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ORGANIZATION OF WORK OF WOMEN'S COUNSELING DISPENSARY MONITORING OF PREGNANT WOMEN

Women's consultation (LC) is a subdivision of a polyclinic, medical center or maternity hospital, providing outpatient treatment, prophylactic, obstetric and gynecological care to the population.

The main tasks of the antenatal clinic are:

the provision of qualified obstetric and gynecological care to the population of the attached territory;

conducting preventive measures aimed at preventing pregnancy complications, the postpartum period, and preventing gynecological diseases;

the provision of social and legal assistance to women in accordance with legislation on the protection of the health of the child’s material;

introducing into practice the work 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 tasks, women's consultation should carry out:

the organization and conduct of sanitary and preventive work among women;

preventive examinations of the female population;

contraception to prevent an unplanned pregnancy;

ensuring continuity in the examination and treatment of pregnant women, women in childbirth and gynecological patients between the antenatal clinic and the maternity ward, children's consultation, other health care facilities (Family and Marriage consultation, counseling and diagnostic centers, genetic counseling).

An important task of a doctor of antenatal clinics is the registration of pregnant women and the implementation of therapeutic measures for pregnant women included in the risk group.

The consultation activity is based on the precinct principle. The obstetric and gynecological site is designed for 6000 women living in the territory of this consultation. On each of them, up to 25% of women are of reproductive age (from 15 to 49 years). The mode of operation of the women's consultation is established taking into account the failure-free provision of outpatient obstetric and gynecological care for women during their non-working hours. One day a week is allocated to a doctor for assistance and preventive examinations of workers of attached industrial enterprises, geographically located on the doctor’s site or for a specialized appointment.

STRUCTURE OF FEMALE COUNSELING: registry, obstetrician-gynecologist's offices for pregnant women, puerperas, gynecological patients, manipulation room, physiotherapy room, where treatment procedures, therapist, dentist, venereologist and lawyer are provided 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, an ultrasound room.

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

The doctor of the site, in addition to admission to the antenatal clinic, provides home care for pregnant women, women in childbirth, gynecological patients who, due to their health, cannot come to the antenatal clinic themselves. If the doctor finds it necessary, he actively visits the patient or pregnant at home without a call (patronage).

Sanitary-educational work is carried out by doctors and midwives according to the plan. The main forms of this work: individual and group conversations, lectures, answers to questions using audio and video cassettes, radio, cinema, television.

Legal protection of women is carried out by legal counselors of the women's consultation, which, together with doctors, identify women who need legal protection, give lectures, conduct talks on the basics of Russian legislation on marriage and the family, and the benefits of labor legislation for women.

One of the main tasks of the antenatal clinic is the identification of precancerous diseases, the prevention of cancer. There are three types of preventive examinations: comprehensive, 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.

OBSERVATION OF PREGNANT WOMEN

The main task of the antenatal clinic is the medical examination of pregnant women. The registration period is up to 12 weeks of pregnancy. At the first visit, fill out the “Individual card of the pregnant woman and the woman in childbirth” (form 111u), in which all the data of the survey, examination, appointment at each visit are recorded. After clinical and laboratory examination (up to 12 weeks), each pregnant woman is assigned to a particular risk group. For a quantitative assessment of risk factors, one should use the scale "Assessment of prenatal risk factors in points" (order No. 430).

GYNECOLOGICAL HELP

Gynecological diseases are detected when women attend antenatal clinics, at routine examinations at antenatal clinics or enterprises, and examination rooms of polyclinics. For each woman who first applied to the antenatal clinic, an “Outpatient Medical Record” is entered into (form 025u). If there are indications for clinical examination, fill out the “Control Card for Dispensary Surveillance” (form 030у).

ORGANIZATION OF OBSTETRIC AND GYNECOLOGICAL ASSISTANCE TO WOMEN IN INDUSTRIAL ENTERPRISES

Doctors obstetricians-gynecologists of antenatal clinics carry out a complex of medical and preventive work at the enterprises attached to the consultation. To carry out this work, the doctor is given one day a week. Currently, an obstetrician-gynecologist is allocated in the antenatal clinic for working with enterprises at the rate of one doctor per 2000-2500 women.

