Women's consultation lecture on obstetrics. Biological and immunological methods for diagnosing pregnancy

1. Anomalies of the contractile activity of the uterus. Narrow pelvis. Birth trauma of mother and fetus. Modern approaches to the diagnosis and treatment of maternal and fetal birth injuries - 2016
2. POSTPARTUM COMPLICATIONS AND THEIR PREVENTION - 2016
3. GABARAEVA VICTORIA VLADISLAVOVNA. A DIFFERENTIATED approach to choosing a protocol for CONTROLLED OVARIAN STIMULATION IN OOCYTE DONORS AND PATIENTS WITH ONCOLOGICAL DISEASES. Dissertation for the degree of candidate of medical sciences. St. Petersburg - 2016 - 2016
4. KOSOVA ANNA SERGEEVNA. PRE-ECLAMPSIA: MODERN APPROACHES TO PREDICTION AND PREVENTION. Dissertation for the degree of candidate of medical sciences. Eagle 2015 - 2015
5. KUZNETSOV VADIM PETROVICH MANAGEMENT OF PREGNANT WOMEN WITH PRE-ECLAMPSIA COMPLICATED BY LIVER METABOLIC FUNCTION DISTURBANCE AND ENDOGENOUS INTOXICATION SYNDROME. Moscow 2015 - 2015
6. Mikhailova Kristina Pavlovna INFLUENCE OF THE STATE OF THE AUTONOMIC NERVOUS SYSTEM ON THE COURSE OF PREGNANCY, BIRTH AND THE STATE OF THE NEWBORN. Dissertation for the degree of candidate of medical sciences. Moscow -2015 - 2015
7. KAZAKOVTSEVA SOFIA BORISOVNA. Evaluation of the effectiveness of conservative, puncture and surgical methods for the treatment of tubo-ovarian formations of the small pelvis. Dissertation for the degree of candidate of medical sciences. MOSCOW -2015 - 2015
8. KUSHLINSKY Dmitry Nikolaevich. Clinical significance of angiogenesis factors and matrix metalloproteinases in patients with ovarian neoplasms. Dissertation for the degree of candidate of medical sciences. Moscow -2015 - 2015
9. MAGOMEDOVA Ludmila Azzikadievna Early stage diagnosis of postoperative abdominal complications in gynecology. Dissertation for the degree of candidate of medical sciences. Moscow-2015 - 2015
10. GERKULOV DMITRY ANDREEVICH OPTIMIZATION OF PREPARATION FOR IVF PROTOCOL IN PATIENTS AFTER SURGICAL TREATMENT OF OVARIAN ENDOMETRIOMAS. Dissertation for the degree of candidate of medical sciences. St. Petersburg 2015 - 2015

Lectures on obstetrics for the IV course of the Faculty of Medicine

Here are all lectures on obstetrics and gynecology IV for the course of medical

abbreviations and abbreviations, most of which are given transcripts when used for the first time. For the entire course of lectures, there was only 1 diagram - the Michaelis rhombus, due to the difficulty of transferring graphics, it is not shown here. Some lectures were not presented or presented in a truncated version, because. they were not for recording, but only for listening. In places where the “?” sign is placed in brackets, there are any inconsistencies, or I disagree with the lecturer in some way (this is just my opinion). Made by Niyazov Ravil Rashidovich, Kazan, 2005

VII semester.

Lecture No. 2 (09/13/2004)

The first lecture was given by Professor Lev Alexandrovich, she Kozlov dealt with organizational aspects, including the student scientific circle.

Obstetrics (dr. Greek) - standing nearby.

Obstetrics is a science that studies the changes that occur in a woman's body during pregnancy, childbirth and postpartum period.

Vaginal epithelial cells, as they mature, accumulate glycogen for the vaginal microflora, for example, Doderlein vaginal bacillus (from the family of lactic acid bacteria) creates a pH of 3.5-4.5 in the vagina. Since 1949, in Russia, all women in the early postpartum period are examined

the cervix for a rupture, and if it is, then the gap is sutured. chronic inflammation uterus can transform into cervical cancer.

