Midwifery - Roma Azienda Ospedaliera Sant’Andrea

Activity type

Scienze ostetriche

SSD

MED/47

Year

N/D

Semester

N/D

CFU

1

Hours distribution

8 classroom hours

Lecturers

ROMOLO DI IORIO

Activity type

Interdisciplinari e cliniche

SSD

MED/40

Year

N/D

Semester

N/D

CFU

2

Hours distribution

16 classroom hours

Lecturers

ROMOLO DI IORIO

Activity type

Scienze medico - chirurgiche

SSD

MED/17

Year

N/D

Semester

N/D

CFU

1

Hours distribution

8 classroom hours

Lecturers

ROMOLO DI IORIO

Activity type

Scienze biomediche

SSD

MED/03

Year

N/D

Semester

N/D

CFU

1

Hours distribution

8 classroom hours

Lecturers

SIMONA PETRUCCI

Activity type

Scienze medico - chirurgiche

SSD

BIO/14

Year

N/D

Semester

N/D

CFU

1

Hours distribution

8 classroom hours

Lecturers

STEFANIA MACCARI

Activity type

Interdisciplinari e cliniche

SSD

MED/40

Year

N/D

Semester

N/D

CFU

2

Hours distribution

16 classroom hours

Lecturers

ISABELLA FABIETTI

Activity type

Interdisciplinari e cliniche

SSD

MED/11

Year

N/D

Semester

N/D

CFU

1

Hours distribution

8 classroom hours

Lecturers

GIULIANO TOCCI

At the end of the course, students will be able to:
understand risk factors and identify high-risk pregnancies
understand the main pregnancy complications (hypertension, diabetes, prematurity, etc.)
understand screening and prenatal diagnosis methods
understand genetics applied to prenatal diagnosis
understand the characteristics of the main drugs used in obstetrics and gynecology

Knowledge of physiological changes during pregnancy, clinical genetics, and clinical pharmacology.

Module: MONITORING OF PREGNANCY LABOR AND DELIVERY
The obstetric examination
Physiology of uterine contraction
Abnormalities of uterine contractile activity: uterine hypertonicity and hyperkinesis
Pathophysiology of fetal cardiac activity: baroreceptors, chemoreceptors, sympathetic and parasympathetic nervous system
Ontogeny: Periods of fetal activity and rest
Mean and baseline FHR: definition, pathophysiology, and significance
FHR accelerations: definition, pathophysiology, and clinical significance
Variable, early, and late FHR decelerations: definition, pathophysiology, and clinical significance
CTG tracing classification: national and international guidelines
Clinical management of CTG tracing abnormalities
The cardiotocography clinic
Ancillary methods for assessing fetal well-being during labor: pulse oximetry, fetal ECG, fetal scalp, Clark test
Intermittent FHR auscultation (indications, limitations, advantages and disadvantages, (method)
Antepartum cardiotocography: non-stress test
Fetal movement counting
Obstetric ultrasound in the first, second, and third trimesters: timing, indications, purposes
Ultrasound assessment of cervical length during pregnancy (indications, predictive value)
Ultrasound assessment of amniotic fluid volume: amniotic fluid index, maximum pocket
Ultrasound in the delivery room
Maternal and fetal Doppler velocimetry (indications)
Fetal magnetic resonance imaging


Module: HIGH-RISK PREGNANCY
"High-Risk Pregnancy"
Spontaneous Miscarriage: Definition, Classification, Causes
Recurrent Miscarriages
Nausea and Vomiting in Pregnancy, Hyperemesis Gestationalis
Preterm Birth: Definition, Pathophysiology, Risk Factors, Diagnosis, Treatment
Prematurity: Fetal and Neonatal Outcomes, Stimulation of Fetal Lung Maturity, Prevention of Fetal Neurological Damage
Cervical Incompetence and Cervical Cerclage
Twin Pregnancy: Maternal, Fetal, and Obstetric Risks
Diabetes in Pregnancy
Hypertension in Pregnancy
Cholestasis of Pregnancy
Premature Rupture of Membranes (PROM) at Term and Preterm
Oligoamnios
Polyamnios
Postterm Pregnancy
Placental Previa
Induction of Labor


