Works and female consultation. Structure of women's advice: functions, tasks and principles of work in gynecology

24.07.2019

What institution is the female consultation?
Women's consultation is a medical and prophylactic facility of the dispensary type and carries out its work on the precinct principle.

What are the main functions and tasks of women's advice?

The main functions and tasks of women's consultation are the following:

1. Dispensary of pregnant and herds. Reduced maternal and perinatal morbidity and mortality.

2. Medical assistance to gynecological patients and their dispensarization. Prevention and treatment of menopausal disorders.

3. Prevention of oncological diseases and diseases of the mammary glands.

4. Preservation of the reproductive health of the woman: regulation of the reproductive function, reducing the number of abortions.

5. Socio-legal assistance to pregnant, maternity hospitals and gynecological patients.

What are the advantages of the precinct service principle?

The precinct principle allows the Akuster-gynecologist to carry out a permanent connection with the district therapist of the district polyclinic, the therapist of women's consultation and other specialists. This contributes to the timely registering of pregnant women. To solve issues about the possibility of preserving pregnancy in women suffering from those or other diseases, their comprehensive surveys and the establishment of the appropriate regime and treatment, and in some cases, joint dispensary observation.

The mandatory annual analysis of the performance of the district gynecologist allows him to own information on the socio-economic, environmental state of the area of \u200b\u200bresidence, features of work and harm in industrial enterprises, which makes it possible to rationally plan prophylactic measures.

What are the organizational principles of providing medical care for pregnant women in women's consultation?

The observation of pregnant women is the main task of a female consultation. From the quality of outpatient surveillance, the outcome of pregnancy and childbirth depends largely. The organizational principles of medical care include:

1. Early coverage of pregnant women with medical supervision. A woman should be taken into account at a pregnancy time up to 12 weeks. This will allow in a timely manner to diagnose the extragenital pathology and resolve the issue of the feasibility of further pregnancy, rational employment, determine the degree of risk and, if necessary, ensure the improvement of pregnant women. It has been established when observed
Women in early pregnancy and visiting by the doctor 7-12 times the level of perinatal mortality 2-2.5 times lower than that of all pregnant women in general, and 5-6 times lower than when visiting the doctor under the period of pregnancy more than 28 weeks . In this way,
Sanitary and educational work in combination with qualified medical supervision is the main reserve to increase the number of women applying to doctors in early pregnancy.

2. Taking account. When taking a pregnant woman registered independently of the pregnancy term, a female consultation is obliged to familiarize himself with the outpatient cargo (or discharge from it) Women from a polyclinic network to identify the risk factors for the development of perinatal complications.

3. Timely (within 12-14 days) examination. Effectiveness of early takes of pregnant women will be completely leveled if it is not examined in a minimum time for a pregnant program. As a result of the examination, it is determined by the possibility of carrying pregnancy and the degree of risk, and also produce a pregnancy plan.

4. Determination of the risk of occurrence and development of perinatal, obstetric and "extragnenital pathology.

5. Derodova and postpartum patronage. Derodaya patronageperforms a sewing midwife in obligatory twice: when taking accounting and before childbirth, and, moreover, it is carried out as needed (to call a pregnant to the doctor, control the designated regime, etc.). Postpartum patronage It is that during the first 3 days after discharge from the maternity hospital, workers are visited by women's consultation workers (after pathological delivery) or midwife (after normal genera). To ensure timely postpartum patronage, women's consultation should have a permanent connection with the maternity hospitals.

6. Timely hospitalization of a woman during pregnancy and to childbirth. If indications occur, the emergency or planned hospitalization of pregnant woman is the main task of a female consultation doctor. Timely hospitalization reduces perinatal mortality 8 times compared with a group of women to be in charge of inpatient treatment, but not timely hospitalized.

7. The observation of pregnant women should be carried out on the following dates: in the first half of pregnancy - 1 time per month; from 20 to 28 weeks - 2 times a month; From 28 to 40 weeks - 1 time per week (10-12 times during pregnancy). When identifying somatic or obstetric pathology, the frequency of visits increases. With the failure of a woman to the doctor within 2 days after the next period, it is necessary to conduct patronage and achieve a regular visit to the consultation.

8. Physiopsychoprophylactic preparation for childbirth 100% of pregnant women. Classes in the "School of Mothers".

9. 100% coverage of husbands of pregnant women's classes in the School of Fathers.

10. The antenatal prevention of rickets (vitamins, ultraviolet irradiation).

11. Prevention of purulent-septic complications, which includes compulsory dental, urological and ENT Sanation.

With the second inspection, the pregnant therapist identifies the disease of the internal organs due to pregnancy or arising independently, determines the need to hospitalize pregnant on diseases of the internal organs, and also decides together with an obstetrician-gynecologist. The question of choosing a institution (specialized or ordinary) for treatment and delivery (in In a pregnant extragenital disease).

In the first half of pregnancy, blood and urine tests are made, blood group and rezes-affiliation are determined, the Vasserman reaction, hepatitis markers in (HBSAG), C (HCV), HIV. If there is a negative reserves-affiliation of the blood, a re-study is carried out to detect antibodies (1-2 times and more when they are detected), each time a female consultation is visited.
The bodies of pregnant women, the height of the bottom of the uterus and the abdominal circle, measure blood pressure; Urine and blood tests are repeated periodically.

What are the mandatory and additional methods of examination of pregnant women?

Mandatory: Collection of Anamnese, inspection of the therapist, otorinolaryngologist, dentist, laboratory studies (general blood test, vasserman reaction, HIV, HBSAG, HCV, blood type, rezes-affiliation, blood sugar level, general urine analysis, analysis of the vaginal discharge on the microflora, analysis Cala on the eggs of worms).

In the future, laboratory studies are carried out in the following dates:

- general blood analysis - 1 time per month, and from 30 weeks of pregnancy - 1 time in 2 weeks;

- analysis of urine In the first half of pregnancy - monthly, and then - 1 time in 2 weeks;

- blood sugar in blood - in 36-37 weeks;

- coagulogram - in 36-37 weeks;

- RW and HIV in 30 weeks and before childbirth;

- bacteriological (preferably) and bacterioscopic(mandatory) study of the discharge from the vagina - in 36-37 weeks;

- ECG- In 36-37 weeks.

Additional, In women with a burdened obstetric history (stillbirth, unbearable) and extragenital diseases, it is necessary to determine the content of hemolysins in the blood of a pregnant woman, to establish a group and the rhesus-belonging of the blood of the husband, especially when determining the rhesus-negative type of blood in a pregnant or blood group O (1) Studies for the presence of causative agents of urogenital infection, determining the excretion of hormones, indicators of immunoresistance, as well as all necessary studies for judgment on the presence and nature of the flow of extragenital diseases. It is especially thoroughly necessary to carry out medical and genetic counseling of pregnant women with a burdened obstetric, family and gynecological history.

