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:

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

Similar table would need to be made for each module Ultra Sonographic Competencies:

List of Ultrasound guided invasive procedures:

Number of Procedures Performed During the Training: