Women's consultation is an outpatient clinic of a dispensary type, the work of which most fully reflects the basic principle of modern healthcare - the unity of prevention and treatment. Tasks:― implementation of therapeutic and preventive measures aimed at preventing complications of pregnancy, childbirth, postpartum and gynecological diseases, carrying out perinatal protection of the fetus; - organization of dynamic observation of pregnant women in order to prevent complications of pregnancy, childbirth and the postpartum period; gynecological pathology; - consultation and provision of family planning services ( carrying out work on contraception to prevent unplanned pregnancy, etc.); - implementation into practice modern methods diagnosis, prevention and treatment of obstetric and gynecological pathology; - providing women with social and legal protection in accordance with the legislation on the protection of motherhood and childhood; - carrying out hygiene education, formation healthy image life and health-preserving behavior of the population; - ensuring continuity in the examination and treatment of pregnant women, postpartum women and gynecological patients with medical institutions that provide specialized care for this category of patients (MHC, maternity hospital (department), adult and children's clinics, ambulance station (department) urgent medical care, anti-tuberculosis, dermatovenerological, oncology dispensaries, etc.).
Structure of the antenatal clinic :― registry; ― offices of local obstetricians and gynecologists; ― family planning office; ― room for psychoprophylactic preparation for childbirth; ― physiotherapy room; ― manipulative; ― offices for receiving a therapist, oncogynecologist, dentist; ― social and legal office; ― room of the “young mother”; ― operating room for outpatient operations; ― clinical diagnostic laboratory; ― diagnostic rooms; ― offices for administrative and economic needs.
Work organization. The antenatal clinic organizes its work on a territorial-precinct basis. Staffing standards for the medical staff of the antenatal clinic are determined based on the number of obstetric and gynecological areas and are set at the rate of one obstetrician-gynecologist per 2000–2200 female population. The most rational operating hours for the antenatal clinic are from 8.00 to 20.00. It is advisable to organize appointments on Saturdays, Sundays, holidays and pre-holidays from 9.00 to 18.00. The antenatal clinic registration office provides pre-registration for an appointment with a doctor on all days of the week in person or by telephone. A local obstetrician-gynecologist spends the bulk of his working time on outpatient appointments , alternating appointments in the morning and evening, and also provides home care to women who, for health reasons, cannot come to the consultation themselves (on average 0.5 hours of working time per day). A local obstetrician-gynecologist has the following calculated workload standards: 6 women per 1 hour of appointment, 8 - during preventive examinations, when working from home - 1.25 calls per hour.
Accounting and reporting documentation for the antenatal clinic
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Sample forms of medical records | |
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Statistical card for registering final (refined) diagnoses | |
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Outpatient medical record | |
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Dispensary observation checklist | |
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Home birth log | |
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Book of records of VKK conclusions | |
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Book of registration of certificates of incapacity for work | |
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Work diary of a doctor at a polyclinic (outpatient clinic, dispensary, consultations) | |
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Outpatient surgery log | |
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Sanatorium-resort card | |
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Certificate of temporary incapacity for work due to a domestic injury, abortion operation | |
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Individual card of a pregnant woman, postpartum woman (Appendix A) | |
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Exchange card (Appendix B) | |
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Medical record of termination of pregnancy (Appendix B) | |
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Certificate of incapacity for work | |
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Report of a treatment and prevention organization | |
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Report on medical care for pregnant women, women in labor and postpartum women |
Analysis of the activities of the antenatal clinic (indicators):
1. Staffing of the antenatal clinic with obstetricians and gynecologists:
number of occupied medical positions of obstetricians and gynecologistsgov x 10000
number of female population served at the end of the year
2. Provision of outpatient obstetric and gynecological care:
number of doctor visits per year
average number of female population served
3. Locality indicator:
number of visits to obstetrician-gynecologists by women in their area x100
number of visits to obstetrician-gynecologists by women in the area serving the antenatal clinic
4. Complete coverage of women with preventive examinations:
number of women actually examined x 100
number of women to be examined according to plan
5. Structure of medical examinations by observation groups:
number of persons in this group of dispensary observation x 100
number of medical examinations (healthy and sick)
6. Composition of those undergoing medical examination for illness:
number of patients with this disease who are under dispensary observation x100
number of medical examinations
7. Completeness of coverage of patients with dispensary observation (for individual diseases):
number of patients with this pathology under dispensary observation x100
number of patients registered with this pathology
8. Timeliness of taking patients under dispensary observation:
number of patients taken under observation in the reporting year
with newly diagnosed disease x100
number of patients with this disease first identified in the reporting year
Purpose of the lesson: study the tasks and organization of the work of the antenatal clinic, the principles of monitoring pregnant women.
The student should know : main regulatory documents (orders) on the organization of the work of the antenatal clinic, indicators of the work of the antenatal clinic, timing of registering pregnant women, prenatal and postnatal care, frequency of visits to the antenatal clinic, scope of examination during pregnancy (timing and goals of ultrasound), organization and methodology of conducting physiopsychoprophylactic preparation (FPPP) for childbirth, prenatal risk factors, risk groups, timing and duration of maternity leave.
The student must be able to : analyze the performance indicators of the antenatal clinic, count factors and assess the degree of risk of pregnant women for the occurrence and development of perinatal, obstetric and extragenital pathologies, fill out an individual card for pregnant women.
Women's consultation(LC) is a department of a clinic, medical unit or maternity hospital that provides outpatient treatment and preventive, obstetric and gynecological care to the population.
Main tasks antenatal clinics are:
provision of qualified obstetric and gynecological care to the population of the assigned territory;
carrying out therapeutic and preventive measures aimed at preventing complications of pregnancy, the postpartum period, and preventing gynecological diseases;
providing women with social and legal assistance in accordance with the legislation on the protection of child health;
introduction into practice of modern methods of prevention, diagnosis and treatment of pregnant and gynecological patients;
introduction of advanced forms and methods of outpatient obstetric and gynecological care.
In accordance with the main objectives, the antenatal clinic should carry out:
organizing and conducting sanitary and preventive work among women;
preventive examinations of the female population;
carrying out work on contraception to prevent unplanned pregnancy;
security continuity in the examination and treatment of pregnant women, postpartum women and gynecological patients between the antenatal clinic and the maternity hospital, children's consultation, other medical institutions (consultation “Family and Marriage”, consultative and diagnostic centers, medical and genetic consultations).
An important task of the antenatal clinic doctor is to register pregnant women and carry out therapeutic measures pregnant women included in the risk group.
Consultation activities are based on local principle . Obstetrics and gynecology department designed for 6,000 women living in the area where this consultation operates. In each of them, up to 25% of women are of reproductive age (from 15 to 49 years). The working hours of the antenatal clinic are established taking into account the reliable provision of outpatient obstetric and gynecological care to women during their non-working hours. One day a week is allocated to the doctor to provide assistance and preventive examinations to female workers of attached industrial enterprises located on the doctor’s site or for specialized appointments.
STRUCTURE OF WOMEN'S CONSULTATION: registry, offices of obstetricians and gynecologists for receiving pregnant women, postpartum women, gynecological patients, a manipulation room, a physiotherapy room where medical procedures are carried out, offices of a therapist, dentist, venereologist and lawyer for consultations on social and legal issues. Specialized reception rooms have been organized for women suffering from infertility, miscarriage, for consultations on contraception, pathology of the premenopausal, menopausal and postmenopausal periods, a laboratory, and an ultrasound room.
Registry The antenatal clinic provides pre-registration of appointments with a doctor on all days of the week during a personal visit or by telephone.
The local doctor, in addition to visiting the antenatal clinic, provides home care to pregnant women, postpartum women, and gynecological patients who, for health reasons, cannot come to the antenatal clinic themselves. If the doctor finds it necessary, he actively visits the sick or pregnant woman at home without calling (patronage) .
Sanitary education work carried out by doctors and midwives according to plan. The main forms of this work: individual and group conversations, lectures, answers to questions using audio and video tapes, radio, cinema, television.
Legal protection women are provided by legal advisers of the antenatal clinic, who, together with doctors, identify women in need of legal protection, give lectures, and conduct conversations on the basics of Russian legislation on marriage and family, and the benefits of labor legislation for women.
One of the main tasks of the antenatal clinic is to identify precancerous diseases and prevent cancer. There are three types of preventive examinations: complex, targeted, individual. Preventive examinations of the female population are carried out from the age of 20, twice a year with mandatory cytological and colposcopic examinations.
MONITORING OF PREGNANT WOMEN
The main task of the antenatal clinic is medical examination of pregnant women. Registration period is up to 12 weeks of pregnancy. On your first visit, fill out “Individual card for pregnant and postpartum women”(Form 111у), in which all data from the survey, examination, and appointments are recorded at each visit. After a clinical and laboratory examination (up to 12 weeks), each pregnant woman’s belonging to a particular risk group is determined. To quantitatively assess risk factors, you should use the scale “Evaluation of prenatal risk factors in points” (order No. 430).
GYNECOLOGICAL CARE
Gynecological diseases are detected when women visit antenatal clinics, during preventive examinations in antenatal clinics or enterprises, examination rooms of clinics. For every woman who initially applied to the antenatal clinic, a “Outpatient medical record”(form 025у). If there are indications for medical examination, fill out the “Dispensary Observation Control Card” (form 030u).
ORGANIZATION OF OBSTETRIC AND GYNECOLOGICAL CARE FOR WOMEN IN INDUSTRIAL ENTERPRISES
Obstetrician-gynecologists at the antenatal clinic carry out a complex of treatment and preventive work at the enterprises attached to the consultation. The doctor is given one day a week to carry out this work. Currently, the antenatal clinic assigns an obstetrician-gynecologist to work with enterprises at the rate of one doctor per 2000-2500 women.
At the enterprise, the obstetrician-gynecologist carries out:
preventive examinations of women;
in-depth analysis of gynecological morbidity;
pregnancy and childbirth outcomes;
receives gynecological patients; controls the work of the personal hygiene room;
studies the working conditions of women at the enterprise;
participates in efforts to improve working conditions for female workers.
ORGANIZATION OF OBSTETRIC AND GYNECOLOGICAL CARE FOR RURAL WOMEN
On-site antenatal clinic is a regularly operating branch of the antenatal clinic of the central district hospital (CRH) and was created to provide obstetric and gynecological care to the rural population.
On the rural paramedic-midwife station(FAP) of pre-hospital care, the work of a midwife is aimed mainly at early registration and systematic observation of pregnant women in order to prevent pregnancy complications and carry out sanitary educational work. Periodic medical examination of women at the FAP is carried out by doctors from the antenatal clinic of the district hospital (RB) or the central district hospital (CRH), as well as doctors from the visiting team of the CRH, consisting of an obstetrician-gynecologist, a therapist, a dentist and a laboratory assistant. The main task of an on-site antenatal clinic is clinical observation of pregnant women and provision of assistance to patients with gynecological diseases.
ANALYSIS OF THE ACTIVITIES OF WOMEN'S CONSULTATION
The analysis of work is carried out in the following sections of the activities of the antenatal clinic: general data on consultation, analysis of preventive activities, obstetric activities. The analysis of obstetric activities includes: a report on medical care for pregnant and postpartum women (Insert No. 3): early (up to 12 weeks) taking pregnant women for clinical observation, examination of pregnant women by a therapist, pregnancy complications ( late gestosis, diseases independent of pregnancy), information about newborns (born alive, dead, full-term, premature, deceased), perinatal mortality, mortality of pregnant women, parturients and postpartum women (maternal mortality).
MONITORING OF PREGNANT WOMEN
PRINCIPLES OF CHECKLIST FOR PREGNANT WOMEN
Monitoring pregnant women is the main task of the antenatal clinic. The outcome of pregnancy and childbirth largely depends on the quality of outpatient monitoring.
Early coverage of pregnant women with medical supervision. A woman must be registered when her pregnancy is up to 12 weeks. This will make it possible to timely diagnose extragenital pathology and resolve the issue of the advisability of continuing pregnancy, rational employment, establish the degree of risk and, if necessary, ensure the health of the pregnant woman. It has been established that when observing women in early dates pregnancy and visiting a doctor 7-12 times, the perinatal mortality rate is 2-2.5 times lower than for all pregnant women in general, and 5-6 times lower than when visiting a doctor during pregnancy after 28 weeks. Thus, health education work in combination with qualified medical supervision is the main reserve for increasing the number of women visiting doctors in the early stages of pregnancy.
Many expectant mothers, without hesitation, register for pregnancy dispensary registration at a regular antenatal clinic at their place of residence or registration. The state gives every woman the opportunity to receive the necessary qualified examination and treatment free of charge.
Program of state guarantees for citizens Russian Federation free medical care provides the following list of services provided to pregnant women in antenatal clinics:
1. Appointments with an obstetrician-gynecologist. According to the order of the Ministry of Health of the Russian Federation, the number of appointments during pregnancy is on average 12–15 with early (up to 12 weeks) registration of a woman at a dispensary. An obstetrician-gynecologist is the main doctor who monitors a pregnant woman.
2. Maintaining an exchange card. Almost immediately upon registration for pregnancy dispensary registration, an exchange card is created. In this document, the midwife enters all doctor’s appointments, tests, results of additional studies, and hospital discharges. An exchange card (pregnant woman's passport) is issued to the pregnant woman at 28 weeks. A pregnant woman enters the maternity hospital with an exchange card.
3. Consultations with other doctors. The therapist examines the expectant mother at least 2 times during pregnancy. The first appointment is carried out 7–10 days after registration, with blood, urine and ECG tests. The second appointment is timed to coincide with maternity leave (30 weeks of pregnancy). If a pathology is detected, examinations by a therapist may be more frequent. An ophthalmologist examines expectant mothers once. For serious eye problems, a second appointment should be carried out at a specialized ophthalmology center. The purpose of visiting a dentist is to identify expectant mother chronic foci of infection - carious teeth. This specialist examines the woman once during pregnancy. The number of further visits to the dentist depends on the condition of the oral cavity and the need for treatment. An otolaryngologist (ENT doctor) conducts one appointment in the first trimester (or upon registration), and then according to indications. Other specialists examine the pregnant woman after the recommendation of the therapist. In emergency cases, consultations with other specialists may be prescribed by an obstetrician-gynecologist. Endocrinologist, neuropathologist, cardiologist, rheumatologist, urologist are the most common specialists who provide advisory and therapeutic assistance to the therapist.
Visits to specialists take place at the clinic, which has an attached antenatal clinic. As a rule, the clinic does not have an assigned general practitioner who examines pregnant women, and all expectant mothers visit local therapists. In addition, in many clinics there are still queues to see these specialists and for tests.
4. Laboratory and instrumental examination methods. The order for antenatal clinics contains a list of tests for pregnant women and instructions on how often they should be taken. If necessary, the obstetrician-gynecologist can increase the frequency of tests in connection with the pathology of the pregnant woman. General analysis urine tests are performed for pregnant women before each dose. A complete blood count is performed every trimester or monthly for anemia (low hemoglobin). A coagulogram - a study of coagulation and anticoagulation factors in venous blood - is usually performed twice during pregnancy. A biochemical blood test is taken at least 2 times during pregnancy. A blood test for syphilis, hepatitis B and C, and HIV infection is taken three times: when registering for pregnancy, at 30 weeks when receiving maternity leave, and 2–3 weeks before childbirth, at 37–38 weeks. When registering, it is also necessary to check your blood type and Rh factor. If Rh-negative blood is detected, it is necessary to be regularly tested for Rh antibodies: up to 30 weeks - once a month, then - every 10 days.
When registering and examining a pregnant woman in a chair, they must take a smear to determine the degree of purity of the vaginal discharge, atypical cells from the cervix and, if indicated, an examination of the contents of the vagina and cervical canal for high-quality composition bacteria - bacteriological examination. This study is repeated at 30 weeks and before birth. According to the orders of the Ministry of Health of the Russian Federation, ultrasound examination (screening) must be carried out three times: at 10–14 weeks, 20–24 weeks, 32–34 weeks. From 32 weeks of pregnancy, cardiotocography is regularly performed - a method of simultaneously recording the fetal heartbeat and uterine tone.
At 10–13 weeks of pregnancy, a “double test” is performed to determine markers of fetal malformations in high-risk women. In venous blood, the concentration of PAPPA protein and human chorionic gonadotropin is determined. At 16–20 weeks of pregnancy, a “triple test” is performed - a study of venous blood for alpha-fetoprotein and human chorionic gonadotropin - markers of fetal malformations, as well as free estriol - an early marker of placental disorders. If the tests are changed, a consultation with a geneticist is carried out.
5. Issuance of sick leave. All municipal antenatal clinics are licensed to issue sick leave certificates for pregnancy and childbirth. Therefore, all pregnant women working or registered with the employment office have the right to receive “maternity leave”. This document is issued at 30 weeks of pregnancy. If a woman gets a job or contacts the employment office after 30 weeks, she receives “maternity leave” upon application. If a woman is registered with a antenatal clinic after 30 weeks, then she is issued “maternity leave” from the date of registration.
If this antenatal clinic is not able to provide the pregnant woman with the above services, then the administration of the medical institution must provide the necessary consultation or examination in another medical institution free of charge.
If the antenatal clinic is not part of the maternity hospital, then it should have a day hospital - a short-stay department, where the pregnant woman spends several hours a day while the necessary procedures are performed (for example, IVs), and after they are completed she goes home. If indicated, the expectant mother undergoes examination and treatment in a day hospital. Women with pregnancy complications or who are at high risk due to the state of their health or the fetus are hospitalized in a 24-hour inpatient gynecological department or maternity hospital. Each antenatal clinic is assigned by order of the Ministry of Health of a given region to a specific hospital and maternity hospital.
A woman who is registered for pregnancy at the antenatal clinic is issued the following documents and certificates:
- In case of early attendance (up to 12 weeks), an appropriate document is issued to receive a one-time cash benefit at the place of work.
- When registering, a pregnant woman receives a certificate to transfer her to “light labor” while maintaining her previous salary. A certificate is also issued stating that the expectant mother has the right to an examination with a break from work for 1-3 days with the same salary depending on the duration of pregnancy.
State antenatal clinics are licensed to issue birth certificates. This document gives a citizen of the Russian Federation the right to free observation and examination in a antenatal clinic for pregnancy and for 42 days of the postpartum period, free delivery in a maternity hospital of her choice, as well as free observation of a child up to 1 year old by a pediatrician. A birth certificate is issued to a pregnant woman at 30 weeks of pregnancy or with continuous observation in one antenatal clinic for at least 12 weeks. If the observation period is shorter or there is no observation at the antenatal clinic, a birth certificate is issued without the first coupon (“Observation at the antenatal clinic”). In this case, the certificate is called “cancelled” and is issued either at the antenatal clinic or (in the absence of any supervision at the antenatal clinic) at the maternity hospital on the day of birth. According to the provisions on birth certificates, a woman can be observed in the antenatal clinic of her choice, as well as choose a maternity hospital and a children's clinic. However, practice shows that the most convenient is observation in the antenatal clinic closest to the woman’s actual place of residence. In relation to the choice of maternity hospital, the situation is often considered according to the provisions on emergency care for pregnant women and women in labor. If a pregnant woman needs emergency care or urgent delivery, she goes by ambulance (or independently) to the nearest maternity hospital.
Paid medical center
Pregnancy management in a non-state (commercial) medical center is carried out with a license from the Ministry of Health for this type of medical activity. Some centers are licensed to care for pregnant women only up to 20 weeks, while others care for pregnancies up to the due date. In their work, paid centers adhere to the same orders and operating principles as antenatal clinics. Obtaining a license for a paid center to conduct pregnancy is possible only after approval by several commissions. This service is provided on a paid basis, and its price varies depending on the possibility of the examination provided and the level of the medical center.
In paid centers there are pregnancy management programs starting from the first weeks. The program can be standard, including consultations with a gynecologist, necessary examinations by specialists, tests and examinations, or it can be compiled individually after the first visit to the doctor, taking into account the characteristics of the pregnancy of a particular patient. Many medical centers include in their programs a consultation with a perinatal psychologist or psychological support for the expectant mother throughout pregnancy, the opportunity to contact a doctor at any convenient time and receive advice by phone, as well as call a doctor at home if necessary. An expanded program may include visits to gymnastics, a school for expectant mothers, and additional consultations with doctors (for example, a neurologist, cardiologist, geneticist). There are also “Beauty and Pregnancy” programs, VIP programs - observation and testing at home, etc. Or you can get certain consultations and tests, paying for them separately.
Now let's talk about the features of service in a paid center.
An obstetrician-gynecologist working in the center treats much fewer pregnant women than the same specialist in a state antenatal clinic. Consequently, more time is allocated for each pregnant woman’s appointment (from 30 minutes to 1 hour). There is no queue at the paid center; all appointments are by appointment, except in emergency cases. It is even possible to serve patients at home. Typically, the number of appointments during a normal pregnancy is no more than those regulated by order of the Ministry of Health.
The list of tests performed is the same as in the antenatal clinic. Tests are usually carried out at a time convenient for patients during the day. Additional examinations and consultations with specialists are paid separately. The center does not always have all the necessary specialists and examinations, then the expectant mother may be recommended to undergo the necessary examination in another private center (this information is reflected in the contract, where there is always a full list of consultations and tests that will be provided to the pregnant woman during the observation period).
Obtaining a license to issue certificates of incapacity for work and “maternity leave” to non-state medical institution more difficult than municipal ones, so they are not issued by all medical centers. A birth certificate is issued only by a government agency. A woman needs it to receive free medical care during childbirth, the postpartum period and in a children's clinic. If a pregnant woman is observed in a paid center, then she can obtain a birth certificate at the antenatal clinic at her place of residence at 30 weeks or later, but if she plans to enter into a contract for childbirth, then there is no need to obtain a birth certificate.
Paid centers strive to make the expectant mother’s stay within their walls as comfortable as possible, thinking through the interior, rest rooms, and equipping specialists’ offices with modern furniture and equipment.
For a woman being observed in a paid center, delivery is carried out in any maternity hospital in accordance with the provisions on the birth certificate and state guarantees. Paid centers with a high level of service usually enter into an agreement with the maternity hospital, as well as with individual doctors, to conduct paid births for their patients. In large paid centers that have their own maternity hospital, it is possible to conclude a contract for delivery with the choice of a doctor, method of pain relief, level of ward, the possibility of relatives being present at the birth or visiting them in the postpartum period. All paid centers bear legal responsibility for pregnancy management and are subordinate to the Ministry of Health of the corresponding region. Maternity clinics are also subordinate to district and city health care centers. Cases of incompetent management of pregnancy in a regular antenatal clinic are considered at all structural levels of health care in the corresponding region.
Regardless of where the pregnant woman is observed: in municipal institution or a paid center, the obstetrician-gynecologist tries to fulfill his duties in the most high level. The main goal is the birth of a healthy baby and maximum preservation of the woman’s health. A woman’s knowledge of the need for observation and examination and confidence in her rights will help her decide on the choice of a medical institution.
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 mother and child protection system, taking into account and analyzing the state of their health and social-hygienic factors, helps to preserve and strengthen the health of women and children. This Toolkit covers issues of organizing the work of the antenatal clinic and maternity hospital. The antenatal clinic, as a state medical and preventive institution, provides outpatient obstetric and gynecological care to protect the reproductive health of the population.
The main goal of the antenatal clinic is to protect the health of mothers and children by providing qualified outpatient obstetric and gynecological care to gynecological patients, women during pregnancy and the postpartum period, family planning services, and reproductive health care.
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, the postpartum period, and gynecological diseases, and also provides qualified medical assistance and care for newborns during their stay in the obstetric hospital.
This manual is intended for students.
Obstetric and gynecological care is provided by the following standard institutions:
— maternity hospitals (general and specialized);
— antenatal clinics (independent, as part of a united maternity hospital, clinic or outpatient clinic);
— maternity and gynecological departments of research institutes and universities;
— obstetrics and gynecology departments of multidisciplinary city and other hospitals;
— perinatal centers;
— antenatal clinics and gynecological offices of medical and sanitary units;
— examination rooms of clinics;
— consultations “Marriage and family”;
— medical and genetic consultations (offices);
— family planning and reproduction centers;
— sanatoriums for pregnant women
and other institutions not provided for in the nomenclature. The main institutions providing outpatient care to women are antenatal clinics.
Chapter 1. Organization of the work of the antenatal clinic
A antenatal clinic is a dispensary-type treatment 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 local principle. The size of 1 obstetrics and gynecology department is approximately 2 therapeutic areas, therefore one obstetrician-gynecologist has 2-2.5 thousand women under supervision.
1.1. Structure and tasks of the antenatal clinic
The main objective is to protect the health of mothers and children by providing qualified outpatient obstetric and gynecological care outside of pregnancy, during pregnancy and the postpartum period, family planning and reproductive health services.
1. Carrying out preventive measures aimed at preventing complications of pregnancy, childbirth, the postpartum period, and gynecological diseases.
2. Providing medical obstetric and gynecological care.
3. Providing advisory services on family planning, prevention of abortion, sexually transmitted diseases, incl. HIV infections, introduction of modern methods of contraception.
4. Introduction into practice of modern achievements in diagnosis and treatment.
5. Carrying out hygienic education and training of the population, creating a healthy
lifestyle.
6. Providing social and legal assistance to women.
7. Ensuring continuity in examination and treatment.
Structure and organization of work of the antenatal clinic
Depending on the size of the population served, a antenatal clinic may have the following structural divisions:
Registry
Offices of local obstetricians and gynecologists,
Gynecology office for children and adolescents
Family planning and pregnancy prevention rooms,
Rooms for psychoprophylactic preparation for childbirth,
Offices for receiving a therapist, gynecological oncologist, venereologist, dentist,
Social and Legal Cabinet,
Room of the "young mother"
Physiotherapeutic office,
Manipulative,
Operating room for outpatient operations,
Endoscopy room
Cytological laboratory and clinical diagnostic laboratory,
Cabinet functional diagnostics,
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; performing minor gynecological operations and manipulations.
The working time of a local obstetrician-gynecologist consists of:
Outpatient appointment (alternating: morning-evening; 4.5 hours a day at the rate of 5 women per 1 hour of appointment)
Home assistance (about 5 hours per day based on 1.25 calls per hour)
Other types of work (1.5 hours)
A 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, carries out medical procedures, and upon doctor’s prescription, medical procedures can be carried out at home by nursing staff , as well as diagnostic manipulations.
1.2. The main sections of the work of a local obstetrician-gynecologist.
One of the main sections of the work of the antenatal clinic is clinical observation, which is subject to 3 groups of women:
1) Healthy women with a normal pregnancy
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) those suffering from recurrent 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 the pregnant woman under the supervision of the antenatal clinic.
A woman must register with an antenatal clinic before 12 weeks of pregnancy, which helps reduce the number of errors in determining the timing of birth, 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 labor and the health of the child.
2. Systematic monitoring of the health status of pregnant women, examination, identification of risk groups, treatment of somatic diseases.
When a woman first consults about pregnancy and, if she wishes to maintain it, the doctor carries out the following activities:
Get acquainted with general and special anamnesis;
Performs a general examination of the woman;
Measures height, weight, abdominal circumference and pelvic dimensions;
Measures blood pressure (on both arms);
Performs necessary obstetric examinations;
Determines the condition of the most important organs.
After the examination, the woman must attend a consultation with all tests and doctor’s opinions 7-10 days after the first visit. In total, during pregnancy, a woman should attend a consultation approximately 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 examination procedure are determined individually.
In addition, every pregnant woman must be examined by a therapist (2 times - at the first visit and at 32 weeks of pregnancy), a dentist, and an otorhinolaryngologist.
After a comprehensive examination, the pregnant woman’s belonging to the risk group is determined.
3. Preparation of documentation for a pregnant woman.
All data from a woman’s survey and examination, as well as advice and prescriptions, are recorded in the “Individual Card of a Pregnant and Postpartum Woman” (f. 111/u) and stored in the office of each doctor in a file for the dates of the scheduled follow-up visit, as well as in the dispensary book of the pregnant woman (she is given to them and records of all visits are duplicated in it).
4. Organization of prenatal care for pregnant women.
It is carried out as prescribed by a doctor; for this purpose, cards of women who do not appear on time are selected.
5. Study of working conditions of pregnant women.
To resolve the issue of employment of pregnant women, “Hygienic recommendations for the rational employment of pregnant women” are used. If necessary, the obstetrician-gynecologist at the antenatal clinic issues pregnant women certificates of transfer to light and harmless work (f. 081/u), draws up certificates of incapacity for work, which are registered in the “Registration Book of Certificates of Incapacity for Work” (f. 036/u). Students are issued certificates for exemption from classes.
6. Ensuring timely provision of qualified treatment.
If the pregnancy is up to 20 weeks and there are 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 in a group method. In consultation, women learn special complex exercises that are recommended to be performed at home for a certain time. It is advisable to start group classes (no more than 8-10 people in a group) on psychoprophylactic preparation for childbirth from 32-34 weeks of pregnancy. Preparing pregnant women for childbirth is carried out by the site doctor, one of the consultation doctors, and a specially trained midwife.
8. Organizing and conducting classes in “schools for mothers.”
Classes with women in “schools of mothers” begin from 15-16 weeks of pregnancy; classes are held on some topics with future fathers (about the regime of a pregnant woman, nutrition during pregnancy, child care, etc.). Some antenatal clinics organize special “schools for fathers”.
2. Observation, health improvement and rehabilitation treatment of postpartum women.
During the normal course of the postpartum period, the 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 examination is carried out 5-6 weeks after birth.
