The organization of work in obstetric hospitals is based on a single principle in accordance with the current position of the maternity hospital (separation), orders, orders, instructions and existing methodological recommendations.
How is the organization of the obstetric hospital?
- The structure of the obstetric hospital must comply with the requirements of the construction standards and the rules of therapeutic and preventive institutions;
- Equipment - Tabel equipment of the maternity hospital (separation);
- Sanitary anti-epidemic regime - current regulatory documents.
Currently, there are several types of obstetric hospitals, which provide medical and preventive care for pregnant women, women in labor, and maternity hospitals:
- Without medical care - collective farm maternity hospitals and heads with obstetric codes;
- With general medical care - precinct hospitals with obstetric beds;
- With qualified medical care - obstetric branches of the Republic of Belarus, CRH, city maternity hospitals; With a multi-profile qualified and specialized help - the branch offices of multidisciplinary hospitals, obstetric departments of regional hospitals, inter-district obstetric branches based on large CRH, specialized obstetric branches based on multi-profile hospitals, bornery hospitals united with departments of obstetrics and gynecology of medical institutions, separation of profile research institutes.
A variety of types of obstetric hospitals involves more rational use of their use to provide qualified assistance to women in the position.
Structure of obstetric hospitals
The distribution of obstetric hospitals at 3 levels for the hospitalization of women, depending on the degree of risk of perinatal pathology, is presented in Table. 1.7 [Serov V.N. et al., 1989].
The hospital of the maternity hospital - the obstetric hospital - has the following main divisions:
- receiving block;
- physiological (I) obstetric department (50-55% of the total number of obstetric beds);
- department (chambers) of pregnant pathology (25-30% of the total number of obstetric beds), recommendations: bring these beds to 40-50%;
- department (chambers) for newborns in the composition of I and II of the obstetric departments;
- observation (II) obstetric department (20-25% of the total number of obstetric beds);
- gynecological department (25-30% of the total number of beds of the maternity hospital).
The structure of the premises of the maternity hospital should ensure isolation of healthy pregnant women, feminine, the podiums from the patients; Compliance with the strictest rules of asepsis and antiseptics, as well as timely isolation of the fallen. The receiving-bandwidth of the maternity hospital includes a reception (lobby), a filter and viewing rooms that are created separately for women entering the physiological and observative offices. Each observation room should have a special room for sanitary processing of incoming women equipped with toilet and shower. If the gynecological separation is functioning in the maternity hospital, the latter must have an independent receiving block. The reception room or the lobby is a spacious room, the area of \u200b\u200bwhich (like all other spaces) depends on the king power of the maternity hospital.
For the filter, there is a room of 14-15 m2, where the table of midwives, couches, chairs for incoming women stand.
Viewing rooms must have an area of \u200b\u200bat least 18 m2, and each sanitary processing room (with a shower cabin, a restroom for 1 toilet bowl and installation for washing the ship) - at least 22 m2.
Principles of work of the obstetric hospital
The procedure for admission of patients
Pregnant or feminine, entering the adopted obstetric hospital (lobby), removes the upper clothes and goes into the filter room. In the filter, the duty officer decides the question of which of the departments of the maternity hospital (physiological or observative) should be sent. To properly solve this issue, the doctor collects in detail the history, from which the epidemic environment of the household worryers (infectious, purulent-septic diseases) is found, the obstetrics measures the body temperature, carefully examines the skin (pustal diseases) and zev. In the physiological department and the department of pathology of pregnant women send women who do not have any signs of infection and who did not have contacts with infectious patients, as well as the results of the study on RW and AIDS.
All pregnant women and guides representing the slightest threat of infection of healthy pregnant women and women in the observation department of the maternity hospital (maternity hospital department). After it is established, at which separation should be directed pregnant or feminine, the midwife translates the woman into the appropriate viewing (I or II obstetric branch), introducing the necessary data in the "Journal of taking into account pregnant women in the guinea and herds" and filling the passport part of the childbirth history. Then the midwife together with the duty officer conducts a general and special obstetric examination; Weighs, measures the growth, determines the size of the pelvis, the stomach circumference, the standing height of the bottom of the uterus above the pubic, the position and presence of the fetus, listen to his heartbeat, prescribes the analysis of urine on the blood protein, on the hemoglobin content and to rhesk affiliation (in the absence in the exchange card) .
