The Pathology in Labour, Birth and Puerperium

Midwifery care in pathology of pregnancy
Assessment of fetal well-being
Midwifery care in multiple pregnancy
Hemodynamic monitoring of cardiovascular disease in pregnancy
Midwifery care of kidney disease and urinary infections in pregnancy
Midwifery care of epileptic seizures in pregnancy
Midwifery care of cerebrovascular disease in pregnancy
Midwifery care of miscarriage
Hyperemesis
Midwifery care of gastrointestinal disease in pregnancy
Midwifery care of ectopic pregnancy
Emergency/urgency case management
Midwifery care of risk of premature birth
Midwifery care of pre-eclampsia
Midwifery care of diabetes in pregnancy

Anticoagulants
Antianemic
Antibacterial
Antiviral, antifungalsci e antiprotozoy
Antiacids
Antiulcer
Antiemetics, antihistamines
Thyroid and antithyroid hormones
Hypotalamic and pituitary hormones
Diabetes therapy
Uterotonic and tocolytic drugs
Fans, corticosteroids, asthma
Anticonvulsants
Antihypertensive

Perinatal problems and care in the child of a diabetic mother and with thyroid disease.
Perinatal problems and care in the case of multiple pregnancy.
Newborn with intrauterine growth retardation (IUGR): definition, anatomical and physiological characteristics; care for the newborn with intrauterine growth retardation.
Preterm newborn:
- Definition
- Classification based on weight and E.G.
- Perinatal problems and care for the preterm newborn:
o Thermoregulation
o Respiratory problems (Hyaline Membrane Disease, respiratory instability of the preterm newborn, differential diagnoses)
o Cardiocirculatory problems
o Metabolic problems
o Neurological problems
o Infectious problems
o Feeding problems
o Prognosis and follow-up

Resuscitation of the preterm newborn; management of the umbilical cord at birth in preterm birth.
Congenital infections
Pathogenesis of hemolytic disease of the newborn due to ABO and Rh incompatibility: clinical picture; main diagnostic tests and therapeutic measures.
Malformative pathology of the respiratory system. Diaphragmatic hernia.
Malformative pathologies of the upper airways: lymphangioma and teratoma of the neck, laryngeal and tracheal atresia.

Benign gynecological diseases
Menstrual cycle disorders (amenorrhea, irregularities, bleeding, premenstrual syndrome)
Cervical polyps and endometrial
Fibroids
Endometriosis/Adenomyosis
Ovarian cysts: functional (luteal and follicular), cystadenomas (serous and mucinous), dermoid cysts
Polycystic ovary syndrome (PCO)
Pelvic static diseases: prolapses and incontinence (stress, mixed, urgency)
Malaformations of the female genital system
Gynecological infections (vaginal, pelvic, sexually transmitted)
Malignant gynecological diseases
Carcinomas: of the vulva, vagina, cervix, endometrium, ovary, fallopian tubes
Sarcomas
Mole vesicularis, choriocarcinoma and other tumors in pregnancy
The main benign breast diseases
Tumors malignant breast cancer

Midwifery care in pathology of pregnancy
Assessment of fetal well-being
Midwifery care in multiple pregnancy
Hemodynamic monitoring of cardiovascular disease in pregnancy
Midwifery care of kidney disease and urinary infections in pregnancy
Midwifery care of epileptic seizures in pregnancy
Midwifery care of cerebrovascular disease in pregnancy
Midwifery care of miscarriage
Hyperemesis
Midwifery care of gastrointestinal disease in pregnancy
Midwifery care of ectopic pregnancy
Emergency/urgency case management
Midwifery care of risk of premature birth
Midwifery care of pre-eclampsia
Midwifery care of diabetes in pregnancy

Midwifery care in pathology of pregnancy
Assessment of fetal well-being
Midwifery care in multiple pregnancy
Hemodynamic monitoring of cardiovascular disease in pregnancy
Midwifery care of kidney disease and urinary infections in pregnancy
Midwifery care of epileptic seizures in pregnancy
Midwifery care of cerebrovascular disease in pregnancy
Midwifery care of miscarriage
Hyperemesis
Midwifery care of gastrointestinal disease in pregnancy
Midwifery care of ectopic pregnancy
Emergency/urgency case management
Midwifery care of risk of premature birth
Midwifery care of pre-eclampsia
Midwifery care of diabetes in pregnancy

