AIMS AND LEARNING OUTCOMES

Postpartum haemorrage. In Italy, postpartum haemorrhage (PPH) was responsible, in the period 2006-2012, for 58 direct maternal deaths (within 42 days from the delivery), representing the major cause (43%) of the 149 direct maternal deaths in that time. The haemorrhagic event after childbirth can occur in women with and without risk factors and in a very short time can lead to the death of the woman. The theoretical-practical teaching aims to give the theoretical basis of PPH (causes, pathophysiology, medical and surgical treatment), the technical skills to face the start of the event, the technical and non-technical skills for the teamwork. At the end of the lessons, the midwifery student will be able to apply the updated Italian ISS guideline n° 26 in order to recognize pregnant women at risk of PPH, to recognize the signs of PPH in progress, to call for help early, to know which first-line drugs and emergency maneuvers are necessary from the beginning of the event, to communicate with the woman and the members of the multidisciplinary team, all according to the updated Italian ISS guideline n° 26.

Shoulder dystocia. This pathology of the expulsive period (disengagement of the head not followed by disengagement of the shoulders within 3 minutes) is infrequent (0.6-0.7% of vaginal deliveries) and therefore can occur unexpectedly and unpredictably only after years of obstetric profession. Inexperience due to the rarity of the event can lead to the death of the unborn child, if not resolved within 5 minutes. The theoretical-practical course aims to give the theoretical basis and the technical and non-technical skills necessary to face this eventuality. At the end of the lessons, the student will be able to recognize the signs of shoulder dystocia, to ask for help early, to know which maneuvers implement and which to avoid, to communicate effectively with the pregnant woman and with the doctors in the delivery room. according to guideline 42 of the Royal College of Obstetricians and Gynaecologists.

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

ITOSS (Italian Obstetric Surveillance System). Guideline 26 "Postpartum haemorrhage: how to prevent it, how to cure it" - published in October 2016, and the update (pdf 101 kb) of December 2018 with the modification of the recommendation on treatment with tranexamic acid in the course of postpartum hemorrhage.

“Shoulder dystocia”, RCOG GTG 42, March 2012.

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