The duty officer checks the data of the midwife, meets the "individual map of the pregnant and the parental", collects a detailed history and reveals swelling, measures the blood pressure on both hands, etc. The doctor has determined the presence and nature of generic activity. All examination data does not enter the relevant sections of childbirth.
After examination, the feminine is carried out sanitary processing. The volume of surveys and sanitary treatment in the observation is regulated by the general state of the woman and the period of childbirth. At the end of the sanitary processing of the fever (pregnant), it receives an individual package with sterile linen: a towel, a shirt, a bathrobe, slippers. From the viewing I of the physiological department, the female in labor is transferred to the prenatal chamber of the same department, and pregnant - to the department of pathology. From the observation observation department of all women are sent only to observative.
Departments of the pathology of pregnant women
Departments of the pathology of the obstetric hospital are organized in the maternity hospitals (compartments) with a capacity of 100 beds and more. In the department of pathology, women usually come through the viewing I of the obstetric branch, in the presence of signs of infection - through the observation separation department in the isolated chambers of this department. In the appropriate observation reception, the doctor leads (in the daytime, doctors of separations, from 13.30 - duty doctors). In maternity hospitals, where independent departments of pathology can not be organized, the chambers in the composition of the I obstetric departments are distinguished.
The department of pathology is hospitalized pregnant women with extragenital diseases (hearts, vessels, blood, kidneys, liver, endocrine glands, stomach, lungs, etc.), with complications (gestosis, threat of interrupting pregnancy, fetoplacentar failure, etc.), with improper position of the fetus , with a burdened obstetric history. In the department, along with an obstetrician-gynecologist (1 doctor on 15 beds), the therapist of the maternity hospital is working. In this compartment, there is usually an office of functional diagnostics, equipped with devices for assessing the state of women and the fetus (FKG, ECG, ultrasonic scanning device, etc.). In the absence of its own cabinet for examination of pregnant women, the overall branches of functional diagnostics are used.
In the obstetric hospital for treatment, modern drugs, barotherapy are used. It is desirable that in the small chambers of the specified branch of women were partitioned by the profile of pathology. The separation should be reliable to supply oxygen. Of great importance is the organization of rational nutrition and therapeutic and protective regime. In this department, equip the viewing, small operating room, the study of physiopsychoprophylactic preparation for childbirth.
From the Department of Pathology, pregnant is discharged home or translated into the maternity hospital for the delivery.
In a number of obstetric hospitals, the departments of the pathology of pregnant women with a semi-channel regime are deployed. This is especially true for regions with a high birth rate.
The department of pathology is usually closely associated with sanatoriums for pregnant women.
One of the criteria for extracting with all types of obstetric and extragenital pathology is the normal functional state of the fetus and the most pregnant.
The main types of research, the average period of examination, the basic principles of treatment, the average treatment time, the extracting criteria and the average length of stay in the hospital of pregnant women with the most important nosological forms of obstetric and extragenital pathology are presented in the order of the Ministry of Health of the USSR No. 55 of 09.01.86
Physiological department
I (physiological) branch of the obstetric hospital includes a sanitary bandwidth, which is part of the general receiving block, the generic unit, postpartum chambers for the joint and separate stay of the mother and the child, the discharge room.
The generic unit consists of prenormal chambers, chambers of intensive observation, generic chambers (maternity halls), manipulating for newborns, operational block (large operational, preoperative anestrational, small operational, premises for blood storage, portable equipment, etc.). In the generic unit also place rooms for medical personnel, buffet, sanitary nodes and other utility rooms.