Lecture No. 3 (20.09.2004)

Lecturer - candidate of medical sciences, associate professor Zhuravleva Vera Ivanovna Menstrual-ovarian cycle (utero-ovarian cycle).

The reproductive system of a woman is a self-regulating system, it has 4 functions:

1. Menstrual;

2. Childbearing;

3. Secretory;

4. Sexy.

reproductive function is functional systems, similar to the cardiovascular system, etc., however, it provides reproduction, while all the others are aimed at maintaining homeostasis, which is necessary for the existence of the individual.

functional activity reproductive system increases by the age of 14, and fades by 45, and by 55, the hormonal function of the reproductive system. The hormonal function of the reproductive system is built according to a hierarchical principle: there are 5 links, each of which regulates the underlying: cortex-hypothalamus-pituitary ( top management regulation), ovaries, uterus, target organs: mammary glands, hair follicles, vagina, bones, blood vessels, brain neurons, etc.

Menstrual function is a constant cyclical preparation of a woman's body for pregnancy. Menstruation is the result of the cyclic activity of the entire reproductive system. Menstrual cycle - physiological process in the body of a woman (non-pregnant), starting with the first for the last menstruation and ending with the beginning next menstruation, during which in the ovaries

hypothalamus, stimulating the release of gonadotropin releasing factor. The hypothalamus secretes gonadotropin releasing factor (GTRF) in the circoral mode. Normally, 1 act of secretion occurs every 60-90 minutes, in response to this, the pituitary gland after 2-5 minutes

releases gonadotropic hormones. GTRF is a liberin and statin for follicle-stimulating and luteinizing hormones (FSH and LH), due to which folliculogenesis and ovulation are ensured. By changing the frequency and amplitude of the releasing factor, it is possible to change the secretion of FSH and LH. So, if the pulsation frequency of GTRF more than after 1 hour, the concentration of LH drops by 50%, and the concentration of FSH by 65%. If every 15 minutes, then FSH and LH in the blood are not determined. Prolactin-releasing factor - thyroliberin, also affects thyroid gland through thyroid-stimulating hormone. A statin for prolactin is a prolactin inhibitory factor (PIF - dopamine). With an increase in the concentration of prolactin, menstrual function decreases up to amenorrhea, with a decrease in its level, the concentration of glucocorticoids decreases.

FSH to LH ratio every day menstrual cycle regulated by gonadal factors. An increase in the concentration of estrogen leads to a decrease in the concentration of FSH; and an increase in the concentration of progesterone leads to a decrease in the level of LH.

There are 3 types of gonadotropic hormone secretion rhythm:

1. In response to GTRF stimulation,

2. Cyclic type of secretion. FSH before ovulation, LH in the second half of the cycle.

3. Basic type of secretion.

The value of FSH is the growth and development of the follicle. Primordial follicle, second order oocyte, dominant follicle diameter 20 mm - preovulatory follicle. 90% of follicles die before the age of 14 - 10% mature.

Mature granulosa synthesizes estrogens. Immature granulosa produces androgens. Estrogens (estriol, estrol, estradiol) are the strongest mitogens of the endometrium - the proliferation phase. Estriol is a hormone of a pregnant woman, estrone is nongonadal secretion (adipocytes, etc.), estradiol affects the myometrium 14 days before. Ovulation is the peak concentration of estradiol and the production of LH. Luteal granulosa under the influence of LH produces gestagens.

The second phase should not be shorter than 11 days, if shorter, then infertility occurs. Progesterone is the secretion phase. Uteroglobulins for blastocyst nutrition.