At the enterprise, an obstetrician-gynecologist conducts:

preventive examinations of women;

in-depth analysis of gynecological morbidity;

pregnancy and childbirth outcomes;

is taking gynecological patients; controls the work of the personal hygiene room;

studying the working conditions of women in the enterprise;

takes part in improving working conditions for women workers.

ORGANIZATION OF OBSTETRIC AND GYNECOLOGICAL ASSISTANCE TO WOMEN IN RURAL AREAS

The visiting women's consultation is a regularly operating branch of the women's consultation of the central district hospital (CRH) and was created to provide obstetric and gynecological care to the rural population.

At the rural feldsher-midwife center (FAP) of pre-medical care, the work of the midwife is mainly aimed at the early registration and systematic monitoring of pregnant women in order to prevent pregnancy complications, and to conduct sanitary-educational work. Periodic medical examination of women at the FAP is carried out by the doctors of the women's consultation of the district hospital (RB) or the central district hospital (CRH), as well as the doctors of the visiting team of the CRH as part of the obstetrician-gynecologist, therapist, dentist and laboratory assistant. The main task of the on-site women's consultation is the dispensary observation of pregnant women and the provision of assistance to patients with gynecological diseases.

ANALYSIS OF WOMEN'S CONSULTATION

Analysis of the work is carried out in the following sections of the antenatal clinic: general information on the consultation, analysis of preventive activities, obstetric activities. An analysis of obstetric activities includes: a report on medical care for pregnant women and women in childbirth (insert No. 3): early (up to 12 weeks) admission for follow-up of pregnant women, examination of pregnant women by a therapist, complications of pregnancy (late gestosis, diseases independent of pregnancy), information about newborns (born alive, dead, full-term, premature, dead), perinatal mortality, mortality of pregnant women, women in childbirth and parturient women (maternal mortality).

OBSERVATION OF PREGNANT WOMEN

PRINCIPLES OF PREPARATION OF PREGNANT WOMEN

Supervision of pregnant women is the main task of antenatal care. The outcome of pregnancy and childbirth largely depends on the quality of outpatient monitoring.

Early coverage of pregnant women with medical supervision. A woman should be registered with a gestational age of up to 12 weeks. This will make it possible to diagnose extragenital pathology in a timely manner and resolve the issue of the appropriateness of further preserving the pregnancy, rational employment, establish the degree of risk and, if necessary, ensure the recovery of the pregnant woman. It was found that when women are observed in early pregnancy and when they visit a doctor 7-12 times, the level of perinatal mortality is 2-2.5 times lower than that of all pregnant women in general, and 5-6 times lower than when visiting a doctor in pregnancy after 28 weeks. Thus, sanitary-educational work in combination with qualified medical supervision is the main reserve for increasing the number of women going to doctors in the early stages of pregnancy.

Registration. When registering a pregnant woman, regardless of the gestational age, the doctor of the antenatal clinic is obliged to: familiarize herself with the outpatient card (or extract from it) of the woman from the outpatient network to identify

Timely (within 12-14 days) examination. The effectiveness of early registration of a pregnant woman will be completely leveled if, in the shortest possible time, the pregnant woman is not examined in full. As a result of the examination, the possibility of gestation and the degree of risk are determined, as well as a pregnancy management plan is developed.

Antenatal and postpartum patronage. Antenatal care is carried out by the district midwife without fail twice: upon registration and before childbirth and, in addition, it is carried out as necessary (to call the pregnant woman to the doctor, control of the prescribed regimen, etc.). Postpartum Patronage. During the first 3 days after discharge from the maternity ward, a woman is visited by a maternity ward - a doctor (after a pathological birth) or a midwife (after a normal birth). To ensure timely postpartum patronage, antenatal clinics should have a permanent relationship with maternity hospitals.

Timely hospitalization of a woman during pregnancy and before childbirth. If there are indications, emergency or planned hospitalization of the pregnant woman is the main task of the doctor of the antenatal clinic. Timely hospitalization can reduce perinatal mortality by 8 times compared with a group of women subject to inpatient treatment, but not hospitalized in a timely manner.

Pregnant women should be observed at the following times: in the first half of pregnancy - 1 time per month; from 20 to 28 weeks - 2 times a month; from 28 to 40 weeks - 1 time per week (10-12 times during pregnancy). If somatic or obstetric pathology is detected, the frequency of visits increases. If a woman does not appear to the doctor within 2 days after the next deadline, it is necessary to carry out patronage and achieve regular visits to the consultation.

