FNB Maternal and Foetal Medicine: Check out NBE released Curriculum
The National Board of Examinations (NBE) has released the curriculum for FNB Maternal and Foetal Medicine.
I. TEACHING AND TRAINING ACTIVITIES:
Institutional Teaching Programme over 2 years should cover complete curriculum. In addition to clinical work and postings, following format (minimum no of sessions) is recommended.
1. Multidisciplinary Case discussion
i. Maternal Medicine - 10
ii. Fetal Medicine - 5
2. Basic Sciences Lectures - 5
3. Seminars - 6
4. Journals Clubs - 4
5. CTG meetings - 6
6. Clinical Audits - 2
7. Grand Rounds - 20
8. Clinical Risk Management - 1 each per candidate
9. Maternal Mortality Review - 1 each per candidate
10. Perinatal Mortality Review - 1 each per candidate
In addition to these FNB classes, FNB students should also attend relevant PG classes in the institution.
Research Project
Candidate must carry out a research project under the guidance of designated teacher and write a project report of 50 pages which should be targeted to learn research methodology followed by presentation / publication.
Timeline for Project:
Topic Allocation - 1st 6 months
Project Completion – 6 months prior to completion of tenure
Project report of 50 pages to be submitted along with the logbook at the time of exam.
20 marks of logbook may be divided into 15 marks for logbook + 5 marks for research project.
He/ she would also be given opportunity to take part in the research projects going on in the departments to learn their planning, methodology and execution so as to learn various aspects of research.
II. SYLLABUS:
Curriculum will be covered under following modules. This is indicative and not limited only to following the modules.
Skills for counselling the patient and her family, taking of informed consent from the patient, being available to answer questions especially in an unexpected situation must be part of training for ALL modules. Counselling skills must include preconception care and counselling where required/ indicated.
Details of Modules:
Module 1: Maternal Medicine
Module 2: Antenatal Complications
Module 3: Intrapartum Care
Module 4: Postnatal care
Module 5: Fetal Medicine
Module 6: Genetics
Module 7: Neonatal Care: Medical & Surgical
Module 8: Miscellaneous
1. Module 1: Maternal Medicine:
The pathophysiology, presentation and implications for maternal and/ or fetal health of common maternal conditions present at booking or that may occur during pregnancy. Effect of pregnancy on the medical conditions, impact of treatment on mother and fetus.
Topics:
Detailed knowledge of following:
i. Hypertension [HT]-chronic HT, preeclampsia, eclampsia, others
ii. Renal Disease-Chronic Kidney disease, Acute Renal Injury/ failure, Others
iii. Cardiac Disease - congenital Heart Disease [corrected, uncorrected], Rheumatic Heart Disease [Operated, unoperated], Postpartum Cardiomyopathy.
iv. Hepatic Disorders, Obstetric Cholestasis, Acute fatty liver of pregnancy, Hepatitis, Preexisting liver disease, Others.
v. Gastrointestinal Disease-Preexisting GI disease, Hyper emesis Gravid arum, Appendicitis, others
vi. Respiratory problems – Bronchial asthma, Influenza etc.
vii. Neurology-seizure disorders, Migraine, ICSOL, CVA, Others
viii. Autoimmune/Connective Tissue Disease-SLE, APS, Others
ix. Hematological-Anemia, Haemoglobinopathies, Thrombocytopenia, Others
x. Thromboembolic Disease-Previous VTE, Thrombophilia [with and without previous VTE], Acute DVT, Pulmonary embolism, Others
xi. Psychiatric Disease- Post natal depression, Puerperal psychosis, Maniac depressive disorders, Addictions
xii. Legal and Medico legal issues, Others
xiii. Diabetes-Gestational diabetes mellitus, Type I DM, Type II DM, Others
xiv. Other Endocrinological Diseases-Thyroid disorders [Hypothyroidism, Hyperthyroidism], Phaeochromocytoma
xv. Pregnancy after ART
xvi. Skin diseases in pregnancy
xvii. Substance Abuse-Smoking/ Tobacco/ Alcohol, Others
xviii. Neoplastic diseases -Before/ During pregnancy
xix. Infections –Tuberculosis, HIV, Hepatitis, Other Viral Infections, Urinary Tract Infections, Pulmonary infections, Genital tract infections, vector borne diseases [Malaria, dengue], Covid and other new/ unusual infections, H1N1, etc.