Module: INFECTUOS DISEASES IN PREGNANCY
Infectious Diseases and Pregnancy: Role of the Placenta, Infected Fetus vs. Affected Fetus, Embryo-Fetal, Congenital, and Neonatal Infection
Rubella (General Information, Fetal and Neonatal Effects, Diagnosis, Treatment, Prevention, Screening in Pregnancy)
Toxoplasmosis (General Information, Fetal and Neonatal Effects, Diagnosis, Treatment, Prevention, Screening in Pregnancy)
Cytomegalovirus (General Information, Primary and Secondary Infection, Fetal and Neonatal Effects, Diagnosis, Treatment, Prevention, Screening in Pregnancy)
Herpes Virus (General Information, HSV1 and HSV2, Fetal and Neonatal Effects, Diagnosis, Treatment, Method of Delivery, Screening in Pregnancy)
Varicella (General Information, Primary Infection and Reactivation, Fetal and Neonatal Effects, Diagnosis, Treatment, Method of Delivery, Screening in Pregnancy)
Parvovirus B-19 (General Information, Fetal and Neonatal Effects)
Hepatitis A (General Information, Fetal and Neonatal, Maternal, and Obstetricians, pregnancy screening)
Hepatitis B (general information, mother-to-child transmission, treatment, delivery method, pregnancy screening)
Hepatitis C (general information, mother-to-child transmission, treatment, delivery method, pregnancy screening)
HIV (general information, mother-to-child transmission, treatment, delivery method, pregnancy screening)
Chagas disease (pregnancy screening)
Prevention of neonatal group B streptococcal infection


Module: CARDIOVASCULAR DISEASES AND PREGNANCY
GENES AND GENE MUTATIONS
MENDEL'S LAWS
MONOGENEIC INHERITANCE IN HUMAN BEHAVIOR
DIGENIC INHERITANCE
MULTIFACTORIAL INHERITANCE
HUMAN CHROMOSOMES
PRENATAL GENETIC DIAGNOSIS
PREIMPLANTATION DIAGNOSIS


Module: PHARMACOLOGY IN OBSTETRICS AND GYNECOLOGY
Advanced pharmacology: receptors, agonists, and antagonists, hepatic metabolism (CYP450), toxicity, and drug interactions.
Pathophysiology of stress: concepts of homeostasis, allostasis, and allostatic load; classic models of Selye, McEwen, and Lazarus.
Neuroendocrinology of stress: hypothalamic–pituitary–adrenal (HPA) axis, sympathetic and immune responses.
Clinical implications of chronic stress and individual vulnerability: ulcers, immunosuppression, addictions, mood disorders.
Anti-stress and therapeutic role of oxytocin and its agonists (e.g., carbetocin) in neuroendocrine regulation, uterine contraction, and maternal-infant bonding.


Module: PRENATAL DIAGNOSIS
Prenatal screening tests: Nuchal translucency (NT), Combined test, NIPT
Invasive prenatal diagnostic tests: Amniocentesis, Chorionic Villus Sampling, cordocentesis
Obstetric ultrasound: First trimester ultrasound, Second trimester ultrasound, Third trimester ultrasound
Doppler velocimetry
Fetal echocardiography
Fetal MRI: purpose, indications, safety
Fetal surgery


Module: CLINICAL GENETICS IN MATERNAL-FETAL MEDICINE
• Anatomy and physiology of cardiovascular system in pregnant woman, in foetus and newborn
• Arterial hypertension: pathophysiology and therapy during pregnancy
• Clinical presentation and diagnostic classification of chest pain
• Ischemic heart disease: definition, classification, pathophysiology and therapy during pregnancy
• Clinical presentation and diagnostic of dyspnoea
• Heart failure: definition, classification, pathophysiology and therapy during pregnancy
• Principles and interpretation of conventional electrocardiography
• Main alterations of the heart rhythm: bradycardias and tachycardias during pregnancy

Module: MONITORING OF PREGNANCY LABOR AND DELIVERY
N/D
Module: HIGH-RISK PREGNANCY
N/D
Module: INFECTUOS DISEASES IN PREGNANCY
N/D
Module: CARDIOVASCULAR DISEASES AND PREGNANCY
N/D
Module: PHARMACOLOGY IN OBSTETRICS AND GYNECOLOGY
N/D
Module: PRENATAL DIAGNOSIS
N/D
Module: CLINICAL GENETICS IN MATERNAL-FETAL MEDICINE
Volpe M. Manuale di Cardiologia. Edizioni SEU.

Module: MONITORING OF PREGNANCY LABOR AND DELIVERY
N/D
Module: HIGH-RISK PREGNANCY
Royal College of Obstetrics and Gynaecologists. Tocolysis for women in preterm labour. Green-top Guideline No. 1b. February 2011
American College of Obstetricians and Gynecologists. Management of preterm labor. Practice Bulletin n.127, 2012
Duley L et al. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Library, issue 7, 2013
American College of Obstetricians and Gynecologists. Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Committee Opinion n.623, February 2015
National Institute of Clinical Excellence. NICE Guideline : Diabetes in pregnancy : management of diabetes and its complications from preconception to the postnatal period. February 2015
American College of Obstetricians and Gynecologists. Gestational diabetes mellitus. Practice Bulletin n.137, 2013



Module: INFECTUOS DISEASES IN PREGNANCY
N/D
Module: CARDIOVASCULAR DISEASES AND PREGNANCY
N/D
Module: PHARMACOLOGY IN OBSTETRICS AND GYNECOLOGY
N/D
Module: PRENATAL DIAGNOSIS
N/D
Module: CLINICAL GENETICS IN MATERNAL-FETAL MEDICINE
Guidelines and clinical recommendations
1. Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023
2. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912-4018
3. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13–115.
4. Volpe M, Rosei EA, Ambrosioni E, Cottone S, Cuspidi C, Borghi C, et al. 2012 consensus document of the Italian Society of Hypertension (SIIA): strategies to improve blood pressure control in Italy: from global cardiovascular risk stratification to combination therapy. High Blood Press Cardiovasc Prev. 2013;20(1):45–52.
5. François Mach, Colin Baigent, Alberico L Catapano, Konstantinos C Koskinas, Manuela Casula, Lina Badimon, M John Chapman, Guy G De Backer, Victoria Delgado, Brian A Ference, Ian M Graham, Alison Halliday, Ulf Landmesser, Borislava Mihaylova, Terje R Pedersen, Gabriele Riccardi, Dimitrios J Richter, Marc S Sabatine, Marja-Riitta Taskinen, Lale Tokgozoglu, Olov Wiklund, ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020 Jan 1;41(1):111-188. doi: 10.1093/eurheartj/ehz455.
6. Authors/Task Force Members; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis. 2019 Nov;290:140-205. doi: 10.1016/j.atherosclerosis.2019.08.014.Epub 2019 Aug 31.
7. Alberico L Catapano, Ian Graham, Guy De Backer, Olov Wiklund, M John Chapman, Heinz Drexel, Arno W Hoes, Catriona S Jennings, Ulf Landmesser, Terje R Pedersen, Željko Reiner, Gabriele Riccardi, Marja-Riita Taskinen, Lale Tokgozoglu, W M Monique Verschuren, Charalambos Vlachopoulos, David A Wood, Jose Luis Zamorano. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 2016 Oct;253:281-344.doi: 10.1016/j.atherosclerosis.2016.08.018. Epub 2016 Sep 1.