The main therapeutic and health measures during a normal postpartum period are:
A woman's personal hygiene
Breast care,
Performing a special set of physical exercises,
Compliance with the regime of housework, rest, balanced nutrition,
Fortification.
3. Gynecological care.
1. Active identification of gynecological patients.
Identification of gynecological patients is carried out:
When receiving women who have applied for 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 clinics.
Every woman should be examined by an obstetrician-gynecologist once a year using cytological and colposcopic examination methods.
For those subject to a preventive examination, a “List of persons subject to a targeted medical examination” (f. 048/u) is compiled, for those examined, a “Card of the person subject to a preventive examination” (f. 074/u).
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 record” is created (f. 025/u).
Treatment of gynecological patients is carried out mainly in antenatal clinics, but can also be organized at home (as prescribed by a doctor). IN outpatient setting Individual minor gynecological operations and manipulations can be performed, for example, in a day hospital.
3. Timely hospitalization of women in need of inpatient treatment.
When assigned to inpatient treatment, a referral for hospitalization is issued, and a record of the referral and actual hospitalization is made in the outpatient card.
After the patient is discharged from the hospital, follow-up treatment can be provided in the antenatal clinic. The hospital information is transferred to the outpatient card, and the woman retains the extract.
4. Examination of working capacity for gynecological diseases. Examination of temporary and permanent disability for 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/u) is filled out. Medical examination is terminated after the patient has recovered or due to her leaving the area of the consultation.
4. Prevention of abortions.
In accordance with current legislation, every woman has the right to independently decide the issue of motherhood.
Artificial termination of pregnancy is carried out at the request of a woman with a pregnancy period of up to 12 weeks, for social reasons - women with a pregnancy period of up to 22 weeks, and if there is medical indications and the woman’s consent - regardless of the stage of pregnancy.
Referral for surgery artificial interruption pregnancy is given by a local obstetrician-gynecologist, however, this right is also granted to a family doctor, and in rural areas an obstetrician-gynecologist at a district or local hospital.
In the absence of medical contraindications to the operation of terminating a pregnancy, the woman is given a referral to a medical institution indicating the duration of pregnancy, the results of the examination, and the conclusion of the commission on terminating the pregnancy for specific medical (diagnosis) or social indications.
Consent to medical intervention in relation to persons under 15 years of age and citizens recognized as legally incompetent is given by their legal representatives.
On an outpatient basis, artificial termination of pregnancy is permitted:
- in the early stages of pregnancy when menstruation is delayed by up to 20 days (mini abortion);
- during pregnancy up to 12 weeks - in a day hospital on the basis of specialized research institutes, clinical, multidisciplinary city and regional hospitals for women without aggravated obstetric history. In other cases, abortion is performed only in a hospital setting. In accordance with Article 36 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993, artificial termination of pregnancy for social reasons is carried out at the request of a woman up to 22 weeks of pregnancy. The issue of termination of pregnancy for social reasons is decided in an outpatient clinic or inpatient institution by a commission consisting of an obstetrician-gynecologist, the head of the institution (department), a lawyer, upon a written application from the woman, in the presence of a conclusion on the gestational age established by the obstetrician-gynecologist and relevant legal documents (certificate of death of a husband, divorce, etc.), confirming social testimony.
In connection with the operation of artificial termination of pregnancy, working women are issued a certificate of incapacity for work in in the prescribed manner, but not less than 3 days.
Recommendations play an important role in preventing abortions: individual selection and contraceptive education for women who wish to abstain from pregnancy. During the consultation, it is advisable to have an exhibition display of contraceptives and organize their sale. If a woman, especially a primigravida, seeks consultation, before being referred for an abortion, it is necessary to explain the dangers and harms of terminating a pregnancy.
5. Work on creating a healthy lifestyle.
This work is carried out according to plan, taking into account local characteristics and conditions. For this type of work, fixed hours and days are allocated, records are kept in the “Register of Sanitary Education Work” (f. 038/OU).
1.3. Analysis of the work of the antenatal clinic
As in every medical and preventive institution, medical documentation is maintained in the antenatal clinic. Many types of medical documents are the same for all outpatient clinics and have been described previously. However, the antenatal clinic has some registration forms that are unique to this institution:
1. Individual card of a pregnant woman and a postpartum woman (F. 111/U).
2. Medical report on the transfer of a pregnant woman to another job (f. 084/u).
3. Exchange card of the maternity hospital, maternity ward of the hospital (f. 113/u).
4. Logbook for recording obstetric care at home (f. 032/u).
To analyze the work of the antenatal clinic, a number of indicators characteristic only of this institution are calculated. And, although some of them are excluded from state statistics, for an individual medical institution they are of undoubted importance. These are the following indicators:
1. Timely admission of pregnant women under consultation supervision:
1.1. Early admission (up to 12 weeks):
admitted for observation with a gestational age of up to 12 weeks x 100%
1.2. Late admission (over 28 weeks):
was admitted for observation at 28 weeks' gestation. and more x 100%
received only under observation of pregnant women
2. Frequency of errors in determining the timing of delivery:
2.1. Percentage of women who gave birth 15 days or more ahead of schedule:
number of women who gave birth earlier than established
number of women who gave birth and had prenatal leave
2.2. Percentage of women who gave birth 15 days later than the consultation date and
more:
number of women who gave birth later than 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 birth (14-15 times):
number of prenatal consultation visits by 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 have never attended prenatal consultation
number of pregnant women admitted under consultation supervision
4. Completeness of examination of pregnant women admitted under consultation supervision:
number of women examined for Rhesus status x 100%
On time+
The completeness of the examination of pregnant women for the Wasserman reaction and toxoplasmosis is also considered. The percentage of women with Rh-negative form identified during the examination is calculated separately.
5. Number of pregnant women who were examined by a therapist:
number of pregnant women who were examined by a therapist x 100%
number of women who completed their pregnancy with childbirth:
6. Complications of pregnancy:
number of pregnant women who suffered from toxicosis in the second half of pregnancy x 100%
number of women who completed their pregnancy with childbirth:
on time+ premature birth+ abortions
The percentage of women who suffered from extragenital diseases and other complications is calculated in the same way.
7. Mortality of pregnant women:
number of women who died during pregnancy x 100%
admitted under consultation supervision
8. Pregnancy outcomes:
number of pregnant women who completed their pregnancy with birth at term x 100%
premature birth + abortion
The percentage of women who ended their pregnancies prematurely is determined similarly.
during childbirth.
9. Coverage of pregnant women with classes on preventive preparation for childbirth:
number of pregnant women with whom classes were conducted
psychoprophylactic preparation for childbirth x 100%
number of women who completed their pregnancy with childbirth:
on term + premature birth + abortion
The coverage of pregnant women in the “school for mothers” is calculated in a similar way.
10. Proportion of women using hormonal contraceptives:
the number of women registered in the antenatal clinic,
using hormonal contraceptives x 100%
number of women of fertile age who are
registered at the antenatal clinic
Calculate similarly specific gravity women using IUDs and other contraceptives.
11. Abortion rate:
11.1. The abortion rate is calculated per number of women of fertile age:
number of pregnant women who ended their pregnancy with abortions,
of those registered at 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 abortions x 100%
number of pregnant women who completed their pregnancy with childbirth:
on term + premature birth + abortion
The frequency of mini-abortions is calculated similarly. 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 the maternity hospital
The main tasks of organizing inpatient obstetric and gynecological care:
1.Providing inpatient qualified medical care to women during
pregnancy, childbirth, the postpartum period, gynecological diseases;
2.Providing qualified medical care and care for newborns during
the duration of their stay in the obstetric hospital. The main institution providing
inpatient obstetric and gynecological care is a combined maternity
Maternity hospitals provide assistance to the population on a territorial basis, but first and emergency assistance to pregnant women is provided regardless of their place of residence and departmental subordination of the health care institution.