How is an objective study of pregnant?

During pregnancy, the growth of the woman's body should be measured. Definition anthropometric indicators It is a prerequisite for the diagnosis of obesity, controlling the body weight of pregnant. Obviously, the
A woman will visit the consultation, the more reliable data will receive a doctor.

When establishing increased blood pressure in the early period of pregnancy, a survey is necessary to exclude or confirm the hypertensive disease. In the late period of pregnancy, the differential diagnosis of hypertension and gestosis is complicated. Be sure to establish the value of blood pressure to pregnancy, since it is up to 125/80 mm Hg. Art. Women with hypotension can
Being a symptom characteristic of nephropathy.

Inspection The pregnant woman includes an assessment of its physique, degree of development of the subcutaneous basis, the definition of visible edema, the state of the skin and mucous membranes, the mammary glands.

Outdoor and interior obstetric study Includes the measurement of the pelvis, determining the state of the genital organs and, starting with 20 weeks of pregnancy, measurement, palpation and an auscultation of the abdomen.

At first vaginal research, In addition to the determination of the magnitude of the uterus, it is necessary to establish the presence of exostoses in a small pelvis, anomalies of the development of genital organs, the condition of the tissue.

Palpation Belly allows you to determine the condition of the front abdominal wall and the elasticity of the muscles. After increasing the size of the uterus when its outer palpation becomes possible (13-15 weeks), you can determine the tone of the uterus, and then, by
The improvement of pregnancy is the fetal location, its position, position and appearance. Palpation is carried out using 4 classic obstetric receptions (by Leopold).

Auscultation The tones of the heart of the fetus are carried out with 20 weeks of pregnancy. Fetal heartbeat is determined by an obstetric stethoscope in the form of rhythmic double blows with a constant frequency of 130-140 per minute, as well as using ultrasound and doppler techniques, which significantly improves the accuracy of the study. It should be indicated that even a clear definition of the ear of rhythmic noise until 19-20 weeks of pregnancy does not indicate the presence of cardiac tones, so fixes in the surveillance map
Fetal heartbeats before the specified period is inappropriate.

How often should pregnant attend women's advice?

With the normal course of pregnancy, the woman visits consultation 1 time per month in the first half of pregnancy, 2 times - in the second and after 32 weeks - 3-4 times a month. On average, pregnant must visit the consultation 10-12 times. If it has extragenital diseases, complications during pregnancy require more frequent visits to a female consultation. In many countries, the number of visits is significantly less (4-6).

During each visit to the consultation, the doctor gives pregnant with the necessary recommendations for personal hygiene, labor, recreation, recreation, picks up a corresponding complex of exercise.

What is physiopsychoprophylactic preparing for pregnant women?

Developed and introduced by domestic scientists I.Z. Velvovsky and A.P. Nikolaev and widely promoted abroad as the "Russian Method" physiopsychoprophylactic preparation of pregnant women to childbirth is a set of events,
Including 5-6 conversations that conduct a doctor. During conversations (including individual) with pregnant women, starting with 33-35 weeks of pregnancy, issues of the physiology of a generic act, proper behavior in childbirth, ways to relieve pain
sensations during battles.

In practice, pregnant women give recommendations on the regime of the day and nutrition, they offer special complexes of physical exercises, contributing to the achievement of the necessary level of psychophysical activity of the body. Correctly conducted physiopsychophylactic preparation eliminates the fear of the upcoming clauses, it is capable of significantly reduce pain during battles, to ensure adequate behavior of the feminine.

What is the role of the exchange and notification map of the pregnant and herds?

For implementation continuity In the observation of a pregnant woman in a female consultation and a maternity hospital, an exchange-eyed card of a pregnant and a parental is issued on the hands of each pregnant woman, in which the basic data on
Standing the health of a woman and which she gives a doctor when entering the maternity hospital. In consultation, special attention should be paid to pregnant women, related to groups of high
risk of developing perinatal, obstetric and extragenital pathology.

In the presence of exacerbations of extragenital diseases in pregnant women or pregnancy complications, an obstetrician gynecologist and a female consultation therapist are obliged to appoint appropriate treatment on outpatient conditions or hospitalize a woman in a hospital.

Pregnant women suffering from tuberculosis, diabetes, cardiovascular and venereal diseases, without pregnancy, infectious diseases, besides, are under the supervision of specialist doctors and for delivery are directed, as a rule, to specialized maternity hospitals or separation of relevant hospitals.

Does the woman need after childbirth in further medical supervision?

In the postpartum period, women need compulsory medical supervision, since after childbirth they may have postpartum diseases. The parent's must visit an obstetrician-gynecologist or midwife at the Feldshera point
2-3 weeks after childbirth and re-with the normally proceeding postpartum period after 4-5 weeks, i.e. Before the end of the postpartum vacation. Pregnant warns are warned before delivery. A woman should be inspected, in case of need for treatment, to carry out the individual selection of the contraception method. The parent's who has not visited the doctor after childbirth is subject to a patronage at home.

What is the risk strategy in obstetrics and perinatology?

The risk strategy in obstetrics provides for the allocation of groups of women who have pregnancy and childbirth can be complicated by a violation of the life of the fetus, obstetric or extragationalital pathology. Pregnant women who are registered in women's consultation can be attributed to the following risk groups:

Perinatal pathology from the fetus;

Obstetric pathology;

Extgazenital pathology.

What are the risk groups of perinatal pathology allocate pregnant women?

It has been established that 2/3 of all cases of perinatal mortality occurs in women from a group of high risk that make up no more than 1/3 of the total number of pregnant women. Based on the literature data, its own clinical experience, as well as the multifaceted development of childbirth stories when studying perinatal mortality, O.G. Frolova and E.N. Nikolaev (1979) identified separate risk factors. They include only those factors that led to a higher level of perinatal mortality towards this indicator in the entire group of pregnant women surveyed. All risk factors authors are divided into two large groups: prenatal (a) and intranatal (B).

Prenatal factors In turn, divided into 5 subgroups:

1) Socio-biological:

2) obstetric and gynecological anamnesis;

3) extragenital pathology;

4) complications of real pregnancy.

5) Estimates of the state of the intrauterine fetus.
The total number of prenatal factors amounted to 52.
Intranatal factors Also were divided into 3 subgroups. These are factors from:

1) mother;

2) placenta and umbilical cord;

This group combines 20 factors. Thus, 72 risk factor was allocated.