Ovulation. A symptom of the pupil is an expansion of the diameter of the uterine canal, there are many clear slime the more estrogen, the more viscous the mucus is a symptom of stretching cervical mucus. Symptom of crystallization (arborization). A picture of a fern under a microscope - a lot of estrogens (?). study of the vaginal epithelium - colpocytology of the anterolateral fornix of the vagina - the more mature cells, the more estrogen. Karyopyknotic index (max. 70-80%). Progesterone raises the temperature by 0.6-0.8 ° C; diuresis decreases, therefore, edema, adynamia occur.

Lecture No. 4 (27.09.2004)

Lecturer - candidate of medical sciences, associate professor Zhuravleva Vera Ivanovna Fertilization and pregnancy

After intercourse, sperm is sucked into cervical canal. Capacitation (maturation) of spermatozoa takes place there within 24 hours.

The blastocyst feeds on endometrial glycogen, while the egg cell feeds on pyruvate. fallopian tubes. Peristalsis of the fallopian tubes is provided by estrogens. Blockade of peristalsis - progesterone (after 72 hours). On day 5-6, the blastocyst is in the uterus. Nidation occurs on the 8-9th day. Stimulation of protein production by the blastocyst. Implantation is carried out with high sensitivity of the endometrium.

Contact at other times does not cause a decidual reaction with the endometrium. typical place implantation - back wall uterus. Trophoblast lyzes the endometrium, and the blastocyst very quickly sinks into the thickness of the endometrium. By day 22, 2 layers of trophoblast are formed: cytotrophoblast and syncytiotrophoblast. Primary chorionic villi. Chorion (membrane, shell). Secondary chorionic villi are mesenchymal ingrowths. Tertiary chorionic villi - there are vessels, formed at week 12, chorionic villi, which are located on

decidua capsularis degenerate - chorion laevae, the rest of the chorion with villi - villous chorion (chorion froddosum). By the tenth month, chorion froddosum and decidua basalis occupy 1/3 of the surface of the uterus. Highlight 3 structural element placenta:

Chorionic membrane, basement membrane, intervillous space.

Cotyledon is the basic functional unit of the placenta. Villus + cotyledon complex

– uterine area, where 1 spiral artery opens. Cotyledons unite to form placentons. Hemochorial type - close contact of the mother's blood and the chorion.

Morphogenesis of the placenta depends on the development of the uteroplacental circulation, and not on the blood circulation in the fetus. Leading value attached to spiral arteries - terminal branches uterine artery. From the 12th week of gestation, the period of placentation begins

– the critical period of embryogenesis, because. vascularization occurs. Anchor villi found on decidua basalis.

By the 140th day of gestation, the placenta is formed. 10-12 large, 40-50 small and 140-150 rudimentary cotyledons: dimensions and thickness 1.5-2.0 cm, further increase occurs due to hypertrophy of the spiral arteries at the border of the myometrium and endometrium. They are equipped muscle layer, diameter 20-50 mm, SMCs are lost in the intervillous space, diameter 200 microns, there are 150-200 spiral arteries in total.

The outflow of blood occurs through 72-170 veins. Diffusion of blood is carried out due to the pressure difference, because. no SMC - no sensitivity to adrenergic regulation, no ability to vasoconstriction. The umbilical cord is formed from mesenchyme - a strand into which the allantois grows, which carries the umbilical vessels.

umbilical cord.

Before childbirth, the placenta is 15-18 cm in diameter, 2-3 cm thick, weighing 500-600 g. The placental barrier consists of 5 layers:

1. Syncytiotrophoblast (thin layer);

2. ... basement membrane;

3. loose connective tissue with reticular fibers;

4. Basement membrane of the capillary;

5. Endothelium of the capillary of the fetus (embryo).

At 33-35 weeks of pregnancy, the permeability of the placenta increases, .to. syncytiotrophoblast disappears.

