Future mother 

Women's consultation - what is it? Women's consultation or medical center: what to choose

Women's consultation is a medical institution in which a number of specialists provide outpatient medical care. At the moment, a network of state budgetary institutions operates in Moscow, as well as centers that are attached to outpatient clinics and maternity hospitals. As an alternative to such complexes, there is a commercial orientation of the centers.

Work organization

In large cities, the best consultation on performance indicators is basic and also performs, in addition to the standard list of tasks, the functions of an obstetric and gynecological center.

Women's consultation is a complex in which work is arranged according to the territorial-district principle. One obstetric site is equivalent to two therapeutic sites, and is served by a midwife and an obstetrician-gynecologist. The normal load per specialist is 4.75 visits per hour.

Thanks to the principle of locality, the doctor can constantly communicate with the therapeutic department and other specialists. This helps to timely register pregnant women and, if necessary, for various pathologies, joint

A successful delivery largely depends on timely admission to the antenatal clinic, registration, completeness and regularity of examination and monitoring of the expectant mother.

Tasks

Here are the goals of these institutions:

  1. Providing quality obstetric and gynecological support to the population.
  2. Implementation of therapeutic and preventive measures aimed at preventing pregnancy pathologies, as well as timely detection of gynecological diseases.
  3. Assistance to women in providing social and legal protection in accordance with the law.
  4. Introduction into practice of modern methods of diagnostics, prevention and treatment of pregnant women, as well as gynecological patients.
  5. Introduction of current methods and forms of outpatient obstetric and gynecological support.

Structure

Women's consultation is an institution that has its own scheme of offices and complexes:

  • registry;
  • office of obstetricians-gynecologists for the reception of women in labor and pregnant women, as well as gynecological patients;
  • treatment room;
  • manipulation room;
  • laboratory;
  • office for termination of pregnancy at short terms;
  • rooms in which vascular surgeons, therapists, consultants and psychologists are received.

Pros and cons of state consultation

Such institutions, compared with private ones, have a number of advantages:

  • close to home;
  • for free;
  • you can get any necessary documents, provided that there are observed at least 12 weeks in a row;
  • the doctor issues a referral for hospitalization in the maternity hospital, and if necessary, a free consultation of a narrowly focused doctor (nephrologist, urologist, cardiologist) will be provided.

Despite all the positives, there are also disadvantages:

  • standing queues;
  • bureaucracy - starting with attaching to a consultation and ending with examinations of specialists who do not work in this institution, then a woman in labor can be sent to the other end of the city;
  • there is no confidence in the professionalism of working doctors;
  • in fact, it is very rare to choose a doctor on your own;
  • sometimes there is rude treatment of patients;
  • you will have to forget about new equipment and comfortable conditions.

The main positive factor in women's consultation is that it's all free. Of course, if there is no extra money, then there is nothing to choose from.

Required documents

Women's consultation is a center in which the expectant mother receives the necessary papers for pregnancy management:

  1. Information about the fact of pregnancy. It may be needed at the registry office as a basis for speeding up the procedure for registering a marriage or at work.
  2. Certificate of registration issued in the initial 12 weeks of pregnancy. Gives the privilege to a woman to receive a one-time allowance from the state in the amount of 412 rubles.
  3. An exchange card is the main document that can be obtained at your site in the antenatal clinic, it contains all the distinguishing features of the course of pregnancy and the examinations passed. Serves as a link between the maternity hospital and the consultant doctor. If there is no such booklet, then the woman is considered unexamined.
  4. A birth certificate is the leading document to enter a maternity hospital for free. It is required to pay for the childbirth procedure at public expense. If it was lost, then it cannot be restored. In the case of planning paid childbirth, it is not needed.
  5. Certificate of temporary disability due to childbirth and pregnancy. In other words, this is a sick leave. It may be needed in the early stages if they put it on hold, and after the 30th week comes, a sick leave for 140 days will be issued. If the pregnancy is multiple, then the term of the bulletin is longer, it can be received already from the 28th week to 194 days.

When to register?

According to the legislation, it is better to become registered at the 12th week of pregnancy.

At this moment, the woman fills out all the necessary documents and receives recommendations for further visits and analyzes. The doctor must necessarily issue an exchange card, which is the main document of the woman in labor. If a woman chooses a private consultation for herself, then you need to ask if the clinic can provide all the necessary documents, if not, then a parallel examination is required.

Observation of pregnant women

The main goal of the antenatal clinic is the medical examination of expectant mothers. At 12 weeks, the girl becomes registered, after which she is observed by her obstetrician-gynecologist until the birth itself.

After a laboratory and clinical examination, the predisposition of each pregnant woman to various risk groups is determined. For a numerical assessment of deterrent factors, it is required to use the scale "Assessment of perinatal risk factors in points" (Order No. 430).

Gynecological support

Often, when visiting a antenatal clinic for women in labor, doctors diagnose gynecological diseases.

After that, an “outpatient medical record” is entered into the patient. If there are indications for clinical examination, a "dispensary observation control card" is created.

Exchange card

This is a document that is issued to be registered in the antenatal clinic. There will be indicated the specifics of the course of pregnancy and the examinations passed. Without such papers, you can only give birth at home or in an infectious area from the usual one, it differs in stricter sanitary conditions, and visits are prohibited at all.

To obtain an exchange card, you need to pass all the tests at least once and visit the doctor several times. Then, at the initial consultation and after receiving a referral for examinations, the woman is issued such a document.

Doctors, of course, will call for a systematic appointment, which, in the normal course of pregnancy, takes place once a month until 28 weeks, and after that it is required to be shown every few weeks.

However, if the woman in labor feels well, and various trips do not bring harmony to life, then the woman has the right to refuse constant visits to the gynecologist. If such a conclusion was made, then the doctor is obliged to treat it with understanding and politely tell the possible consequences for the child and mother.

Leading women's consultations in Moscow

There are about 100 institutions in the city, and most of them are considered true "Women's Health Centers", as they solve not only therapeutic, diagnostic and consultative tasks, but also provide their patients with additional services to improve beauty and women's health, create psychological comfort and social adaptation.

Each consultation works on the principle of territory. Obstetrician-gynecologists are familiar with the patient population they see. Expectant mothers who are registered are entitled to a full examination, as well as observation and treatment in the postpartum period.

You can sign up for a antenatal clinic, depending on the address of residence or personal preferences, the main complexes are located at such addresses.

1. Center at the City Polyclinic No. 113, located at Kuusinen Street 6/6v. This formation is part of the structure of the polyclinic and is housed together with standard units in a separate five-story building, built just for him in 1980.
2. The medical institution at the City Polyclinic No. 157 can be found at M. Raskova Street, 16/26-2. It was founded in 1968 after a decision was made by the executive committee of deputies of the Moscow City Council. This institution is designed for 200 visits per shift and provides a wide range of services.
3. Women's consultation in hospital No. 164 is located at 13/3 Dmitrovskoye Highway. This organization is part of the structure of the building and is located in its main four-story building, which was built in the 60s according to a typical project.
4. Consultation No. 4 is located on 4th Novomikhailovsky Prospekt, 63. This institution is headed by the honored doctor Nadezhda Alexandrovna Lukina, it was built to receive residents of the Koptevo district and, to some extent, the Golovinsky city of Moscow.
5. Women's consultation number 5 is located at Stepan Suprun, 3/5. This center was organized in 1976 by order of the Moscow City Council, and today it is actively fulfilling its functions. Works specifically for residents of Moscow in this area.

Moscow is a very large city, and this is literally a small part of the centers that you can visit in it.

