Box 4. Technical skills in obstetric procedures.
| General goal: acquisition of competencies related to obstetrical procedures. | ||
|---|---|---|
| LEVEL | COMPETENCIES | COMPONENTS |
| R1 | - Performs pelvic examination for assessment of small pelvis, fetal presentations and cervical dilation; | S |
| - Performs antepartum and intrapartum Electronic fetal monitoring; | S | |
| - Performs first trimester dilation, curettage, and suction in cases of incomplete spontaneous abortion; | S | |
| - Performs basic obstetrical skills in spontaneous vaginal delivery; | S | |
| - Performs perineal protection and selective episiotomy; | S | |
| - Performs repair of 1st and 2nd degree perineal or vaginal lacerations; | S | |
| - Performs primary cesarean section; | S | |
| - Performs insertion of intrauterine device (IUD) and subdermal implants intrapartum, after abortion and in the immediate postpartum period; | S | |
| - Applies trichloroacetic acid in genital warts; | S | |
| R2 | - Performs limited obstetrical sonography, gestational age assessment, and antenatal assessment (e.g., fetal presentation, fetal biometry, biophysical profile); | S |
| - Performs uterine evacuation (medical and surgical) in cases of legal abortion or incomplete spontaneous abortion; | S | |
| - Performs second trimester uterine evacuation (medical and surgical) in incomplete spontaneous abortion; | S | |
| - Performs surgical treatment of ectopic pregnancy; | S | |
| - Performs external cephalic version for breech presentation; | S | |
| - Performs vaginal delivery in breech presentation and shoulder dystocia; | S | |
| - Performs operative vaginal delivery using forceps and vacuum extractor; | S | |
| - Performs appropriate management of 3rd and 4th degree perineal tears; | S | |
| - Performs repeat cesarean section; | S | |
| - Performs tubal ligation during cesarean delivery; | S | |
| R3 | - Performs cervical cerclage: | S |
| - Performs detailed obstetrical sonography assessment (including Doppler, first and second trimester fetal anatomy, placental location following a previous cesarean section scar and prenatal diagnosis or therapeutic procedures such as amniocentesis); | S | |
| - Performs vaginal delivery in breech presentations (including the second twin); | S | |
| - Performs operative rotational vaginal delivery using forceps; | S | |
| - Identifies and manages uterine rupture or perforations; | S | |
| - Identifies and manages urinary bladder injuries; | S | |
| - Performs exploratory laparotomy and surgical treatment in cases of acute abdomen due to hemorrhage, including compressive sutures (B-Lynch and uterine artery ligation) and hysterectomy; | S | |
| - Performs cesarean sections in complex obstetrical complications (multiple repeat cesarean sections, placenta previa, placenta accreta, morbid obesity); | S | |
Abbreviation: S, skills.