The function of the placenta is to nourish the fetus. 6 mg/min of glucose per 1 kg of fetal weight. Sahara, molecular mass which does not exceed the weight of glucose, pass by diffusion. Complex molecules are broken down by enzymes. Protein synthesis in the placenta is intense in the third month of gestation. Amino acids are carried by active transport. The placenta synthesizes many proteins. Lipids are transported in the form of triglycerides and higher fatty acids. The permeability for vitamins is different, for vitamin A the placenta is impermeable. At the beginning of gestation, the growth of the placenta exceeds the growth of the fetus, in the middle of gestation, the weight of the fetus increases by 800 times, and the placenta by 15-20 times. endocrine function placenta: producer - syncytiotrophoblast. Protective function: incomplete, depends on the property of the damaging factor, gestational age, the state of the mother's body.

Pathology of the placenta. Extrachorial placentation, in which the chorionic plateau is inferior in size to the basal plateau. Colon-marginal placenta, val-marginal placenta. Placental infarction (white plaques), with necrosis of more than 10%, fetal hypoxia occurs, up to antenatal death. A consequence of thrombosis of the uteroplacental vessels. Late necrosis, atherosclerosis, calcification. Placental infection - in 98% of cases, the genesis is unclear. Tumors of the placenta. Nontrophoblastic: placental metastases, hemangiomas, chorioangiomas (1% of all births). Clinical Significance have hemangiomas with a diameter of 5 cm, which are the causes of polyhydramnios, premature birth.

Lecture No. 5 (October 4, 2004)

Lecturer - Head of the Department of Obstetrics and Gynecology No. 1 Doctor of Medical Sciences, Professor Khasanov Albir Almazovich

female pelvis

I. Classification of the planes of the pelvis fan-shaped diverging from the symphysis. entry plane. True conjugate (obstetric, conjugata vera) - normally 11 cm (now 11.5-12 cm) - cape - the closest point of the pubic articulation. Cape - parallel to the oblique size - the size of Krassovsky (8.8 cm). Wide part II-III sacral vertebra

- middle inner surface symphysis. The narrow part is the horizontal part 9.5-10.5 cm; straight size - 11 cm.

The pelvis can expand - Deventer (fr.). Lying increases the true conjugate. Squatting reveals the horizontal size of the narrow. PartsThe capacity of the sacral cavity is increased by 30%. MacRoberts posture: the hips are pressed against the stomach and the pelvis "dresses" the head.

exit plane.

II. System of parallel planes:

1. The boundary plane is approximately equal to the plane of the entrance to the small pelvis.

2. Through the lower edge of the pubic articulation, parallel to the first plane (main plane).

3. Through the spines of the ischial bones (spinal plane).

4. exit plane.

All planes are parallel to each other.

III. In the UK and USA.

there is a transformation of the spiral arteries: the diameter of their distal section increases by an order of magnitude. On the 18th day of gestation, chorion elements by type cancerous tumor penetrate into the wall of the spiral arteries (cytotrophoblast invasion, muscle is replaced by fibrinoid), so the spiral artery is constantly gaping. If transformation does not occur, in some cases, the total peripheral vascular resistance (OPVR) increases, resulting in an increase in blood pressure.

Lecture No. 6 (10/11/2004)

Lecturer - Candidate of Medical Sciences, Associate Professor Nurullina Dilyara Vladimirovna Immunoconflict pregnancy. Hemolytic disease of the newborn Immunoconflict pregnancy. Hemolytic disease of the newborn - cause

perinatal morbidity and mortality in 8-11% of cases. There are 4 main types of human erythrocytes:

The Rh factor was discovered in 1940 by Landsteiner and Wiener. Varieties of Rh antigens. Rh0 , rh', rh''. If the last 2 variants of antigens are located on the erythrocyte, the blood is considered Rh negative. There are no natural antibodies to the Rh system in the blood, they can only appear during immunization. 2 main reasons for their appearance:

1. Transfusion of Rh incompatible blood.

2. Pregnancy with an Rh positive fetus (the mother is Rh negative).

Risk groups of pregnant women with Rh-negative blood.

1. Rh negative pregnant woman Rh-positive husband (father of the child), but without a complicated obstetric history (OAA), without the presence of antibodies (AT) - the examination is carried out once a month up to 32 weeks, after 32 weeks 2 times a month.