Gathering in the maternity hospital, the future mother, waiting for his first baby, usually experiences excitement. A lot of incomprehensible procedures that are waiting for a woman in the maternity hospital, like an unknown, causes some alarm. To dispel it, let's try to figure out what a medical personnel will do at every stage of childbirth.
Birth in the maternity hospital. Where will you guide?
So, you have started regular contractions or started separating the accumulative water, in other words, childbirth began. What to do? If at this time you will be in the hospital in the pregnancy pathology department, then you need to inform about this on duty medical sister, and she, in turn, will cause a doctor. The duty officer-gynecologist will examine and decide whether you really began to give birth, and if so, it will translate into the maternity hospital, but before this will make a cleansing enema (the enema does not make in the case of bleeding from the genital paths, with full or close to it Opening of the cervix, etc.).
In the event that the generic activity begins outside the hospital, you need to seek help in the maternity hospital.
When hospitalizing in the maternity hospital, a woman passes through a receiving-bandwidth, which includes: receiving (lobby), filter, viewing rooms (separately for healthy and patients) and sanitary room.
A pregnant or guinea, acting into the reception, removes the upper clothes and passes into the filter, where the doctor's duty decides the question of which one of the offices should be directed. To do this, it collects in detail the history (asks for health, about the course of this pregnancy) in order to clarify the diagnosis, trying to find out the presence of infectious and other diseases, meets the data, conducts an outdoor inspection (reveals the presence of guns on the skin and various kinds of rash, inspects ZEV) , the midwife measures the temperature.
Patients having a exchange card and without signs of infection are hospitalized into the physiological department. Pregnant and fencers representing the threat of infection of healthy women (without a exchange card that have certain infectious diseases - ORZ, carpentry skin diseases, etc.), are sent to the observation department specifically designed for these purposes. Due to this, the possibility of infection of healthy women is excluded.
In the department of pathology, a woman can put in the case when the beginning of birth is not confirmed using objective research methods. In doubtful cases, a woman is hospitalized into the maternity block. If, during the surveillance, generic activity does not develop, the pregnant woman later can also translate into the department of pathology.
In the observation room
After it is installed, at which separation is a pregnant or guide, it is transferred to the corresponding look room. Here the doctor, together with the midwife, conducts a common and special examination: weighs the patient, measures the sizes of the pelvis, the abdomen circumference, the height of the bottom of the uterus above the Lone, the position and presence of the fetus (head or pelvic), listens to his heartbeat, examines a woman for swelling, measures arterial pressure. In addition, the duty doctor produces a vaginal study to clarify the obstetric situation, after which it determines whether there is generic activities, and if there is, what it is characteristic. All examination data is entered into the history of childbirth, which is given here. As a result, the doctor examines the diagnosis, writes the necessary analyzes and appointments.
After the examination, sanitation is carried out: shave outdoor genital organs, enema, shower. The volume of surveys and sanitary treatment in the viewing depends on the general state of the woman, the availability of generic activities and the period of childbirth. At the end of the sanitary processing, a woman is issued sterile shirt and bathrobe. If the birth has already begun (in this case, a woman is called a woman in labor), the patient is transferred to the predatory chamber of the generic unit, where it holds the entire first period of childbirth before the occurrence of fence, or in a separate generic boxing (if such is equipped with a hospital). Pregnant, still only waiting for birth, send to the department of pregnancy pathology.
What is KTG during childbirth?
Consistent assistance to assess the state of the fetus and the nature of labor activities is provided by cardiotokography. The cardiomonitor is a device that captures the palpitations of the fetus, and also makes it possible to track the frequency and streams. A woman on the belly is attached the sensor, which allows the fetal heartbeat on the paper tape. During research, a woman is usually offered to lie on the side, because in the standing position or during the walk the sensor is constantly shifted from the place where the palpitations of the fetus can be registered. The use of cardiomonitorial observation makes it possible to identify hypoxia (oxygen deficiency) of the fetus and anomalies of generic activities, to evaluate the effectiveness of their treatment, predict the outcome of genera and choose the optimal method of the delivery.
