La_donna_e_la_gravidanza

Fertilization and planting
Anatomy and function of the fetal appendages
Normal placentation
Fetal-placental perfusion and nutrient transport
Determinants of fetal growth; brief outline of fetal development
The fetal circulation;
Amniotic fluid and its pathology;
Umbilical cord and its anomalies;
Maternal adaptation to pregnancy:
Modification of organs and systems during pregnancy;
Monitoring of maternal and fetal well-being during pregnancy;
History and physical examination;
Blood tests in pregnancy [LEA]; including gestational diabetes screening;
Urinary tract infections;
Abnormal hemoglobins; Rh incompatibility;
TORCH group infections;
Prevention of Styreptococcus agalactiae infection
Nausea and vomit;
Monitoring of fetal well-being.
Diet during pregnancy:
Relationship between body mass index, weight gain and pregnancy outcome;
Need for macro and micronutrients;
Pregnancy hygiene:
Physical activity;
Working activity;
Sexuality [two slides];
Makeup and beauty;
Medicines and radiological examinations; vaccines;
Traveling while pregnant;
Voluptuous habits.

The ultrasound in pregnancy
- Indications and purposes US I quarter
- Indications and purposes US II quarter
- Indications and purposes US III quarter
Evaluation criteria of the ultrasound report
- Morphological ultrasound
- Ultrasound markers of chromosomal disorders
Counseling for chromosomal diagnosis in low-risk couples
- Genetic counseling
- Epidemiology of birth defects
- Chromosomal abnormalities
- Gene abnormalities
- Multifactorial diseases
- Environmental factors (maternal diseases, drugs)
invasive procedures
- Screening tests
- Diagnostic tests.
Fetal surgery

REGULATION, OBSTETRICS CARE MODELS
- Midwifery profession: intellectual profession
- European Legislation and Italian Legislation: skills, responsibilities and autonomy of the midwife for assistance in pregnancy, prescribing tests during pregnancy, midwife's recipe book
- Italian guidelines and WHO recommendations on the quality of prenatal care for a positive pregnancy experience
- Care models of pregnancy: medical-led model, shared-led model, midwife-led continuity model of care
- WHO definition of obstetric risk, risk-dependent management, dynamic risk concept and reassessment of obstetric risk
- The BRO model of low-risk obstetric assistance, personalized, centered on the specific needs of the pregnant woman and on the continuity of care: decrees, laws and instruments

MIDWARE APPROACH TO PHYSIOLOGICAL PREGNANCY
- The midwife and communication
- The transition of power from the midwife to the woman: empowerment, enhancement of knowledge and activation of the skills of the woman and the parental couple
- Obstetrician-woman relationship and therapeutic alliance, sharing of responsibilities
- The midwife as facilitator of the pregnancy process through the promotion of women's psycho-physical health
- Protection of physiology: concept of physiology and health understood as a 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.
- Spontaneous regression and narcissism, self-image, emotional changes and ambivalence.
- Being a mother and having a baby, the imaginary baby and the real baby
- Attachment and primary maternal concern
- The levels of mother-to-child communication
- The prenatal link, a tool for maternal-fetal health and well-being
- Mother - unborn child - father interaction
- The father: emotions, role, prenatal father-unborn bond
- Analysis of sensory development during prenatal life: the development of sensory organs (touch, smell, taste, hearing, sight), fetal skills and the importance of prenatal bonding, the first extrauterine experience.

HYGIENE OF PREGNANCY, SIGNS OF PREGNANCY, IAN
- Pregnancy hygiene: food and nutrition, main foodborne illnesses, alcohol and effects on the fetus, binge drinking
- Lifestyles: states of change, Prochaska-Di Clemente cycle, smoke-free mothers programme
- Signs of pregnancy, certain and uncertain signs, signs of probability and presumption
- Modifications of the maternal microbiota during pregnancy: breasts, intestines and uterus
- Anatomy of the breast and modifications of the breast in pregnancy, accessory breast tissue, supernumerary nipples
- Lactation stages: when breastfeeding starts, how the midwife can promote breastfeeding in pregnancy, completing the UNICEF prenatal checklist
- Birth accompaniment meetings: breathing, relaxation and visualizations, mother-friendly care UNICEF, IAN and paternity
- How to deal with the "disturbances" of pregnancy: the midwife's approach to minor ailments of pregnancy: recommended exercises for the well-being of the perineum, circulation, spine, pelvis, lower limbs
- Care of the perineum and pelvic floor during pregnancy, prevention and risk reduction of perineal damage, perineal massage and pelvic floor exercises, postpartum gymnastics
- POF, the optimal positioning of the fetus: how to favor the anterior positions in the third trimester of pregnancy, nutation and counter-nutation: body work and exercises to promote the mobility of the maternal pelvis