Physiopsychoprophylactic preparation for childbirth of 100% of pregnant women. Classes at the School of Mothers.

100% coverage of husbands of pregnant women with classes at the School of Fathers.

Antenatal prophylaxis of rickets (vitamins, ultraviolet radiation).

Prevention of purulent-septic complications, including necessarily urological and ENT rehabilitation.

EXAMINATION OF PREGNANT WOMEN

When registering, the doctor examines the pregnant woman and writes the results to the individual card of the pregnant woman.

Passport data:

Surname, name, patronymic, series and passport number.

Age. The age group is determined for primiparas: young primiparous - up to 18 years old, elderly primiparous - 26-30 years old, old primiparous - over 30 years.

Address (according to registration and the one where the woman actually lives).

Profession.

In the presence of occupational hazards, in order to eliminate the adverse effects of production factors on the pregnant woman’s body and the fetus, the issue of rational employment of a woman should be immediately addressed. If there is a medical unit at the place of work, information about the pregnant women is transmitted to the shop doctors - the therapist and gynecologist - with recommendations of the antenatal clinic, and from the medical unit they request an extract from the woman's outpatient card. In the future, the woman is watched by the doctor of the antenatal clinic, but the doctors of the medical unit provide antenatal protection of the fetus (hygiene measures, ultraviolet radiation, therapeutic exercises until 30 weeks of pregnancy). Despite the fact that many enterprises have medical facilities, it is more advisable to observe pregnant women at the place of residence. This provides better and more qualified supervision and reduces the number of complications during pregnancy and childbirth.

When a pregnant woman first contacts a consultation, she will be given an “Individual card of the pregnant woman and the woman in childbirth”, where they will enter the data of the detailed medical history, including family history, general and gynecological diseases, operations, blood transfusions, menstrual, sexual and generative features, transferred in childhood and adulthood. functions.

ANAMNESIS

An anamnesis helps the doctor to find out the living conditions, the effect of general somatic and infectious diseases (rickets, rheumatism, scarlet fever, diphtheria, viral hepatitis, typhoid fever, tuberculosis, pneumonia, heart disease, kidney disease), genital diseases (inflammatory processes, infertility, menstrual dysfunction, operations on the uterus, tubes, ovaries), former pregnancies and childbirth for the development of a real pregnancy.

A family history gives an idea of ​​the health status of family members living with a pregnant woman (tuberculosis, alcoholism, sexually transmitted diseases, smoking abuse), and heredity (multiple pregnancies, diabetes, cancer, tuberculosis, alcoholism).

It is necessary to obtain information about the diseases suffered by a woman, especially rubella, chronic tonsillitis, diseases of the kidneys, lungs, liver, cardiovascular system, endocrine pathology, increased bleeding, operations, blood transfusions, allergic reactions, etc.

The obstetric and gynecological history should include information about the features of menstrual and generative functions, including the number of pregnancies, the intervals between them, polyhydramnios, multiple pregnancy, duration, course and outcome, complications of childbirth, after childbirth and abortion, newborn weight, development and the health of children in the family, the use of contraceptives. It is necessary to clarify the husband’s age and state of health, his blood type and Rhesus affiliation, as well as the presence of occupational hazards and bad habits in spouses.

An objective examination is carried out by an obstetrician, therapist, dentist, otolaryngologist, optometrist, and if necessary - an endocrinologist, a urologist.

If a pregnant woman reveals extragenital pathology, the therapist must decide on the possibility of bearing a pregnancy and, if necessary, conduct additional studies or send the pregnant woman to a hospital.

The dentist must not only perform an examination, but also the rehabilitation of the oral cavity. The obstetrician-gynecologist controls how the recommendations of the specialists are followed at each visit to the consultation of the pregnant woman. In the presence of a high degree of myopia, especially complicated, it is necessary to obtain a specific opinion of the optometrist about the management or exclusion of the second stage of labor. In case of indications, medical genetic counseling is carried out. Repeated examinations by the therapist - at 30 and 37-38 weeks of pregnancy, and by the dentist - at 24 and 33-34 weeks.



LABORATORY RESEARCH

When a pregnant woman is taken into account, a general blood test is carried out, the Wasserman reaction, HIV infection, blood type and Rhesus affiliation of both spouses, blood sugar level, general urine analysis, analysis of vaginal discharge for microflora, feces for helminth eggs are determined.