For a quantitative assessment of factors, a bullery system is applied, which gives it possible not only to estimate the likelihood of adverse outcome of the generations under the action of each factor, but also to obtain the total expression of the likelihood of all factors. Based on the calculations of the estimate of each factor in points, the authors identify the following risk degrees: high - 10 points and higher; Middle - 5-9 points: low - up to 4 points. The most common mistake when calculating points is that the doctor does not summarize the indicators that seek it insignificant, believing that there is no need to increase the risk group. The allocation of a group of pregnant women with a high risk allows you to organize intensive observation of the development of the fetus from the start of pregnancy.

How are the groups of pregnant women with the risk of occurrence of perinatal pathology?

In 32 and 38 weeks of pregnancy ballery creakssince new risk factors appear in these deadlines. These studies indicate the growth of a group of pregnant women with a high degree of perinatal risk (from 20 to 70%) by the end of pregnancy. After re-determining the degree of risk, the pregnancy plan specifies.

With 36 weeks of pregnancy, women from the middle and high risk group re-examine the head of women's advice and the head of the obstetric department, which will be pregnant will be hospitalized before childbirth. This inspection is an important point in conducting pregnant women from risk groups. In those areas where there are no maternity departments, pregnant women are hospitalized on the schedules of regional and historicals for prophylactic treatment in certain obstetric hospitals. Since the prenatal hospitalization for examination and comprehensive preparation for childbirth for women from risk groups is mandatory, the period of hospitalization, the presumptive plan for maintaining the last weeks of pregnancy and childbirth should be produced in conjunction with the head of the obstetric department.

The prenatal hospitalization on time defined by jointly by doctors consultation and hospital is the last but very important task of women's advice. In a timely manner, hospitalized pregnant from a group of secondary or high risk, a female consultation doctor may consider its function performed.

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Abstract:

« Women's consultation»

Introduction

Women's consultation - Health Organization, providing outpatient obstetric and gynecological assistance using modern medical technologies, family planning services and reproductive health.

Women's consultation works on the precinct principle:

One position of the district obstera gynecologist for 2000-2200 women;

The number of obstetric posts is equal to the number of positions of obstetricians of gynecologists;

Opening hours: up to 6 hours at the reception, 0.5 hours call service;

Load at a reception for 1 patient 15 minutes, call service at home 1.25 per 1 hour, preventive inspections of 10 minutes per person.

1. Female consultation structure

Cabinet head

Cabinets of precussion obstetrician

Cabinet of children's and adolescent gynecologist

Cabinet senior midwife

cabinets of other specialists: therapist, psychotherapist, lawyer, social worker, psychoprophylactic preparation for childbirth.

In women's consultation, specialized techniques are functioning:

Cabinet planning family

Unbearable during pregnancy

Cabinet of infertility and unbearable

Reception of the doctor of the therapist of women's consultation

2. Organization and planningwomen's Consultation

The basis of the work of the female consultation is the principle of territoriality and the method of dispensary observation of pregnant and gynecological patients. Women's consultation works on the principle of district police in the APTC system. The APT is organized - the complexes, the work of which organizes the Polyclinic Pharmacy Council and the Pharmk Council of the city.

Tasks and registry functions, its role in the medical diagnostic process:

Women's consultation is centralized with polyclinic, where there are general medical cards. Registry provides a preliminary entry for the reception to the doctor on all days of the week with a personal visiting or by phone. Gives information about the work of the doctors of the consultation provided by the consultation of the services. Delivers medical maps to specialist reception rooms.

Doctors are receiving 5 - day week, on a sliding schedule: from 8.00. Until 14. 00. And from 14.00. Until 20. 00., Saturday - from 8.00. Up to 15. 00. The doctor of the site, in addition to admission to the female consultation, assists at home pregnant, maternity hospitals, gynecological patients who cannot appear in the female consultation. If the doctor finds it necessary, he actively visits the patient or pregnant at home without a call (patronage).

The clinical diagnostic laboratory is centralized, it highlighted a special office for servicing pregnant and gynecological patients.

Women's consultation widely uses the possibilities of separating prevention for rehabilitation treatment. Sanitary and educational work is carried out doctors and midwives according to plan. The main forms of this work are individual and group conversations, lectures, answers to questions using audio and video cassettes, radio, movies, television.

Information about the presence of drugs in the pharmacy network of the city through the Cabinet pharmaceutical is organized.

The distribution of functional duties between medical personnel, knowledge of official instructions, the presence of methodical folders in the workplace, manuals for work allows you to clearly and qualitatively fulfill their job responsibilities. Women's consultation is fully provided with disinfectants, detergents, medigation .

Taking patients is organized by coupons and pre-recording. For pregnant women highlighted separate hours on reception, the reception is carried out by appointment in the gynecologist and in the reception. The registration includes a separate window for recording pregnant women to specialists.

Operating, "Maternity School" work, Women's training is conducted by the rules of the mammary glands, video-hectares for adolescents and a family planning office. It helps rational use time to work at the reception with doctors.

The main task of women's consultation is to provide highly qualified preventive and therapeutic care, strengthening the reproductive health of the woman at all stages of her life. To implement this, the following programs are developed and improved and improved:

The program to reduce maternal, perinatal and infant mortality

Demographic safety program

Programs for improving work with women of group RR, family planning, reduced abortion.

Improving the quality of professional women and adolescent girls with mandatory oncocytology and subsequent dispensarization, rehabilitation.

Active identification of women with STIs, venereal diseases.

Propaganda principles of a healthy lifestyle, activities to preserve and strengthen reproductive health in various age and social groups of women.

To manage the quality of the department, the UKRV and Ukr separation is analyzed. The population is conducted monthly with the definition of the coefficient of social satisfaction and the development of measures to eliminate the defects of the work of women's consultation. Computer programs for hospitalization, dispensarization of gynecological patients and pregnant women, oncology have been developed and implemented. A computer medical care review computer is used. With the help of a computer, the forms of monthly reporting, operational information are unified. All employees of women's consultation are trained in the basics of work on the computer.

Tasks for women's advice:

1. Providing qualified obstetric and gynecological assistance to the population of attached territory;

2. Provision of obstetric assistance during pregnancy, postpartum period, preparing for pregnancy and childbirth; Taking into account pregnant women and the implementation of therapeutic measures for pregnant women included in the risk group.