In Rodbok
The generic unit consists of prenormal chambers (one or several), generic chambers (maternity halls), the chamber of intensive observation (for observing and treating pregnant and feminines with the most severe forms of pregnancy complications), manipulating for newborns, operational block and a number of utility rooms.
In the prenatal ward (or male boxing), the details of the course of pregnancy, past pregnancies, childbirth, conduct an additional inspection of the manufacturers (the physique, the constitution, the form of the abdomen is evaluated, etc.) and a detailed obstetric examination. Be sure to take analysis to a group of blood, Rh. Factor, AIDS, syphilis, hepatitis, produce urine and blood research. The doctor and midwife are carefully followed by the guinea: they are aware of her well-being (degree of pain, fatigue, dizziness, headache, vision disorder, etc.), regularly listen to the palpitations of the fetus, follow the generic activity (the duration of the bouts, the interval between them, Strength and soreness), periodically (every 4 hours, and if necessary - more often), arterial pressure and the pulse of the manufacturer are measured. The body temperature is measured 2-3 times a day.
In the process of observing the generic process, there is a need for vaginal research. During this study, the doctor fingers determines the degree of opening of the cervix, the dynamics of the advancement of the fetus by generic paths. Sometimes in the maternity block during a vaginal study, a woman is offered to the gynecological chair, but more often the study is carried out when the fever lies on the bed.
Vaginal research in childbirth is necessarily carried out: upon admission to the maternity hospital, immediately after the influence of accumulating waters, as well as every 4 hours during labor. In addition, it may be necessary in additional vaginal studies, for example, in carrying out anesthesia, deviation from the normal flow of labor or the appearance of bloody secretions from the generic pathways (the frequent vaginal research should not be feared - it is much more important to ensure full orientation in assessing the correctness of childbirth). In each of these cases, the testimony and the manipulation itself are recorded in the history of labor. In the same way, in the history of labor, all studies and actions carried out with the guinea during childbirth (injections, blood pressure, pulse, fetal heartbeat, etc.) are recorded.
In childbirth, it is important to monitor the work of the bladder and intestines. The overflow of the bladder and the rectum prevents the normal flow of childbirth. To prevent the bladder overflow, the feminine is offered to urinate every 2-3 hours. In the absence of independent urination, they resort to catheterization - the introduction into the urethra thin canal of the plastic tubule, by which urine is exposed.
In the prenatal chamber (or individual maternity boxing), the woman in labor holds the entire first period of childbirth under the constant supervision of medical personnel. In many maternity homes, the presence of a husband in childbirth is allowed. With the beginning of the waiting period, or the period of expulsion, the fever is transferred to the generic chamber. Here she is changing a shirt, a shop (or a one-time hat), shoe covers and put on the bed Rakhmanov - a special obstetric chair. Such a bed is equipped with stops for legs, special handles that need to pull on themselves while drought, adjusting the position of the head end of the bed and some other devices. If childbirth occurs in an individual box, then a woman is translated from a regular bed on Rachmanov's bed or, if the bed on which the woman lay during the battle is functional, it is transformed into the bed Rakhmanov.
Normal labor in uncomplicated pregnancy takes an obstetrician (under the control of the doctor), and all pathological genera, including childbirth at the fetus, is a doctor. Operations such as cesarean section, the impulse of obstetric forceps, vacuum extraction of the fetus, examination of the uterine cavity, stitching the breaks of soft tissues of the genital tract, etc., only the doctor performs.
After the birth of the kid
As soon as the child is born, the midwife, receiving childbirth, crosses the cord with scissors. Neonatologist, necessarily present in childbirth, sucks the newborn mucus from the upper respiratory tract using a sterile canister or catheter connected to an electrical suction, and examines the child. Newborn necessarily show mothers. If the baby and mom feel good, the child is laid out on the stomach and applied to the chest. It is very important to attach a newborn to the chest immediately after delivery: the first drops of poles contain the necessary kids vitamins, antibodies and nutrients.