Referral to the maternity hospital for emergency care is carried out:
Ambulance and emergency aid station (department),
Obstetrician-gynecologist,
Doctors of other specialties,
Average medical workers
A woman can go to the maternity hospital on her own. Planned hospitalization
Pregnant women in the maternity hospital are carried out by an obstetrician-gynecologist, and in his absence - by a midwife.
Operation of the receiving and inspection unit
The reception and inspection block has one filter room and 2 inspection rooms,
one is for admitting women to the physiological obstetric department, the other is for observation.
Upon admission to the unit, a woman in labor (postpartum) presents a passport and a Dispensary
a pregnant woman’s book (“Exchange card” (f. 113/u)), the following is drawn up for it: “Childbirth history” (f.
096/у), make an entry in the “Register of admission of pregnant women, women in labor and postpartum” (f.
002/у) and in the alphabet book.
In the reception and examination block, an anamnesis is collected, an examination is carried out, and documents are reviewed. Women in the filter room are divided into two streams: those with an absolutely normal pregnancy, sent to the first obstetric department, and those who pose an “epidemiological danger” to others, sent to the observation department.
In the examination rooms of the physiological and observation departments, an objective examination of the woman is carried out, she is sanitized, a set of sterile linen is given, and blood and urine are taken for tests.
Observation department
Women are admitted to the observation department both through the reception and examination block of the obstetric departments and from the physiological obstetric department. Patients are placed in wards according to nosological forms of diseases, pregnant women are placed separately from postpartum women. Admission to the observation department Pregnant and postpartum women who have
- acute respiratory diseases, flu, sore throat;
- manifestations of extragenital inflammatory diseases;
— febrile state (body temperature 37.6 degrees C and above without clinical symptoms);
affected by other symptoms);
- long anhydrous period (outpouring amniotic fluid 12 hours or more before admission
captivity in a hospital);
- unexamined and in the absence of medical documentation;
— intrauterine death fetus;
— fungal diseases 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;
- postpartum women in case of childbirth outside a medical institution (within 24 hours after birth);
- for termination of pregnancy for medical and social reasons during
second trimester of pregnancy.
Transfer to the observation department from other departments of the obstetric hospital under-
pregnant women, women in labor and postpartum women are lying, having:
- 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:
The following are placed in the observation department: 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 moves to the labor room.
block or department of pathology of pregnant women (if indicated, transported on a gurney).
Generic block
The generic block includes:
Prenatal wards;
Maternity ward;
Intensive care ward;
children's room;
Small and large operating rooms;
Sanitary facilities.
A woman spends the entire first stage of labor in the prenatal ward. 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 maternity rooms, births are performed in them alternately. Each maternity room is open for 1-2 days, then it is thoroughly cleaned.
If there is one delivery room, births are carried out alternately on different Rakhmanov beds. The delivery room is thoroughly cleaned twice a week. A midwife attends a normal birth.
After the baby is born, the midwife shows the baby to the mother, paying attention to him
gender and the presence of congenital developmental anomalies (if any), then he is given:
Secondary treatment of the umbilical cord,
Primary processing skin,
Weighing a child
measuring body length, chest and head circumferences.
Bracelets are tied to the child's hands, and after swaddling, a medallion is tied on top of the blanket.
They indicate: last name, first name, patronymic, mother’s birth history number, gender of the child, weight, height, hour and date of birth.
After finishing the treatment of the newborn, the midwife (doctor) fills out the necessary columns in the “History of Birth” and “History of Development of the Newborn.”
The “History of Development of a Newborn” is filled out by the pediatrician on duty, and in his absence
- obstetrician-gynecologist on duty. When preparing the “History of development of a newborn”, it
the number must correspond to the mother’s “birth history”.
In the normal course of the postpartum period, 2 hours after birth, the woman is transferred on a gurney along with the child to the postpartum department.
When filling the wards of the postpartum ward, strict cyclicity is observed (one ward is filled with women in labor for no more than three days).
The cyclicity of filling maternal wards corresponds to the cyclical filling of newborn wards, which allows healthy children to be discharged with their mothers at the same time.
When mothers or newborns show any signs of disease, they are transferred to a second obstetric (observation) department or to another specialized institution.
Neonatal department
Wards for newborns are allocated in the physiological and observational departments.
In the neonatal department of the observation department there are children:
Born in this department;
Those born outside a maternity hospital;
Transferred from the physiological department;
Those born with severe congenital anomalies;
Born with manifestations of intrauterine infection;
Born with a body weight of less than 1000 g.
For sick children in the observation department there is an isolation ward with 1-3 beds. Children subject to adoption may be placed in a separate isolation ward.
To maintain cyclicity, children's wards must correspond to the mother's wards. Children with a difference in birth date of up to 3 days can be accommodated in the same room. The temperature in the wards should be maintained within 22-24 "C, and air humidity 60%.
Pediatricians in the neonatal department conduct daily examinations of children. On weekends and holidays bypass is provided through a staggered work schedule.
At the end of the examination of newborns, the pediatrician (obstetrician-gynecologist) informs the mothers about the condition of the children and carries out sanitary and educational work with them. Postpartum physiological department with a joint stay of mother and child
Staying together between mother and child significantly reduces the incidence of diseases in postpartum women and the incidence of diseases in newborn children. The main feature of such maternity hospitals or obstetric departments is the active participation of the mother in caring for the newborn child. Staying together significantly limits the contact of the newborn with the medical staff of the obstetric department and reduces the possibility of infection of the child. With this regimen, early attachment of the newborn to the breast is ensured, and the mother is actively trained in the skills of practical nursing and caring for the newborn.
Contraindications to the joint stay of mother and child are:
1) on the part of the parturient woman - late toxicosis of pregnant women, extragenital diseases in the stage of decompensation, surgical interventions during childbirth, rapid or prolonged labor, a long (more than 18 hours) anhydrous period during childbirth, the presence elevated temperature during childbirth, rupture or incisions of the perineum.
2) on the part of the newborn - prematurity, immaturity, long-term intrauterine fetal hypoxia, intrauterine malnutrition of the II-III degree, birth trauma, asphyxia at birth, developmental anomaly, hemolytic disease.
Neonatal resuscitation and intensive care wards
They are created with the aim of reducing perinatal mortality, organizing constant monitoring of the state of vital functions of newborns and timely implementation of correlating and diagnostic measures in obstetric institutions.
Newborns with severe damage to vital organs and systems in need of resuscitation measures, newborns at high risk of developing adaptation disorders in the early neonatal period are transferred to the intensive care unit.
Children are examined and diagnostic and therapeutic procedures are carried out by a qualified neonatologist.
Rules for discharging a woman from the maternity hospital
The main criteria for a woman’s discharge from the maternity hospital are: satisfactory general condition, normal temperature, pulse rate, blood pressure, condition mammary glands, uterine involution, normal laboratory results.
In the case of an uncomplicated course of the postpartum period in a postpartum woman and the early neonatal period in a newborn, with a fallen umbilical cord and good condition umbilical wound, positive dynamics of body weight, mother and child can be discharged 5-6 days after birth.
