AIMS AND CONTENT

AIMS AND LEARNING OUTCOMES

Postpartum Hemorrhage

In Italy, postpartum hemorrhage (PPH) was responsible for 38 direct maternal deaths occurring within 42 days of pregnancy, accounting for 37.1% of the 103 direct maternal deaths recorded during the same period. Since 2006, PPH has consistently been the leading cause of direct maternal mortality. The maternal mortality ratio (MMR) due to obstetric hemorrhage decreased from 2.49 maternal deaths per 100,000 live births (95% CI: 1.75–3.43) in 2007–2013 to 0.77 per 100,000 live births (95% CI: 0.33–1.58) in 2014–2018, representing a statistically significant reduction.

Postpartum hemorrhage may occur in women both with and without identifiable risk factors and can rapidly progress to a life-threatening condition following childbirth. This theoretical and practical course aims to provide students with a comprehensive understanding of postpartum hemorrhage, including its etiology, pathophysiology, and medical and surgical management. In addition, the course is designed to develop the technical and non-technical skills required for the prompt recognition and effective management of PPH, as well as for multidisciplinary teamwork in emergency situations.

Upon successful completion of the course, midwifery students will be able to identify women at risk of postpartum hemorrhage, recognize the early signs and symptoms of ongoing bleeding, activate timely clinical support, implement appropriate first-line pharmacological and emergency interventions, and communicate effectively with both the woman and members of the multidisciplinary team. All learning outcomes are aligned with the updated Italian National Institute of Health (ISS) Guideline No. 26 and the most recent FIGO and WHO recommendations.

Shoulder Dystocia

Shoulder dystocia is an uncommon but potentially life-threatening obstetric emergency, occurring in approximately 0.6–0.7% of vaginal deliveries. Owing to its relative rarity and unpredictable nature, it may occur unexpectedly and presents a significant clinical challenge for healthcare professionals. If not promptly recognized and managed, shoulder dystocia can result in severe neonatal morbidity or mortality within a few minutes.

This theoretical and practical course aims to provide students with the knowledge and skills necessary for the effective management of shoulder dystocia. The course focuses on the pathophysiology of the condition and on the development of both technical and non-technical competencies required to respond appropriately in a high-pressure clinical setting.

Upon successful completion of the course, midwifery students will be able to recognize the clinical signs of shoulder dystocia, summon assistance promptly, perform the recommended obstetric manoeuvres while avoiding potentially harmful interventions, and communicate effectively with the woman and the multidisciplinary delivery-room team. All educational content is consistent with the January 2024 Recommendation on the Management of Shoulder Dystocia.

TEACHING METHODS

For both topics (postpartum haemorrage and shoulder dystocia): frontal lesson with audiovisual devices followed by simulation on low and high fidelity mannequins.

SYLLABUS/CONTENT

Postpartum haemorrage (PPH): prophylaxis (third stage pathophysiology, risk factors, drug prophylaxis), causes, recognition, medical treatment, compression maneuvers, intrauterine tamponade, technical and non-technical obstetric skills in the diagnostic and therapeutic algorithm.

Shoulder dystocia: risk factors, prophylaxis (what not to do), recognition, non-technical skills (early help call and communication), maneuver algorithm.

RECOMMENDED READING/BIBLIOGRAPHY

Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage [Internet]. Geneva: World Health Organization; 2025. PMID: 41264754.

ITOSS (Italian Obstetric Surveillance System) Linea guida 26 “Emorragia post partum: come prevenirla, come curarla” - pubblicata a ottobre 2016, e l’aggiornamento (pdf 101 kb) di dicembre 2018 relativo alla modifica della raccomandazione sul trattamento con acido tranexamico in corso di emorragia del post partum.

Raccomandazioni sulla gestione della distocia delle spalle. Realizzato dalla Fondazione Confalonieri Ragonese su mandato SIGO, AOGOI, AGUI. Gennaio 2024. https://www.sigo.it/wp-content/uploads/2024/04/Raccomandazioni_GestioneDistociaSpalle.pdf

Ragusa A., Crescini C. "Urgenze ed emergenze in sala parto". Piccin Nuova Libraria, 2016.

“Shoulder dystocia”, RCOG GTG 42, March 2012. https://www.rcog.org.uk/media/ewgpnmio/gtg_42.pdf

LESSONS

LESSONS START

Check the schedule of lessons.

Class schedule

The timetable for this course is available here: Portale EasyAcademy

EXAMS

EXAM DESCRIPTION

Oral examination.