For a woman after the birth of a child, childbirth does not end yet: there is no less responsible third period of childbirth - it ends with the birth of the last, so it is called the sequence. The subsequent placenta, spindle shells and umbilical cord. In the last period, under the influence of sequences, the placenta and shells are separated from the walls of the uterus. The birth of the lapse occurs in about 10-30 minutes after the birth of the fetus. Exile is carried out under the influence of dyuch. The duration of the lateral period is approximately 5-30 minutes, after its completion, the generic process is completed; During this period, a woman is called a purse. After the birth of the pilot on the belly, the woman put ice so that the uterus is better than shrinking. Ice bubble remains on the stomach for 20-30 minutes.
After the birth of the post, the doctor inspects the generic pathway pathor in the mirrors, and if there are soft tissue ruptures or in childbirth, the tissue dissection was carried out, restores their integrity - sews. If there are small cervical breaks, they are sewn without anesthesia, as there are no pain receptors in the neck. Rales of the walls of the vagina and the perineum are always restored against the background of anesthesia.
After this stage is over, the young mother is shifted to the catal and export in the corridor or it remains in the individual maternity boxing.
The first two hours after childbirth should remain in the maternity hospital under the careful observation of the doctor's duty in connection with the possibility of various complications that may arise in the early postpartum period. The newborn is inspecting and treated, then peeling, they put on it a warm sterile sprinkle, wrapped in a sterile diaper and a blanket and leave for 2 hours on a special heated table, after which a healthy newborn is translated along with a healthy mother (herds) to the postpartum ward.
How do pain relief?
At a certain stage of labor, there may be a need for anesthesia. For drug painting of labor, the most commonly applied:
- nitrogen rushing (gas that is served through a mask);
- spasmolitics (barallgan and similar means);
- promedol - a narcotic substance that is introduced intravenously or intramuscularly;
- - The method in which an anesthetic substance is introduced into the space before the solid cerebral shell surrounding the spinal cord.
Madina Esaulova,
Doctor obstetrician-gynecologist, maternity hospital at IKB №1 Moscow
Vi. The procedure for providing medical care to women with HIV infection during pregnancy, childbirth and in the postpartum period
51. The provision of medical care to women with HIV infection during pregnancy, childbirth and in the postpartum period is carried out in accordance with sections I and III of this Procedure.
52. Laboratory examination of pregnant women for the presence of antibodies to the human immunodeficiency virus (hereinafter referred to as HIV) is carried out when registered with pregnancy.
53. With a negative result of the first survey on HIV antibodies, women planning to preserve pregnancy, re-test at 28-30 weeks. Women who, during pregnancy, used parenteral psychoactive substances and (or) entered into sex with HIV-infected partner, it is recommended to examine an additional 36 week of pregnancy.
54. Molecular biological examination of pregnant women on DNA or HIV RNA is carried out:
a) in obtaining dubious test results for antibodies to HIV, obtained by standard methods (immunoassay analysis (hereinafter - IFA) and immune blotting);
b) when receiving negative test results on the antibodies to HIV, obtained by standard methods in the event that a pregnant woman belongs to a high-risk group on HIV infection (drug use intravenously, unprotected sex with HIV-infected partner in the last 6 months).
55. Blood fence when testing for antibodies to HIV is carried out in the procedural office of women's consultation using vacuum systems for blood intake, followed by blood transmission to the laboratory of a medical organization with a direction.
56. Testing for antibodies to HIV is accompanied by a mandatory dotesting and post track consulting.
Postvestment consulting is carried out by pregnant women regardless of the test results on HIV antibodies and includes a discussion of the following questions: the value of the result obtained, taking into account the risk of HIV infection; recommendations for further testing tactics; transmission paths and ways to protect against HIV infection; risk of HIV transmission during pregnancy, childbirth and breastfeeding; Methods for the prevention of HIV infection from mother to a child who are available to a pregnant woman with HIV infection; The possibility of conducting the chemoprophylaxis of HIV transfer to the child; possible outcomes of pregnancy; the need to follow the observation of the mother and the child; The possibility of informing about the results of the penis of the sexual partner and relatives.