xx. Acute Abdomen and other surgical problems during pregnancy – acute appendicitis, Cholecystitis, SAIO etc.
xxi. Pregnancy after special surgery- post transplant, Bariatric surgery etc.
xxii. Domestic violence, mental health issues etc.
xxiii. Vaccination in pregnancy
xxiv. Critical care obstetrics
Competencies / Skills
[Mandatory / Must Know]
i. Drugs/ Prescribing in Pregnancy
ii. Risk/ Severity Scoring of various types
iii. Patient Evaluation / Stabilization of the High Risk Parturient
iv. Maternal and Fetal Surveillance in High Risk Pregnancies
v. Planning and Conduct of delivery in these cases
vi. Fluid and Electrolyte management
vii. Near- miss morbidity and scoring systems for prediction
viii. Maternal death, Review and audit
[Desirable / Good to know]
i. ABG Interpretation
ii. ECG Interpretation
iii. Chest X-Ray interpretation
iv. Insertion of CVP line
2. Module 2: Antenatal Complications:
Topics
i. Miscarriages / Fetal death - Recurrent early pregnancy losses [RPL], - diagnosis, investigations and management. Intrauterine death, Ectopic pregnancy, Trophoblastic diseases, Cervical incompetence, Septic abortion, others
ii. Antepartum haemorrhage- Placental abruption, Placenta Previa, PAS disorders
iii. Preterm Birth-Prior history of preterm/PROM, Preterm labor, PROM [< 24, weeks,>24 Weeks], Elective preterm delivery, diagnosis, management, prediction and prevention
iv. Multiple pregnancy - Complications, Single fetal demise, Co- twin demise after 12 weeks, Malpresentation, Delivery planning, Higher order multiple pregnancies.
v. Breech presentation at term/ other Malpresentation
vi. Postdate pregnancy
vii. Pregnancy with previous CS
viii. Polyhydramnios
ix. Abdominal/ Gynecological Problems-Acute abdomen, Ovarian mass, Fibroid uterus, Others
Competencies / Skills
i. Ultrasonography
[Mandatory / Must Know]
i. First trimester scan: CRL, Chorion city, NT measurement, NB and other gross abnormalities
ii. Anomaly scan in detail
iii. Doppler Studies-Uterine, umbilical, Middle cerebral artery, Ductus venosus Doppler,
iv. Screening for preterm birth – Measurement of cervical length
v. Growth scan and comparison with other standards
vi. Biophysical profile
vii. Ultrasound assessment of placental site (TVS)
viii. Morbid adherence of Placenta
ix. Cervical Cerclage – Elective
x. External Cephalic version
[Desirable / Good to know]
i. Doppler’s of other vessels
ii. Cervical Cerclage – Rescue, Abdominal
3. Module 3: Intrapartum Care Topics
i. Normal labour and partogram (All types)
ii. Intrapartum fetal monitoring
iii. Failure to Progress-First stage of labour, Second stage of labour
iv. TOLAC
v. Multiple pregnancy
vi. Malpresentation- Breech labour and delivery, Transverse lie
vii. Shoulder Dystocia-Prior history of shoulder dystocia, Shoulder dystocia
viii. Instrumental delivery- Forceps/ vacuum
ix. Prevention and management of PPH- Massive PPH [with/Without laparotomy], Balloon tamponade, UAE, DIC etc.
x. Genital tract Trauma-Prior history of 3rd/4th degree perineal tear, Diagnosis and repair of OASI, Uterine scar rupture, Others
xi. Caesearean Section, Cesarean hysterectomy, PAS disorders
xii. Anaesthesia/Analgesia- Assessment and Counselling high risk case
xiii. Maternal Collapse-Massive hemorrhage, Amniotic fluid embolism, Cerebrovascular accidents, septic shock
xiv. Assessment, transfer and management of critically Ill woman in HDU/ICU
Competencies and skills
[Mandatory / Must Know]
i. CTG interpretation
ii. Plotting and interpretation of partogram
iii. Digital Fetal scalp stimulation test
iv. Cesarean section- all types including repair of scar rupture
v. Versions-External cephalic
vi. Assisted vaginal delivery- Forceps/ vacuum/ breech/twin vaginal delivery
vii. Managing shoulder dystocia
viii. Repair of OASI
ix. Surgical management of PPH, genital trauma
x. Massive transfusion protocols
xi. ICU management including fluid and electrolyte management, ABG interpretation
[Desirable / Good to know]
i. Vibroacoustic stimulation test
ii. Cesarean hysterectomy for PPH, PAS etc.