Personal bibliography
1. Cesario V, Presta V, Figliuzzi I, Citoni B, Battistoni A, Miceli F, Volpe M, Tocci G. Epidemiological Impact and Clinical Consequences of Masked Hypertension: A Narrative Review. High Blood Press Cardiovasc Prev. 2020 Jun;27(3):195-201. doi: 10.1007/s40292-020-00382-1. Epub 2020 May 2. PMID: 32361899.
2. Tocci G, Citoni B, Presta V, Leoncini G, Viazzi F, Bonino B, Volpe M, Pontremoli R. Effects of dual inhibition of renin-angiotensin-aldosterone system on cardiovascular and renal outcomes: balancing the risks and the benefits. Intern Emerg Med. 2020 Apr;15(3):373-379. doi: 10.1007/s11739-019-02257-3. Epub 2019 Dec 21. PMID: 31865522.
3. Miceli F, Presta V, Citoni B, Canichella F, Figliuzzi I, Ferrucci A, Volpe M, Tocci G. Conventional and new electrocardiographic criteria for hypertension-mediated cardiac organ damage: A narrative review. J Clin Hypertens (Greenwich). 2019 Dec;21(12):1863-1871. doi: 10.1111/jch.13726. Epub 2019 Nov 6. PMID: 31693279.
4. Volpe M, Gallo G, Tocci G. Novel blood pressure targets in patients with high-normal levels and grade 1 hypertension: Room for monotherapy? Int J Cardiol. 2019 Sep 15;291:105-111. doi: 10.1016/j.ijcard.2019.04.074. Epub 2019 Apr 24. PMID: 31060756.
5. Volpe M, Gallo G, Tocci G. New approach to blood pressure control: Triple combination pill. Trends Cardiovasc Med. 2020 Feb;30(2):72-77. doi: 10.1016/j.tcm.2019.03.002. Epub 2019 Mar 14. PMID: 30926237.
6. Volpe M, Gallo G, Battistoni A, Tocci G. Highlights of ESC/ESH 2018 Guidelines on the Management of Hypertension: What Every Doctor Should Know. High Blood Press Cardiovasc Prev. 2019 Feb;26(1):1-8. doi: 10.1007/s40292-018-00297-y. Epub 2019 Jan 2. PMID: 30604199.
7. Volpe M, Battistoni A, Gallo G, Rubattu S, Tocci G; Writing Committee; Scientific Societies. Executive Summary of the 2018 Joint Consensus Document on Cardiovascular Disease Prevention in Italy. High Blood Press Cardiovasc Prev. 2018 Sep;25(3):327-341. doi: 10.1007/s40292-018-0278-8. Epub 2018 Sep 20. PMID: 30232768.
8. Tocci G, Figliuzzi I, Presta V, Miceli F, Citoni B, Coluccia R, Musumeci MB, Ferrucci A, Volpe M. Therapeutic Approach to Hypertension Urgencies and Emergencies During Acute Coronary Syndrome. High Blood Press Cardiovasc Prev. 2018 Sep;25(3):253-259. doi: 10.1007/s40292-018-0275-y. Epub 2018 Jul 31. PMID: 30066227.
9. Fogacci F, Tocci G, Presta V, Fratter A, Borghi C, Cicero AFG. Effect of resveratrol on blood pressure: A systematic review and meta-analysis of randomized, controlled, clinical trials. Crit Rev Food Sci Nutr. 2019;59(10):1605-1618. doi: 10.1080/10408398.2017.1422480. Epub 2018 Jan 23. PMID: 29359958.
10. Volpe M, Gallo G, Tocci G. Is early and fast blood pressure control important in hypertension management? Int J Cardiol. 2018 Mar 1;254:328-332. doi: 10.1016/j.ijcard.2017.12.026. Epub 2017 Dec 13. PMID: 29273242.
