Department of Obstetrics & Gynecology

The goals of the inpatient aspect of the rotation are to teach the resident:
Intrapartum management of normal term labor.
Understanding of normal physiology of pregnancy.
Indications for maternal transport.
Cervical ripening and induction of labor.
Knowledge of fetal heart rate patterns, uterine contractility and states of fetal wellbeing.
Management of abnormalities of fetal-well being.
Management of intrapartum complications, including hemorrhage, fetal distress, failure to progress, and chorioamnionitis.
Management of preterm labor; understanding pharmacology and use of tocolytics.
Diagnosis and management of abruptio placenta and placenta previa.
Diagnosis and management of preterm rupture membranes.
Diagnosis and management of preeclampsia/eclampsia.
Diagnosis, management, and understanding of pathophysiology of medical problems in pregnancy including hypertension, diabetes, heart disease, asthma, anemia, pyelonephritis, other renal disorders, seizure disorders.
Management of the pregnant woman requiring intensive care.
Coordination of medical care with use of consultants.
Understanding, diagnosis, and management of obstetric infections and their influence on maternal and fetal outcomes.
Performance of operative techniques including vacuum extraction, forcep delivery, cesarean section, postpartum tubal ligation, cerclage, external cephalic version.
Operative and medical management of obstetric hemorrhage, including cesarean hysterectomy, uterine and hypogastric artery ligation.
Maternal and fetal effects of anesthesia.

Outpatient Clinics

The goals of the outpatient clinics at University Hospital involve prenatal care of the low and high risk obstetric patient. Specifically, to teach the resident:
Management of the normal prenatal patient.
The importance and techniques of education of the pregnant woman.
Identification of complications in the normal patient.
Diagnosis and management of common obstetrical problems including IUGR, multiple gestation, fetal demise, post dates, pregnancy loss, placenta previa, vaginal bleeding.
Management of medical problems in pregnancy as outlined in inpatient goals.
Basis and advanced ultrasonographic technique. Genetic amniocentesis. Systematic ultrasonography is performed in conjunction with an MFM specialist.
Indications and techniques of antenatal testing, including NST, OCT, biophysical profiles, and amniotic fluid indices.

Tulane University Health Sciences Center

While on the obstetrics rotation at Tulane, residents learn prenatal, intrapartum and postpartum care of the high risk pregnant woman as described for the University Hospital rotation. This includes labor and delivery, antenatal inpatient and outpatient management.

Once a week, residents attend the obstetrical high risk clinic. In this clinic are women with obstetric high risk problems, medical problems, and fetal abnormalities who are seen for either continued care, or consultation only. The continued care patients in this clinic are then delivered by the team who sees them in the clinic, supervised by the faculty maternal-fetal medicine specialist.

While a variety of obstetric and medical high risk patients are seen in this clinic, because the faculty in charge of the clinic has specialty training in both Maternal-Fetal Medicine and Human Genetics, the majority of patients have a fetal anomaly or a genetic high risk problem.

Ultrasonographic diagnosis and obstetric management of fetal structural abnormalities. Ultrasonography with resident involvement is performed in the clinic itself.
The genetics etiologies of fetal abnormalities (chromosomal, mendelian, teratogenic, etc.).
Preconception genetic counseling and pedigree analysis.
Advanced maternal age; mechanisms, risks, options and counseling.
Genetic screening (triple screen; targeted ultrasonography; genetic history).
Prenatal invasive diagnostic procedures including genetic amniocentesis (performed by resident); chorionic villus sampling, placental biopsy, and fetal cord blood sampling (involvement by resident).
Molecular and cytogenetic testing procedures performed on prenatal samples for common genetic disorders.. i.e. karyotype, Tay-Sach Disease, sickle cells disease, cystic fibrosis, etc.
Interpretation of genetic tests, including limitations.
Cytogenetic testing procedures (Residents may spend time in the cytogenetics and molecular laboratory if desired).
Counseling of couples regarding test results and options available in pregnancy; including the medical-legal and ethical issues of these options.
Abortion options and techniques.
Management of pregnant women with genetic problems that make pregnancy high risk, i.e. connective tissue disorders, phenylketonuria (PKU), repaired congenital heart disease.
Intrapartum management of congenital heart disease; including ICU care when appropriate.