3. Conducting medical and preventive measures aimed at preventing pregnancy complications, postpartum period, prevention of gynecological diseases;

4. Providing outpatient assistance to women with gynecological diseases;

5. Ensuring advice and family planning services (including abortion prevention, sexually transmitted diseases);

6. Provision of specialized obstetric and gynecological assistance;

7. Provision of certain types of inpatient care (in a day hospital);

8. Organization and conduct of sanitary and preventive work among women, hygienic education and training on reproductive health issues;

9. Ensuring sanitary and anti-epidemic measures;

10. Preventive inspections of the female population;

11. Holding work on contraception to prevent non-planned pregnancy;

11. The provision of social and legal assistance in accordance with the legislation on the protection of the health of the child's matter;

12. Implementation into the practice of modern methods of prevention, diagnosis and treatment of pregnant and gynecological patients, the introduction of new medical technologies, the introduction of advanced forms and methods of outpatient obstetric and gynecological care.

13. Ensuring continuity in examination and treatment of pregnant women, pupils and gynecological patients between women's consultation and maternity hospital, children's consultation, other medical and preventive institutions (Consultation "Family and Marriage", Consultative and diagnostic centers, medical and genetic advice).

3. Accounting and reporting medical documentation usedand work in women's consultation

Journal of taking into account patients and failures in hospitalization (001 / y).

Journal of taking into account pregnant women, feminine and herds (002 / y).

Medical map of pregnancy interruption (003-1 / y).

Protocol in case of identifying in a patient launched shape of malignant neoplasm (027-2 / y).

Medical card of an outpatient patient (025 / y).

Individual map of pregnant and parental (111 / y).

Doctor's call record book (031 / y).

Magazine recording outpatient operations (069 / y).

Consolidated statement of the accounting of diseases registered in this institution (071 / y).

Diary of the work of the doctor Polyclinic Consultation (039 / y).

Diary of the Middle Medical Personnel Consultation (039-1 / y).

Direction on IRK (088 / y).

Extract from the medical card of an outpatient, stationary patient (027 / y).

Exchange card of the maternity hospital, maternity hospital (113 / y).

Notification of the patient with for the first time in the life of an established diagnosis of active tuberculosis, venereal disease, trico, microsporia, Favus, scabies, trachors, mental illness (089 / y).

Notification of the patient with the first time in the life of a diagnosis of cancer or other malignant neoplasm (090 / y).

Journal of Sanitary Working Journal (038-0 / y).

Certificate of perinatal death (106-2 / y).

Magazine registration of outpatient patients (074 / y).

female documentation Consultation

4. Continuity in the activities of women's consultation. Communication with other healthcare organizations (children's clinic, maternity hospital). Organization and holding of consultations, consiliums, clinical, clinico-patologistanatomical conferences

Women's consultation complies with the principle of medical care. Supports contact with children's clinic, maternity hospital. Pursuing in the "Maternity School" Woman passes 3 classes of obstetrician-gynecologist and 2 pediatricians and 1 legal advisions if available. Data on pregnancy is transferred to the children's clinic.

In order to inform the obstetric hospital about the health status of women and the peculiarities of the course of pregnancy, the female consultation doctor issues a pregnant woman under the term of pregnancy 30 weeks "The exchange card of the maternity hospital, the maternity hospital". In turn, the maternity hospital reports information on the course of childbirth and the postpartum period in the female consultation.

Consulting, consultations, clinical, clinical and pathoanatomical conferences occur according to plan, compiled by the head of women's consultation. The conferences conducted jointly with the Hospital staff, the gynecological department of the city hospital, and doctors of other women's consultations, are planned to be the main obstetrician-gynecologist of the city together with the heads of the above divisions, as well as NCHMF NCGB.

5. Responsibilities of the district doctor Obsterbut-ginecologist, his work schedule,participation in L.anti-diagnostic process

Responsibilities:

1. provide qualified and specialized obstetric and gynecological assistance to the population of attached territory;

2. provide obstetric care during pregnancy, postpartum period, to prepare for pregnancy and childbirth; To take into account pregnant women and the implementation of therapeutic measures for pregnant women included in the risk group.

3. carry out medical and preventive measures aimed at preventing pregnancy complications, postpartum period, prevention of gynecological diseases;

4. Render an outpatient assistance to women with gynecological diseases;

5. Conduct advice and provide family planning services (including abortion prevention, sexually transmitted diseases);

6. provide specialized obstetric and gynecological assistance;

7. Conduct sanitary and prophylactic work among women, hygienic education and training on reproductive health issues;

8. Ensure sanitary and anti-epidemic activities;

9. Conduct preventive inspections of the female population;

10. To carry out the work on contraception to prevent non-planned pregnancy;

11. To introduce into practice modern methods of prevention, diagnosis and treatment of pregnant and gynecological patients, introduce new medical technologies, advanced forms and methods of outpatient obstetric and gynecological care;

13. In his work, guided the principles of medical ethics and deontology.

Participation in the medical diagnostic process.

An obstetrician-gynecologist of female consultation conducts primary reception of the patient, his primary examination. Solves the question of the necessary medical care (stationary / outpatient). If necessary, he guides the patient to the hospital for finishing and \\ or treatment, sends a higher level to advisory centers.

When conducting outpatient treatment, assigns the necessary addition to the clinic or hospital, prescribes treatment and controls the therapeutic process. In case of difficulty, the patient's counseling has a female consultation.

6. Dispensary observation of pregnant women, accounting, examination, examination, dispensary observation and treatment of pregnant women nonsense and gynecological patients

Dispensary observation of pregnant women.

1. Timely taking on account - up to 12 weeks

2. Systematic observation: the first time to 12 weeks, the 2nd time after 7-10 days, then in the first half of the pregnancy 1 time per month, after 20 weeks - 2 times a month, after 32 weeks - 3-4 times a month (i.e. up to 15 times). First inspection: general and special history, general inspection, growth, weight, abdominal circumference, sizes of the pelvis, hell on two hands, obstetric studies, research of the most important bodies.