Women's consultation is a medical institution in which women are received, examined, and treated for diseases of a certain nature. What is the structure of the antenatal clinic? What do the experts do? What tasks does this type of institution have and what functions does it perform? Let's consider all this in more detail below.

General concept

Before understanding what is the structure of the antenatal clinic, the tasks and principles of work, you need to decide what is meant by this concept.

So, a women's consultation is considered to be medically presented in the form of a dispensary. Such institutions are created in order to provide the female half of the population with obstetric and gynecological care on an outpatient basis. In the process of carrying out all actions and medical events, specialists can use medical technologies. In addition, in institutions of this type, activities aimed at protecting the reproductive health of women are carried out, as well as local specialists provide family planning services.

As for the principle of operation of the considered category of medical institutions, it is a district one. Observations of extras and specialists in the field of gynecology show that the antenatal clinic area corresponds in number to two therapeutic ones. Having made simple calculations, it is easy to establish that, on average, for one gynecologist who works in the institution in question, there are about 2.5 thousand of the fair sex living in a densely populated region of Russia.

Tasks

As for the main tasks and functions of the antenatal clinic, the main one is to ensure the health of women, as well as mothers and children. It is produced mainly by the method of providing professional medical care by gynecologists and obstetricians, and it does not matter at all whether a woman is pregnant or not. In addition, the tasks of this type of medical institution include ensuring the protection of reproductive health.

What tasks of the women's consultation are also among the primary and most important? When considering this issue, one should pay attention to the fact that it is in such institutions that they carry out all kinds of preventive measures that are aimed at preventing problems that may arise during pregnancy or its planning. In addition, special attention is paid to the prevention of diseases in the postpartum period, as well as health problems in the field of gynecology, which may not be related to pregnancy.

Among the main tasks of antenatal clinic doctors is also the provision of professional medical care in the field of gynecology and obstetrics. In parallel with this, specialists are required to consult on all issues that may arise in women of any age. Their tasks also include holding consultations on issues related to abortion, as well as on venereal and other sexual diseases.

One of the main goals and objectives of the midwives of the antenatal clinic is to conduct educational work among the representatives of the Russian population regarding contraceptives. In addition, they must actively work to introduce modern methods of treating diseases and eliminating problems.

If necessary, consultations can be provided with assistance of a social and legal nature.

Like any other medical institution, women's consultation must have a certain structure. There is only an approximate list of units of which it may consist. Specialists in the field of medicine note that each of the following units is important, as they provide specialized assistance on certain issues.

So, in the structure of the antenatal clinic of any locality, there must be a registry in which a direct record of visitors to specialists is kept, a general list of patients, and all data entered in personal cards is stored.

In addition to the registry, the consultation must have a general department, an obstetrics and gynecology department, as well as an office for an adolescent and pediatric gynecologist.

When determining the structure of the antenatal clinic, one should definitely pay attention to the office, in which there are specialists involved in issues related to family planning, as well as the prevention of unwanted pregnancies. Without fail, the consultation must also include a prenatal preparation room, in which psychoprophylactic procedures are performed with expectant mothers.

Special attention in the structure of the medical institution under consideration should be given to rooms in which certain manipulations are carried out or additional examinations are carried out. These may include departments for endoscopy, x-rays, functional diagnostics, as well as those in which some other specialists are received: a dentist, an oncogynecologist, a venereologist and a therapist. Without fail, an institution of this type must have at least two laboratories: clinical diagnostic and cytological.

In connection with the special specialization of consultations for women, their structure necessarily provides for the presence of manipulation rooms, as well as rooms for a young mother.

In addition to all of the above, in the antenatal clinic, as in any other medical institution, there should be rooms for household and administrative needs.

Practice shows that in large medical institutions there are additional structural units. In particular, hospitals equipped to treat patients and conduct examinations of those individuals who suffer from gynecological diseases can serve as vivid examples of such. Another variant of such a structural element is a department for gynecological manipulations and small operations.

Work organization

The normal implementation of medical work, first of all, is ensured by the correct creation of the organizational structure of the antenatal clinic. Among its divisions, there must be those that can perform all the necessary functions necessary to maintain a normal level of health for the female half of the population in a particular region, provide an appropriate level of theoretical education in the field of family planning, prevention of unwanted pregnancy, as well as sexually transmitted diseases and ways to transmission.

As for the organization of this type of institution in large cities, in practice one consultation, which according to various indicators is recognized as the best in the locality, is appointed as the main one. In fact, the structure and functions of the antenatal clinic remain the same, but new ones are added to them - those that are characteristic of an obstetric and gynecological center that provides consulting services to the population. In such medical complexes, services are actively provided in the field of traditional treatment of diseases in the field of gynecology that arose at an early age, problems with the endocrine system, as well as infertility.

Locality is the basic principle of consultation. It directly affects the quality indicator. This is due to the peculiarity of the organizational structure of the institutions of this nature. First of all, good indicators are due to the fact that in the centers organized according to this principle, specialists who are also directly related to the control of women's health work at the same time: a dentist, an endocrinologist, a therapist, etc. So, they closely interact with each other, which allows specialists to comprehensively consider the resulting health problem for a particular woman. It is often this factor that makes it possible to register a patient in a timely manner, to ensure the normal state of which this is really necessary. Specialists also share positive statistical indicators regarding the timeliness of establishing a special treatment regimen, registration due to pregnancy, etc. Moreover, in such a situation, according to experts, a complex patient is possible.

generic block

In the structure of antenatal clinics and work with expectant mothers, a special place is occupied by the birth unit. This place consists of several parts: wards (prenatal, intensive care, delivery), children's room, sanitary facilities, operating rooms. In addition, there is also a department for newborns. All children's wards must be equipped in accordance with medical requirements: they maintain the temperature and humidity recommended by the standards, as well as sanitary conditions. Every day, pediatricians should inspect these wards and note the condition of newborns. As a result of all this, the doctor is obliged to inform the mother about the available information regarding the health of the baby.

Working with pregnant women

The organization of the structure of the antenatal clinic and the work of this medical institution also provides for certain medical actions in relation to women who are preparing to become mothers. In relation to them, the specialists of the centers conduct special work aimed at maintaining the state of health of women and its comprehensive improvement.

In order to ensure all the main goals and objectives of the antenatal clinic, the structure of the institution provides for the presence of a team of specialists who carry out not only manipulation, but also psychological work with expectant mothers. They are engaged in the observation of a woman, as well as her fetus. To do this, she must register with the consultation and pass a certain list of tests. Before this, the specialist is obliged to examine the patient, measure her pelvis, abdominal circumference, height and weight. If necessary, additional obstetric studies can be performed, as a result of which the state of individual organs is studied.

After the first examination is carried out, the woman needs to visit the consultation again after 10 days. From this moment on, the expectant mother should periodically come to the consultation for observation. In the first 20 weeks, this must be done once a month, and after - twice. In the period that follows after 30 weeks of fetal maturation, a woman needs to visit her assigned obstetrician-gynecologist once a week. In some cases, the frequency of a visit to a specialist can be changed, first of all, this applies to the option when a woman suffers from any gynecological disease.

In addition to all of the above, in the process of fetal maturation, a woman should be examined by other specialists. In particular, this is an otorhinolaryngologist, therapist and dentist. After these doctors make their conclusion about the patient's health status, on the basis of the general available data, the obstetrician draws conclusions regarding the patient's belonging to any risk group.

On the 15-16th week, a woman can start attending a school for pregnant women, which are also organized at antenatal clinics. The organizational structure of this type of institution also provides for the presence of a psychologist with it. The staff of specialists working in this organizational structure is primarily responsible for the moral preparation of the expectant mother for childbirth.