11. Tocci G, Desideri G, Roca E, Calcullo C, Crippa M, De Luca N, Gaudio GV, Lonati LM, Orselli L, Scuteri A, Vulpis V, Acone B, Zaninelli A; THYPERevolution Steering Committee. How to Improve Effectiveness and Adherence to Antihypertensive Drug Therapy: Central Role of Dihydropyridinic Calcium Channel Blockers in Hypertension. High Blood Press Cardiovasc Prev. 2018 Mar;25(1):25-34. doi: 10.1007/s40292-017-0242-z. Epub 2017 Dec 2. PMID: 29197935; PMCID: PMC5842506.
12. Volpe M, Tocci G, de la Sierra A, Kreutz R, Laurent S, Manolis AJ, Tsioufis K. Personalised Single-Pill Combination Therapy in Hypertensive Patients: An Update of a Practical Treatment Platform. High Blood Press Cardiovasc Prev. 2017 Dec;24(4):463-472. doi: 10.1007/s40292-017-0239-7. Epub 2017 Oct 31. PMID: 29086364; PMCID: PMC5681620.
13. Volpe M, Santolamazza C, Mastromarino V, Coluccia R, Battistoni A, Tocci G. Monotherapy and Dual Combination Therapies Based on Olmesartan: A Comprehensive Strategy to Improve Blood Pressure Control. High Blood Press Cardiovasc Prev. 2017 Sep;24(3):243-253. doi: 10.1007/s40292-017-0216-1. Epub 2017 Jun 12. PMID: 28608026.
14. Volpe M, Santolamazza C, Mastromarino V, Coluccia R, Battistoni A, Tocci G.Triple Combination Therapies Based on Olmesartan: A Personalized Therapeutic Approach to Improve Blood Pressure Control. High Blood Press Cardiovasc Prev. 2017 Sep;24(3):255-263. doi: 10.1007/s40292-017-0217-0. Epub 2017 Jun 12. PMID: 28608025.
15. Volpe M, Volpe R, Gallo G, Presta V, Tocci G, Folco E, Peracino A, Tremoli E, Trimarco B; Italian Society of Cardiovascular Prevention (SIPREC) Writing Committee. 2017 Position Paper of the Italian Society for Cardiovascular Prevention (SIPREC) for an Updated Clinical Management of Hypercholesterolemia and Cardiovascular Risk: Executive Document. High Blood Press Cardiovasc Prev. 2017 Sep;24(3):313-329. doi: 10.1007/s40292-017-0211-6. Epub 2017 May 18. PMID: 28523635.
16. Volpe M, Santolamazza C, Tocci G. Hypertension in Patients with Heart Failure with Reduced Ejection Fraction. Curr Cardiol Rep. 2016 Dec;18(12):127. doi: 10.1007/s11886-016-0807-9. PMID: 27796865.
17. Volpe M, Battistoni A, Savoia C, Tocci G. Understanding and treating hypertension in diabetic populations. Cardiovasc Diagn Ther. 2015 Oct;5(5):353-63. doi: 10.3978/j.issn.2223-3652.2015.06.02. PMID: 26543822; PMCID: PMC4609903.
18. Borghi C; SIIA Task Force, Rossi F; SIF Task Force. Role of the Renin-Angiotensin-Aldosterone System and Its Pharmacological Inhibitors in Cardiovascular Diseases: Complex and Critical Issues. High Blood Press Cardiovasc Prev. 2015 Dec;22(4):429-44. doi: 10.1007/s40292-015-0120-5. Epub 2015 Sep 24. Erratum in: High Blood Press Cardiovasc Prev. 2016 Mar;23(1):65. PMID: 26403596.
19. Battistoni A, Canichella F, Pignatelli G, Ferrucci A, Tocci G, Volpe M. Hypertension in Young People: Epidemiology, Diagnostic Assessment and Therapeutic Approach. High Blood Press Cardiovasc Prev. 2015 Dec;22(4):381-8. doi: 10.1007/s40292-015-0114-3. Epub 2015 Jul 8. PMID: 26153401.
20. Volpe M, Tocci G, Battistoni A, Rubattu S. Angiotensin II Receptor Blocker Neprilysin Inhibitor (ARNI): New Avenues in Cardiovascular Therapy. High Blood Press Cardiovasc Prev. 2015 Sep;22(3):241-6. doi: 10.1007/s40292-015-0112-5. Epub 2015 Jun 23. PMID: 26100410.