3. Comprehensive examination of pregnant and treatment of somatic diseases: general urine analysis (for each appearance); Common blood test, platelets, coagulation, hematocrit - at the first turnout, at 22 weeks, 30 weeks, 34-36 weeks, in the postpartum period - OAK; Blood on syphilis - at the first turnout, 28-30 weeks, 36 weeks; blood glucose - at the first turnout, in 24-28 weeks; A blood group and a rhesus factor, if necessary, a husband examination - at the first turnout. Control Titra AT - up to 20 weeks 1 time per month, after 20 weeks - 1 time in 2 weeks;

Biochemical examination of blood - urea, bilirubines, alosa, asat, common protein, electrolytes - at the first turnout, 30 weeks, 36 weeks. Coagulogram, fibrinogen, prothrombin index - at the first turnout, at 28-30 weeks, 36 weeks; Examination for STIs, perinatal infections - when taking into account; Blood on toxoplasmosis - at the first appearance, in case of seronegative reactions - control 1 time in trimester; HIV testing, voluntary at the first turnout; Survey on pathogenic staphylococcus - at the first turnout, in 30 weeks, in 36-37 weeks; Survey on helminths at the first turnout, on HBS, HCV - when identifying the STI; Inspection of the therapist at the first turnout of 28-30 weeks, inspection by specialists at the first turnout, ECG - at the first turnout; Oncocytology - at the first turnout, in 30 weeks, in the postpartum period, colposcopy - with the presence of the pathology of the cervix; Inspection in mirrors and vaginal examination, taking smears to determine the degree of purity and flora at the first turnout, in 16-18 weeks, 28-30 weeks, 32-34 weeks and 36-37 weeks. pregnancy (when leukocyte discovery in leukocyte strokes are more than 30 in the field of view - the smears three times with bapposev; listening to the heartbeat of the fetus by an obstetric stethoscope from 20 weeks; determination of the use of the fetus of the fetus by leopold with 28-30 weeks;

4. Determination of the belonging of a pregnant woman to the risk group.

Accounting for five groups of factors:

socio-biological,

obstetric and gynecological history,

extgazenital Mother diseases

complications of pregnancy,

estimation of the state of the fetus.

A group of high risk 10 and more points, mid-risk 5-9 points, low risk up to 5 points.

5. Derodal patronage (those who have not appeared within the deadline).

6. Registration of documentation:

individual map of pregnant and parental f. 111U;

in 32 weeks of pregnancy, the exchange map of the maternity hospital F. 113U; (Forms 3 cells: to be patronage that gave birth, hospitalized; stored in the doctor's office by the date of the subsequent visit).

7. Determination of the duration of childbirth and design of pregnancy and childbirth in 30 weeks 126 calendar days, focusing on the first day of the last menstruation, the first turnout in the LCD and the data of Uz-screening 1 trimester.

8. Prevention of congenital pathology - Folic acid 1 Tablet 4 times a day to 12 weeks, iodine deficiency - from 14 -34 weeks of 200 μg. Prevention of insufficiency of vitamins and minerals - courses for 2-3 weeks throughout the entire pregnancy.

9. Balanced and full nutrition, employment in the presence of professional harm in the workplace, restriction of physical activity, rational labor and recreation mode. Sexual rest.

10. Uz-screenings on congenital and hereditary pathology - 11-12, 16-21, 24-26, 32-34 weeks. When a group of risk is detected - conducting medical and genetic counseling, followed by the fence of the material of the fetus (chorion vane, placenta or spindle water). According to the testimony, the examination on ultrasound outside screening (the state of the fetus and placenta, the state of the lower segment of the uterus, the cervix, the amount of water, the clarification of the situation and the prelation of the fetus, the curse of the umbilical, etc.)

11. Identification of chronic foci of infection, examination on pathogenic staphylococcus, perinatal infections, STIs, sanations within 10-14 days followed by controlling crisp. Conduct voluntary HIV testing to test and after test counseling.

12. Dispensary observation jointly by other specialists with extragationalital pathology (therapist, endocrinologist, oculist, otolaryngologist, dentist, according to testimony - cardiologist, urologist, etc.).

13. Preventive hospitalization with extragnenital pathwood in terms of up to 12 weeks, 20-24, 28-32 weeks and indications.

14. Antianemic treatment of iron preparations outpatient or in the hospital for 4 weeks - 200 mg per day, 2 weeks 100 per day. Prevention of anemia from 14 to 34 weeks of 200 μg in Ned.

15. Early detection of symptoms of pregestosetsis, its timely treatment, in the absence of effect within 1-2 weeks - hospitalization. Preventive courses in the risk group of gestosses from 8 -9 week - therapeutic and pre-maintenance regime, diet, vitaminotherapy, from 16-19 weeks - Trental, Kuraltil, Essentialya-Forte, Lipostabil, Aspirin 60 mg per day from the 2nd trimester Eukonol 1 capsule per day 30 days, magnesium preparations, phytotherapy, vitamin E, Bed REST method.

16. Timely detection of signs of the threat of abortion, urgent hospitalization.

17. Preventive courses of therapy in general critical deadlines for unbearable - up to 12 weeks, 14-16 weeks, 18-20, 22-24, 28-32, 34-36 weeks, as well as on individual dates - outpatient or in hospital.

18. Control of AT in blood with a rhesse-negative blood when the AT is detected by hospitalization, subsequent controls depending on the Tutor AT.

19. Joint inspection with the head of female consultation in 30 weeks at the issuance of a disability sheet, in case of refusal to hospitalization, to correct the survey and treatment, the choice of time and the level of delivery.

20. Prevention of labor anomaly from 36 weeks of pregnancy (Galoskorbin, Askorutin, Folic Acid, Vitamin C).

21. Prevention of bleeding in childbirth with 36 weeks of pregnancy (Folic acid, Askorutin, Calckene, Vikasol, Glucose - Vitamino - Hormonal - Calcium complex, spasmolytics, ATP, Vitamins B1, B2, B6 - 10 days).

22. Maternity school and mental physiophysyophylactic preparation for childbirth.

23. Determination of the alleged mass of the fetus of 38 weeks of pregnancy.

24. Prevention of feto-placental insufficiency and hypoxia of the fetus in 16-18 weeks, 28,30-32, 35-36 weeks (Kuraltil, Riboxin, Kidokoxylase, Trental, Actovegin, Picasol, Ashiver, Provenavit, Vitamin E, etc.). In the early signs of the hypoxia of the PLDD - hospitalization.

25. Prevention of postpartum septic infection of the parental and newborn - examination and sanitation of urinary tract, nasopharynx in 36-38 weeks.

26. The prenatal hospitalization of a pregnant woman in 34-36 weeks, 37 weeks, 38-39 weeks.

27. Rhodeworce - ІІ - ІІІ level.

Posted on Allbest.ru.

Goal

Since women's consultations, in most cases, are state, they have a specific list of objectives and tasks that they are required to pursue and perform in the maximum full. Among them, the following points are distinguished:

Qualitative and timely provision of obstetric and gynecological support for the female part of the population;
Conducting therapeutic and preventive measures, the main purpose of which is to prevent the development of diseases or pathologies in a pregnant woman, early diagnosis of gynecological problems;
Provision of social and legal assistance to women in accordance with applicable law;
Implementation of modern methods of treatment and diagnostics, as well as the prevention of gynecological deviations.

As for the organization of work, in each such medical institution there is a certain scheme of cabinet complexes.

LCD represents the range of the Cabinets. Source: Ulgov.ru.

