Organization of obstetric care at the obstetric units

August 12, 2017 17:50 | Paramedic

obstetric care to the rural population provides a range of health care settings.Depending on the degree of proximity to the villages, from the specialization and qualification of health care, the level of material and technical equipment in the system of obstetric care to distinguish between the three stages.

First step: the implementation of pre-hospital and first medical aid.This step is a rural medical district.It includes the rural district hospitals with outpatient and hospital, midwife points (FAP), maternity homes.Location of the first stage - the periphery area.

second phase: implementation of the qualified medical aid.It includes the district (the number), and the central district hospital, having in its c

omposition of obstetric and gynecological departments and antenatal clinics.Location of the second stage - the district center.

The third step: to provide the rural population of highly qualified (specialized) obstetric care.It includes regional (regional, national) hospital, having in its composition of obstetric and gynecological departments and antenatal clinic or maternity home with a separate women's clinic.The deployment of the third stage - the regional (territorial, republican) center.

medical obstetric care at rural medical section provides general practitioner - the head physician of a rural district hospital (if the local hospital two doctors - one of them).Under his direct leadership works midwife local hospital, which helps the doctor in the hospital (involved in the conduct of birth) as well as in outpatient clinics (involved in the monitoring of pregnant women, women in childbirth and the treatment of gynecological patients).

Despite the presence in the periphery area of ​​the medical hospital - rural district hospital, the bulk of obstetric care in rural medical district referred to as pre-hospital care, and carried her midwife obstetric points.

feldsher-midwife points (FAP) provides the nomenclature of health facilities.FAP is organized in the village with a population of between 300 and 800 residents in cases when within a radius of 4-5 km there are no rural district hospital or outpatient clinic.

All work FAP provide Paramedic obstetrician, a midwife, a nurse.

Depending on local conditions, the FAP may lead only outpatient care or have maternity beds.In the latter case, the FAP, together with outpatient care and is stationary.

Due to the fact that FAP medical assistance around the rural population, and not only women, the room in which it is located, should consist of two parts: medical assistant and obstetric.

Obstetric of the FAP must have the following set of spaces: entrance hall, waiting room and office midwives.FAP have maternity beds, in addition to these facilities must have a viewing room, childbirth and the postnatal ward.Midwife FAP carries out all the work of organization and delivery of obstetric care to rural women living in a radius of service area.

The duties of midwives FAP include: identifying as early as possible of all pregnant women in the service area, provision of follow-up for them, including the necessary treatment and prevention, nursing pregnant, postpartum women and children under the age of 1 year;conduct health education among women;medical assistance at normal childbirth;detection of gynecological patients, referral to a doctor and to provide them with medical care prescribed by a doctor.

great help in the early detection of pregnant women have a homestead detours population conducted by a midwife FAP.All pregnant women identified from the earliest stages of pregnancy (before 12 weeks), and subject to medical examination of the woman in childbirth.In prenatal care midwife performs the entire bulk of the necessary studies.For the first time a pregnant midwife collects detailed history: a general (family history, past illnesses, etc.), And a special maternity (menstrual, sexual, generative, lactation function, gynecological diseases, etc.).From history midwife discovers peculiarities of previous pregnancies, the presence of extragenital diseases and other abnormalities in the transferred state of women's health that could affect the course of pregnancy and childbirth.

survey every pregnant woman midwife starts with the study of the internal organs: heart activity, blood pressure measurement (both arms), pulse, urine protein (by boiling).The study of the state of health of pregnant women are currently holding a midwife based on measurements of growth, body weight (over time), the presence of edema, pigmentation, a condition of mammary glands and nipples, the state of the abdominals.

wires of special obstetric examination, the midwife measures the external dimensions of the pelvis by vaginal examination establishes gestational age and the size of the internal gas.In the second half of pregnancy measures the height of standing uterus above the vagina, and determines the position of the fetal presentation, listens to his heartbeat.