21. Tocci G, Battistoni A, Passerini J, Musumeci MB, Francia P, Ferrucci A, Volpe M. Calcium channel blockers and hypertension. J Cardiovasc Pharmacol Ther. 2015 Mar;20(2):121-30. doi: 10.1177/1074248414555403. Epub 2014 Nov 14. PMID: 25398848.
22. Francia P, Adduci C, Santini D, Musumeci B, Tocci G. New oral anticoagulants in non-valvular atrial fibrillation. High Blood Press Cardiovasc Prev. 2013 Jun;20(2):53-60. doi: 10.1007/s40292-013-0011-6. Epub 2013 May 8. PMID: 23653173.
23. Tocci G, Paneni F, Passerini J, Volpe M. Triple combination therapy to improve blood pressure control: experience with olmesartan-amlodipine-hydrochlorothiazide therapy. Expert Opin Pharmacother. 2012 Dec;13(18):2687-97. doi: 10.1517/14656566.2012.745510. Epub 2012 Nov 21. PMID: 23170911.
24. Chin D, Battistoni A, Tocci G, Passerini J, Parati G, Volpe M. Non-invasive diagnostic testing for coronary artery disease in the hypertensive patient: potential advantages of a risk estimation-based algorithm. Am J Hypertens. 2012 Dec;25(12):1226-35. doi: 10.1038/ajh.2012.90. Epub 2012 Jul 12. PMID: 22785407.
25. Volpe M, Battistoni A, Tocci G, Rosei EA, Catapano AL, Coppo R, del Prato S, Gentile S, Mannarino E, Novo S, Prisco D, Mancia G. Cardiovascular risk assessment beyond Systemic Coronary Risk Estimation: a role for organ damage markers. J Hypertens. 2012 Jun;30(6):1056-64. doi: 0.1097/HJH.0b013e3283525715. PMID: 22573072.
26. Tocci G, Volpe M. Modern clinical management of arterial hypertension: fixed or free combination therapies? High Blood Press Cardiovasc Prev. 2011 Sep 6;18 Suppl 1:3-11. doi: 10.2165/1159615-s0-000000000-00000. PMID: 21895049.
27. Tocci G, Volpe M. Fixed-combination therapy to improve blood pressure control: experience with olmesartan-based therapy. Expert Rev Cardiovasc Ther. 2011 Jul;9(7):829-40. doi: 10.1586/erc.11.59. PMID: 21809963.
28. Tocci G, Ferrucci A, Guida P, Avogaro A, Comaschi M, Corsini A, Cortese C, Giorda CB, Manzato E, Medea G, Mureddu GF, Riccardi G, Titta G, Ventriglia G, Zito GB, Volpe M; EFFECTUS Steering Committee. An analysis of the management of cardiovascular risk factors in routine clinical practice in Italy: an overview of the main findings of the EFFECTUS study. High Blood Press Cardiovasc Prev. 2011 Mar 1;18(1):19-30. doi: 10.2165/11588040-000000000-00000. PMID: 21612309.
29. Sciarretta S, Palano F, Tocci G, Baldini R, Volpe M. Antihypertensive treatment and development of heart failure in hypertension: a Bayesian network meta-analysis of studies in patients with hypertension and high cardiovascular risk. Arch Intern Med. 2011 Mar 14;171(5):384-94. doi: 10.1001/archinternmed.2010.427. Epub 2010 Nov 8. PMID: 21059964.
30. Volpe M, Tocci G. Challenging hypertension: how to diagnose and treat resistant hypertension in daily clinical practice. Expert Rev Cardiovasc Ther. 2010 Jun;8(6):811-20. doi: 10.1586/erc.10.47. PMID: 20528639.
31. Volpe M, Tocci G. 2007 ESH/ESC Guidelines for the management of hypertension, from theory to practice: global cardiovascular risk concept. J Hypertens Suppl. 2009 Jun;27(3):S3-11. doi: 10.1097/01.hjh.0000356766.86388.e5. PMID: 19506449.