2. Rh negative pregnant women Rh-positive husband (father of the child), without the presence of AT, but with OAA.

3. Pregnant with the presence of specific anti-Rhesus antibodies. Observation 2 times per

month in the first half of gestation and 3 times a month in the second half of gestation. OAA - intrauterine fetal death at 26-28 weeks with maceration; the birth of children with jaundice; stillbirth in anamnesis - these women are observed in the Rhesus center (RCH). Hidden antibodies are examined here, if they are detected, observation is carried out according to 3 risk groups, if hidden antibodies are not detected, an examination is carried out 2 times a month + general strengthening therapy.

Hyposensitizing therapy:

1. Vitamin therapy (C, B 6, B12, E, P (rutin));

2. 2% novocaine solution intramuscularly;

3. methionine tablets;

4. hormone therapy after 12 weeks (glucocorticoids: prednisolone, dexamethasone);

5. infusion therapy in the second half of gestation (reopoliglyukin, povidone - hemodez);

6. plasmapheresis in OAA;

7. grafting of a skin flap and lymphocytes of the husband (father of the child) is a distracting factor, there is suppression cellular immunity humoral, antibodies are fixed on the graft antigen, block them and reduce the reactivity of the host.

Pathogenesis hemolytic disease newborns

1. Maternal isoimmunization.

2. Penetration of the formed antibodies through the placenta into the fetus.

3. The effect of AT on the fetus.

blood transfusion. Most often, immunization occurs in the third stage of labor.

2. Breakthrough of antibodies occurs during childbirth, neonatopathy occurs - postpartum icteric form of hemolytic disease of the newborn (HDN).

3. Antibodies do not pass through the placenta, a healthy baby is born Rh-positive fetus (child).

Actually GBN. The severity of HDN is not the same and depends on many factors: the amount of antibodies, when and for how long the exposure occurred, reactivity, compensatory capabilities of the fetus.

Rh-AT can be fixed on erythrocytes, therefore, hemolysis occurs, on Rh-Ag of tissues, resulting in tissue damage.

There are 5 main forms of HDN:

1. Fetal death with maceration

2. Edema

3. Congenital icteric

4. Anemic

5. Postpartum icteric

1. The result of fetopathy. Penetration of AT term 5-7 months. Massive passage of AT. Tissues are mostly affected. Formation of Ag-AT immune complexes → dystrophic processes followed by necrotic changes. Organs that are rich in enzymes (liver, pancreas) are most susceptible, autolysis occurs in the first 2 days after the death of the fetus.

2. Always fetopathy, but the number of antibodies is much less than in the first form.

Intravascular and tissue changes. Intravascular hemolysis, increased concentration of indirect bilirubin; lack of conjugation in the liver → indirect bilirubin enters the mother's body and amniotic fluid. Tissue reactions - compensatory reactions → decompensation: permeability increases vascular wall, protein-synthesizing function of the liver decreases, severe fetal hypoproteinemia → massive edematous syndrome. Severe anemia. Violation of fibrinogen synthesis → thrombohemorrhagic syndrome. Fetal death antenatally or intranatally. The fetus always dies.

3. Occurs as a fetopathy, but antibodies act on a fairly mature fetus(8-9 months of gestation). No decompensation, fetus is born with signs of jaundice or

4. One of the lightest forms. Low doses of antibodies a short time(during childbirth). Due to the usefulness of liver enzymes, there is no jaundice, only hemolysis.

barrier), so kernicterus may occur.

Conflict on the AB0 system (II and Group III blood in the fetus and I blood group in the mother). Breakthroughs of AT only during childbirth → anemic or postpartum icteric form. Features of the course of pregnancy with Rh isosensitization.