OBSTETRICS OBJECTIVE EXAMINATION
- Introduction to Obstetric Physical Examination - first stage: Medical history, lifestyles, nutrition, support network, detection of maternal body weight, BMI calculation, recommended weight gain during pregnancy
- Second stage - Inspection: spine, evaluation of mobility, degree of inclination and morphology of the pelvis, breasts, external pelvimetry, evaluation of the upper strait by measuring the external diameters of the pelvis
- Third stage - Palpation. Symphysis-fundus measurement and fetal growth curves, Leopold's maneuvers, obstetric diagnosis of: fetal development and uterine growth, situation, presentation, position, level of the presenting part and fetus-pelvic proportion, fetal weight estimation: Johnson's rule
- Fourth time - Auscultation: Pinard's stethoscope and ultrasounds, abdominal quadrants and focus of maximum intensity in the different fetal positions
- Fifth stage - Vaginal exploration: ask for permission, internal pelvimetry, evaluation of the pelvic excavation, medium and inferior straits

AGENDA OF THE BIRTH COURSE, ASSESSMENT OF MATERNAL-FETAL WELL-BEING
- Pre-conceptional health assessment: medical history, anemia and hemoglobinopathies screening, cou nselling food and lifestyles, recommended tests, recommendations on pre-pregnancy intake of folic acid
- First prenatal obstetric health assessment: reception of the pregnant woman, information on the care conduct, execution of the obstetric examination and diagnosis of maternal-fetal well-being
- Criteria for the attribution of the obstetric care model: physiological birth path under obstetric management, birth path under medical-specialist management in collaboration with the midwife
- PAI or individual care plan: pregnancy care plan (physiological)
- Methods and times for carrying out the obstetric objective examination in the various stages of pregnancy: clinical assessment and emotional-relational assessment of the pregnant woman
- Signs of health of mother and fetus: interpretation of general and local maternal physical changes, vital parameters, weight gain, fetal growth estimate, symphysis-fundus measurement, BCF, MAF, laboratory tests and instrumental investigations in the various trimesters of pregnancy, obstetric diagnosis
- Term pregnancy clinic: control of maternal-fetal well-being at term of pregnancy, birth plan, places of birth
- Annotation on the obstetric record of the birth path diary of all the information and surveys relating to the course of the pregnancy.
- Evaluation of the effectiveness of the services provided and the satisfaction of the woman/couple with respect to the care provided by the midwife
- Technical and communicative aspects of conducting a meeting/interview

Elements of perinatal obstetric care
- Primary maternal concern.
Exposure to risk.
- Chemical agents (drugs)
- Physical agents (radiation)
- Biological agents (infections)
- Times, doses and reason for exposure.
- Who to consult in case of potentially dangerous exposure.
- Information services on teratogens.
- The possibilities of prevention.
Awareness of one's own methods of
communication
- The prenatal interview
- The history
- The interview on the chosen test
- Informed consent
The expert/woman or couple relationship
- Is a non-directive interview possible?
- Accompaniment to the decision-making process
Exercises and group work
The assistance plan during the diagnostic procedure
- Chorionic villus sampling
- Amniocentesis
The communication of the result
- The diagnosis of normality
- The doubtful diagnosis and the need for further investigations
- Post amniocentesis or post CVS abortion
- Collection of follow up and archiving
- The role of the midwife in the prenatal diagnosis team

Because the midwife / or must know what is the prenatal diagnosis
Code of ethics (FNCO June 2010): in the premise, in the general principles (spt 2.7) and in relations with the assisted person (spt 3.13 and 3.14)
Professional profile: art.1.1 assists and advises women during pregnancy
The woman expects to be able to get answers and explanations from the midwife she meets
Meeting for information and preparation for prenatal diagnosis: the example of the Mangiagalli Clinic where a group meeting is held with couples, and other hospitals where individual or couple meetings are held with those directly involved
New LEA 3/18/17, attachment 10 C concerns prenatal diagnosis, new orientation
What is done in PD: invasive prenatal diagnosis, diagnostics and therapeutics
Non-invasive prenatal diagnosis: where it was born, aims, limits
Reference to guidelines in prenatal diagnosis: Italy, UK, USA
The midwife and teamwork
Introduction to assistance in the prenatal diagnosis operating room: prepare the sterile table
Interview: techniques for gathering all the information you need, mistakes you shouldn't make
What is fetal therapy: risks and benefits, planning of an intervention (even just PSF or IUFT), the skills of the midwife