Service for gynecological patients

Considering the structure and organization of antenatal clinics, attention should also be paid to the main activities that are carried out by specialists of medical institutions of this type. One of their main areas of work is to serve patients who have gynecological diseases. What is it?

It should be noted that this type of activity is carried out in strict accordance with the main principle of the work of women's clinics - district. This means that women who need hospitalization and specialized medical care can only be referred to the institution to which they belong in their place of residence.

As for the service itself, it is carried out in certain stages. First of all, a person who wants to be examined is sent to the registry of a medical institution. Here, a registration card with personal data, complaints made by the patient about his state of health should be entered on him.

During the reception, the doctor is engaged in a thorough examination of the patient, draws his conclusions and writes the conclusion in the card. As for the examination, it can be both complex and general or gynecological (using bimanual instruments, mirrors, etc.). In the event that during the examination there are any doubts or suspicions about the development of the disease, the specialist must refer the patient for an additional examination, take tests from her and send them to the laboratory.

As for the additional examination, it is a cytological examination of smears, biopsy, and colposcopy.

At the appointment with the gynecologist, which is carried out in the antenatal clinic, the amount of medical care that is necessary to treat the disease or prevent its occurrence should be determined. In particular, surgical manipulations, physiotherapy, injections or taking certain drugs, the use of tampons, etc. can be prescribed for this.

In some cases, patients may be placed in a gynecological hospital. This is done only in those cases when the patient needs special treatment, which consists in the use of special equipment, special manipulations, etc.

One of the principles of the antenatal clinic's work is qualitative indicators, which should be on top. It should be noted that they can be achieved only with the correct prescription of treatment, its urgency, as well as timeliness. In some cases, the patient requires urgent hospitalization, which can also be carried out within the consultation. Hospitalization can also be planned.

Gynecological care

The principles of operation of the antenatal clinic provide that all women should receive appropriate qualified specialist assistance. That is why the main tasks of this type of medical institution include the timely detection of diseases in the female half of the population of Russia. To do this, in accordance with medical recommendations, it is necessary to visit a gynecologist at least once a year. During the reception, the specialist conducts a preventive examination and, if necessary, refers the patient to another specialist. Such preventive examinations can be performed at home, on call.

In the event that serious diseases or infections are detected during the examination, the specialist is obliged to prescribe a course of treatment for the patient, as well as, if necessary, her hospitalization for the purpose of dispensary observation and therapy using modern methods and equipment.

Abortion prevention

One of the main tasks of the antenatal clinic in any locality of Russia is the importance of this activity lies in the fact that the correct termination of pregnancy by artificial means is the key to the further normal functioning of the woman's body.

As for the features of this type of activity, it is carried out exclusively with the consent of the expectant mother and only for the period of fetal development, which is no more than 12 weeks. In the event that an abortion is necessary for medical reasons, then the period during which the fetus develops in the womb does not matter.

If it is necessary to perform an artificial termination of pregnancy, the obstetrician should give a direction for this operation. In some settlements (as a rule, in small ones), a family doctor also has the right to issue this document.

As for the termination of pregnancy in an outpatient setting, this is possible only at very early stages (up to twenty days of delay) or up to twelve weeks.

Obstetricians working in institutions of this type are also entrusted with the task of conducting educational work among the fair sex in the field of contraception and other modern methods of preventing unwanted pregnancies.

consultation work

There are certain criteria by which the level of work of the antenatal clinic is assessed. The tasks assigned to the institution must be carried out clearly and in the proper form. It should be noted that the level of work of the consultation is determined primarily by the timeliness of registration of pregnant women, as well as the timeliness of their examination. This also shows the observance of the basic principle of the women's consultation - efficiency.

As for the completeness of the survey, the level of work of the consultation on this indicator is determined depending on several factors, calculated as a percentage: the study of pregnant women on the Wasserman reaction, the average number of visits during pregnancy (the norm is 13-16 times for the entire time), the number of births . In addition, for each consultation, the number of women who did not attend an obstetric examination should be taken into account: under normal circumstances, it should be equal to zero.

Work time

Speaking about the structure, functions and tasks of the antenatal clinic, one cannot fail to note the peculiarities of planning the working time of individual employees who conduct their activities in separate structural divisions.

Separate rules establish that the working day of any obstetrician-gynecologist should include the performance of three types of actions: receiving visitors, providing specialized home care, and performing other work.

As for the outpatient appointment with a gynecologist, it can alternate, as a result of which it is carried out, for example, in the morning and in the evening. For this type of activity, the regulations allocate 4.5 hours of working time per day. If you make a simple calculation, then for an hour of admission, a specialist can examine and advise up to five women.

Home care is the provision of specialized assistance to those individuals who, for whatever reason, are unable to visit a specialist on their own. For this type of work, the doctor is given no more than 5 hours during the working day. The doctor is able to handle approximately one call per hour.

As for other types of work, this group includes classes related to writing, developing new materials, etc.

Any gynecologist has a midwife in his direct subordination, who should provide him with direct assistance in all types of professional activities. Her duties include compiling a list of those women who live in the allotted area (exclusively those who have reached the age of 15). In addition, she is obliged to prepare documentation, medical instruments necessary for conducting examinations of patients. The midwife is engaged in issuing referrals for examinations, tests, as well as other medical procedures prescribed by the gynecologist. Specialists of this level can also take part in the provision of direct medical care to patients at home, as well as perform diagnostics.

Where is the expectant mother usually seen? In the antenatal clinic at the place of residence. And here she often gets into some kind of addiction: you have to go to appointments often, you need to take tests all the time and undergo a lot of examinations, and at some specific time! And God forbid you miss something! Yes, examinations during pregnancy are necessary, but you should not forget about your rights and comfort. Let's talk about what the expectant mother has the right to in the residential complex.

1 be observed anywhere

According to the legislation of the Russian Federation, a pregnant woman can choose any antenatal clinic (LC), and not just the one to which she is attached at the place of registration. This means that you can live in one area of ​​the city, and be observed in a completely different one: for example, next to your place of work or just in the antenatal clinic that you like best. Moreover, you can register for pregnancy even in the residential complex of another city. The main thing is that you need a compulsory medical insurance policy valid throughout Russia. To register outside the place of registration, you need to write an application addressed to the head physician of the consultation, bring the original and a copy of the passport, compulsory medical insurance policy, insurance certificate SNILS.
And even if for some reason you stop visiting the LCD, for example, you go to a private clinic, no one has the right to deregister you in the LCD.

2 choose a doctor

Also, according to the legislation of the Russian Federation, you can choose a doctor who will monitor your pregnancy, or change a doctor who, for some reason, did not suit you. To do this, you also need to write an application addressed to the head physician of the LCD.
In addition, every expectant mother in a antenatal clinic or maternity hospital has the right to read her medical record or birth history, to look at records of examinations. And you don't need to explain why you need it. If you do not understand why you need some kind of appointment or analysis, then the doctor should explain everything in an accessible form.

3 register at any time

You can register with the antenatal clinic at any stage of pregnancy. True, in a very short period, neither a doctor nor an ultrasound scan will yet be able to accurately confirm pregnancy, so it’s still better to register after the 6-8th week. It is at this time that the doctor will be able to reliably establish the fact of pregnancy during the examination.
There is one more recommendation - to come to the antenatal clinic before 12 weeks of pregnancy. This is due to the fact that the first ultrasound is done at 10-12 weeks and at this time it is possible to most accurately determine the gestational age. By the way, those women who register with the LCD before 12 weeks receive a cash payment called “a one-time allowance for women registered with a medical institution in the early stages of pregnancy (up to 12 weeks)”. True, they give nothing at all, but they will come in handy for someone.
But all this does not mean that it is necessary to register strictly up to 12 weeks. No, you can come at any time (even in the last trimester), the main thing is to have time to pass the necessary tests before the birth.