In the “History of the Development of a Newborn,” the nurse notes the time of his discharge from the maternity hospital and the condition of the skin and mucous membranes, and introduces the mother to the record. The entry is certified by the signatures of the nurse and mother. The nurse issues the mother a “Medical Birth Certificate” f. 103/u and “Exchange card of the maternity hospital, maternity ward of the hospital” f. 113/у, where the pediatrician notes basic information about the mother and newborn.
On the day the child is discharged, the head nurse of the neonatal department reports by telephone to the children's clinic at the place of residence basic information about the discharged child. This ensures faster first home visits. Elder sister notes in the journal the date of discharge and the name of the clinic employee who received the telephone message.
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.
The following pregnant women are hospitalized in the pathology department: women with extragenital diseases, complications of pregnancy (severe toxicosis, threat of miscarriage, etc.).
d.), with incorrect position fetus with a burdened obstetric history. The department of pathology of pregnant women has complete isolation from the obstetric departments, the ability to transport pregnant women to the obstetric physiological and observation departments (bypassing other departments), as well as an exit for pregnant women from the department to the street. The department has at its disposal:
Functional diagnostics room with modern equipment (mainly cardiological);
Observation room;
Small operating room;
Office of physio-psycho-preventive preparation for childbirth;
Covered verandas or halls for walking pregnant women.
Centralized oxygen supply.
A department of pathology for pregnant women with a semi-sanatorium regime can be organized, having a close connection with sanatoriums for pregnant women, where the results of treatment obtained in the maternity hospital are consolidated.
Work of gynecological departments Gynecological departments of maternity hospitals come in three profiles:
1. For hospitalization of patients requiring surgical treatment.
2. For patients in need of conservative treatment.
3. To terminate pregnancy (abortion).
The structure of the department includes:
Reception department;
dressing room;
Manipulative;
Small and large operating rooms;
Physiotherapeutic office;
Discharge room;
Intensive care ward.
In addition, for the diagnosis and treatment of gynecological patients, they use
other departments of the maternity hospital: clinical laboratory,
X-ray room, etc.
IN last years They are trying to remove abortion departments from obstetric hospitals and create independent departments. Independent gynecological hospitals and day hospitals are being organized. Departments for cancer patients are usually located in appropriate hospitals.
2.2 Organization and implementation of a set of sanitary and hygienic measures to prevent nosocomial infections
The main feature of obstetric institutions is the constant presence of newborn children and women in the postpartum period who are highly susceptible to infections. Therefore, a special set of sanitary and hygienic measures must be organized in a maternity institution. This complex includes:
Timely identification and isolation of women in labor, postpartum women and newborns with purulent-septic diseases,
Timely identification 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 treating various environmental objects
(bedding, clothing, shoes, dishes, etc.) of potential epidemiological significance in the mechanism of transmission of nosocomial infections.
Responsibility for carrying out a set of sanitary and hygienic measures to combat nosocomial infections in the maternity hospital rests with the chief physician.
The heads of the departments, together with the senior midwives (sisters) of the departments, organize and control this work.
The senior midwife (sister) of the department instructs middle and junior staff on the implementation of sanitary and hygienic measures at least once a month. Personnel entering work at the maternity hospital undergo a full medical checkup and instructions on carrying out sanitary and hygienic measures at the assigned work site.
All maternity hospital staff should be under clinical supervision to ensure timely identification of foci of infection.
Head The department once a quarter organizes inspection and examination of personnel for carriage Staphylococcus aureus. The staff takes every day before going on shift
a hygienic shower and undergoes a medical examination (thermometry, examination of the pharynx and skin). Maternity hospital workers are provided with individual lockers for clothes and individual towels. Sanitary clothing is changed daily; if nosocomial infections occur in the observation department, 4-ply 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 maternity hospital beds are allocated as isolation wards. In large maternity hospitals, special septic departments are organized.
Monitoring compliance with the anti-epidemiological regime in the maternity hospital is carried out by the Sanitary and Epidemiological Surveillance Center (SEN).
2.3. Analysis of the activities of the maternity hospital hospital
1. Indicators of bed capacity and its use:
1.1 Average annual bed occupancy (number of days a bed is open per year):
Number of bed days spent by pregnant women
Number of average annual beds
Approximate norm of average bed occupancy for urban maternity hospitals
houses and branches - 320 days. And in the postpartum department - 300 days).
1.2 Bed turnover:
Number of postpartum women leaving 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
Number of patients leaving the hospital
The average length of stay for postpartum women in the hospital is 8-9 days.
2. Indications for medical care during childbirth
Frequency of use of drug pain relief during childbirth:
number of births performed with drug pain relief x 100%
total births accepted
Defined similarly
Frequency of use of psychoprophylactic preparation for childbirth;
Frequency of childbirth with drug pain relief and psychoprophylactic preparation;
Frequency of surgical aids during childbirth (for all types of aids - obstetric forceps,
vacuum extractor, manual separation of placenta, manual and instrumental examination of the uterus after childbirth).
3. Maternal health indicators:
3.1. Frequency of complications during childbirth (determined for each type of complication):
for example, the frequency of perineal ruptures:
number of women giving birth. having a perineal gap x 100%
number of delivered births + number of admitted women. who gave birth outside the maternity hospital
3.2. 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 rate):
stillborn newborns x 100%
total born (dead and alive)
4. 2. Frequency of prematurity:
born premature (living and dead) x 100%
total born (alive and dead)
4.3. Morbidity of newborns(full-term, premature, full-term of this
disease, prematurely born with this disease). For example: morbidity in premature babies:
born sick and sick premature x100%
born alive premature
4.4. Newborn mortality rates(general, full-term, premature,
from various diseases). For example: mortality rate of full-term:
died full term x 100%
born alive full-term (born alive total - born alive premature).
The full version of the manual is presented in the photographs.
ORGANIZATION OF OBSTETRIC AND GYNECOLOGICAL CARE
Obstetric and gynecological care for women is provided in special outpatient or inpatient institutions. The nomenclature of these institutions is determined by order of the Minister of Health. In regional centers of large cities, the main ones are maternity hospitals, antenatal clinics, maternity and gynecological departments of general hospitals, gynecological hospitals, independent antenatal clinics, antenatal clinics or gynecological offices that are part of clinics or medical units of industrial enterprises.
In rural areas, obstetric and gynecological care is provided in maternity (gynecological) departments of regional, district and central district hospitals, rural district hospitals or outpatient clinics and at first aid stations.
Out-of-hospital obstetric and gynecological care for women is provided in special outpatient clinics, the main of which is the antenatal clinic. The basis of the treatment and preventive work of the antenatal clinic is the principle of territorial locality, and the leading method of its work is the dispensary.
Most antenatal clinics are a functional subdivision of a maternity hospital, clinic, medical unit or other medical and preventive institution and are under their administrative subordination. An antenatal clinic can also be an independent institution that is subordinate to local health authorities. The head of the antenatal clinic is in charge. A antenatal clinic can be located in a standard or adapted building or occupy part of a building in the institution of which it is part (clinic, medical unit, maternity hospital). Its premises should be isolated to prevent contact of pregnant women with patients seeking medical attention from other specialties.
Objectives of the antenatal clinic:
1) carrying out preventive measures aimed at preventing complications of pregnancy, childbirth, the postpartum period, and gynecological diseases;
2) provision of qualified obstetric and gynecological care to the population of the attached territory;
3) carrying out work on pregnancy planning;
4) introduction into practice of advanced forms and methods of outpatient obstetric and gynecological care, modern methods of diagnosis and treatment of pregnancy pathology, extragenital pathology, gynecological diseases;
5) carrying out sanitary educational work;
6) providing women with legal protection in accordance with the legislation on compulsory health insurance;
7) ensuring continuity in the examination and treatment of pregnant women, postpartum women and patients, implementing systematic communication with the maternity hospital (department), ambulance and emergency medical care station (department), clinic and children's clinic, as well as other treatment and preventive institutions (anti-tuberculosis, skin -venereology, oncology clinics, etc.);
8) organization of coordinated work of the obstetric-therapeutic-pediatric complex.
