Training in the management of critical problems: teacher's view.
Teaching in critical obstetric problems should have special interest during residency and thereafter. Obstetric emergencies are relatively rare but may occur at any time. The obstetrician at that moment enters a special area requiring a multidisciplinary approach. From experiences in recent years and study of the literature the following recommendations can be summarized; (1) the need to understand (patho)physiologic changes in pregnancy, (2) cultivation of an anticipative attitude towards conditions with elevated risks, (3) adequate knowledge of diagnostic procedures, (4) the discipline to make a differential diagnosis, (5) experience with monitoring of (fetal and) maternal condition, (6) availability of management protocols for emergencies such as shock, eclampsia, uterine rupture, amniotic fluid embolism, thrombo-embolism, sepsis and diabetic ketoacidosis, (7) awareness of pitfalls with inspection of lesions and assessment of blood loss, (8) awareness that caesarean section without prior stabilization can be a life threatening procedure, (9) practice in life-saving measures such as uterine compression, packing, ligation of vessels, postpartum hysterectomy, (10) teaching of postoperative care, (11) insight into the cascade of events finally leading to multi-organ failure. Obstetric emergencies require a disciplined approach, in which teamwork is the cornerstone.
van Geijn
H P
HP
Department of Obstetrics and Gynecology, Free University Hospital, De Boelelaan 117, Amsterdam, The Netherlands.
Vothknecht
S
S
D004635:Emergency Medicine; D005260:Female; D006801:Humans; D007396:Internship and Residency; D009426:Netherlands; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D013663:Teaching