Anticoagulants
Antianemic
Antibacterial
Antiviral, antifungalsci e antiprotozoy
Antiacids
Antiulcer
Antiemetics, antihistamines
Thyroid and antithyroid hormones
Hypotalamic and pituitary hormones
Diabetes therapy
Uterotonic and tocolytic drugs
Fans, corticosteroids, asthma
Anticonvulsants
Antihypertensive

REGULATIONS, MIDWIFERY CARE MODELS
- Midwifery Profession: intellectual profession
- European and Italian regulations: midwife's skills, responsibilities and autonomy for pregnancy care, pregnancy test prescription, midwife's recipe book
- Italian guidelines and WHO recommendations on the quality of prenatal care for a positive pregnancy experience
- Pregnancy care models: medical-led model, shared-led model, midwife-led continuity model of care
- WHO definition of obstetric risk, risk-based care, dynamic concept of risk and reassessment of obstetric risk
- The BRO model of Low Obstetric Risk Care, personalized, centered on the specific needs of the pregnant woman and on continuity of care: decrees, laws and tools

MIDWIFE'S APPROACH TO PHYSIOLOGICAL PREGNANCY
- The midwife and communication
- The transfer of power from the midwife to the woman: empowerment, valorization of knowledge and activation of the skills of the woman and the parental couple
- Midwife-woman relationship and therapeutic alliance, sharing of responsibilities
- The midwife as a facilitator of the pregnancy process through the promotion of the psycho-physical health of the woman
- Protection of physiology: concept of physiology and health understood as dynamic adaptive balance to the external and internal environment
- The three trimesters of pregnancy or endogestation: characteristics and correspondences with the three periods of childbirth and with the three trimesters of exogestation (communication, interaction, mother/infant bond)
- The father: emotions, role, prenatal bond with the unborn child
- Analysis of fetal development: the development of sensory organs (touch, smell, taste, hearing, sight), fetal skills and the importance of prenatal bonding, the first extrauterine experience.

PREGNANCY HYGIENE, SIGNS OF PREGNANCY and birth support meetings (IAN)
- Pregnancy hygiene: diet and nutrition, main food poisonings, alcohol and effects on the fetus, binge drinking
- Lifestyles: the states of change, Prochaska-Di Clemente cycle, smoke-free mothers program
- Signs of pregnancy, certain and uncertain signs, signs of probability and presumption
- Changes in the maternal microbiota during pregnancy: breasts, intestine and uterus
- Breast anatomy and breast changes during pregnancy, accessory breast tissue, supernumerary nipples
- Stages of lactation: when breastfeeding begins, how the midwife can promote breastfeeding during pregnancy, filling out the UNICEF prenatal checklist
- Birth support meetings: breathing, relaxation and visualizations, UNICEF mother-friendly care, IAN and paternity
- How to deal with "disorders" of the pregnancy: the midwife's approach to minor pregnancy disorders: recommended exercises for the well-being of the perineum, circulation, spine, pelvis, lower limbs
- Perineal and pelvic floor care during pregnancy, prevention and reduction of the risk of perineal damage, perineal massage and pelvic floor exercises, postpartum gymnastics
- optimal positioning of the fetus (POF): how to promote anterior positions in the third trimester of pregnancy, nutation and counter-nutation: bodywork and exercises to promote the mobility of the maternal pelvis

OBSTETRIC OBJECTIVE EXAMINATION
Introduction to the Obstetric Objective Examination:
- first stage: anamnesis, lifestyles, nutrition, support network, measurement of maternal body weight, calculation of BMI, recommended weight gain during pregnancy
- second stage, inspection: spine, assessment of mobility, degree of inclination and morphology of the pelvis, breasts, external pelvimetry, assessment of the upper strait by measuring the external diameters of the pelvis
- third stage, palpation: measurement symphysis-fundus and fetal growth curves, Leopold maneuvers, obstetric diagnosis of: fetal development and uterine growth, situation, presentation, position, level of the presenting part and fetal-pelvic ratio, fetal weight estimation: Johnson's rule
- fourth time, auscultation: Pinard stethoscope and ultrasound, abdominal quadrants and focus of maximum intensity in different fetal positions
- fifth time, vaginal exploration: ask permission, internal pelvimetry, evaluation of the pelvic cavity, middle strait and lower strait
- sixth time, execution of first level diagnostic tests: the eco office

