1. Classify diabetes mellitus in pregnancy.
2. Interpret screening tests for gestational diabetes.
3. Monitor and control blood sugar in the pregnant patient with diabetes mellitus.
4. Assess, recognize, and manage fetal and maternal complications such as:
a. Fetal malformations
b. Disturbances in fetal growth
c. Diabetic ketoacidosis
5. Counsel patients with diabetes regarding future reproduction and long-term health implications.
B. Diseases of the urinary system
1. Evaluate signs and symptoms of urinary tract pathology in pregnant patients.
2. Describe the indications for the common diagnostic tests for renal disease in pregnancy.
3. Interpret the results of common diagnostic tests for renal disease in pregnancy.
4. Counsel patients about the possible adverse effects of diseases of the urinary tract on fetal and maternal outcome, such as:
a. Intrauterine growth restriction
b. Prematurity
c. Perinatal mortality
d. Pregnancy-induced hypertension
5. Develop, in consultation with other specialists, a comprehensive plan for the perinatal management of a patient with renal disease.
C. Infectious diseases
1. Perform a focused history and physical examination in pregnant patients who have known or suspected infectious diseases.
2. Choose and perform laboratory tests to confirm the diagnosis of infection.
3. Assess the severity of a specific infection and its potential maternal, fetal, and neonatal impact.
4. Manage specific infections or obtain appropriate consultation for co-management.
5. Describe the possible adverse maternal and fetal effects of antibiotics administered during pregnancy, eg, teratogenic effects of tetracycline and quinolones.
D. Hematologic disorders
1. Evaluate possible causes of anemia, thrombocytopenia, deep vein thrombosis, and coagulopathy in pregnancy.
2. Institute appropriate acute and chronic management for these conditions, including prophylaxis to minimize recurrance risk.
3. Counsel patients about the fetal and maternal impact of hematologic disorders in pregnancy.
E. Cardiopulmonary disease
1. Describe symptoms and physical findings suggestive of cardiopulmonary disease in pregnancy.
2. Describe the indications for common diagnostic tests for cardiopulmonary disease in pregnancy, such as:
a. Electrocardiography
b. Echocardiography
c. Cardiac catheterization
d. Chest X-ray
e. Pulmonary function tests
f. Arterial blood gases
3. Interpret the results of common diagnostic tests for cardiopulmonary disease in pregnancy, such as:
a. Electrocardiography
b. Echocardiography
c. Chest X-ray
d. Pulmonary function tests
e. Arterial blood gases
4. Develop, in consultation with other specialists, a comprehensive plan for the perinatal management of patients with cardiopulmonary disease.
5. Classify maternal cardiac disease in pregnancy and describe the associated maternal and fetal risks.
6. Order appropriate fetal evaluation in patients with congenital heart disease.
7. Counsel patients about the impact of pregnancy on cardiopulmonary disease and the impact of these diseases on pregnancy
F. Gastrointestinal disease
1. Perform a history and physical examination for the diagnosis of gastrointestinal disease in pregnancy.
2. Describe the indications for, and advantages and disadvantages of, common diagnostic tests for gastrointestinal disease, such as:
a. Stool examination for ova, parasites, bacteria, leukocytes, and occult blood
b. Endoscopy
c. Imaging studies
d. Antibody/antigen testing
e. Liver function tests
3. Interpret the results of common diagnostic tests for gastrointestinal disease in pregnancy.
4. Diagnose, and provide initial management of, common gastrointestinal diseases in pregnancy, such as:
a. Hyperemesis gravidarum
b. Reflux esophagitis
c. Peptic ulcer disease
d. Cholelithiasis
e. Cholecystitis
f. Pancreatitis
g. Hepatitis
h. Cholestasis of pregnancy
i. Acute fatty liver of pregnancy
G. Neurologic disease
1. Perform a focused history and neurologic examination in pregnant patients with a known or suspected neurologic disorder.
2. Describe the indications for common diagnostic tests for neurologic disease in pregnancy, such as:
a. Electroencephalogram
b. Lumbar puncture
c. CT or MRI
d. Nerve conduction studies
3. Interpret the common diagnostic tests for neurologic disease in pregnancy.
4. Counsel pregnant patients regarding the impact of pregnancy on neurologic disease and the impact of the disease on pregnancy.
5. Develop, in consultation with other specialists, a comprehensive plan for the perinatal management of patients with neurologic disease.