If there is a history of stillbirths, miscarriage, the hemolysin content in the pregnant woman’s blood should be determined, the blood group and the Rhesus affiliation of the husband’s blood should be established, especially when determining the Rh-negative blood type in a pregnant woman or blood group 0 (I).
In addition, it is necessary to carry out the complement binding reaction with the toxoplasma antigen (we believe that the intradermal test should be discarded, since it is not non-specific).

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

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

urinalysis in the first half of pregnancy - monthly, and then - once every 2 weeks;

blood sugar - in 36-37 weeks;

coagulogram - in 36-37 weeks; RW and HIV at 30 weeks and before birth;

bacteriological (preferably) and bacterioscopic (required) studies of vaginal discharge - at 36-37 weeks;

ECG - in 36-37 weeks.

OBJECTIVE RESEARCH

During pregnancy, the height and weight of a woman should be measured. Determination of anthropometric indicators is a prerequisite for the diagnosis of obesity, monitoring the increase in body weight of a pregnant woman. Obviously, the sooner a woman visits the consultation, the more reliable data the doctor will receive.

When establishing high blood pressure in the early stages of pregnancy, an examination is necessary to exclude or confirm hypertension. In late pregnancy, the differential diagnosis of hypertension and late gestosis is complicated. Be sure to establish the values ​​of blood pressure before pregnancy, since its increase to 125/80 mm Hg in women with hypotension, it may be a symptom characteristic of nephropathy.

Inspection of a pregnant woman includes an assessment of her physique, the degree of development of the subcutaneous basis, the determination of visible edema, the condition of the skin and mucous membranes, mammary glands.

External and internal obstetric examinations include measurement of the pelvis, determination of the condition of the genitals and, starting from 20 weeks of pregnancy, measurement, palpation and auscultation of the abdomen.

At the first vaginal examination, which is performed by two doctors, in addition to determining the size of the uterus, it is necessary to establish the presence of exostoses in the pelvis, the state of the tissues, and the presence of abnormalities in the development of the genital organs. In addition, the height of the bosom (4 cm) is measured, since in the presence of a high pubic symphysis and its inclined position to the entrance plane, the pelvic capacity decreases.

Palpation of the abdomen allows you to determine the condition of the anterior abdominal wall and muscle elasticity. After increasing the size of the uterus, when its external palpation becomes possible (13-15 weeks), it is possible to determine the tone of the uterus, the size of the fetus, the amount of amniotic fluid, the underlying part, and then, as the pregnancy progresses, the position of the fetus, its position, position and view. Palpation is carried out using 4 classical obstetric techniques (according to Leopold).

Auscultation of fetal heart sounds is carried out from 20 weeks of pregnancy. It should be noted that even a clear definition of rhythmic noise before 19-20 weeks of pregnancy does not indicate the presence of cardiac tones, therefore, it is impractical to record the fetal heartbeat in the observation card before the indicated period. The fetal heartbeat is determined by an obstetric stethoscope in the form of rhythmic double strokes with a constant frequency of 130-140 per minute, as well as using ultrasound and Dopplerometry devices.

DETERMINATION OF THE DURATION OF PREGNANCY, DELIVERY, Prenatal and Puerperal Vacation

Determining the gestational age and the expected date of birth is an extremely important factor ensuring the timeliness of diagnostic, preventive and therapeutic measures, depending on the women belonging to certain risk groups.

In accordance with the legislation, working women, regardless of the length of service, are granted maternity leave of 140 (70 calendar days before childbirth and 70 - after childbirth) days. In the case of complicated delivery - 86, and at the birth of 2 children or more - 110 calendar days after delivery.

The task of the antenatal clinic is to show maximum objectivity in determining the period of prenatal and the delivery of postpartum leave. The first examination of a woman in consultation should be carried out by two doctors for a more qualified opinion on the duration of pregnancy. If a woman agrees with the deadline, this should be registered in the pregnant observation card. If a disagreement occurs, you must immediately determine the gestational age using all available methods.

Ultrasound during pregnancy is performed in dynamics. The first - up to 12 weeks - to exclude violations in the mother-placenta system; the second - in the period of 18-24 weeks in order to diagnose congenital malformations of the fetus; the third - in the period of 32-34 weeks for fetal biometry and identification of compliance of its physical parameters with gestational age (signs of intrauterine growth retardation).