4 visit the residential complex at the time you need

If you feel well, the tests are normal and you do not want to go to the antenatal clinic often, you have the right to refuse regular visits to the gynecologist. Just tell your doctor about it, he should respect your decision. Yes, the doctor will warn you that you are responsible for your choice, but he should not intimidate or threaten you to refuse to issue an exchange card. If something like this happens, immediately go to the head physician of the antenatal clinic or contact the health department.
But you need to know that there are studies (ultrasound, blood test for chromosomal pathologies) that must be done within strictly defined terms, otherwise their result may be unreliable. Therefore, ask the doctor in advance about the time of some examinations.

5 select surveys

If you want to do all the examinations you need, you have the right to receive them in full. Each antenatal clinic has a list of examinations and consultations required during pregnancy. You can ask your doctor to tell you in detail about them and do everything that you are supposed to. If you, on the contrary, think that you do not need this or that appointment or is unacceptable for you, you can refuse it. No one has the right to force you to do an ultrasound, screening, take any drugs. Even if you refuse something, you cannot be deregistered due to pregnancy, you cannot be issued a birth certificate and an exchange card. The doctor will simply record your refusal in the card and write that it was explained to you why this or that study was recommended.
In general, to get an exchange card, you need to pass a series of tests at least once (clinical blood test, urinalysis, smear, tests for HIV, RW, hepatitis B and C) and visit an obstetrician-gynecologist at least twice. The first time you come for an initial examination and in order to get a referral for tests, the second time - to enter the results of the examination into the exchange card.

6 do as you please

All examinations in the antenatal clinic are carried out completely free of charge. And even if there is no specialist or there is temporarily no research, you should be given a referral to another medical institution where all this is available. The doctor does not have the right to refer you to any additional paid tests or consultations if they can be done free of charge under compulsory medical insurance.
If you want to do some research yourself for a fee and in another clinic (for example, to do an expert ultrasound), then you must accept its results at the antenatal clinic (and not say that we believe only our analyzes or specialists).

If you want to be seen in the antenatal clinic the way you want, don't be afraid to talk about your preferences. Calmly and confidently remind you of your rights, your job is to choose what you need from medicine and what you don’t.

Introduction

The problem of protecting the health of women and children is of great medical and social importance.

Indicators of the health of women and children are indicators of the socio-economic development of society.

The system of mother and child protection, taking into account and analyzing the state of their health and social and hygienic factors, contributes to the preservation and strengthening of the health of women and children. This manual covers the issues of organizing the work of the antenatal clinic and the maternity hospital. Women's consultation, as a state medical and preventive institution, provides outpatient obstetric and gynecological care for the protection of the reproductive health of the population.

The main goal of the antenatal clinic is to protect the health of mother and child by providing qualified outpatient obstetric and gynecological care to gynecological patients, women during pregnancy and in the postpartum period, family planning services, and reproductive health protection of the population.

The main institution providing inpatient obstetric and gynecological care is the maternity hospital. The maternity hospital provides inpatient qualified

medical assistance to women during pregnancy, childbirth, in the postpartum period, with gynecological diseases, and also provides qualified medical assistance and care for newborns during their stay in an obstetric hospital.

This manual is intended for students.

Obstetric and gynecological care is provided by the following typical institutions:

— maternity hospitals (general and specialized);

- women's consultations (independent, as part of a united maternity hospital, polyclinic or outpatient clinic);

- maternity and gynecological departments of research institutes, universities;

- obstetric and gynecological departments of multidisciplinary city and other hospitals;

- perinatal centers;

- women's consultations and gynecological rooms of medical and sanitary units;

- examination rooms of polyclinics;

- "Marriage and family" consultations;

– medical genetic consultations (offices);

- reproduction family planning centers;

- sanatoriums for pregnant women

and other institutions not provided for by the nomenclature. The main institutions providing outpatient care for women are women's consultations.

Chapter 1. Organization of the work of the antenatal clinic

Women's consultation is a dispensary-type medical and preventive institution that provides outpatient obstetric and gynecological care using modern medical technologies, family planning and reproductive health services based on accepted standards.

The work of the antenatal clinic is based on the district principle. The size of the 1st obstetric-gynecological site is approximately 2 therapeutic sites, therefore, 2-2.5 thousand women are under supervision of one obstetrician-gynecologist.

1.1. The structure and tasks of the antenatal clinic

The main task is to protect the health of mother and child by providing qualified outpatient obstetric and gynecological care outside, during pregnancy and in the postpartum period, family planning and reproductive health services.

1. Carrying out preventive measures aimed at preventing complications of pregnancy, childbirth, the postpartum period, gynecological diseases.

2. Provision of medical obstetric and gynecological care.

3. Provision of advisory services on family planning, prevention of abortions, sexually transmitted diseases, incl. HIV infection, the introduction of modern methods of contraception.

4. Introduction into practice of modern achievements in diagnostics and treatment.

5. Carrying out hygienic education and training of the population, the formation of a healthy

lifestyle.

6. Provision of social and legal assistance to women.

7. Ensuring continuity in examination and treatment.

The structure and organization of the work of the antenatal clinic

Women's consultation, depending on the number of people served, may have the following structural units:

Registry

Offices of district obstetrician-gynecologists,

Gynecology room for children and adolescents

Family planning and pregnancy prevention rooms,

Rooms for psychoprophylactic preparation for childbirth,

Offices for reception of the therapist, oncogynecologist, venereologist, dentist,

social and legal office,

Young mother's room

physiotherapy room,

manipulation,

Operating room for outpatient operations,

Endoscopy room

Cytological laboratory and clinical diagnostic laboratory,

Functional diagnostics room,

x-ray room,

Office for administrative and economic needs.

In large antenatal clinics, day hospitals can be organized for the examination and treatment of gynecological patients; carrying out minor gynecological operations and manipulations.

The working time of the district obstetrician-gynecologist consists of:

Outpatient reception (alternation: morning-evening; 4.5 hours a day at the rate of 5 women per 1 hour of admission)

Home care (oh, 5 hours a day at a service rate of 1.25 calls per hour)

Other types of work (1.5 hours)

The midwife assists the doctor in his work. She compiles a list of women over 15 years of age living in the obstetric area, prepares instruments, medical documentation, weighs pregnant women and measures blood pressure, issues referrals for tests and consultations, performs medical procedures, according to the doctor's prescription, nursing procedures can be carried out at home. and diagnostic manipulations.

1.2. The main sections of the work of the district obstetrician-gynecologist.

One of the main sections of the work of the antenatal clinic is dispensary observation, which is subject to 3 groups of women:

1) Healthy women with normal pregnancies

2) Pregnant women: with genital and extragenital pathology (risk group):

a) with diseases of the cardiovascular system;

b) with kidney disease

c) who had a caesarean section

d) with an anatomically narrow pelvis

e) suffering from habitual miscarriage, etc.

3) Women suffering from gynecological pathology (cervical erosion, uterine fibroids, infertility, uterine bleeding, etc.)

1. Medical examination of pregnant women.

1. Timely (early - up to 3 months) taking a pregnant woman under the supervision of a antenatal clinic.

A woman should be registered with the antenatal clinic before 12 weeks of pregnancy, which allows to reduce the number of errors in determining the timing of childbirth, prescribe treatment in a timely manner and hospitalize if necessary. Late (after 28 weeks of pregnancy) registration of women can adversely affect the course of childbirth and the health of the child.