In the zone of the input group there is a registry office where you can take an outpatient card and write to a specialist. There is necessarily one or more cabinets in which obstetrics and gynecologists work. There they are taking pregnant women, feminine and provide medical assistance to women with various problems in the gynecological part.

In large cities, women's consultations have a laboratory, manipulative and procedural cabs, in smaller settlements they may be absent, as well as the branch for artificial interruption of pregnancy and the paps of narrow specialists (therapist, psychologist, vascular surgeon, etc.).

Features

As it is known that women's advice can be a private or state type, it is necessary to determine what advantages will be when visiting a medical institution at a place of residence free of charge.

Among the advantages of the state LCD, allocate:

Immediate proximity to home;
Lack of need to pay for examination;
The possibility of receiving any documents if a woman will be registered within 12 weeks to a row;
The gynecologist issues a direction to the maternity hospital, as well as to hospitalization, if necessary, preservation of pregnancy.

Unfortunately, government agencies have a wide range of disadvantages. Quite often, women face that they have to stand in line for a long time, or it is impossible to get to the reception to a specialist who have they were next time.

Bureaucratic factor plays the last role. Difficulties may occur at any stage of the formulation of the future manufacturer to record, the need to collect an extensive package of documents, and if a number of rules are not compared to a number of rules, can be sent to a consultation, which is at the other end of the city.

Often, gynecologists in state women's consultation are roughly treated with their patients, and also have a low level of professionalism and prefer to work "in the old manner", neglecting new modern techniques for diagnosis, treatment and maintenance of pregnant women.

Documents

Given all the data described above, the main advantage of public women's consultations is that the survey is free of charge. If the girl does not have the opportunity to contact a private clinic, then she needs to know which package of documents can be counting, servicing at the place of residence.

Help, which confirms the fact of the occurrence of pregnancy. Such a document is sometimes necessary to married couples that are not married yet, but they plan to get married before the birth of a child (helps to carry out the procedure at an accelerated order).

Specialists can also issue a document that the woman is really registered in the female consultation on the fact of pregnancy, and turned there no later than 12 weeks. This certificate allows you to get a one-time financial assistance, in the amount of just over 400 rubles.

An exchange card will be charged for each woman. This document is the most important throughout the pregnancy, since it reflects all changes that occur with the future mother, studied research and their results, identified pathologies, as well as their absence. The document is a certain connection between the maternity hospital and the female consultation. If it is not, then the patient is considered to be non-learned.

In public women's consultations give birth certificates.

Structure of women's consultation.

1. Registry.

2. Cabinet obstetrician gynecologist

3. Cabinets of specialized reception:

family planning, unbearable pregnancy, gynecological endocrinology, cervical pathology, infertility, gynecology of children's and adolescence, functional and perinatal diagnostics.

4. Cabinets of other specialists:

therapist, dentist (dentist), psychotherapist, lawyer, social worker, psychoprophylactic preparation of pregnant women to childbirth, therapeutic physical education, physiotherapy treatment methods.

5. Other divisions:

Small operating room, clinical and biochemical laboratory, sterilization, set of rooms for day hospital.

Staff schedule for women's consultation Completed on the basis of the order of the USSR MW of 29.12. 19983 No. 1495 "Staff regulations of medical, pharmaceutical personnel of workers in kitchens of maternity houses, obstetric departments (chambers) and departments (chambers) for newborns and female consultations."

Women's consultation is an independent division of the maternity hospital, polyclinic or health part, providing all types of outpatient obstetric and gynecological assistance to the population.

The territory of the female consultation is established by the relevant health authority on subordination.

The states of the medical personnel of women's consultation are established in accordance with existing full-time standards.

The work of the female consultation (obstetric and gynecological office) is organized in accordance with the Regulations on the Women's Consultation (Appendix N 2 to the order of the USSR Ministry of Health No. 830 of September 12, 1977). The work of medical personnel is organized in accordance with the provisions of medical professionals of maternity hospitals and women's consultations (Order of the USSR Ministry of Health No. 360 dated April 7, 1980) and other official documents approved by the USSR Ministry of Health, as well as orders and instructions of higher authorities and officials .

The main tasks of women's advice:

Conducting preventive measures aimed at preventing pregnancy complications, childbirth, postpartum period, gynecological diseases;

Providing qualified obstetric and gynecological assistance to the population of attached territory;

Carrying out work on contraception;

Introduced into practice the work of modern methods of diagnosis and treatment of pathological pregnancy, diseases of the parent's and gynecological patients, advanced forms and methods of outpatient obstetric and gynecological assistance;

Sanitary and educational work;

Providing women to legal protection in accordance with the legislation on the protection of motherhood and childhood;

Ensuring continuity in the examination and treatment of pregnant women, pupils and gynecological patients; The implementation of a systematic connection with the maternity hospital (separation), station (emergency and emergency department of medical, assistance, polyclinic and children's clinic, as well as with other medical and prophylactic institutions (anti-tuberculosis, skin-venereological, oncological dispensaries, etc.).

The work of the female consultation is established taking into account the trouble-free provision of outpatient obstetric-gynecological aid of women in their non-working time. The most rational mode of working female consultations in cities from 8 to 20 hours and from 9 to 18 hours on Saturdays, Sundays, pre-holiday and holidays.

In the female consultation reception, there should be clear visual information: the schedule of techniques of doctors of all specialties and the work of therapeutic and diagnostic cabinets; Information about the work hours of women's consultation, including Saturday and Sundays on where to address the population for medical care during the Women's consultation stopped its work (indicating phone numbers, addresses and types of transport, where you can reach the appropriate medical and prophylactic institutions).

Registry provides a preliminary entry for the reception to the doctor on all days of the week with a personal visiting or by phone. With a preliminary recording, a woman is issued "Talon at the reception to the doctor" (form 025-4 / y). For a preliminary recording in consultation, there must be a "pre-recording card for a doctor" (form 040 / y). A woman can make an appointment with a doctor at a convenient time for her. The midwife in accordance with these records prepares medical records for reception.

The medical doctor assists at home pregnant, maternity hospitals and gynecological patients who cannot appear in consultation for health.

A visit to the doctor's patient's call is carried out on the day of the call, and if necessary, urgent inspection is immediately. After visiting the patient, the doctor makes the appropriate entries in the "book of calling doctors call" (form 031 / y) and the "Medical Map of an Ambulator Patient" (form 025 / y), or in the "Individual Map of Pregnant and Rigor" (shape 111 / y ).

Therapeutic procedures, as well as the manipulation of a diagnostic nature, are carried out at home by middle medical personnel (obstetric, laboratory, etc.) for the appointment of a doctor.

