews with patients of all ages and their families within the care process and/or with other healthcare professionals appropriately, conducting effective negotiations and methodological rigor.
Support and encourage patients to make health choices, strengthening coping skills, self-esteem, and enhancing available resources.
Manage communication skills for national and international exchanges.
Apply teaching and learning principles for informational or educational interventions aimed at individual patients, families, groups, and other professionals such as support staff, midwifery students, nursing students, using clear and organized communication.
Assess the application of research findings through written, oral, and electronic communication strategies to improve organizational quality.
Learning Ability

At the end of the course, the student will have developed the ability to:

Study independently.
Continuously self-assess educational needs in relation to the nature and complexity of the problems to be faced and the strategic and operational management required.
Cultivate doubts and tolerate uncertainties arising from study and practical activity.
Reflect on their professional activity, being relevant in terms of timing, locations, and interlocutors.
Continuously seek opportunities for self-learning, collaborative learning, and self-assessment within the work teams.

	Prerequisites
	OBLIGATION TO EXCEED THE EXAMINATION OF "NOTIONS OF ANATOMY AND PHYSIOLOGY" as reported in the study plane

	Contents
	The teaching is divided into 3 modules: Gynecology and Obstetrics General and Specialist Pediatrics Obstetric-Gynecological Nursing Sciences Module of Gynecology and Obstetrics (MED/40, 2 ECTS, 24 hours) FUNCTIONAL ANATOMY: The birth canal: nutation and counter-nutation. The bony canal: diameters, ligaments, and joints. Soft tissues: pelvic floor (3 hours) PHYSIOLOGY OF LABOR: Causes and factors. The biochemical force of labor. General characteristics of uterine contractions. Pressures generated by uterine contractions. Phenomenon of uterine contractions. Auxiliary forces of labor (3 hours). THE PHENOMENA OF LABOR: Dynamic phenomena, mechanical phenomena, plastic phenomena. CLINICAL EVOLUTION OF VERTEX PRESENTATION: Prodromal phase, dilating phase, expulsive phase (3 hours). CARDIOTOCOGRAPHY IN LABOR AND EXPULSIVE PHASE. PHYSIOLOGICAL SECOND STAGE: Timing and actions. BREECH DELIVERY (3 hours). Module of General and Specialist Pediatrics (MED/38, 2 ECTS, 24 hours) NEONATAL FEEDING: Breastfeeding: Physiology and benefits. Composition of breast milk and cow's milk, weaning/introduction of solid foods, intolerances (3 hours). Percentiles, growth, and brief discussion of puberty. Complete Neonatal Physical Examination: Color: Jaundice-Cyanosis, Gestational Age Assessment: Morphological Criteria, Neonatal Neurobehavioral Examination (4 hours). Important Assessments at Birth: Patency of the esophagus, anus, choanae, birth trauma (3 hours). STAGES OF PRENATAL DEVELOPMENT: Respiratory adaptation, cardiovascular adaptation, temperature regulation, birth assistance, and Apgar score. First care in the neonatal unit (4 hours). ADAPTATION TO EXTRA-UTERINE LIFE: Care in the nursery. Care of high-risk neonates: perinatal asphyxia (3 hours). NEONATAL CLASSIFICATION: Classification based on birth weight/gestational age. Preterm neonate (characteristics, etiopathogenesis, issues, survival). Neonatal physiological phenomena. PHYSIOLOGICAL AND PATHOLOGICAL NEONATAL JAUNDICE (4 hours). NEONATAL SCREENING AND RARE DISEASES: Phenylketonuria, congenital hypothyroidism, cystic fibrosis. Hearing screening. New Expanded Screening, Vaccinations (3 hours). Module of Obstetric-Gynecological Nursing Sciences (MED/47, 3 ECTS, 36 hours) THE PELVIS: JOINTS AND CHANGES. The bony canal, soft canal (2 hours). NUTATION AND COUNTER-NUTATION IN THE 1ST AND 2ND STAGES OF LABOR. Clinical evolution of vertex presentation during the three stages of labor: prodromal phase, dilating phase, expulsive phase, and second stage (3 hours). The Force: Hormones and functional anatomy of uterine muscle fibroblasts (from Braxton-Hicks to labor). Factors of labor: canal, mobile body, and force, uterine contraction. Welcoming the woman in labor, obstetric management of labor. CTG in labor (3 hours). Changes in the Lower Uterine Segment: From the 12th week to labor. Dynamic phenomena: changes from the first to the second stage. Dynamic phenomena: pelvic changes - soft parts. Pelvic floor massage (integrity or hidden damage) (4 hours). MECHANICAL PHENOMENA: FROM ENGAGEMENT TO PROGRESSION. PARTOGRAM GUIDELINES: Partogram: compilation and responsibility of the midwife (3 hours). FETAL ATTITUDE AND ENGAGEMENT OF THE PRESENTING PART IN THE 1ST AND 2ND STAGES OF LABOR: Spatial relationships of the fetus in utero and in the birth canal: situation, presentation, positions, and fetal attitude. Leopold's maneuvers. Obstetric examination during labor and the expulsive phase (4 hours). IMPORTANCE OF FREE AND ANTIPAIN POSITIONS. Places and methods of delivery, labor pain (2 hours). ASSISTANCE IN THE SECOND STAGE OF LABOR WITH INSTRUMENTATION. Checklist in the delivery room. Instrumentation and preparation of the serving table in the delivery room. Neonatal unit (3 hours). ASSISTANCE IN THE PUERPERIUM: Postpartum pain therapy. Early mother-neonate contact (2 hours). BREASTFEEDING AND LACTATION ASSESSMENT SHEET. Puerperium and parenthood (2 hours). TAKING CHARGE AND RESPONSIBILITY OF THE MIDWIFE: Support and promotion for the woman and early discharge. Obstetric agenda and obstetric file. Counseling and health promotion. Hygiene, diet, and lifestyle (3 hours). Taking Charge (from the community to the obstetric emergency department). Certificate of birth assistance and CeDAP (2 hours). Natural Induction: Effects. Bishop score. Pharmacological induction (3 hours).