2. Systematic monitoring of the health of pregnant women, examination, identification of risk groups, treatment of somatic diseases.

When a woman first visits a consultation about pregnancy and, if she wants to save her, the doctor takes the following measures:

Get acquainted with the general and special anamnesis;

Performs a general examination of a woman;

Measures height, weight, abdominal circumference and pelvic dimensions;

Measures blood pressure (on both arms);

Performs the necessary obstetric examinations;

Determines the state of the most important organs.

After the examination, a woman should visit a consultation with all the tests and doctors' conclusions 7-10 days after the first visit. In total, during pregnancy, a woman should visit a consultation about 15 times:

In the first half of pregnancy once a month,

After 20 weeks - 2 times a month,

From 30 weeks 1 time per week.

In the presence of diseases, the frequency of examinations and the order of examination are determined individually.

In addition, each pregnant woman should be examined by a therapist (2 times - at the first appearance and at 32 weeks of pregnancy), a dentist, an otorhinolaryngologist.

After a comprehensive examination, the pregnant woman's belonging to the risk group is determined.

3. Pregnancy paperwork.

All the data of the interview and examination of the woman, as well as advice and appointments, are recorded in the “Individual card of the pregnant woman and the puerperal woman” (f. 111 / y) and are stored in the office of each doctor in a file cabinet according to the dates of the scheduled follow-up visit, as well as in the dispensary book of the pregnant woman (she is handed out to them and records of all visits are duplicated in it).

4. Organization of prenatal care for pregnant women.

It is carried out according to the doctor's prescription, for this, cards of women who did not appear at the appointed time are selected.

5. Study of working conditions of pregnant women.

To address the issue of employment of pregnant women, the Hygienic Recommendations for the Rational Employment of Pregnant Women are used. If necessary, the obstetrician-gynecologist of the antenatal clinic issues certificates to pregnant women about the transfer to easy and harmless work (f. 081 / y), draws up disability certificates, which are registered in the “Registration Book of Disability Leaves” (f. 036 / y). Certificates are issued to students for exemption from classes.

6. Ensuring timely delivery of qualified treatment.

With a gestational age of up to 20 weeks and the presence of extragenital diseases, women can be hospitalized in specialized therapeutic hospitals. In all other cases, prenatal hospitalization is carried out, as a rule, in the department of pathology of pregnant women of the maternity hospital.

7. Physical and psychoprophylactic preparation of pregnant women for childbirth.

Preparation for childbirth should be carried out from the first visits to the antenatal clinic. Physical training is carried out by a group method. In consultation, women learn a special set of exercises that are recommended to be performed at home for a certain time. Group classes (no more than 8-10 people in a group) on psychoprophylactic preparation for childbirth should be started from 32-34 weeks of pregnancy. Preparation of pregnant women for childbirth is carried out by the site doctor, one of the consultation doctors, a specially trained midwife.

8. Organization and conduct of classes in "schools of mothers".

Classes with women in the "schools of mothers" begin at 15-16 weeks of pregnancy, on some topics, classes are held with future fathers (on the mode of a pregnant woman, nutrition during pregnancy, child care, etc.). In some antenatal clinics, special "schools for fathers" are organized.

2. Observation, rehabilitation and rehabilitation treatment of puerperas.

In the normal course of the postpartum period, a woman is observed by an obstetrician-gynecologist 2 times. The first examination is carried out 10-12 days after discharge from the obstetric hospital, the final one - 5-6 weeks after birth.

The main therapeutic and recreational activities in the normal postpartum period are:

Women's personal hygiene

breast care,

Performing a special complex of physical exercises,

Compliance with the regime of housework, rest, rational nutrition,

Vitaminization.

3. Gynecological care.

1. Active detection of gynecological patients.

Identification of gynecological patients is carried out:

When receiving women who applied for a consultation;

When referred by other specialists;

When examining women at home (on call);

When conducting preventive examinations of women in consultations, at enterprises, institutions, examination rooms of polyclinics.

Each woman should be examined by an obstetrician-gynecologist once a year using cytological and colposcopic examination methods.

For those who are subject to a preventive examination, a “List of persons subject to a targeted medical examination” (f. 048 / y) is drawn up, for those who have been examined, a “Card of preventively examined” (f. 074 / y).

2. Organization and conduct of examination and treatment of women with gynecological diseases.

For each woman who initially applied to the antenatal clinic, an “outpatient medical card” (f. 025 / y) is started.

Treatment of gynecological patients is carried out mainly in the antenatal clinic, but can also be organized at home (as prescribed by a doctor). On an outpatient basis, individual small gynecological operations and manipulations can be performed, for example, in a day hospital.

3. Timely hospitalization of women in need of inpatient treatment.

Upon appointment for inpatient treatment, a referral for hospitalization is issued, an entry is made in the outpatient card about the referral and actual hospitalization.

After the patient is discharged from the hospital, aftercare can be carried out in the antenatal clinic. Information from the hospital is transferred to the outpatient card, the extract remains with the woman.

4. Examination of working capacity in gynecological diseases. Examination of temporary and permanent disability in gynecological diseases is carried out on a general basis.

5. Dispensary observation of gynecological patients

For each woman subject to dispensary observation, a “Dispensary observation control card” (f. 030 / y) is filled out. Clinical examination is terminated after the patient recovers or in connection with her departure from the consultation area.

4. Prevention of abortions.

In accordance with the current legislation, every woman has the right to independently decide on the issue of motherhood.

Artificial termination of pregnancy is carried out at the request of a woman with a gestational age of up to 12 weeks, according to social indications - women with a gestation period of up to 22 weeks, and if there are medical indications and the consent of the woman - regardless of the gestational age.

A district obstetrician-gynecologist gives a referral for an artificial termination of pregnancy, however, such a right is also granted to a family doctor, and in rural areas an obstetrician-gynecologist of a district or district hospital.

In the absence of medical contraindications for abortion, a woman is given a referral to a medical institution indicating the duration of pregnancy, the results of the examination, the conclusion of the commission on abortion for specific medical (diagnosis) or social indications.

Consent to medical intervention in respect of persons under 15 years of age, and citizens recognized legally incompetent, is given by their legal representatives.

On an outpatient basis, artificial termination of pregnancy is allowed to be carried out:

- in the early stages of pregnancy with a delay in menstruation up to 20 days (mini abortion);

- with a gestational age of up to 12 weeks - in a day hospital on the basis of specialized research institutes, clinical, multidisciplinary city and regional hospitals in women without a aggravated obstetric history. In other cases, abortion is performed only in a hospital. In accordance with Article 36 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens of July 22, 1993, artificial termination of pregnancy for social reasons is carried out at the request of a woman with a gestational age of up to 22 weeks. The issue of termination of pregnancy for social reasons is decided in an outpatient or inpatient facility by a commission consisting of an obstetrician-gynecologist, the head of the institution (department), a lawyer upon a written application from the woman, if there is a conclusion on the gestational age established by the obstetrician-gynecologist and relevant legal documents (certificate of husband's death, divorce, etc.), confirming social indications.

In connection with the operation of artificial termination of pregnancy, working women are issued a certificate of incapacity for work in the prescribed manner, but not less than 3 days.

Recommendations, individual selection and training in the use of contraceptives for women who wish to abstain from pregnancy have an important role in the prevention of abortion. During the consultation, it is desirable to have an exhibition-showcase of contraceptives, to organize their sale. If a woman, especially a primigravida, goes to the consultation, it is necessary to explain the dangers and harms of abortion before referring her to an abortion.