Sanitary and educational work is carried out by doctors and midwives according to the plan, taking into account local characteristics and conditions. For this work it is necessary to highlight fixed clocks and days. The main forms of this work are: individual and group conversations, lectures, permanent and mobile exhibitions, stained glass windows, bulletins, answers to questions, use of printing facilities, radio and movies, television.

Accounting of the work done is conducted in the "Journal of Sanitary Opening Journal" (form 038-0 / y).

In conducting sanitary and educational work, women's consultations establish communication with sanitary education houses.

Legal protection of women is carried out by legal counseling legal advice. The legal adviser in his work is guided by the "Regulations on the legal adviser of institutions, organizations and enterprises of the health system" (Appendix N 2 to the orders of the USSR Minister of Health of August 22, 2007 N 685, published on the basis of the Resolution of the Council of Ministers of the USSR from 22.06.72. N 467 ). In women's consultation, the legal adviser, together with doctors, identifies women who need legal protection and takes measures to render it; Gives advice on legal issues. Legal Counsel leads "a book of records of the work of senior legal adviser, legal advisers of health care institutions" (form N 087 / y); conducts lectures and conversations on the basics of Soviet legislation on marriage and family, about the benefits of labor legislation for women; Organizes conversations, seminars for doctors and medium medical personnel to clarify the fundamentals of the legislation of the SSR and the Union republics on health care, conducts work on promoting Soviet legislation.

In order to improve the professional skill of the Acoucher-Gynecologist, working in the female consultation, united with the hospital, the periodic work of the doctor's doctor in the hospital departments is obligatory. The alternation of work in consultation and hospital is advisable in a year; At the same time, it is important to consolidate over one piece of two doctors, several years of mutually replacing each other in consultation and in the hospital and well-knowledgeable people.

If necessary, doctors advice are involved in the population of duty in an obstetric and gynecological hospital.

At least once every 5 years, the doctor should improve its qualifications in institutions and faculties of the improvement of doctors in accordance with the current situation.

In the schedules of the doctor of an obstetrician-gynecologist, it is necessary to reflect all recorded types of work performed by the doctor: reception in women's consultation, visits at home, sanitary and educational and other preventive work. Doctor leads "Doctor's diary Polyclinic (ambulatory), consultations" (form 039 / y).

In the reception and treatment of patients, the obstetrics of the site helps: it prepares tools, medical records, produces weighing of pregnant women and measuring blood pressure, issues directions for analyzes and consultations, produces therapeutic procedures to women. The midwife leads the "Diary of the Middle Medical Personnel Polyclinics (Ambulatory) Consultation" (form 039-1 / y).

Basic principles of organization

Medical help women

1. State Character provides for the obligation of all legislative and regulatory documents in the field of women's health for execution throughout the Russian Federation; System of state events in the field of women's health, development of target priority programs.

2. The principle of compulsory medical insurance It provides for the provision of medical assistance to women under the Mandatory Medical Insurance Program by funding Maternity Protection Agencies from Mandatory Medical Insurance Funds:

Ambulance with a state of threatening life or health of a citizen or the surrounding persons caused by sudden diseases, exacerbations of chronic diseases, accidents, injuries and poisoning, pregnancy complications and for childbirth;

Ambulatory and polyclinic assistance, including carrying out measures for prevention, including dispensary observation;

Inpatient assistance in acute diseases and exacerbations of chronic diseases, poisoning and injuries requiring intensive therapy, round-the-clock medical observation and isolation on epidemiological indications; pathology of pregnancy, childbirth and abortions; planned hospitalization for the purpose of treatment and rehabilitation requiring a stationary regime.

3. Principle of continuity Provides continuity in the work between the maternity hospital, women's advice and children's clinic.

4. Principle of legal protection Based on the legislative documents of the Russian Federation in the field of health protection of women mothers, which are consistent with WHO security-legal documents.

5. Principle of district police It is the main organizational principle of maternity protection institutions.

Types of medical and preventive institutions,

Providing medical assistance to women

In accordance with the order of the Ministry of Health of the Russian Federation of October 7, 2005 No. 627 "On Approval of the Nomenclature of Health Agencies" to the institutions providing medical assistance to women include the following types of institutions in Section 1.6. (Meaverism and Destms Protection Institutions):

1.6.1. Perinatal center.

1.6.2. Maternity hospital.

1.6.3. Women's consultation.

1.6.4. Family planning center and reproduction.

1.6.7. Dairy kitchen.

Organization of work and structure of women's consultation

Women's consultation is a preventive institution of an outpatient polyclinic type.

Women's consultations work in close connection with territorial clinics, sanatoriums for pregnant women, profile dispensaries, centers of prenatal diagnosis, medical and genetic consultations, marriage and family consultations, the main branches of obstetric hospitals, children's clinics and specialized branches of multidisciplinary hospitals.

Women's consultation carries out its work on a precinct principle providing for the provision of preventive, medical obstetric and gynecological assistance in women's consultation, patronage and hospital care at home. At the same time, the free choice of physician patients is excluded. Work at the obstetric and gynecological site is based on a female consultation plan, developed on the basis of the analysis of the health status of women, demographic indicators.

The main tasks of women's consultation are:

I. Preventive events

1. Organization of preventive measures aimed at preventing pregnancy complications, childbirth, postpartum period;

2. Prevention of gynecological diseases (women's clisserization);

3. Sanitary and anti-epidemic events.

II. The provision of medical and advisory assistance to women with gynecological diseases, pregnant and maternity hospitals.

III. Sanitary and educational work on the formation of a healthy lifestyle, consulting on contraception and abortion prevention.

IV. Upgrade statistical accounting of all types of activities, drawing up annual reports, organization and holding of medical conferences, seminars and other forms of vocational training

In accordance with the tasks, the main directions are:

1. Preventive work

Dispensarization of pregnant women;

Preventive examinations of women with the aim of early detection of diseases;

Target medical examinations of women to identify gynecological pathology;

2. Medical assistance for women

Recoveful treatment of pants (women after childbirth);

Ensuring the timely conduct of the qualified treatment of pregnant women;

Active identification of gynecological patients;

Organization and conduct of the examination and treatment of women with gynecological diseases;

Timely hospitalization of women in need of inpatient treatment;

Examination of working capacity in gynecological diseases.

3. Organizational and methodical work

The proper maintenance of educational and reporting documentation;

Holding conferences, seminars;

Direction of doctors for advanced training.

4. Organizational-mass work

Promotion of healthy lifestyles;

Consultations on contraception.

Women's consultation organizes its work in close connection with the obstetric and gynecological hospital, perinatal center, clinic and children's clinic, the Consultation "Marriage and Family" (Family and Reproduction Planning Center), Station of Emergency Care and other medical and preventive institutions (Medical and Genetic Consultation, advisory-diagnostic centers, skin-venereological, anti-tuberculosis, oncological dispensaries).