Contents

The teaching is divided into 3 modules:

Gynecology and Obstetrics
General and Specialist Pediatrics
Obstetric-Gynecological Nursing Sciences
Module of Gynecology and Obstetrics (MED/40, 2 ECTS, 24 hours)

FUNCTIONAL ANATOMY: The birth canal: nutation and counter-nutation. The bony canal: diameters, ligaments, and joints. Soft tissues: pelvic floor (3 hours)
PHYSIOLOGY OF LABOR: Causes and factors. The biochemical force of labor. General characteristics of uterine contractions. Pressures generated by uterine contractions. Phenomenon of uterine contractions. Auxiliary forces of labor (3 hours).
THE PHENOMENA OF LABOR: Dynamic phenomena, mechanical phenomena, plastic phenomena. CLINICAL EVOLUTION OF VERTEX PRESENTATION: Prodromal phase, dilating phase, expulsive phase (3 hours).
CARDIOTOCOGRAPHY IN LABOR AND EXPULSIVE PHASE. PHYSIOLOGICAL SECOND STAGE: Timing and actions. BREECH DELIVERY (3 hours).

Module of General and Specialist Pediatrics (MED/38, 2 ECTS, 24 hours)

NEONATAL FEEDING: Breastfeeding: Physiology and benefits. Composition of breast milk and cow's milk, weaning/introduction of solid foods, intolerances (3 hours).
Percentiles, growth, and brief discussion of puberty. Complete Neonatal Physical Examination: Color: Jaundice-Cyanosis, Gestational Age Assessment: Morphological Criteria, Neonatal Neurobehavioral Examination (4 hours).
Important Assessments at Birth: Patency of the esophagus, anus, choanae, birth trauma (3 hours).
STAGES OF PRENATAL DEVELOPMENT: Respiratory adaptation, cardiovascular adaptation, temperature regulation, birth assistance, and Apgar score. First care in the neonatal unit (4 hours).
ADAPTATION TO EXTRA-UTERINE LIFE: Care in the nursery. Care of high-risk neonates: perinatal asphyxia (3 hours).
NEONATAL CLASSIFICATION: Classification based on birth weight/gestational age. Preterm neonate (characteristics, etiopathogenesis, issues, survival). Neonatal physiological phenomena.
PHYSIOLOGICAL AND PATHOLOGICAL NEONATAL JAUNDICE (4 hours).
NEONATAL SCREENING AND RARE DISEASES: Phenylketonuria, congenital hypothyroidism, cystic fibrosis. Hearing screening. New Expanded Screening, Vaccinations (3 hours).

Module of Obstetric-Gynecological Nursing Sciences (MED/47, 3 ECTS, 36 hours)

THE PELVIS: JOINTS AND CHANGES. The bony canal, soft canal (2 hours).

NUTATION AND COUNTER-NUTATION IN THE 1ST AND 2ND STAGES OF LABOR.
Clinical evolution of vertex presentation during the three stages of labor: prodromal phase, dilating phase, expulsive phase, and second stage (3 hours).

The Force: Hormones and functional anatomy of uterine muscle fibroblasts (from Braxton-Hicks to labor). Factors of labor: canal, mobile body, and force, uterine contraction.
Welcoming the woman in labor, obstetric management of labor. CTG in labor (3 hours).

Changes in the Lower Uterine Segment: From the 12th week to labor. Dynamic phenomena: changes from the first to the second stage. Dynamic phenomena: pelvic changes - soft parts. Pelvic floor massage (integrity or hidden damage) (4 hours).

MECHANICAL PHENOMENA: FROM ENGAGEMENT TO PROGRESSION. PARTOGRAM GUIDELINES: Partogram: compilation and responsibility of the midwife (3 hours).

FETAL ATTITUDE AND ENGAGEMENT OF THE PRESENTING PART IN THE 1ST AND 2ND STAGES OF LABOR: Spatial relationships of the fetus in utero and in the birth canal: situation, presentation, positions, and fetal attitude. Leopold's maneuvers. Obstetric examination during labor and the expulsive phase (4 hours).