BIRTH PATH AGENDA, MATERNAL-FETAL WELL-BEING ASSESSMENT
- Pre-conceptional health assessment: medical history, anemia and hemoglobinopathies screening, nutritional and lifestyle counseling, recommended tests, recommendations on pre-pregnancy folic acid intake
- First prenatal obstetric health assessment: welcoming the pregnant woman, information on care conduct, performing the obstetric examination and diagnosis of maternal-fetal well-being
- Criteria for assigning the obstetric care model: physiological birth path with obstetric management, birth path with medical-specialist management in collaboration with the midwife
- PAI or individual care plan: pregnancy care plan (physiological)
- Methods and times of performing the objective obstetric examination in the various stages of pregnancy: clinical assessment and emotional-relational assessment of the pregnant woman
- Signs of health of the mother and fetus: interpretation of physical maternal changes general and local, vital parameters, weight gain, fetal growth estimate, symphysis-fundus measurement, BCF, MAF, laboratory tests and instrumental investigations in the different trimesters of pregnancy, obstetric diagnosis
- Full-term pregnancy clinic: maternal-fetal well-being check-up at the end of pregnancy, birth plan, birth locations
- Annotation on the obstetric record of the birth path agenda of all information and findings relating to the course of the pregnancy.
- Evaluation of the effectiveness of the services provided and the satisfaction of the woman/couple with the care provided by the midwife
- Technical and communicative aspects of conducting a meeting/interview

Elements of perinatal obstetric care
The primary maternal concern
Difference, meaning and results of screening tests and diagnostic tests
National and international guidelines
The awareness of the midwife on her/his own methods of:
- Communication
- Anamnesis
- Interview on the chosen test
- Informed consent
The relationship between the healthcare professional/woman and/or couple
- Is a non-directive interview possible?
- Accompaniment to the decision-making process
Exercises and group work

Care process of the midwife during the diagnostic procedure:
- Role of the midwife in the Prenatal Diagnosis (DP) team
Introduction to care in the operating room of prenatal diagnosis (preparing the sterile table and instruments)
- Chorionic villus sampling
- Amniocentesis
Communicating the result
- The normal diagnosis
- The doubtful diagnosis and the need for further investigations
- Post-amniocentesis or post-CVS abortion
- Collection of follow-up and archiving

Combined Test, scientific foundations, role of the midwife from the interview to the delivery of the result

NIPT (cfDNA), national guidelines and Welfare decree of the Lombardy Region n. 10383; role of the midwife from the interview to the delivery of the results

Why the midwife must know what Prenatal Diagnosis is:
- Code of ethics (FNCO June 2010)
- Professional profile (DM 740/1994)
- LEA 18/3/17, annex 10 C concerns prenatal diagnosis
- What is done in DP: invasive, diagnostic and therapeutic prenatal diagnosis
- Non-invasive prenatal diagnosis: where it starts, aims, limits
- Interview: techniques to collect all the information needed and the mistakes to avoid
- What is fetal therapy: risks and benefits, planning of an intervention (even just PSF or IUFT) and the skills of the midwife

Information and preparation meeting for prenatal diagnosis: the example of the Mangiagalli Clinic where a group meeting with couples is held, and of other hospitals where individual or group meetings are held couple with the interested parties

Benign gynecological diseases
Menstrual cycle disorders (amenorrhea, irregularities, bleeding, premenstrual syndrome)
Cervical polyps and endometrial
Fibroids
Endometriosis/Adenomyosis
Ovarian cysts: functional (luteal and follicular), cystadenomas (serous and mucinous), dermoid cysts
Polycystic ovary syndrome (PCO)
Pelvic static diseases: prolapses and incontinence (stress, mixed, urgency)
Malaformations of the female genital system
Gynecological infections (vaginal, pelvic, sexually transmitted)
Malignant gynecological diseases
Carcinomas: of the vulva, vagina, cervix, endometrium, ovary, fallopian tubes
Sarcomas
Mole vesicularis, choriocarcinoma and other tumors in pregnancy
The main benign breast diseases
Tumors malignant breast cancer

Midwifery care in pathology of pregnancy
Assessment of fetal well-being
Midwifery care in multiple pregnancy
Hemodynamic monitoring of cardiovascular disease in pregnancy
Midwifery care of kidney disease and urinary infections in pregnancy
Midwifery care of epileptic seizures in pregnancy
Midwifery care of cerebrovascular disease in pregnancy
Midwifery care of miscarriage
Hyperemesis
Midwifery care of gastrointestinal disease in pregnancy
Midwifery care of ectopic pregnancy
Emergency/urgency case management
Midwifery care of risk of premature birth
Midwifery care of pre-eclampsia
Midwifery care of diabetes in pregnancy