5. Work on the formation of a healthy lifestyle.

This work is carried out according to the plan, taking into account local features and conditions. For this type of work, fixed hours and days are allocated, records are kept in the "Journal of Sanitary and Educational Work" (f. 038 / OU).

1.3. Analysis of the work of the antenatal clinic

As in every medical and preventive institution, medical documentation is kept in the antenatal clinic. Many types of medical documents are the same for all outpatient clinics and have been described earlier. However, in the antenatal clinic there are some registration forms characteristic only for this institution:

1. Individual card of a pregnant woman and a puerperal (F. 111 / U).

2. Medical opinion on the transfer of a pregnant woman to another job (f. 084 / y).

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

4. Journal of obstetric care at home (f. 032 / y).

To analyze the work of the antenatal clinic, a number of indicators characteristic only for this institution are calculated. And, although some of them are excluded from state statistics, they are of undoubted importance for an individual medical institution. These are the following indicators:

1. Timeliness of admission of pregnant women under the supervision of a consultation:

1.1. Early entry (before 12 weeks):

received under observation with a gestational age of up to 12 weeks x 100%

1.2. Late admission (over 28 weeks):

received under observation with a gestational age of 28 weeks. and more x 100%

received only under the supervision of pregnant women

2. The frequency of errors in determining the timing of childbirth:

2.1. Percentage of women who gave birth 15 days or more earlier than the due date:

the number of women who gave birth earlier than the established

number of women who gave birth and took prenatal leave

2.2. Percentage of women who gave birth 15 days later than the date set by the consultation and

more:

the number of women who gave birth later than the established

consultation for a period of 15 days or more x 100%

number of women who gave birth and received prenatal leave

3. Average number of consultation visits by pregnant women:

3.1. Before childbirth (14-15 times):

number of prenatal consultations for pregnant women

3.2. In the postpartum period (2 times):

number of visits by pregnant women to consultations in the postpartum period

number of pregnant women admitted under consultation supervision

3.3. Those who did not attend the consultation:

number of women who never attended prenatal counseling

number of pregnant women admitted under consultation supervision

4. Completeness of the survey of pregnant women admitted under the supervision of the consultation:

number of women examined for Rh affiliation x 100%

On time+

The completeness of the examination of pregnant women for the Wasserman reaction and toxoplasmosis is also considered. Separately, the percentage of women with the Rh-negative form identified during the examination is calculated.

5. Number of pregnant women who were examined by a therapist:

number of pregnant women who were examined by a general practitioner x 100%

number of women who have completed their pregnancy with childbirth:

6. Complications of pregnancy:

the number of pregnant women who suffered from toxicosis in the second half of pregnancy x 100%

number of women who have completed their pregnancy with childbirth:

at term + premature birth + abortion

Similarly, the percentage of women who suffered from extragenital diseases and had other complications is calculated.

7. Mortality of pregnant women:

number of women who died during pregnancy x 100%

enrolled under the supervision of a consultation

8. Outcomes of pregnancy:

the number of pregnant women who completed the pregnancy with childbirth at term x 100%

premature birth + abortion

Similarly, the percentage of women who ended their pregnancy prematurely is determined.

my birth.

9. Coverage of pregnant women with classes on preventive preparation for childbirth:

the number of pregnant women with whom classes on

psychoprophylactic preparation for childbirth x 100%

number of women who have completed their pregnancy with childbirth:

at term + premature birth + abortion

Similarly, the coverage of pregnant women with classes in the "school of mothers" is calculated.

10. Share of women using hormonal contraceptives:

the number of women registered in the antenatal clinic,

using hormonal contraceptives x 100%

number of women of childbearing age who are

registered in the antenatal clinic

Similarly, the proportion of women using IUDs and other contraceptives is calculated.

11. Frequency of abortions:

11.1. Abortion rate is calculated by the number of women of childbearing age:

the number of pregnant women who ended their pregnancy with abortions,

of those registered in the antenatal clinic x 100%

number of women f. c., registered in the antenatal clinic

11.2. The abortion rate can be calculated by the number of births:

number of pregnant women who ended their pregnancy with abortion x 100%

number of pregnant women who completed the pregnancy with childbirth:

at term + premature birth + abortion

Similarly, the frequency of mini-abortions is calculated. In addition, in the antenatal clinic

the number of justified complaints is calculated. Each complaint is subject to detailed investigation.

Chapter 2. Organization of obstetric and gynecological care

2.1. Organization of work of the maternity hospital

The main tasks of organizing inpatient obstetric and gynecological care:

1. Provision of inpatient qualified medical care to women during the period

pregnancy, childbirth, postpartum period, gynecological diseases;

2. Provision of qualified medical care and care for newborns during

time of their stay in the obstetric hospital. The main institution providing

inpatient obstetric and gynecological care, is the combined maternity

Maternity hospitals provide assistance to the population on a territorial basis, but first and emergency care for pregnant women is provided regardless of their place of residence and departmental subordination of the healthcare institution.

Referral to the maternity hospital for emergency care is carried out:

Station (department) of ambulance and urgent care,

obstetrician-gynecologist,

doctors of other specialties,

paramedical workers

A woman can go to the maternity hospital on her own. Planned hospitalization

pregnant women to the maternity hospital is carried out by an obstetrician-gynecologist, and in his absence - by a midwife.

Operation of the receiving and viewing unit

The reception and viewing block has one filter room and 2 viewing rooms,

one - to receive women in the physiological obstetric department, the other - observational.

Upon admission to the unit, a woman in labor (postpartum) presents a passport and a dispensary

pregnant woman’s book (“Exchange card” (f. 113 / y)), it is issued: “History of childbirth” (f.

096 / y), make an entry in the "Journal of registration of the reception of pregnant women, women in childbirth and puerperas" (f.

002/y) and into the alphabet book.

In the reception and examination unit, an anamnesis is collected, an examination is carried out, acquaintances with the documents of a woman in the filter room are divided into two streams: with an absolutely normal course of pregnancy, sent to the first obstetric department, and representing an “epidemiological danger” to others, sent to the observational department.

In the examination rooms of the physiological and observation departments, an objective examination of the woman is carried out, her sanitization, a set of sterile linen is given out, and blood and urine are taken for analysis.

Observational department

Women enter the observational department both through the reception and observation unit of the obstetric departments and from the physiological obstetric department. Patients are placed in wards according to nosological forms of diseases, pregnant women - separately from puerperas. Admission to the observational department pregnant women and women in labor who have

- acute respiratory diseases, influenza, tonsillitis;

- manifestations of extragenital inflammatory diseases;

- febrile state (body temperature 37.6 degrees C and above without clinical manifestations);

affected other symptoms);

- a long anhydrous period (outflow of amniotic fluid 12 hours or more before admission

captivity in a hospital);

- unexamined and in the absence of medical documentation;

- intrauterine fetal death;

- fungal diseases of hair and skin, skin diseases;

- acute and subacute thrombophlebitis;

-pyelonephritis, pyelitis, cystitis and other infectious diseases of the genitourinary system;

- manifestations of infection of the birth canal;

- toxoplasmosis, listeriosis;

- venereal diseases;

- diarrhea;

- puerperas in case of childbirth outside a medical institution (within 24 hours after childbirth);

- for termination of pregnancy for medical and social reasons during

second trimester of pregnancy.

Transfer to the observational department from other departments of the obstetric hospital

there are pregnant women, women in labor and puerperas who have:

- an increase in body temperature during childbirth and the early postpartum period up to 38 degrees C

and higher, fever of unknown origin, lasting more than a day;

- postpartum inflammatory disease (endometritis, wound infection, mastitis, etc.)