There is an increased risk of miscarriage. Most often when intrauterine death fetus. … Frequent complication: anemia. This is due to the fact that the needs of the fetus in iron are increasing. HDN worsens in the presence of late toxicosis or preeclampsia; chronic placental insufficiency (HFPN); diabetes(SD). Diagnosis of HDN before childbirth:

1. Obstetric history. We study the outcomes of previous pregnancies, blood transfusion analysis, blood tests for Rh-AT. According to the types of Rh-AT titer, there are:

· stable titer,

· Uniform decrease in titer,

· Uniform increase in titer,

· A sharp rise in titer

· A sharp drop in titer

· Alternating increase and decrease in titer.

The first three options can be with mild forms of HDN and the norm. The last three forms are always severe forms of HDN.

2. Studies of bilirubin in the blood serum of a pregnant woman, determination of activity in women alkaline phosphatase in the mother, its thermostable fraction is produced by the placenta. At pathological processes sharply increases the concentration of alkaline phosphatase.

3. Ultrasound examination:

· Thickening of the placenta:(40-42 mm is normal) thickening by 1-1.5 cm - severe forms of HDN.

· An increase in the area of ​​​​the placenta up to 4/5 (normally 1/3 of the uterus).

· With edematous form: a double contour of the head, an increase in the abdomen of the fetus, hepatomegaly, ascites in the fetus.

4. Changes in FKG and CTG - intrauterine suffering of the fetus.

Diagnosis of HDN after the birth of the fetus:

1. Inspection data: pallor, icterus, lethargy, enlargement of the liver and spleen, general swelling and ascites.

2. Determination of the blood group and Rh factor.

3. Determination of bilirubin in umbilical blood.

4. Determination of hemoglobin in umbilical and capillary blood. Fine 170-180 g/l and 200-250 g/l, respectively.

5. Direct Coombs' test (AT titers in the body of the fetus, which came from the mother during childbirth).

6. Repeat the study of quantity and its hourly growth.

Treatment of HDN

1. Replacement blood transfusion (STH). 180-200 ml of blood per 1 kg of a child.

2. Infusion therapy (plasma, albumin, hemodez, reopoliglyukin).

3. Intragastric fluid administration.

4. Phototherapy.

5. Phenobarbital is an inducer of microsomal oxidation in the liver.

6. At severe course- prednisolone.

7. Vitamin therapy (C, B 1, B6, glutamic acid).

8. oxygen inhalation.

Up to 5-7 days of life, feeding with donor milk (hydrochloric acid destroys Rh AT) in case of AB0 conflict - feeding with donor milk or pasteurized milk.

Prevention of Rh isosensitization

1. Compliance with the rules of blood transfusion.

2. Prevention of abortion in women with Rh negative blood.

3. the use of anti-Rhesus IgD within 72 hours after childbirth (abortion) with Rh-negative blood.

Lecture No. 7 (04/18/2004)

Lecturer - Candidate of Medical Sciences, Associate Professor Nurullina Dilyara Vladimirovna Normal physiological childbirth

The physiological essence of childbirth is the expulsion of the fetus and elements gestational sac beyond the borders

premature, more than 42 weeks - belated. Abroad, normal term labor proceeds from 37 weeks.

The uterus of a woman has spontaneous contractility. This activity has been observed since menstrual function up to menopause. At different gestation periods, contractile activity is different. At the beginning of gestation, spontaneous contractility is sharply reduced. From the 30th week of gestation, more intense uterine contractions appear, the so-called. false contractions - Branston-Geeks contractions, with a frequency of 1 contraction per hour. The woman does not feel them. One of the main roles in preparing a woman for childbirth is played by the central nervous system. From the first weeks, a gestational dominant is formed - a focus of excitation, around which a focus of inhibition (progesterone block) is formed. At the end of gestation, a generic dominant is formed in the CNS.

The biological readiness of a woman for childbirth is the formation of a generic dominant + changes that occur in a woman's body.