Structure of the antenatal clinic. The list and number of divisions (premises) of the antenatal clinic are determined by its tasks, capacity, and the nature of administrative subordination.
A typical antenatal clinic provides for the following units:
1) wardrobe for patients and staff;
2) registry;
3) waiting room;
4) offices:
manager;
senior midwife;
medical statistics;
medical obstetrics and gynecology;
Medical specialists (physician, dentist);
5) operating room with preoperative room;
6) treatment rooms for:
Vaginal manipulation;
Intravenous and subcutaneous infusions;
7) endoscopy room;
8) sterilization
9) an office for psychoprophylaxis and classes at the “School of Mothers”;
10) contraception room;
11) office of a social and legal worker;
12) the office of the sister-hostess;
13) toilets for women and staff.
Organization of antenatal clinic work. In large cities or areas where there are well-equipped and well-equipped antenatal clinics, one of them, the best in terms of performance, is designated as the basic one. In addition to regular work, basic antenatal clinics perform the functions of an obstetric and gynecological outpatient consultation center. They provide all types of specialized obstetric and gynecological care: treatment of gynecological diseases in childhood, infertile marriage, endocrine diseases, etc.
The work of the antenatal clinic is based on a territorial (precinct) principle. One obstetric area includes approximately two therapeutic areas. The number of women in the area is 3500 - 4000. The obstetric area is served by an obstetrician-gynecologist and a midwife. The workload per year is 6,000 - 7,000 pregnant and gynecological patients. The principle of locality allows the obstetrician-gynecologist to maintain constant communication with the local therapist, antenatal clinic therapist and other specialists. This facilitates the timely registration of pregnant women, the resolution of questions about the possibility of pregnancy in women suffering from extragenital pathology, their comprehensive examination and the establishment of an appropriate regimen and treatment, and in necessary cases and joint dispensary observation.
The safe delivery of pregnant women largely depends on their timely registration, regularity, completeness of examination and the quality of monitoring them during pregnancy. To reduce maternal morbidity and mortality, reduce errors in determining the timing of childbirth and maternity leave, antenatal clinics should strive to cover all pregnant women with medical supervision as early as possible. In the system of institutions of the Ministry of Health of the Republic of Belarus, 87% of pregnant women coming under the supervision of antenatal clinics have a pregnancy period of up to 12 weeks.
When a pregnant woman first comes to the consultation, an individual card for the pregnant woman and the postpartum woman is created for her (form No. 111/u). This medical document contains passport information, data from a carefully collected anamnesis ( Special attention given to the outcome of previous pregnancies, childbirths), the results of previous examinations of the woman and gynecological examination. Each pregnant woman is sent for consultation to a therapist (in the first and second half of pregnancy), a dentist and, if necessary, to doctors of other specialties. At the first visit of a pregnant woman to a therapist, the issue of the possibility of maintaining the pregnancy is decided, at the second - about identifying diseases internal organs caused by pregnancy or arising independently, their treatment and the choice, together with an obstetrician-gynecologist, of an institution (specialized or regular) for delivery.
In the normal course of pregnancy, a woman visits an antenatal clinic once a month in the first half of pregnancy, 2 times in the second half and 3-4 times a month after 32 weeks, for a total of 14-16 visits.
To ensure continuity in monitoring a pregnant woman in the antenatal clinic and maternity hospital, each pregnant woman is issued an exchange card of the maternity hospital, maternity ward of the hospital (form No. 113/u), where basic data on the woman’s health status and the course of pregnancy is entered. The card consists of three tear-off coupons. The first coupon - information about the pregnant woman from the antenatal clinic - is filled out in the consultation and stored in the birth history. The second coupon - information from the maternity hospital (department) about the postpartum woman - is filled out in the obstetric hospital and given to the woman for transfer to the antenatal clinic, where the features of the course of labor, the postpartum period and the condition of the postpartum woman are described in detail. In the third coupon - information from the maternity hospital (department) about the newborn - the obstetrician-gynecologist and neonatologist enter data on the characteristics of childbirth and the condition of the newborn, which necessitate special monitoring of him after discharge from the hospital. The coupon is given to the mother for transfer to the children's clinic (consultation).
In order to examine the living conditions of a pregnant woman, monitor compliance with the recommended regimen, and teach the rules of personal hygiene, pregnant women are patronized by nursing staff (midwives). The first patronage is carried out 2 weeks after the pregnant woman is registered. In the postpartum period, a woman should visit a midwife at a FAP or a doctor after 2-3 weeks and again after 4-5 weeks. Postpartum women who did not visit a doctor after childbirth are subject to home patronage. During each visit (home patronage), the pregnant woman (postpartum mother) is given the necessary recommendations on maintaining personal hygiene, work, rest, nutrition, etc.
The antenatal clinic operates a “School of Mothers” (visited from the 16th week of pregnancy) to prepare a woman and her close relatives for future motherhood and child care. In the second half of pregnancy (32-34 weeks), 5-6 classes are held on psychoprophylactic preparation for childbirth.
In obstetric institutions and, above all, in antenatal clinics, they carry out sanitary and educational work to prevent abortions, explain their harm to women’s health, and introduce them to contraceptives.
The most important section of the work of the antenatal clinic is social and legal assistance. Its tasks include explaining to women the laws protecting the rights and health of mothers and children. The lawyer of the social and legal office, in agreement with the consultation doctor, through the administration of enterprises and institutions, takes measures for the rational employment of pregnant, nursing mothers and sick women, the protection of their labor and everyday life, and monitors compliance with all benefits provided for by law.
Services for gynecological patients. Gynecological diseases are detected when women visit an obstetrician-gynecologist, as well as during individual or mass preventive examinations. For this purpose, examination rooms have been organized at territorial clinics. All women over 18 years of age who visit the clinic for the first time this year are sent to an examination room, where a midwife examines them. Women suffering from gynecological diseases or suspected of having them are referred for consultation to a gynecologist. Every woman should be examined by a gynecologist once a year, and workers of industrial enterprises - 2 times a year. Gynecological patients in need of inpatient treatment are referred to the appropriate gynecological departments or hospitals.
Performance indicators of the antenatal clinic. The activities of the antenatal clinic are assessed according to the following indicators.
1. Complete coverage of pregnant women with dispensary observation :
number of pregnant women under
up to 12 weeks of pregnancy
number of women admitted under
observation this year
b) late admission (after 28 weeks of pregnancy) - calculated similarly to early admission.
3. Average number of consultation visits by pregnant and postpartum women :
a) before birth:
number of visits by pregnant women,
who gave birth in the reporting year
b) in the postpartum period:
number of visits by postpartum mothers (after childbirth) in the reporting year
number of women who gave birth in the reporting year
If the work is done correctly, pregnant women should visit the antenatal clinic 14-16 times, and postpartum women at least 2-3 times;
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In addition, it is customary to calculate:
Percentage of urgent, premature and late births;
Abortion rate;
Percentage of pregnant women examined by a therapist once or twice;
The percentage of pregnant women examined for the Wasserman reaction once and twice;
Percentage of those screened for Rh status.
All these indicators are calculated based on the number of women whose pregnancy ended in the reporting year.