57. Pregnant women with a positive result of a laboratory survey on HIV antibodies, an obstetrician-gynecologist, and in the case of its absence - a general practice doctor (family doctor), a medical worker of the Feldsher-Okushetsky point, sends to the Center for the Prevention and Fight of AIDS Subject Of the Russian Federation for an additional examination, layouts on the dispensary accounting and purpose of the chemoprophyphylaxis of the perinatal transmission of HIV (antiretroviral therapy).
Information obtained by medical workers about a positive result of testing for HIV infection of a pregnant woman, girlfriend, the parental, the antiretroviral prevention of the transfer of HIV infection from mother to a child, joint observation of a woman with specialists from the Center for the Prevention and Fight against AIDS of the constituent entity of the Russian Federation, perinatal contact HIV The infection in the newborn is not subject to disclosure, except in cases provided for by the current legislation.
58. Further observation of a pregnant woman with a diagnosed diagnosis of HIV infection is carried out jointly by the doctor of the infectiousnessist of the Center for the Prevention and Fight against AIDS of the Directory of the Russian Federation and the obstetrician-gynecologist of women's consultation at the place of residence.
If it is impossible for the direction (observation) of a pregnant woman to the Center for the Prevention and Control of AIDS of the Subject of the Russian Federation, observation is carried out by an obstetrician-gynecologist at the place of residence in the methodical and advisory support of the infectious examinist of the Center for the Prevention and Fighting of AIDS.
An obstetrician-gynecologist of female consultation during the monitoring of a pregnant woman with HIV infection to the center of prevention and control of AIDS of the constituent entity of the Russian Federation information on the course of pregnancy, concomitant diseases, pregnancy complications, the results of laboratory research to adjust the antiretroviral prevention schemes for HIV transmission The mother of the child and (or) antiretroviral therapy and requests from the center of the prevention and control of AIDS of the constituent entity of the Russian Federation information about the features of HIV infection in a pregnant woman, the mode of receiving antiretroviral drugs, coordinates the necessary methods of diagnosis and treatment, taking into account the health status of women and pregnancy .
59. During the entire period of observing a pregnant woman with HIV infection, an obstetrician-gynecologist of women's consultation in conditions of strict confidentiality (using code) notes in medical records of its HIV status, presence (absence) and reception (refusal of admission) Antiretroviral drugs needed to prevent the transfer of HIV infection from the mother to a child appointed by the specialists of the Center for the Prevention and Fighting of AIDS.
On the absence of a pregnant woman antiretroviral drugs, the refusal of their admission, an obstetrician-gynecologist for women's consultation immediately informs the center for the prevention and control of AIDS of the constituent entity of the Russian Federation to take appropriate measures.
60. During the period of dispensary monitoring of a pregnant woman with HIV infection, it is recommended to avoid procedures that increase the risk of fetal infection (amniocentesis, chorion biopsy). The use of non-invasive methods for assessing the state of the fetus is recommended.
61. Upon receipt of women in the obstetric hospital for HIV infection, women without medical documentation or a single survey on HIV infection, as well as psychoactive substances used intravenously during pregnancy, or who had unprotected sex with HIV-infected partner, Laboratory examination is recommended by the express method on HIV antibodies after receiving informed voluntary consent.
62. Testing of the manufacturers on HIV antibodies in the obstetric hospital is accompanied by a dotesty and post-advising counseling, including information on testing, methods for preventing HIV transmission from mother to the child (the use of antiretroviral drugs, the method of delivery, the features of feeding a newborn (after birth, the child is not applied to the chest and It is not fed by maternal milk, but translates into artificial feeding).
63. The survey on HIV antibodies using diagnostic express test systems allowed to use in the Russian Federation is carried out in the laboratory or the receiving department of the obstetric hospital with medical professionals who have passed special training.
The study is carried out in accordance with the instructions attached to a specific express test.