Childbirth is a physiological act for which a woman is evolutionarily prepared. Formation of perinatal matrices. The first matrix is ​​formed at the beginning of the first stage of labor, the second - with increased labor activity and opening of the uterine os by 4-5 cm, the third - in the second stage of labor when the fetus passes through the birth canal,

Chorionic gonadotropin (CGT) begins to be produced in the chorionic villi with early dates trophoblast formation. Produced in high concentrations

aging of the placenta. Placental lactogen is produced in high concentrations up to 36 weeks, a synergist of HCG.

The Importance of Estrogens

1. Activation of the synthesis of contractile proteins (actomyosin).

2. Increased synthesis of catecholamines.

3. Activation of the cholinergic system.

4. Inhibition of oxytocinase and monooxytocinase.

Estrogen concentration rises in the last 2 weeks of gestation. With hypoestrogenism, pregnancy is overdue. Estrogens increase the synthesis of prostaglandins.

Importance of prostaglandins. Produced in the decidua, amnion.

1. Depolarization cell membranes myometrium.

2. Release of bound calcium.

Obstetrics and Gynecology (lectures)

tyumen 2000

General concepts in obstetrics

Obstetrics originated with the birth of man. The founder of domestic obstetrics is N.M. Maksimovich-Ambodik, who wrote the work “The Art of Appearance or the Science of Womanhood”.

Obstetrics- the science of physiological and pathological processes that occur in a woman's body in connection with conception, pregnancy, childbirth and the postpartum period.

Gynecology- this is the science of diseases of the organs of the female reproductive system outside of pregnancy, childbirth and the postpartum period.

The founder of scientific national school gynecologists is Prof. Snegirev (Moscow).

Features of obstetric science:

own terminology.

Providing care not only to the sick, but also to the healthy.

The mass character of the population in need of obstetric care.

Responsibility for both the woman and the child.

This is a surgical specialty.

Types of maternity hospitals(according to the degree of risk of maternal death):

I degree of risk. The contingent: healthy pregnant women with physiological pregnancy, the maximum that can be in the anamnesis is one medical abortion. Maternity hospitals of the I degree of risk include:

CRH rural type where there is an obstetric department; the obstetrician-gynecologist of the Central District Hospital heads the service of the district, travels to the district, examines pregnant women there, carries out the phasing of services for these women, and consultative assistance.

District hospital, which has an obstetrician-gynecologist;

Collective farm house;

A small city family house or small city association;

Feldsher-obstetric stations with obstetric beds.

2. II degree of risk. Contingent: women with complicated pregnancy (but carrying a pregnancy is not contraindicated for them). Maternity hospitals of the II degree of risk include:

Large urban family house;

Obstetric department of a multidisciplinary hospital;

Maternity department of the Central District Hospital of urban type.

It is considered mandatory that these institutions have consultants of various specialties, an extensive anesthesiology service.

III degree of risk. Contingent: pregnant women for whom pregnancy is contraindicated. Maternity hospitals of III degree of risk include:

Obstetric departments of multidisciplinary hospitals (all-Russian centers, etc.);

Large clan houses or departments, on the basis of which the departments are deployed;

Specialized kind of house.

New forms of obstetric and gynecological institutions:

Day hospital.

Specialized consultations (eg “family and marriage”).

Sanatoriums for pregnant women.

The structure of the genus house:

First, the woman enters the filter, where the midwife works and determines the indications for hospitalization. From filter - to I or II obstetric department(department of pathology of pregnant women). Each has a viewing room, shower room, bathroom. All this together is called a receiving-pass block. Then the woman enters the birth unit (their own in each department), the postpartum and discharge wards (their own in each department). The second obstetric department also has wards for pregnant women. Both departments have children's wards. In addition, there is an operating and anesthetic unit in the family home.

Principles of the sanitary-epidemic regime in the clan houses:

are determined by order 691 “On the prevention of nosocomial infection in obstetric hospitals”. The main thing in prevention is the sanitary and epidemiological regime.