iii. Use of different postures for birthing, Water birth
iv. Internal podalic version
v. ICU management - Intubation for mother and neonate, Knowledge of ventilator settings etc.
vi. Labour analgesia techniques
vii. Cephalocentesis / craniotomy
4. Module 4: Postnatal care Topics
i. Routine postnatal care
ii. Complications of puerperium
iii. Lactation – Physiology, Method, Problems, Solutions
iv. Contraception and Pregnancy termination– especially for high risk cases
v. Postpartum depression
Competencies and skills
[Mandatory / Must Know]
i. Ideal position for breast feeding
ii. Clinical Diagnosis and Management of common complications
iii. Contraceptive counselling pertinent to a case
5. Module 5: Fetal Medicine Topics
i. Embryology – normal and development of fetal abnormalities
ii. Normal fetal behavior and activity and its abnormalities
iii. Fetal circulation and adaptation at birth
iv. Management of pregnancies complicated by fetal abnormalities of various organ systems
v. Offer prenatal tests, liase with multidisciplinary team for care, and make a plan for management, and counsel about pregnancy and long term outcome. Make a genetic referral and its justification.
vi. PCPNDT Act
vii. Occurrence, Diagnosis, Management, Prognostication etc. of Anomalies listed below:
a. CNS Anomalies-Anencephaly, Spina bifida, Venticulomegaly, Dandy walker malformations/variant, Holoprosencephaly, Others
b. Cardiac: ASD, VSD, Hypoplastic right and left heart, TOF etc Anomalies of various chambers, Outflow tract abnormalities, Arrhythmias, Others
c. Renal Anomalies-Renal agenesis, Hydronephrosis, Polycystic Kidney (AR/AD), Megacystis/LUTO, Others
d. Pulmonary abnormalities-CCAM, Diaphragmatic hernia, Others
e. Face & Neck Anomalies-Cystic hygroma, Facial cleft, Others
f. Abdominal wall & gastrointestinal anomalies-Gastroschisis, Exomphalos, Others
g. Skeletal anomalies-Talipes, Skeletal dysplasias, Others
viii. Assessment of fetal growth & growth abnormalities
ix. Pregnancy complicated by red cell allo- immunization – diagnosis of fetal anemia, interpretation of MCA Doppler, IUT, Delivery
x. Hydrops – Nonimmune: Causes, investigations, management, counselling, plan for pregnancy management
xi. Multiple pregnancy- Establishing chorion city, Antenatal and Intrapartum care, Growth problems in twins. Complications of monochromic twins – TTTS, sFGR, TAPS and TRAP – diagnosis, follow up and management
xii. Fetal Infections-TORCH, Parvovirus, others – Interpret lab tests, Explain fetal and newborn effects on infection, prenatal diagnosis and management
xiii. Liquor Abnormalities-Oligo / Polyhydramnios
xiv. Prenatal fetal therapy
Competencies & Skills
[Mandatory / Must Know]
h. Multifetal pregnancy- Detect, monitor a twin pregnancy, Manage pregnancy with growth problems
iii. Care for woman with red cell all immunization – Monitoring for fetal anemia, Intrauterine transfusion, Delivery, Postnatal Management etc.
iv. USG for normal fetal anatomy and diagnosis of fetal anomalies of fetal CNS, Face and Neck, Thorax, CVS, abdominal wall and GIT, UGT, Fetal skeleton and extremities[TIFFA]
v. Able to use USG in pregnancy – optimize image, appropriate Doppler
vi. USG for fetal growth, recognize and manage early and late onset FGR
vii. Counselling for prenatal invasive procedures, Prerequisites, Procedures, Post procedure care and follow up
a. Mniocentesis
b. Chorion villus sampling
c. Cordocentesis
viii. Diagnose abnormalities of liquor, Amnioreduction
ix. Counselling for termination of pregnancy for fetal anomalies
x. Prognostication of the anomalous fetus
xi. Communication skills- Breaking bad news
xii. Preconception counseling for cases whose last pregnancy affected by any of above
xiii. Counselling for Neonatal Surgery-Abdominal wall defect, Diaphragmatic hernia, Bowel atresia, Spina bifida, others
xiv. Workup of previous/ unexplained stillbirth
xv. Coordination with Paediatric Physician/ Surgeon for postnatal management
[Desirable / Good to know]
i. Monochorionic twins: TTTS, sFGR, TRAP – Diagnosis, Management, Prognosis etc.