- manifestations of extragenital infectious diseases that do not require transfer to a specialized hospital.

Note:

In the observational department are placed: sick women with a healthy child;

healthy women with a sick child; sick women with a sick child.

From the examination room, accompanied by medical personnel, the woman goes to the birth

block or department of pathology of pregnant women (if indicated, they are transported on a gurney).

generic block

The generic block includes:

Prenatal wards;

birth ward;

Intensive care unit;

children's room;

Small and large operating rooms;

Sanitary facilities.

In the prenatal ward, a woman spends the entire first stage of childbirth. midwife on duty

or a doctor constantly monitors the condition of the woman in labor. At the end of the first stage of labor

the woman is transferred to the delivery room (delivery room).

If there are two delivery rooms, delivery is performed in them alternately. Each delivery room is open for 1-2 days, then it is cleaned.

If there is one delivery room, delivery is carried out alternately on different Rakhmanov beds. Twice a week, a general cleaning of the delivery room is carried out. A normal birth is handled by a midwife.

After the birth of the child, the midwife shows the child to the mother, paying attention to his

gender and the presence of congenital anomalies (if any), then he is given:

Secondary treatment of the umbilical cord,

Primary skin treatment

Weighing a child

measurement of body length, chest and head circumferences.

Bracelets are tied to the child's hands, and after swaddling over the blanket - a medallion.

They indicate: surname, name, patronymic, birth history number of the mother, gender of the child, weight, height, hour and date of his birth.

After the treatment of the newborn is completed, the midwife (doctor) fills in the necessary columns in the “History of childbirth” and “History of the development of the newborn”.

"The history of the development of the newborn" is filled in by the pediatrician on duty, and in his absence

- Duty obstetrician-gynecologist. When drawing up the "History of the development of a newborn" her

the number must match the mother's Birth History.

In the normal course of the postpartum period, 2 hours after the birth, the woman is transferred on a gurney with the child to the postpartum department.

When filling the wards of the postpartum department, a strict cycle is observed (one ward is filled with women in labor for no more than three days).

The cyclical filling of the maternal wards corresponds to the cyclical filling of the neonatal wards, which allows healthy children to be discharged with their mothers at the same time.

When women in childbirth or newborns have certain signs of illness, they are transferred to the second obstetric (observation department) or to another specialized institution.

Department of newborns

Chambers for newborns are allocated in the physiological and observation departments.

In the department of newborns of the observational department there are children:

Born in this branch;

born outside the maternity hospital;

Transferred from the physiological department;

Born with severe congenital anomalies;

Born with manifestations of intrauterine infection;

Born weighing less than 1000 g

For sick children, an insulator for 1-3 beds is allocated in the observation department. Children eligible for adoption may be placed in a separate isolation facility.

To comply with the cycle, the children's wards must correspond to the mother's. Children with a birth difference of up to 3 days can be accommodated in one ward. The temperature in the wards should be maintained within 22-24 "C, and the humidity of the air should be 60%.

Pediatricians of the department of newborns conduct daily examinations of children. Weekends and public holidays are bypassed through a staggered work schedule.

At the end of the examination of newborns, the pediatrician (obstetrician-gynecologist) informs mothers about the condition of the children and conducts sanitary and educational work with them. Postpartum physiological department with the joint stay of mother and child

The joint stay of mother and child significantly reduces the incidence of diseases in puerperas in the postpartum period and the incidence of diseases in newborns. The main feature of such maternity hospitals or obstetric departments is the active participation of the mother in the care of the newborn child. Living together significantly limits the contact of the newborn with the medical staff of the obstetric department, reduces the possibility of infection of the child. In this mode, the early attachment of the newborn to the breast is ensured, and the mother is actively taught the skills of practical care and care for the newborn.

Contraindications to the joint stay of mother and child are:

1) on the part of the puerperal - late toxicosis of pregnant women, extragenital diseases in the stage of decompensation, surgical interventions in childbirth, rapid or prolonged labor, a long (more than 18 hours) anhydrous period in childbirth, the presence of fever during childbirth, perineal rupture or incisions.

2) on the part of the newborn - prematurity, immaturity, long-term intrauterine fetal hypoxia, intrauterine malnutrition II-III degree, birth trauma, asphyxia at birth, developmental anomaly, hemolytic disease.

Resuscitation and intensive care units for newborns

They are created with the aim of reducing perinatal mortality, organizing constant monitoring of the state of vital functions of newborns and timely correlating and diagnostic measures in obstetric institutions.

Newborns with severe lesions of vital organs and systems who need resuscitation, newborns from a high risk group for developing adaptation disorders in the early neonatal period are transferred to the intensive care unit.

Examination of children, carrying out diagnostic and therapeutic manipulations is carried out by a qualified neonatologist.

Rules for discharge of a woman from a maternity hospital

The main criteria for discharge of a woman from the maternity hospital are: a satisfactory general condition, normal temperature, pulse rate, blood pressure, condition of the mammary glands, uterine involution, normal results of laboratory tests.

With an uncomplicated course of the postpartum period in a puerperal and an early neonatal period in a newborn, with a fallen off umbilical cord and a good condition of the umbilical wound, positive dynamics of body weight, the mother and child can be discharged 5-6 days after birth.

In the "History of the development of the newborn", the nurse notes the time of his discharge from the maternity hospital and the condition of the skin, mucous membranes, introduces the mother to the record. The record is certified by the signatures of the nurse and mother. The nurse issues the mother a “Medical Birth Certificate” f. 103 / y and "Exchange card of the maternity hospital, maternity ward of the hospital" f. 113 / y, where the pediatrician notes the basic information about the mother and the newborn.

On the day the child is discharged, the head nurse of the neonatal department reports by telephone to the children's polyclinic at the place of residence the basic information about the discharged child. This ensures a faster first visit at home. The older sister notes in the journal the date of discharge and the name of the clinic employee who received the telephone message.

The work of the department of pathology of pregnant women

The department of pathology of pregnant women is organized in large maternity hospitals with a capacity of 100 beds or more.

Pregnant women are hospitalized in the pathology department: women with extragenital diseases, pregnancy complications (severe toxicosis, threatened miscarriage, etc.)

d.), with an incorrect position of the fetus, with a burdened obstetric history. The department of pathology of pregnant women has its complete isolation from the obstetric departments, the possibility of transporting pregnant women to the birth physiological and observational departments (bypassing other departments), as well as exit for pregnant women from the department to the street. The department has at its disposal:

Functional diagnostics room with modern equipment (mainly cardiological);

lookout;

Small operating room;

Cabinet of physio-psycho-prophylactic preparation for childbirth;

Covered verandas or halls for walking pregnant women.

Centralized oxygen supply.

A department of pathology of pregnant women with a semi-sanatorium regimen can be organized, having a close relationship with sanatoriums for pregnant women, where the results of treatment obtained in the maternity hospital are consolidated.

The work of gynecological departments Gynecological departments of maternity hospitals have three profiles:

1. For hospitalization of patients requiring surgical treatment.

2. For patients requiring conservative treatment.

3. For termination of pregnancy (abortion).

The structure of the department includes:

Reception department;

dressing room;

Manipulation;

Small and large operating rooms;

Physiotherapy room;

Discharge room;

Intensive care unit.

In addition, for the diagnosis and treatment of gynecological patients,

other divisions of the maternity hospital: clinical laboratory,

x-ray room, etc.