PHYSIOPHYPROPHYLAXIC PREPARATION OF PREGNANT WOMEN

The complex of physiopsychoprophylactic preparation of pregnant women for childbirth includes hygienic gymnastics, which is recommended to be practiced daily or every other day from early pregnancy under the guidance of a physiotherapy instructor or a specially trained nurse. After the initial examination, the obstetrician-gynecologist and therapist are sent to the physical education cabinet with an indication of the gestational age and state of health. Groups are formed of 8-10 people, taking into account the duration of pregnancy. Classes are held in the morning, and for working pregnant women additionally in the evening. Physical exercises are divided into 3 complexes, respectively, timing: up to 16 weeks, from 17 to 32 weeks and from 33 to 40 weeks. Each set of exercises provides for the training of certain skills necessary to adapt the body to the corresponding period of pregnancy. It is advisable to complete gymnastics with ultraviolet radiation, especially in the autumn-winter season. If a pregnant woman cannot visit the gym, she is introduced to a set of gymnastic exercises, after which she continues gymnastics at home under the supervision of an instructor every 10-12 days.

Sick pregnant women perform therapeutic exercises differentially, taking into account the underlying disease. Physical education is contraindicated in acute or often aggravating and decompensated somatic diseases, habitual miscarriages in history and the threat of termination of a given pregnancy.

When preparing for childbirth, pregnant women not only get acquainted with the process of childbirth, but also teach exercises in auto-training and acupressure as factors that develop and strengthen a person’s self-hypnosis. The methodology of organizing and conducting classes on the psychophysical preparation of pregnant women for childbirth is presented in the methodological recommendations of the Ministry of Health of the USSR "Physical and mental preparation of pregnant women for childbirth" (1990, Appendix No. 2). Pregnant women are taught the rules of personal hygiene and prepared for future motherhood in the "Schools of Motherhood", organized in antenatal clinics using demonstration materials, visual aids, technical aids and baby care items. All women from early pregnancy should be invited to attend the Maternity School. Pregnant women should explain the importance of attending these classes. The consultation should have vivid information about the program and the time of the classes. The direct assistants to doctors during classes at the School of Maternity are midwives and nurses to care for the child.

When conducting classes on certain days of the week, it is advisable to form groups of 15-20 people, preferably with the same gestational age. The group may include pregnant women under the supervision of either one doctor or several. The head of the consultation organizes classes, taking into account the peculiarities of local conditions, exercises control over the work of the "School of Motherhood" and liaises with the territorial health center to receive methodological assistance and printed materials.

The curriculum of the School of Maternity includes 3 classes of an obstetrician-gynecologist, 2 pediatricians and 1 legal adviser, if available. The curriculum and program of the obstetrician-gynecologist at the "School of Motherhood" are presented in the appendix. In order to inform the obstetric hospital about the state of woman’s health and the features of the course of pregnancy, the doctor of the antenatal clinic issues a pregnant woman with a gestational age of 30 weeks, "Exchange card of the maternity hospital, maternity ward of the hospital."

RATIONAL NUTRITION OF PREGNANT WOMEN

Properly organized rational nutrition is one of the main conditions for a favorable course of pregnancy and childbirth, the development of the fetus and newborn.

Nutrition in the first half of pregnancy is almost no different from the diet of a healthy person. The total energy value of food should fluctuate depending on the growth, weight and nature of the pregnant woman's labor activity. In the first half of pregnancy, the increase in weight should not exceed 2 kg, and with a deficit of weight - 3-4 kg. With obesity, a pregnant woman up to 20 weeks should maintain her previous weight or lose 4-6 kg (with obesity II-III degree). The energy value of the diet for pregnant women under 16 weeks of age who are obese should not exceed 5024 kJ per day, and after 16 weeks - 6113 kJ. However, it should be remembered that a full woman can lose weight by no more than 1 kg per week, because excessive weight loss will adversely affect her health.