Structure of women's advice:

Registry;

Cabinets of precussion obstetricians-gynecologists;

Offices for preventing unwanted pregnancy;

Capacles for psychoprophylactic preparation for childbirth;

Physiotherapy Cabinet;

Manipulative;

Cabinets of the therapist, onkogynecologist, venereologist, dentist;

Socio-legal office;

Room of a young mother;

Operating;

Endoscopic office;

Cytological laboratory;

Clinical diagnostic laboratory;

Cabinet functional diagnostics;

X-ray Cabinet,

Administrative and economicCabinet.

In large female consultations, specialized receptions can be organized, day hospitals for examination, treatment of gynecological patients and making small gynecological operations and manipulations.

Organization of medical and preventive care for pregnant women

Providing a favorable outcome of childbirth for mother and fetus, preventing diseases of the newborn requires a proper organization of medical care. The essence of preventing pregnancy and perinatal pathology complications is to create such a social and hygienic environment that provided a pregnant woman to preserve her health and favorable development of the fetus.

An obstetric and gynecological hospital provides assistance mainly by the territorial principle, but at the same time, pregnant has the right to choose any roving institution.

Currently formed several types of obstetric hospitals, which provide medical and preventive care for pregnant women, women in labor, and maternity hospitals:

With general medical care - district hospitals with obstetric beds (internal assistance is currently restricted in the district hospitals, the delivery is allowed only in emergency cases);

With qualified medical care - obstetric branches of the CRH and district hospitals, city maternity hospitals;

Hospitals with multi-profile qualified and specialized help - the branch offices of multidisciplinary hospitals, obstetric departments of regional hospitals, interdistrict obstetric branches based on large CRH, specialized obstetric branches based on multi-profile hospitals, rowing hospitals, combined with departments of obstetrics and gynecology of higher medical institutions, branch of obstetrics and gynecology.

The direction of pregnant women in the degree of risk to the appropriate obstetric hospitals allows you to fulfill the principle of the pity.

Contingent pregnant women	Level of obstetric hospital
1. Repeated (up to three clans inclusive) and primaries without obstetric complications and extragnenital pathology.	The first level of the maternity department of the district hospital, the Central District Hospital.
2. Pregnant women with extragenital diseases, obstetric complications during this or previous pregnancy. Elevated perinatal risk.	Second level of maternity departments of the city CRH, urban maternity hospital, obstetric and gynecological hospital.
3. Pregnant with severe extragenital diseases in combination with late toxicosis, prelation and detachment of placenta, complications during childbirth, contributing to the impaired hemostasis and obstetric bleeding.	The third level of the obstetric department of the regional or multi-profile hospital, specialized obstetric hospital, separation of profile research institute, perinatal center.

When you first handle pregnant in consultation, f. № 111 / y.

The main principle of dispensing of pregnant women is differentiated maintenance, comprising medical supervision of the health of health, the course of pregnancy, the development of the fetus and the provision of preventive and therapeutic assistance. In the implementation of these events conducted by an obstetrician-gynecologist of women's advice, it is envisaged to the actively participation of the therapist, and if necessary, and doctors of other specialties.

The greatest group of women (healthy and practically healthy) with a normally flowing pregnancy is 38-45%. During the pregnancy, the women of this group should attend a consultation 14-15 times. In the event of a woman of extractive diseases or pregnancy complications, the frequency of inspections increases. After the first inspection, the patient is obliged to appear after 7-10 days with the results of analyzes, the conclusion of the therapist and other specialists; In the future, in the first half of pregnancy - 1 time; After 20 weeks. - 2 times; After 32 weeks. - 3-4 times a month. Each woman of this group is sent twice for consultation to the therapist (after the first inspection and after 30 weeks. Pregnancy).

The task of the second inspection is to identify diseases of internal organs due to pregnancy or arising independently, determining the need to hospitalize pregnant on diseases of the internal organs, as well as in the choice of institution for the delivery. Pregnant should also be examined by a dentist, according to indications - other specialists. A certain part of pregnant women, combined into the so-called high-risk group, is allocated. The "high risk" of perinatal pathology for the fetus during pregnancy can be defined as an increase in the risk of death or disease of the fetus and a newborn due to adverse factors from the mother, the fetal diseases or anomalies of its development.

Currently recommended in obstetrics and neonatology "Risk Strategy" is to identify and allocate risk factors, establishing their adverse effects on the outcome of pregnancy and developing tactics of intensive monitoring of the health of mother and intrauterine fruit both during pregnancy, childbirth and in the postnatal period. , if necessary in carrying out treatment.

Currently, a scheme of differentiated intensive monitoring of pregnant "high risk" of perinatal pathology has been introduced into the health practice practice. Upon completion, the survey is resolved the possibility of preservation of pregnancy.

With a positive solution to the issue of preservation of pregnancy, women with a high degree of risk in each case a differentiated plan of maintenance is required, which includes not only the observation of the health of women, but also the use of special methods to estimate the state of the fetus. The management plan must necessarily be entered in f. № 111 / y.

Re-screening must be carried out at 22-24 weeks, and III screening at 34-36 weeks. Pregnancy in order to solve the issue of place (choice of a specialized hospital) and the timing of the direction for the delivery.

Intensive specialized observation of a group of pregnant "high risk", which had a history of stillbirth, makes it possible to reduce the level of perinatal mortality by 30% compared with a similar group that was under normal observation.

Over 25% of pregnant women from the High Risk Group need prenatal hospitalization. Under the period of pregnancy up to 20 weeks. Pregnant women with extragenital diseases can be hospitalized in profile therapeutic hospitals. With other testimony, the prenatal hospitalization is usually carried out in the department of pathology of pregnant physiological or specialized maternity hospital.

Between the timeliness of hospitalization of pregnant women with obstetric or extragnenital pathology and the level of perinatal mortality, a close connection is traced. With the timely hospitalization of pregnant women with late toxicosis of pregnancy, children's loss are about 25-300 / 00, with untimely they increase several times.

In the postpartum period it is recommended to visit the female consultation after discharge from the obstetric hospital for the 10-12th day, which the woman should be warned before childbirth and when discharge from the hospital. If the woman did not appear at the specified period of consultation, it is subject to the patronage of the midwife. The patronage is also carried out with the complicated course of the postpartum period. Repeated a woman visits a doctor before making maternity leave.

Information about childbirth, inspection results and surveys are recorded in F.№111 / y, which until the end of the postpartum period are stored in the cells of the site.

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