ii. Exchange transfusion
iii. Advanced USG – Fetal Echocardiography, Neuroanatomy etc. as per ISUOG guidelines
iv. Selective fetal reduction in dichorionic twins and vasoocclusive techniques in MC twins
v. Fetal pathology and Fetal autopsy
vi. Fetal red cell intravascular/ intraperitoneal transfusion
6. Module 6: Genetics
Topics
j. Normal chromosome structure and function. Gene structure and function
i. Patterns of genetic inheritance and susceptibility
ii. Types of aneuploidy, including structural rearrangements, Deletions, Trisomies, Sex-chromosome abnormality etc.
iii. Genetic etiology of single gene disorders, with reference to common disorders: Hemoglobinopathies and Bleeding disorders, Inborn errors of metabolism, Muscular dystrophy
iv. Knowledge of common syndromes and associations: e.g. Meckel-Gruber, Beckwith-Wiedmann, DiGeorge etc.
v. Pre and postnatal phenotypes of common aneuploidies, Single gene disorders, Syndromes
vi. Methods of screening of aneuploidy including – USG, biochemical, Non- invasive.
vii. Understand terms relevant to screening, Sensitivity, Specificity, False positive, False negative, LR.
viii. Invasive tests – amniocentesis, CVS, FBS
ix. Molecular basis and Laboratory techniques for analyzing parental and fetal samples, including PCR, FISH, Karyotyping, microarray, Mutational analysis, Next Generation Sequencing (NGS)
x. Chromosomal Anomalies-Previous history/family history/ affected fetus
xi. Genetic anomalies - Previous/family history/current pregnancy
xii. Syndromic anomalies - Previous/family history/current pregnancy
xiii. Index child workup
xiv. Modes of Inheritance
xv. Preimplantation Genetic Diagnosis [PGD]
Competencies & Skills
[Mandatory / Must Know]
i. Ultrasound screen for aneuploidy 11-13+6 weeks’ scan – measurement of CRL, NT, NB, DV, TR, identification of gross structural anomaly
ii. Genetic counselling – Pedigree charting
iii. Interpretation of screening test and further management of abnormal test
iv. Pregnancy at risk / affected by aneuploidy – take history, arrange parental and prenatal investigations, counsel regarding risk, screening and testing options, genetic consultation if needed.
v. Pregnancy at risk / affected by single gene disorder – take history, make family tree, Parental investigations, communicate risk, Screening and testing options, Referral for genetic consultation.
vi. Diagnosis and management of genetic and syndromic disorders
vii. Biochemical screening, molecular, cytogenetic tests for prenatal diagnostic investigations- interpretation and communication of test results and appropriate multidisciplinary consultation.
viii. Fetal autopsy – Counselling, Indications, Technique
[Desirable / Good to know]
i. Lab knowledge of molecular testing
ii. Conducting / Performing fetal autopsy
7. Module 7: Neonatal Care: Medical & Surgical
Topics
i. Characteristics of healthy neonate
ii. Neonatal resuscitation
iii. Birth asphyxia
iv. Meconium aspiration syndrome
v. Birth trauma
vi. Small for gestational age
vii. Neonatal jaundice
viii. Assessment of Newborn
a. Newborn resuscitation
b. Newborn screening
c. Newborn with gross congenital anomaly
d. Evaluation and Management of Antenatally diagnosed structural anomaly
e. Birth trauma
f. Cord Blood ABG
g. Others
Competencies & Skills
[Mandatory / Must Know]
i. Essential care of Newborn including resuscitation
ii. Palade feeding
iii. Kangaroo mother care
iv. Gestational age assessment postnatally (Ballard scoring)
v. Growth evaluation- Ponderal index etc.