On CBC, group affiliation, identification Rh factor, antibody titer, Wassermann reaction, a general analysis of pregnant urine is sent to a nearby lab.It also carried out bacteriological study of vaginal flora on the purity of discharge of the urethra, cervix and vagina for GC, the reaction of vaginal secretions.Radiographic studies in pregnant women (X-rays of the chest, fetal pelviografiya et al.) Produced only with strict indications.

Careful examination of pregnant women provides an opportunity to identify a variety of pathological conditions, the basis on which these pregnant women excel in high-risk groups and require the most careful attention to them during pregnancy;intrapartum and postpartum emit high-risk group for heart disease, bleeding in the postpartum and early successive period, inflammatory and septic complications after childbirth, endocrinopathies - diabetes, obesity, adrenal insufficiency, and other types of obstetric and somatic pathology.

All individual cards of pregnant women at risk, decided to celebrate the appropriate color-coded, indicating a certain color the risk of a particular pathology (red - bleeding, blue - toxicosis, green - sepsis, and others.).

volume studies of gynecological patients also includes a collection of general and special gynecological history.

A special gynecological examination includes a two-handed and tool (speculum examination) study.Carry out direct microscopic study of discharge of the urethra, cervix and vagina to gonococcus using techniques of provocation, but indications - reaction Bordet-Zhang;study of vaginal smear on cell atypia;studies on tests of functional diagnostics.

When the need for a woman to study biochemical blood cholesterol, bilirubin, sugar, residual nitrogen and urine studies acetone urobilin, bile pigments, it is sent to the nearest multidisciplinary laboratory.

Women and couples who have had a history of hereditary diseases or children with deformities of the central nervous system, Down's syndrome, malformations of the cardiovascular system, is sent for examination, including for determining the sex chromatin in specialized medical-genetic centers.

All pregnant women who exhibit the slightest deviations from the normal development of the pregnancy, should be immediately sent to the doctor.

Each subsequent visit FAP pregnant again subjected to necessary research.In the second half of pregnancy should be particularly careful to monitor the possible development of late toxicosis, which is necessary to pay attention to the presence of edema, blood pressure dynamics and the presence of protein in the urine.It is important to monitor the dynamics of the mass of the pregnant woman.

certainly works midwife in prenatal care should be holding classes on psychoprophylactic prepare them for childbirth.

in organizing surveillance of pregnant in the countryside as well as in the city, is a very responsible job patronage.Patronage of pregnant and gynecological patients is an element of active dispensary method.

In addition, a child under one year should be inspected for FAP pediatrician at least once a month.

Case Work midwives strictly planned.The plan provides for the days visiting villages.In a special notebook keeps records of case management, record all visits to women and children.All tips and tricks midwife brings a notebook works at home nurse patronage (patronage sheet) for the subsequent verification of their performance.

paramedic and midwife are required on the site have a list of women to be preventive and periodic inspections.

healthy women with a favorable obstetric history, the normal course of pregnancy between exits Brigade observed in FAP midwife or local hospital, sent to give birth to a nearby precinct or district hospital.

With a group of women who are contraindicated gestation pregnancy, the obstetrician-gynecologist and a midwife give talks about the dangers of pregnancy for their health, the possible complications of pregnancy and childbirth, train them to use contraceptives, IUDs recommend.

In normal healthy pregnancy women are advised to visit the consultation with all the analyzes and conclusions of doctors in 7-10 days after the first treatment, then visit a doctor in the first half of pregnancy once a month 1, after 20 weeks of pregnancy - 2 times a month, after32 weeks - 3-4 times a month.When the disease or pathological women during pregnancy, does not require hospitalization, frequency of inspections determined by the physician on an individual basis.It is important that pregnant carefully attended antenatal consultation during holidays.

very important in the work of midwives FAP is timely hospitalization of pregnant women in medical hospitals with the appearance of initial signs of deviation from the normal course of pregnancy and women with burdened obstetric history.Prenatal hospitalizations in medical hospitals are subject to pregnant women with narrow hips (at the outer conjugate less than 19 cm), malposition and breech, immunological incompatibility between the blood of mother and fetus (including history), extragenital diseases, with the appearance of bleeding from the genital tract, swelling, presence of protein in the urine, high blood pressure, excess weight gain, with the establishment of multiple pregnancies, as well as other diseases and complications that threaten the health of the woman or the child.