Fertilization and planting
Anatomy and function of the fetal appendages
Normal placentation
Fetal-placental perfusion and nutrient transport
Determinants of fetal growth; brief outline of fetal development
The fetal circulation;
Amniotic fluid and its pathology;
Umbilical cord and its anomalies;
Maternal adaptation to pregnancy:
Modification of organs and systems during pregnancy;
Monitoring of maternal and fetal well-being during pregnancy;
History and physical examination;
Blood tests in pregnancy [LEA]; including gestational diabetes screening;
Urinary tract infections;
Abnormal hemoglobins; Rh incompatibility;
TORCH group infections;
Prevention of Styreptococcus agalactiae infection
Nausea and vomit;
Monitoring of fetal well-being.
Diet during pregnancy:
Relationship between body mass index, weight gain and pregnancy outcome;
Need for macro and micronutrients;
Pregnancy hygiene:
Physical activity;
Working activity;
Sexuality [two slides];
Makeup and beauty;
Medicines and radiological examinations; vaccines;
Traveling while pregnant;
Voluptuous habits.

The ultrasound in pregnancy
- Indications and purposes US I quarter
- Indications and purposes US II quarter
- Indications and purposes US III quarter
Evaluation criteria of the ultrasound report
- Morphological ultrasound
- Ultrasound markers of chromosomal disorders
Counseling for chromosomal diagnosis in low-risk couples
- Genetic counseling
- Epidemiology of birth defects
- Chromosomal abnormalities
- Gene abnormalities
- Multifactorial diseases
- Environmental factors (maternal diseases, drugs)
invasive procedures
- Screening tests
- Diagnostic tests.
Fetal surgery

REGULATION, OBSTETRICS CARE MODELS
- Midwifery profession: intellectual profession
- European Legislation and Italian Legislation: skills, responsibilities and autonomy of the midwife for assistance in pregnancy, prescribing tests during pregnancy, midwife's recipe book
- Italian guidelines and WHO recommendations on the quality of prenatal care for a positive pregnancy experience
- Care models of pregnancy: medical-led model, shared-led model, midwife-led continuity model of care
- WHO definition of obstetric risk, risk-dependent management, dynamic risk concept and reassessment of obstetric risk
- The BRO model of low-risk obstetric assistance, personalized, centered on the specific needs of the pregnant woman and on the continuity of care: decrees, laws and instruments

MIDWARE APPROACH TO PHYSIOLOGICAL PREGNANCY
- The midwife and communication
- The transition of power from the midwife to the woman: empowerment, enhancement of knowledge and activation of the skills of the woman and the parental couple
- Obstetrician-woman relationship and therapeutic alliance, sharing of responsibilities
- The midwife as facilitator of the pregnancy process through the promotion of women's psycho-physical health
- Protection of physiology: concept of physiology and health understood as a 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.
- Spontaneous regression and narcissism, self-image, emotional changes and ambivalence.
- Being a mother and having a baby, the imaginary baby and the real baby
- Attachment and primary maternal concern
- The levels of mother-to-child communication
- The prenatal link, a tool for maternal-fetal health and well-being
- Mother - unborn child - father interaction
- The father: emotions, role, prenatal father-unborn bond
- Analysis of sensory development during prenatal life: the development of sensory organs (touch, smell, taste, hearing, sight), fetal skills and the importance of prenatal bonding, the first extrauterine experience.

HYGIENE OF PREGNANCY, SIGNS OF PREGNANCY, IAN
- Pregnancy hygiene: food and nutrition, main foodborne illnesses, alcohol and effects on the fetus, binge drinking
- Lifestyles: states of change, Prochaska-Di Clemente cycle, smoke-free mothers programme
- Signs of pregnancy, certain and uncertain signs, signs of probability and presumption
- Modifications of the maternal microbiota during pregnancy: breasts, intestines and uterus
- Anatomy of the breast and modifications of the breast in pregnancy, accessory breast tissue, supernumerary nipples
- Lactation stages: when breastfeeding starts, how the midwife can promote breastfeeding in pregnancy, completing the UNICEF prenatal checklist
- Birth accompaniment meetings: breathing, relaxation and visualizations, mother-friendly care UNICEF, IAN and paternity
- How to deal with the "disturbances" of pregnancy: the midwife's approach to minor ailments of pregnancy: recommended exercises for the well-being of the perineum, circulation, spine, pelvis, lower limbs
- Care of the perineum and pelvic floor during pregnancy, prevention and risk reduction of perineal damage, perineal massage and pelvic floor exercises, postpartum gymnastics
- POF, the optimal positioning of the fetus: how to favor the anterior positions in the third trimester of pregnancy, nutation and counter-nutation: body work and exercises to promote the mobility of the maternal pelvis