frontal teaching with the aid of Power Point presentations

To be admitted to the final exam, students must complete the required attendance for the entire course.
Distance participation is not permitted or countable.
Attendance is recorded exclusively through a signature register provided by the instructor.

Ongoing assessment of the various modules: written exam (multiple-choice quiz) or oral exam
Final oral assessment

What drugs are used to treat preeclampsia?

Module: MONITORING OF PREGNANCY LABOR AND DELIVERY

• The obstetric examination
  Physiology of uterine contraction
  Abnormalities of uterine contractile activity: uterine hypertonicity and hyperkinesis
  Pathophysiology of fetal cardiac activity: baroreceptors, chemoreceptors, sympathetic and parasympathetic nervous system
  Ontogeny: Periods of fetal activity and rest
  Mean and baseline FHR: definition, pathophysiology, and significance
  FHR accelerations: definition, pathophysiology, and clinical significance
  Variable, early, and late FHR decelerations: definition, pathophysiology, and clinical significance


• CTG tracing classification: national and international guidelines
  Clinical management of CTG tracing abnormalities
  The cardiotocography clinic
  Ancillary methods for assessing fetal well-being during labor: pulse oximetry, fetal ECG, fetal scalp, Clark test
  Intermittent FHR auscultation (indications, limitations, advantages and disadvantages, (method)
  Antepartum cardiotocography: non-stress test
  Fetal movement counting


• Obstetric ultrasound in the first, second, and third trimesters: timing, indications, purposes
  Ultrasound assessment of cervical length during pregnancy (indications, predictive value)
  Ultrasound assessment of amniotic fluid volume: amniotic fluid index, maximum pocket
  Ultrasound in the delivery room
  Maternal and fetal Doppler velocimetry (indications)
  Fetal magnetic resonance imaging

• "High-Risk Pregnancy"
  Spontaneous Miscarriage: Definition, Classification, Causes
  Recurrent Miscarriages
  Nausea and Vomiting of Pregnancy, Hyperemesis Gravidarum


• Preterm Birth: Definition, Pathophysiology, Risk Factors, Diagnosis, Treatment
  Prematurity: Fetal and Neonatal Outcomes, Stimulation of Fetal Lung Maturity, Prevention of Fetal Neurological Damage
  Cervical Incompetence and Cervical Cerclage
  • Books: Royal College of Obstetrics and Gynaecologists. Tocolysis for women in preterm labour. Green-top Guideline No. 1b. February 2011American College of Obstetricians and Gynecologists. Management of preterm labor.  Practice Bulletin n.127, 2012 


• Diabetes in Pregnancy
  • Books: National Institute of Clinical Excellence. NICE Guideline : Diabetes in pregnancy : management of diabetes and its complications from preconception to the postnatal period. February 2015 American College of Obstetricians and Gynecologists. Gestational diabetes mellitus.  Practice Bulletin n.137, 2013 


• hypertension in pregnancy
  • Books: American College of Obstetricians and Gynecologists. Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Committee Opinion n.623, February 2015 


• Cholestasis of Pregnancy
  Premature Rupture of Membranes (PROM) at Term and Preterm
  Oligoamnios
  Polyamnios
  Postterm Pregnancy
  Placental Previa


• induction of labor

• Infectious Diseases and Pregnancy: Role of the Placenta, Infected Fetus vs. Affected Fetus, Embryo-Fetal, Congenital, and Neonatal Infection
  Rubella (General Information, Fetal and Neonatal Effects, Diagnosis, Treatment, Prevention, Screening in Pregnancy)
  Toxoplasmosis (General Information, Fetal and Neonatal Effects, Diagnosis, Treatment, Prevention, Screening in Pregnancy)
  Cytomegalovirus (General Information, Primary and Secondary Infection, Fetal and Neonatal Effects, Diagnosis, Treatment, Prevention, Screening in Pregnancy)
  Herpes Virus (General Information, HSV1 and HSV2, Fetal and Neonatal Effects, Diagnosis, Treatment, Method of Delivery, Screening in Pregnancy)