Indications for placing a woman in the II obstetric department:

Women with genital and extragenital acute and chronic inflammatory processes of specific and non-specific etiology.

An increase in temperature of unknown etiology.

Intrauterine fetal death.

Childbirth road, home and so on.

Women with skin diseases.

Women with malignant neoplasms.

Women not seen in antenatal clinic.

Women carrying a fetus congenital defect development (VPR).

Termination of pregnancy at a later date.

Long waterless period (more than 12 hours)

The principle of flow - a woman should not move from a more “dirty” department (II obstetric department) to a more “clean” one (I obstetric department), only the opposite is possible.

The principle of cyclicality: firstly, this concerns the work of the genus block (it is divided into 2 halves - one is being processed and the other is working), and secondly, the work of the postpartum wards (women are placed in one ward only if the day of delivery is close).

The principle of individuality - everything that comes into contact with a woman during and after childbirth should be sterile and individual for each woman.

In addition, the order determines the organization of epidemiological surveillance by the sanitary and epidemiological service:

constant monitoring of morbidity, mortality in puerperas and newborns;

tank fence. sowing from the nose, throat, from various objects (scheduled 1 time in 3 months and according to epidemiological indications (an outbreak is the simultaneous occurrence of 3 or more diseases)). With poor results, the family home can be closed by epid. testimony.

control over preventive cleanings of the family at home (2 times a year, 1 time with cosmetic repairs), overhaul(1 time in 5 years).

House work indicators:

Maternal mortality (MM):

MC = the number of dead pregnant women, women in childbirth and puerperas in

during the first 42 days after childbirth, regardless of the term

and localization of pregnancy

number of live births x 100,000 live births.

We have MS = 70-90 (this is a big number).

Perinatal mortality (PS).

PS = number of deaths in the perinatal period (28 weeks

pregnancy - 168 hours after birth) per 1000 births.

We have PS - 17-19% about.

Types of perinatal mortality:

antenatal (from 28 weeks of pregnancy to delivery);

intranatal (during childbirth);

postnatal (during the first 7 days).

Structure of maternal mortality:

Abortions (mostly criminal).

• Bleeding.

  Purulent-septic forms.

Structure of perinatal mortality:

asphyxia n/r;

birth injury;

malformations n / r, etc.

Exist scale for assessing postnatal risk factors for perinatal mortality(score in points for 5 groups of signs):

Socio-biological characteristics (age of parents, their alcohol consumption, etc.).

Burdened obstetric history (stillbirth, abortion, etc.).

Extragenital diseases.

Complications of this pregnancy

Pathology of the fetus and placental system.

Up to 5 points - low risk;

5 - 10 points - average degree;

10 points and above - high degree(such women should be observed in the third-degree risk homes).

early turnout- Appearance at the antenatal clinic before 12 weeks of pregnancy.

The Importance of Early Turnout:

Up to 12 weeks, you can accurately determine the gestational age, since the size of the uterus at this time corresponds to the gestational age; subsequently, the size of the uterus depends on the size of the fetus, the number of fetuses.

If pregnancy is contraindicated for a woman, then up to 12 weeks of pregnancy, you can have a honey abortion.

Education of a pregnant woman in the “mother's school” (at the antenatal clinic, an obstetrician-gynecologist, pediatrician, lawyer) from the earliest stages of pregnancy.

Up to 12 weeks there are no changes in the body's hemostasis system, characteristic of physiological pregnancy. Therefore, before this gestational age, it is possible to determine the initial indicators of hemostasis.

Order No. 430 - “Organization of the work of the antenatal clinic”.

Labor protection legislation for pregnant women:

Holidays for pregnant women:

Prenatal - 70 days;

Postpartum - 70 days (if there were complications, then it

lengthen up to 86 days, if 2 or more children were born - up to

Child care leave:

Partially paid vacation up to 1.5 years;

Additional unpaid leave up to 3 years.

Exemption (immediately after diagnosis of pregnancy) from severe physical, harmful, night, overtime, travel work.