In the second half of pregnancy, meat fortunes, spicy and fried foods, spices, chocolate, cakes, cakes are excluded from the diet, and the amount of table salt is reduced. After 20 weeks of pregnancy, a woman should consume 120 g of meat and 100 g of boiled fish daily. If necessary, meat can be replaced with sausages or sausages. All types of products need to be brought to the menu in a certain dose. It was previously believed that dairy products, fruits and berries can be eaten without restrictions. However, excess in the diet of fruits, especially sweet ones, inevitably leads to the development of a large fruit due to the large amount of fruit sugar that quickly accumulates in the body. A pregnant woman’s daily diet should necessarily include sunflower oil (25-30 g), which contains essential unsaturated fatty acids (linoleic, linolenic and arachidonic). It is recommended to eat up to 500 g of vegetables daily. They are low-calorie, provide normal bowel function, contain a sufficient amount of vitamins and mineral salts.

The most affordable way to control your diet is to regularly weigh the pregnant woman. In optimal cases, during pregnancy, a woman's weight increases by 8-10 kg (by 2 kg during the first half and by 6-8 kg during the second half, and therefore, by 350-400 g per week). These guidelines are not a benchmark for everyone. Sometimes they give birth to large children and with an increase in weight during pregnancy up to 8 kg. But, as a rule, this happens when a woman unnecessarily adds to the mass.

Such approximate norms of weight gain during pregnancy are recommended taking into account the woman’s constitution: during the first pregnancy for women with asthenic physique - 10-14 kg, with normal - 8-10 kg, with a tendency to overweight - 2-6 kg; during the second pregnancy - 8-10, 6-8 and 0-5 kg, respectively (depending on the degree of obesity).

For effective control, you need to know exactly the weight of a woman before pregnancy or in her early stages (up to 12 weeks). If a pregnant woman’s weight corresponds to growth, there are no complaints of increased appetite, and she did not give birth to large children in the past, food restrictions should begin after 20 weeks of pregnancy. With increased appetite, excessive weight gain, the presence in the past of a large fetus or childbirth, which was accompanied by complications with a baby weight of 3700-3800 g, with obesity, narrowing of the pelvis, you need to review the menu already from 12-13 weeks of pregnancy and, first of all, limit carbohydrates and fats.

ISOLATION AND DISPENSANIZATION OF PREGNANT WOMEN IN HIGH RISK GROUPS

The risk strategy in obstetrics provides for the identification of groups of women in whom pregnancy and childbirth can be complicated by impaired fetal functioning, obstetric or extragenital pathology. Pregnant women registered in antenatal clinics can be assigned to the following risk groups:

with perinatal pathology from the fetus;

with obstetric pathology;

with extragenital pathology.

At 32 and 38 weeks of pregnancy, scoring is performed, as new risk factors appear during these periods. Research data indicate an increase in the group of pregnant women with a high degree of perinatal risk (from 20 to 70%) by the end of pregnancy. After re-determining the degree of risk, the pregnancy management plan is specified.

From 36 weeks of pregnancy, women from the medium and high risk groups are re-examined by the head of the antenatal clinic and the head of the obstetric department, in which the pregnant woman will be hospitalized before delivery. This examination is an important point in the management of pregnant women at risk. In those areas where there are no maternity wards, pregnant women are hospitalized according to the schedules of the regional and city health departments for preventive treatment to certain obstetric hospitals. Since prenatal hospitalization for examination and comprehensive preparation for childbirth is mandatory for women at risk, the hospitalization period, a tentative management plan for the last weeks of pregnancy and childbirth should be developed jointly with the head of the obstetric department.

Antenatal hospitalization at the time determined jointly by the doctors of the consultation and the hospital is the last but very important task of the antenatal clinic. Having timely hospitalized a pregnant woman from medium or high risk groups, the doctor of antenatal consultation can consider her function to be fulfilled.

A group of pregnant women at risk of perinatal pathology. It was found that 2/3 of all cases of perinatal mortality are found in women from the high-risk group, making up no more than 1/3 of the total number of pregnant women. Based on literature data, our own clinical experience, as well as the multifaceted development of childbirth histories in the study of perinatal mortality O.G. Frolova and E.N. Nikolaev (1979) identified individual risk factors. They include only those factors that led to a higher level of perinatal mortality in relation to this indicator in the entire group of examined pregnant women. The authors divide all risk factors into two large groups: prenatal (A) and intranatal (B). Prenatal factors, in turn, are divided into 5 subgroups:

socio-biological;

obstetric and gynecological history;

extragenital pathology;

complications of a real pregnancy;

assessment of the fetus.