• Varicella (General Information, Primary Infection and Reactivation, Fetal and Neonatal Effects, Diagnosis, Treatment, Method of Delivery, Screening in Pregnancy)
  Parvovirus B-19 (General Information, Fetal and Neonatal Effects)
  Hepatitis A (General Information, Fetal and Neonatal, Maternal, and Obstetricians, pregnancy screening)
  Hepatitis B (general information, mother-to-child transmission, treatment, delivery method, pregnancy screening)
  Hepatitis C (general information, mother-to-child transmission, treatment, delivery method, pregnancy screening)
  HIV (general information, mother-to-child transmission, treatment, delivery method, pregnancy screening)
  Chagas disease (pregnancy screening)


• Prevention of neonatal group B streptococcal infection

• GENES AND
  GENE MUTATIONS: The gene. Origin of mutations. Point mutations, deletions,
  insertions, mutations of splicing sites, dynamic mutations. Consequences of
  mutations. MENDEL'S LAWS: Mendel experiments. Concepts of hereditary
  characters, genes, alleles, loci. Pedigree building and models of transmission:
  autosomal dominant, autosomal recessive, X-linked dominant and X-linked
  recessive, Y-linked. Monogenic inheritance in humans.
  
  
  MONOGENETIC INHERITANCE IN HUMANS. Mendelian and non-Mendelian inheritance:
  Unstable Mendelian inheritance, Mendelian inheritance with parental effect,
  mitochondrial inheritance. DIGENIC INHERITANCE. MULTIFACTORIAL INHERITANCE


• HUMAN
  CHROMOSOMES: number, structure and function. Cell division mechanisms (mitosis
  and meiosis), independent assortment and recombination. Organization of the
  human genome. Normal and altered karyotype. Numerical (aneuploidy, polyploidy)
  and structural (deletions, inversions and translocations) chromosomal
  anomalies.  Main clinical conditions
  related to chromosomal abnormalities.


• PRENATAL
  GENETIC DIAGNOSIS: noninvasive predictive tests (combined test, noninvasive
  prenatal test). Invasive prenatal diagnosis: sampling techniques (chorionic
  villus sampling, amniocentesis, cordocentesis); cytogenetic and molecular
  analysis of fetal DNA (karyotype molecular cytogenetics, sequencing analysis,
  dynamic mutation study). Examples of diseases


• PREIMPLANTATION
  DIAGNOSIS: Introduction to medically assisted reproduction. Perimplantation
  genetic diagnosis: inclusion and exclusion criteria. PGT for monogenic
  disorders (PGT-M), for chromosomal alterations (PGT-SR), for chromosomal
  aneuploidies (PGT-A).

• Advanced pharmacology: receptors, agonists, and antagonists, hepatic metabolism (CYP450), toxicity, and drug interactions.


• Pathophysiology of stress: concepts of homeostasis, allostasis, and allostatic load; classic models of Selye, McEwen, and Lazarus.


• Neuroendocrinology of stress: hypothalamic–pituitary–adrenal (HPA) axis, sympathetic and immune responses.


• Clinical implications of chronic stress and individual vulnerability: ulcers, immunosuppression, addictions, mood disorders.


• Anti-stress and therapeutic role of oxytocin and its agonists (e.g., carbetocin) in neuroendocrine regulation, uterine contraction, and maternal-infant bonding.

• Prenatal screening tests: Nuchal translucency (NT), Combined test, NIPT


• Invasive prenatal diagnostic tests: Amniocentesis, Chorionic Villus Sampling, cordocentesis


• Obstetric ultrasound: First trimester ultrasound, Second trimester ultrasound, Third trimester ultrasoundDoppler velocimetryFetal echocardiographyFetal MRI: purpose, indications, safety


• fetal surgery

• Anatomy and physiology of cardiovascular system in pregnant woman, in foetus and newborn


• Arterial hypertension: pathophysiology and therapy during pregnancy


• Clinical presentation and diagnostic classification of chest painIschemic heart disease: definition, classification, pathophysiology and therapy during pregnancyClinical presentation and diagnostic of dyspnoeaHeart failure: definition, classification, pathophysiology and therapy during pregnancy


• Principles and interpretation of conventional electrocardiographyMain alterations of the heart rhythm: bradycardias and tachycardias during pregnancy