[Desirable / Good to know]
i. Sick newborn care
ii. Cord and IV cannulation
8. Module 8: Miscellaneous
Topics
i. Dietary recommendation in pregnancy
ii. Modification of diet in special condition e.g. diabetes in pregnancy
iii. Exercise in normal pregnancy
iv. Modifications of Exercise routine and dietary counselling for special cases e.g. Hypertension, Obesity, Renal and Hepatic disorders
v. Non-conventional methods of pain relief in labor- Hypnotherapy, Meditation, Yoga and other traditional methods
III. LOG BOOK:
1. Log Book should be simple.
i. Log book is mandatory.
ii. In the absence of production of log book, the result will not be declared.
iii. Should not exceed 120 pages in total
2. List of following is to be included
i. Departmental presentations:
a. Clinical Audits
b. Seminars
c. Journals Club
d. Case presentations
e. Quality improvement processes
f. Research project summary- two pages
ii. Scientific meeting and courses attended by the fellow
iii. Papers presented at scientific meetings
iv. Published papers
Log book should be maintained module wise. It should reflect both case mix seen and details of few special cases in which student participated. Details of few interesting cases especially those managed by student in each module may be elaborated.
Suggested format is presented below:
S.no. | Name | Age | CR no. | DOA | DOD | Diagnosis | Faculty Signature |
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For more details, the following format can be followed: Adapted from European Association of Perinatal Medicine (EAPM)/ European Board College of Obstetrics and Gynecology (EBCOG).
Suggested summary at the end of each module can be on following lines:
3. Evaluation of Clinical Skills: Scoring System:
i. Passive attendance, assistance
ii. Needs close supervision
iii. Able to carry out procedure under some supervision
iv. Able to carry out procedure without supervision
v. Able to supervise and teach the procedure
The general aim is to get at least mark 4.
Module-1: Diagnosis and management of medical and surgical complications of pregnancy
Target | Expected competence level Fellow ticks when achieved | Trainer sign when competence level achieved | |||||
Hypertension | 1 | 2 | 3 | 4 | 5 | Sign | Date |
Kidney diseases | |||||||
Heart diseases | |||||||
Liver diseases | |||||||
Fluid balance and transfusion | |||||||
Diabetes | |||||||
Other endocrine disorders | |||||||
Gastrointestinal diseases | |||||||
Differential diagnosis of abdominal pain | |||||||
Lungs diseases | |||||||
Auto-immune,Haematological diseases | |||||||
CNS diseases | |||||||
Cancers | |||||||
Psychiatric disorders | |||||||
Infectious , parasitic diseases |
Similar table would need to be made for each module Ultra Sonographic Competencies:
Target Perform ultrasound scan to assess: | Expected competence level Fellow ticks when achieved | Trainer sign when competence level achieved | |||||
1 | 2 | 3 | 4 | 5 | Sign | Date | |
Biometry to assess gestational age and fetal growth | |||||||
Anomaly scanning (morphology) | |||||||
Biophysical profile | |||||||
Doppler ultrasound blood velocity scanning of all the major vessels of the fetus and placenta | |||||||
Alternative imaging technique like MRI |
List of Ultrasound guided invasive procedures:
Target | Expected competence level Fellow ticks when achieved | Trainer sign when competence level achieved | |||||
1 | 2 | 3 | 4 | 5 | Sign | Date | |
Amniocentesis | |||||||
CVS | |||||||
Fetal blood sampling | |||||||
Fetal blood transfusion | |||||||
Feto-amniotic shunting | |||||||
Other invasisve procedures (specify) |
Number of Procedures Performed During the Training:
PROCEDURES | Number Performed |
Caesarean section < 32 weeks | |
Caesarean hysterectomy | |
Cervical cerclage | |
External cephalic version | |
Operative vaginal delivery | |
Technique for control of haemorrhage | |
Management of postpartum and Postoperative complications | |
Medical and surgical first and second trimester abortion | |
Embryo reduction | |
Ultrasound guided ovarian cyst Aspiration during pregnancy | |
Amniocentesis | |
Cvs | |
Fetal blood sampling | |
Fetal blood transfusion | |
Feto-amniotic shunting | |
Other fetal invasive procedures (specify) |
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