On FAPs envisaged holding only normal (uncomplicated) delivery.In cases where the birth occurs in a particular complication (which is not always possible to foresee), FAP midwife should immediately call a doctor or (if possible) to deliver the woman in childbirth in hospital bedside.In this case, it is very important to solve the question of the means of transport.It must be remembered that women can not be separated from the afterbirth, preeclampsia and eclampsia, as well as threatening uterine rupture can not be transported.If a woman can not be separated from the afterbirth in need of transportation in connection with certain complications of pregnancy, the midwife FAP owes primarily to make manual removal of the placenta and the uterus to reduce transport the woman.If it is impossible to render the necessary assistance to the woman in such an extent that she was able to transportability, it should call a doctor with him to outline a plan of action.

FAP midwife is obliged to make patronage of children, especially the first three years of life.It is necessary to respect the multiplicity of observations of children first year of life midwife (paramedic) FAP:

• 1st month of life - watching at home only 5 times;

• 2nd month of life - watching at home 3 times;

• 3-5-th month of life - watching at home 2 times a month;

• 6-12-th months of life - watching at home 1 time per month.

Providing emergency first aid pregnant and laboring women, the midwife FAP has the right to produce the following obstetrical surgery and benefits: fruit twist on the leg with the full opening of the uterine mouth and whole or just departed the waters, the extraction of the fetus for pelvic end, manual removal of placenta, manual examinationuterus, restoring the integrity of the perineum (perineal or after perineotomy).When bleeding in the early postpartum period is necessary to eliminate the gap midwife the birth canal tissue.Complications that arise during childbirth, midwives require, in addition to medical emergencies, clear action organizational nature, which largely depends on the outcome of labor.The midwife must fully own the primary methods of resuscitation of infants born in asphyxia.

very important in the work of midwives FAP carry out a thorough record keeping.Each FAP refer to a pregnant woman is filled with "Individual card of the pregnant woman in childbirth" (F-111 / y).In identifying obstetric complications and extragenital diseases is filled with a duplicate of the card, which is transmitted to the district obstetrician-gynecologist.

For every woman in childbirth is filled with "History of childbirth" (F-099 / y).All women who have given birth to the FAP, registered in the register of births (F-098 / y).In addition to these documents, to the FAP being pregnant diary-book entries (F-075 / y) and blog (f-039-l / y).

When the direction of pregnancy (after 28 weeks of pregnancy) or puerperal issued "trading card" (Form account number 113) in medical maternity hospital in her hands.

If hospitalized pregnant until 28 weeks into her arms issued an extract from the medical history (account form number 27).Writing from the hospital, it receives the same form of an extract from the history of the disease, which she presents a midwife FAP.

An important part in the work of the midwife obstetric point is the organization and carrying out of prophylactic examinations of women.Prophylactic examinations of rural residents is preferably carried out in the autumn-winter period, so that before the start of spring field work to complete treatment TB patients.

all the work on the organization of preventive examinations run by the regional obstetrician and midwife home district.Pre-prepared plan for inspections, which shall specify the place where the examination will be conducted, examinations calendar dates for each locality.Routine inspections carried midwives FAP specially trained and instructed.For the success of the preventive examination midwife must first make a door-bypass, whose task -. To educate women aim inspection, the method of its implementation, spot inspection and other

purpose of preventive examinations is early detection in women precancerous, neoplastic, inflammatory and so-called functional organs diseasesgenitalia and the appointment, if necessary, appropriate treatment.Routine inspections are also given the opportunity to identify among the organized part of the female population of the professional hazards that affect the genital organs, and to develop measures to address them.

Direct examination of women consists of two sequentially conducted procedures: first, a survey of external genitals, vagina and vaginal part of the cervix (using mirrors), and secondly, two-hand research to ascertain the condition of the internal reproductive organs.

When preventive examinations using objective methods of diagnosis: cytology vaginal discharge, "prints" from the cervix, colposcopy study.