H. Endocrine disorders (excluding diabetes mellitus)
1. Perform a focused history and physical examination in pregnant patients with known or suspected endocrine disease.
2. Describe the indications for common diagnostic tests for endocrine disease, such as:
a. Thyroid function tests
b. Adrenal function tests
c. Pituitary function tests
d. Parathyroid function tests
e. Imaging studies
3. Interpret the results of common diagnostic tests for endocrine disease in pregnancy.
4. Counsel patients about the impact of endocrine disease and its treatment on pregnancy and the impact of pregnancy on the endocrine disorder.
5. In consultation with other specialists, develop a comprehensive plan for the perinatal management of patients with an endocrine disorder.
I. Collagen vascular disorders
1. Perform a focused history and physical examination in pregnant patients with known or suspected collagen vascular disease.
2. Describe the indications for common diagnostic tests for collagen vascular disease in pregnancy, such as:
a. Serologic tests for rheumatoid factor
b. Anti-DNA antibodies
c. Antinuclear antibodies
d. Lupus anticoagulant
e. Anticardiolipin antibodies
3. Interpret the results of common diagnostic tests for collagen vascular disease in pregnancy.
4. Counsel patients about the impact of collagen vascular disease and its treatment on pregnancy and the impact of pregnancy on collagen vascular disease.
5. Develop, in consultation with other specialists, a comprehensive plan for the perinatal management of patients with collagen vascular disease.
J. Psychiatric disorders
1. Perform a mental status examination.
2. Describe the symptoms of common psychiatric disorders in pregnancy, such as:
a. Affective disorders
b. Anxiety disorders
c. Psychosis
d. Somatization disorders
e. Eating disorders
3. Assess the risk of psychiatric disorders and the safety of psychiatric medications in the patient and her fetus.
4. Identify patients who require referral for psychiatric consultation.
K. Emergency care during pregnancy
1. Perform a diagnostic history and physical examination in pregnant patients with a medical or surgical emergency.
2. Order and interpret diagnostic tests, such as CT or MRI scan, lumbar puncture, and X-rays, to assess for adverse effects of emergency conditions on the developing pregnancy.
3. Initiate therapy, in consultation as necessary, and describe the impact of the condition and its management on the pregnancy as well as the impact of the pregnancy on the emergent condition.
4. Describe the timing of delivery in obstetric patients with emergent conditions.
L. Substance abuse in pregnancy
1. describe behavior patterns suggestive of substance abuse.
2. Perform a thorough history and physical examination in patients suspected of substance abuse in pregnancy.
3. Counsel patients about the impact of substance abuse on the fetus/neonate.
4. Assess the fetus for adverse effects of substance abuse, such as congenital anomalies or growth restriction.
5. Diagnose and manage drug overdose and drug withdrawal in pregnant patients.
6. Refer patients with known or suspected substance abuse for counseling and follow-up.
M. Multiple gestation
1. Describe the factors that predispose to multiple gestation.
2. Describe the physical findings suggestive of multiple gestation.
3. Confirm the diagnosis of multiple gestation by performing an endovaginal or abdominal ultrasound examination.
4. Understand the medical rationale for selective fetal reduction in higher order multiple gestation.
5. Describe, diagnose, and manage the maternal and fetal complications associated with multiple gestation.
6. Perform tests to assess the general well-being of the fetuses of a multiple gestation
N. Isoimmunization and alloimmune thrombocytopenia
1. Describe the major antigen-antibody reactions that result in red cell isoimmunization or thrombocytopenia.
2. Interpret antibody titer assays.
3. Describe the appropriate indications for determination of paternal antigen status.
4. Describe the indications for amniocentesis for assessment of amniotic fluid optical density and determination of fetal blood type.
5. Describe the performance of amniocentesis at appropriate intervals to assess patients with isoimmunization.
6. Detect signs of fetal anemia on ultrasound examination.
7. Describe the indications for cordocentesis in assessment of the fetus with red cell isoimmunization or thrombocytopenia.
8. Describe the indications for, and complications of, intrauterine fetal transfusion:
a. Intraperitoneal transfusion
b. Intravascular transfusion
9. Determine the appropriate time and method of delivery for the isoimmunized fetus.
10. Describe the short- and long-term prognosis for infants with red cell isoimmunization or thrombocytopenia.
11. Counsel patients regarding the recurrence risk for isoimmunization and thrombocytopenia.
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