The total number of prenatal factors was 52.

Intranatal factors were also divided into 3 subgroups. These are factors from:

mothers;

placenta and umbilical cord;

fetus.

This group combines 20 factors. Thus, a total of 72 risk factors were identified.

For a quantitative assessment of factors, a point system was used, which makes it possible not only to assess the probability of an unfavorable outcome of labor under the influence of each factor, but also to obtain a summary expression of the probability of all factors. Based on the calculation of the assessment of each factor in points, the authors distinguish the following degrees of risk: high - 10 points and above; average - 5-9 points; low - up to 4 points. The most common mistake when calculating scores is that the doctor does not summarize indicators that seem to him insignificant, believing that there is no need to increase the risk group.

The selection of a group of pregnant women with a high degree of risk allows you to organize intensive monitoring of the development of the fetus from the beginning of pregnancy. Currently, there are many possibilities for determining the condition of the fetus (determination of estriol, placental lactogen in the blood, amniocentesis with the study of amniotic fluid, PCG and ECG of the fetus, etc.).
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ORGANIZATION OF WORK OF WOMEN'S COUNSELING DISPENSARY MONITORING OF PREGNANT WOMEN

  1. ORGANIZATION OF WORK OF WOMEN'S COUNSELING DISPENSARY MONITORING OF PREGNANT WOMEN
    Women's consultation (LC) is a subdivision of a polyclinic, medical center or maternity hospital, which provides outpatient treatment, prophylactic, obstetric and gynecological care to the population. The main tasks of the antenatal clinic are: providing qualified obstetric and gynecological care to the population of the attached territory; conducting preventive measures,
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  5. Protection of motherhood and infancy in Russia. Organization of outpatient obstetric and gynecological care. Women's consultation, tasks, structure, performance indicators.
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  9. DISPENSARY SURVEILLANCE
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  10. TYPICAL PROVISION FOR WOMEN'S CONSULTATION
    The provision of outpatient obstetric and gynecological care is provided by women's consultations, the activities of which are regulated by the health authorities of the constituent entities of the Russian Federation. I. General issues 1.1. Women's consultation is a medical institution providing outpatient obstetric and gynecological care using modern medical technologies,
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    When organizing a dynamic follow-up clinic, the physician should be strictly guided by the relevant orders and instructions on the aircraft. The most common diseases of the ear, throat, nose among the military are chronic tonsillitis, acute and chronic rhinitis, sinusitis and otitis media. Primary prevention of these diseases includes: - implementation of measures to
  12. Clinical observation of children with diseases of the urinary system and digestive tract. Protection of medical history
    Questions for repetition: 1. Rules for collecting urine. 2. The physiological role of bile. Control questions: 1. Rehabilitation of children in outpatient settings with: gastritis, gastroduodenitis, peptic ulcer of the stomach and 12 duodenal ulcer, diseases of the biliary tract, chronic eating disorders. 2. The frequency of observation by a pediatrician and narrow specialists. 3. Anti-relapse treatment
  13. General principles of conducting at the stage of female consultation
    determine the titer of Rhesus antibodies in the blood (when registering, at 20 weeks, and then 1 time in 4 weeks); • examine the blood for the presence of group immune antibodies (in pregnant women with 0 (I) blood type, in husband A (P), B (W), AB (IY)); • carry out non-specific desensitizing therapy (3 courses of 10 days at a gestational age of 10-12, 22-24, 32-34 weeks in all Rh-negative women, even with
  14. Antenatal Pregnancy Monitoring Program
    The algorithm for examining pregnant women, in addition to the generally accepted routine screening, includes a 3-fold ultrasound examination in the dynamics of pregnancy (order of the Ministry of Health of the Russian Federation No. 457), preparation of a gravidogram in the antenatal period, in which the main results of clinical and laboratory examinations are recorded, a test of fetal movements from 28 weeks before delivery , 3-fold screening for women in groups
  15. Regulation on medical and social audit of the monitoring system of a pregnant woman and family
    The definition of medical and social audit: is an internal or independent, comprehensive, documented examination of the quality of the system for monitoring a pregnant woman and her family during pregnancy, childbirth and the early postpartum period, assessing the effectiveness of the use of all types of resources and compliance with legal requirements in the field of health and social providing audited
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