IMPORTANCE OF FREE AND ANTIPAIN POSITIONS. Places and methods of delivery, labor pain (2 hours).

ASSISTANCE IN THE SECOND STAGE OF LABOR WITH INSTRUMENTATION. Checklist in the delivery room. Instrumentation and preparation of the serving table in the delivery room. Neonatal unit (3 hours).

ASSISTANCE IN THE PUERPERIUM: Postpartum pain therapy. Early mother-neonate contact (2 hours).

BREASTFEEDING AND LACTATION ASSESSMENT SHEET. Puerperium and parenthood (2 hours).

TAKING CHARGE AND RESPONSIBILITY OF THE MIDWIFE: Support and promotion for the woman and early discharge. Obstetric agenda and obstetric file. Counseling and health promotion. Hygiene, diet, and lifestyle (3 hours).

Taking Charge (from the community to the obstetric emergency department). Certificate of birth assistance and CeDAP (2 hours).

Natural Induction: Effects. Bishop score. Pharmacological induction (3 hours).

	Teaching Methods
	THE COURSE IS DIVIDED INTO LECTURES, CLASSROOM EXERCISES AND GROUP WORK, PRACTICAL ACTIVITY SIMULATION WITH MANNEQUINS. THE LECTURES WILL ALLOW THE STUDENT TO ACQUIRE THE KNOWLEDGE OF PATHOPHYSIOLOGY AND THERAPEUTIC APPROACH OF THE MAIN CLINICAL CONDITIONS. THE EXERCISES WILL ALLOW THE STUDENT TO DEVELOP THE ABILITY TO APPLY THE ACQUIRED KNOWLEDGE IN DIFFERENTIAL DIAGNOSIS AND IN THE MEDICAL-PATIENT APPROACH. THE TEACHING ALSO INCLUDES THE DEVELOPMENT OF AN INDIVIDUAL/GROUP WORK AIMED AT ACQUIRING THE SKILLS OF DIFFERENTIAL DIAGNOSIS AND SCIENTIFIC STUDY. THE DEVELOPMENT OF THE PAPER WILL BE DISCUSSED WITH THE CLASS INDIVIDUALLY WITH THE STUDENT DURING THE TEACHER'S OFFICE HOURS.

Teaching Methods

THE COURSE IS DIVIDED INTO LECTURES, CLASSROOM EXERCISES AND GROUP WORK, PRACTICAL ACTIVITY SIMULATION WITH MANNEQUINS. THE LECTURES WILL ALLOW THE STUDENT TO ACQUIRE THE KNOWLEDGE OF PATHOPHYSIOLOGY AND THERAPEUTIC APPROACH OF THE MAIN CLINICAL CONDITIONS. THE EXERCISES WILL ALLOW THE STUDENT TO DEVELOP THE ABILITY TO APPLY THE ACQUIRED KNOWLEDGE IN DIFFERENTIAL DIAGNOSIS AND IN THE MEDICAL-PATIENT APPROACH.
THE TEACHING ALSO INCLUDES THE DEVELOPMENT OF AN INDIVIDUAL/GROUP WORK AIMED AT ACQUIRING THE SKILLS OF DIFFERENTIAL DIAGNOSIS AND SCIENTIFIC STUDY. THE DEVELOPMENT OF THE PAPER WILL BE DISCUSSED WITH THE CLASS INDIVIDUALLY WITH THE STUDENT DURING THE TEACHER'S OFFICE HOURS.

	Verification of learning
	The exam consists of an oral test. The score of the oral exam depends on the student's ability to effectively present the content and critically discuss the topics covered. The final grade is derived from the weighted average of the grades obtained in the various modules. Excellence requires achieving the maximum score in all the tests related to the integrated course modules and requires demonstrating in-depth knowledge, including with reference to the rarer clinical conditions.

Verification of learning

The exam consists of an oral test. The score of the oral exam depends on the student's ability to effectively present the content and critically discuss the topics covered. The final grade is derived from the weighted average of the grades obtained in the various modules. Excellence requires achieving the maximum score in all the tests related to the integrated course modules and requires demonstrating in-depth knowledge, including with reference to the rarer clinical conditions.

	Texts
	COSTANTINI ET AL .: MIDWIFE, AND PICCIN ; COLACURCI ET AL .: OBSTETRICS , AND PESCETTO ET AL .: OBSTETRICS AND GYNECOLOGY MANUALE DI PEDIATRIA DI TOM LISSAUER, WILL CARROLL EDITORE: EDRA DATA DI PUBBLICAZIONE: MARZO 2018 – PREZZO COPERTINA 39.00/33.00 EURO INTEGRATED COURSE OF PEDIATRICS SSD MED / 38 - GENERAL AND SPECIALIST PAEDIATRICS (6 CREDITS)

	More Information
	THE TEACHER IS ALWAYS AVAILABLE FOR INTERVIEWS AND INSIGHTS

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Daniela MELIS | PHYSIOLOGICAL childbirth AND PUERPERIUM: MECHANISM AND ASSISTANCE