OBSTETRICS OBJECTIVE EXAMINATION
- Introduction to Obstetric Physical Examination - first stage: Medical history, lifestyles, nutrition, support network, detection of maternal body weight, BMI calculation, recommended weight gain during pregnancy
- Second stage - Inspection: spine, evaluation of mobility, degree of inclination and morphology of the pelvis, breasts, external pelvimetry, evaluation of the upper strait by measuring the external diameters of the pelvis
- Third stage - Palpation. Symphysis-fundus measurement and fetal growth curves, Leopold's maneuvers, obstetric diagnosis of: fetal development and uterine growth, situation, presentation, position, level of the presenting part and fetus-pelvic proportion, fetal weight estimation: Johnson's rule
- Fourth time - Auscultation: Pinard's stethoscope and ultrasounds, abdominal quadrants and focus of maximum intensity in the different fetal positions
- Fifth stage - Vaginal exploration: ask for permission, internal pelvimetry, evaluation of the pelvic excavation, medium and inferior straits

AGENDA OF THE BIRTH COURSE, ASSESSMENT OF MATERNAL-FETAL WELL-BEING
- Pre-conceptional health assessment: medical history, anemia and hemoglobinopathies screening, cou nselling food and lifestyles, recommended tests, recommendations on pre-pregnancy intake of folic acid
- First prenatal obstetric health assessment: reception of the pregnant woman, information on the care conduct, execution of the obstetric examination and diagnosis of maternal-fetal well-being
- Criteria for the attribution of the obstetric care model: physiological birth path under obstetric management, birth path under medical-specialist management in collaboration with the midwife
- PAI or individual care plan: pregnancy care plan (physiological)
- Methods and times for carrying out the obstetric objective examination in the various stages of pregnancy: clinical assessment and emotional-relational assessment of the pregnant woman
- Signs of health of mother and fetus: interpretation of general and local maternal physical changes, vital parameters, weight gain, fetal growth estimate, symphysis-fundus measurement, BCF, MAF, laboratory tests and instrumental investigations in the various trimesters of pregnancy, obstetric diagnosis
- Term pregnancy clinic: control of maternal-fetal well-being at term of pregnancy, birth plan, places of birth
- Annotation on the obstetric record of the birth path diary of all the information and surveys relating to the course of the pregnancy.
- Evaluation of the effectiveness of the services provided and the satisfaction of the woman/couple with respect to the care provided by the midwife
- Technical and communicative aspects of conducting a meeting/interview

Elements of perinatal obstetric care
- Primary maternal concern.
Exposure to risk.
- Chemical agents (drugs)
- Physical agents (radiation)
- Biological agents (infections)
- Times, doses and reason for exposure.
- Who to consult in case of potentially dangerous exposure.
- Information services on teratogens.
- The possibilities of prevention.
Awareness of one's own methods of
communication
- The prenatal interview
- The history
- The interview on the chosen test
- Informed consent
The expert/woman or couple relationship
- Is a non-directive interview possible?
- Accompaniment to the decision-making process
Exercises and group work
The assistance plan during the diagnostic procedure
- Chorionic villus sampling
- Amniocentesis
The communication of the result
- The diagnosis of normality
- The doubtful diagnosis and the need for further investigations
- Post amniocentesis or post CVS abortion
- Collection of follow up and archiving
- The role of the midwife in the prenatal diagnosis team

Because the midwife / or must know what is the prenatal diagnosis
Code of ethics (FNCO June 2010): in the premise, in the general principles (spt 2.7) and in relations with the assisted person (spt 3.13 and 3.14)
Professional profile: art.1.1 assists and advises women during pregnancy
The woman expects to be able to get answers and explanations from the midwife she meets
Meeting for information and preparation for prenatal diagnosis: the example of the Mangiagalli Clinic where a group meeting is held with couples, and other hospitals where individual or couple meetings are held with those directly involved
New LEA 3/18/17, attachment 10 C concerns prenatal diagnosis, new orientation
What is done in PD: invasive prenatal diagnosis, diagnostics and therapeutics
Non-invasive prenatal diagnosis: where it was born, aims, limits
Reference to guidelines in prenatal diagnosis: Italy, UK, USA
The midwife and teamwork
Introduction to assistance in the prenatal diagnosis operating room: prepare the sterile table
Interview: techniques for gathering all the information you need, mistakes you shouldn't make
What is fetal therapy: risks and benefits, planning of an intervention (even just PSF or IUFT), the skills of the midwife