In recent years, they have been trying to withdraw the department for abortion from obstetric hospitals with the creation of independent departments. Organized independent gynecological hospitals, day hospitals. Departments for oncological patients, as a rule, are located in the corresponding hospitals.

2.2 Organization and implementation of a set of sanitary and hygienic measures for the prevention of nosocomial infections

The main feature of obstetric institutions is the constant stay in them of newborns and women who are highly sensitive to infections in the postpartum period. Therefore, a special set of sanitary and hygienic measures should be organized in the obstetric institution. This complex includes:

Timely detection and isolation of women in childbirth, puerperas and newborns with purulent-septic diseases,

Timely detection of carriers of infections and their sanitation,

the use of highly effective methods for disinfecting the hands of medical personnel and the skin of the surgical field, dressings, instruments, syringes, the use of disinfection methods and means for processing various environmental objects

(bedding, clothes, shoes, dishes, etc.) that have potential epidemiological significance in the mechanism of transmission of nosocomial infections.

Responsibility for carrying out a complex of sanitary and hygienic measures to combat nosocomial infections in the maternity hospital rests with the head physician.

Heads of departments together with senior midwives (nurses) of departments organize and control this work.

The senior midwife (sister) of the department instructs the middle and junior staff on the implementation of sanitary and hygienic measures at least once a month. Personnel entering the maternity hospital undergo a full medical examination and instructions on sanitary and hygienic measures in the assigned area of ​​work.

All staff of the maternity hospital should be under dispensary observation for the timely detection of foci of infection.

Head the department once a quarter organizes an examination and examination of personnel for carriage of Staphylococcus aureus. Every day before going to the shift, the staff takes

a hygienic shower and a medical examination (thermometry, examination of the pharynx and skin). Employees of the maternity hospital are provided with individual lockers for clothes, individual towels. Sanodezhu change daily; in the event of nosocomial infections in the observational department, 4-layer labeled masks are changed every 4 hours. Obstetric hospitals are closed for complete disinfection at least once a year.

If nosocomial infections occur in the maternity hospital, the admission of women in labor to the maternity hospital is stopped, the SES epidemiologist conducts a detailed epidemiological examination and a set of anti-epidemiological measures.

About 5% of the beds in the maternity hospital are allocated for insulators. In large maternity hospitals, special septic units are organized.

Control over compliance with the anti-epidemiological regime in the maternity hospital is carried out by the Center for Sanitary and Epidemiological Supervision (SES).

2.3. Analysis of the activities of the maternity hospital

1. Bed Fund Indicators and Its Use:

1.1 Average annual bed occupancy (number of bed days per year):

Number of bed-days spent by pregnant women

Number of average annual beds

Estimated rate of average bed occupancy for urban maternity hospitals

houses and offices - 320 days. And in the postpartum department - 300 days).

1.2 Bed turnover:

The number of postpartum women who left the hospital

Number of average annual beds

1.3 Average length of stay of postpartum women in bed:

Number of bed-days spent by postpartum women

The number of patients who left the hospital

The average length of stay of puerperas in the hospital is 8-9 days.

2. Indications of medical care in childbirth

Frequency of use of medical anesthesia during childbirth:

number of births performed with medical anesthesia x 100%

total births accepted

Similarly defined

The frequency of the use of psychoprophylactic preparation for childbirth;

The frequency of childbirth with medical anesthesia and psychoprophylactic preparation;

The frequency of surgical aids during childbirth (for all types of aids - obstetric forceps,

vacuum extractor, manual separation of the placenta, manual and instrumental examination of the uterus after childbirth).

3. Maternal health indicators:

3.1. The frequency of complications in childbirth (determined for each type of complication):

for example, the frequency of perineal tears:

the number of mothers. having a perineal rupture x 100%

the number of delivered births + the number of admitted women. who gave birth outside the maternity hospital

3.2. The frequency of complications in the postpartum period (by type of complications per 1000 births). Each case of maternal death is subject to separate proceedings.

4. Indicators of medical and preventive care for newborns:

4.1. Stillbirth rate (stillbirth):

stillborn newborns x 100%

born in total (dead and alive)

4. 2. Frequency of prematurity:

born prematurely (alive and dead) x 100%

all born (alive and dead)

4.3. Morbidity in newborns(full-term, premature, full-term given

disease, preterm with this disease). For example: morbidity of preterm infants:

were born sick and sick premature x100%

born alive prematurely

4.4. Neonatal mortality rates(general, full-term, premature,

from various diseases). For example: mortality of full-term:

died full-term x 100%

born alive full-term (born alive total - born alive prematurely).

The full version of the manual is presented in the photographs.

Organization of the work of the antenatal clinic

Women's consultation is a dispensary-type medical and preventive institution that provides all types of outpatient obstetric and gynecological care to the population.

The main tasks of the antenatal clinic are:

1. Carrying out preventive measures aimed at preventing complications of pregnancy, childbirth, the postpartum period, gynecological diseases.

2. Provision of medical obstetric and gynecological care to the population of the attached territory.

3. Introduction into practice of modern achievements in the diagnosis and treatment of pathology of pregnancy, diseases of puerperas and gynecological patients, new organizational tools that help reduce prematurity of pregnancy, maternal and perinatal mortality.

4. Ensuring continuity in the examination and treatment of pregnant women, puerperas and gynecological patients with obstetric and gynecological hospitals and other medical institutions (polyclinic, children's polyclinic, dermatovenerological dispensary, oncological dispensary, etc.

5. Assistance to the population in family planning (abortion prevention, contraception, infertility treatment).

6. Carrying out hygienic education and training of the population on the formation of a healthy lifestyle.

7. Provision of social and legal assistance to women. The structure of the antenatal clinic is determined by the tasks ahead. The main structural subdivisions of a large modern antenatal clinic are: a registry, offices of local obstetrician-gynecologists, pregnancy prevention offices, psychoprophylactic preparation for childbirth, a physiotherapy room, a manipulation room, rooms for receiving a general practitioner, an oncogynecologist, a dermatovenereologist, a dentist, a social and legal office (office a lawyer), a "young mother" room, an operating room for outpatient operations, an endoscopic room, cytological and clinical diagnostic laboratories, a functional diagnostics room, and an X-ray room. For the examination and treatment of gynecological patients, day hospitals can be organized for minor gynecological operations and manipulations.

Women's consultation builds its work according to the territorial-district principle, i.e. each obstetrician-gynecologist (district) serves a certain part of the female population living in a fixed territory (site).

The required number of district obstetrician-gynecologists is calculated according to the current standards, and district midwives - according to the number of doctors.

The mode of operation of the antenatal clinic is built taking into account the trouble-free provision of outpatient obstetric and gynecological care for women during their non-working hours.

The antenatal clinic registry provides a preliminary appointment with a doctor for all days of the week during a personal visit or by phone.

The registry should provide visual information: the schedule of appointments of district obstetrician-gynecologists, the work of doctors of other specialties, treatment and diagnostic rooms.

The local obstetrician-gynecologist spends most of his working time at an outpatient appointment, alternating appointments in the morning and evening hours, and also provides home care to women who, for health reasons, cannot come to the consultation themselves. According to the doctor's prescription, medical procedures and diagnostic manipulations are carried out at home by paramedical personnel.

In order to improve the professional skills of an obstetrician-gynecologist working in a antenatal clinic combined with a maternity hospital, it is advisable to periodically work with a site doctor in a hospital department. The alternation of work in the consultation and the hospital should be carried out after a year, while it is important to assign two doctors to one site, who have been mutually replacing each other in the consultation and in the hospital for several years, who know their area well. Doctors of the consultation may be involved in duty in the obstetric and gynecological hospital.