A part of the blood sample taken to conduct an express test is sent to conduct an examination for HIV antibodies according to the standard method (ELISA, if necessary, immune blot) in a screening laboratory. The results of this study are immediately transmitted to the medical organization.
64. Each HIV study with the use of express tests must be accompanied by a mandatory parallel study of the same portion of blood by classical methods (ELISA, immune blot).
Upon receipt of a positive result, the remaining part of the serum or plasma of blood is sent to the laboratory of the Center for the Prevention and Control of AIDS of the constituent entity of the Russian Federation for conducting a verification study, the results of which are immediately transmitted to the obstetric hospital.
65. In the case of obtaining a positive result of HIV testing in the laboratory of the Center for the Prevention and Fighting of AIDS of the Directory of the Russian Federation, a woman with a newborn after extracting from the obstetric hospital is sent to the Center for the Prevention and Fight against AIDS of the Directory of the Russian Federation for counseling and further surveys.
66. In emergency situations, if it is impossible to expect the results of standard testing for HIV infection from the Center for the Prevention and Fight against AIDS of the constituent entity of the Russian Federation, the decision to conduct a preventive course of antiretroviral treatment of HIV transmission of HIV to the child is accepted when antibodies are detected to HIV antibody with an express test - Systems. The positive result of the express test is the basis only for the appointment of antiretroviral prevention of the transfer of HIV infection from the mother to the child, but not for the diagnosis of HIV infection.
67. To ensure the prevention of the transfer of HIV infection from the mother to the child in an obstetric hospital, the necessary supply of antiretroviral drugs constantly should have.
68. Conducting antiretroviral prevention in a woman in the period of childbirth is carried out by an obstetrician-gynecologist, leading childbirth, in accordance with the recommendations and standards for the prevention of HIV transfer to the child.
69. The preventive course of antiretroviral therapy during childbirth in the obstetric hospital is carried out:
a) in the guinea with HIV infection;
b) with a positive result of express testing women in childbirth;
c) in the presence of epidemiological testimony:
the impossibility of express testing or timely obtaining the results of a standard test for HIV antibodies to the Hife;
a history of fever in the period of real pregnancy parenteral use of psychoactive substances or sexual contact with a partner with HIV infection;
with a negative result of a survey on HIV infection, if from the moment of the last parenteral use of psychoactive substances or sexual contact with HIV-infected partner passed less than 12 weeks.
70. Measures are taken to prevent an obstetrician-gynecologist to prevent the duration of anhydrous gap for more than 4 hours.
71. When conducting birth through natural generics, the vagina is treated with a 0.25% aqueous solution of chlorhexidine when entering childbirth (at the first vaginal study), and in the presence of coloring - with each subsequent vaginal study. With anhydrous interval of more than 4 hours, chlorhexidine vagina is carried out every 2 hours.
72. While conducting birth to a woman with HIV infection with a living fruit, it is recommended to limit procedures that increase the risk of fetal infection: relatives; Rhodesion; Perinao (episio) Tomiya; amniotomy; the impulse of obstetric tongs; Vacuum extraction of the fetus. Performing data of manipulations is made only on life indications.
73. Planned caesarean section for the prevention of intranatal infection of the child with HIV infection is carried out (in the absence of contraindications) prior to the beginning of the generic activity and influence the accumulative water in the presence of at least one of the following conditions:
a) the concentration of HIV in the blood of the mother (viral load) before childbirth (on the period not earlier than 32 weeks of pregnancy) is more or equal to 1 000 kopecks;
b) the mother's viral load before childbirth is unknown;
c) Antiretroviral chemoprophylaxis was not carried out during pregnancy (or was carried out in monotherapy mode or its duration was less than 4 weeks) or it is impossible to apply antiretroviral drugs in childbirth.
74. If it is impossible to conduct chemoprophylaxis in kinds of caesarean section, a cross-section can be an independent preventive procedure that reduces the risk of infection with HIV infection during the birth, while it is not recommended to be carried out at anhydrous interval of more than 4 hours.
75. The final decision on the method of the delivery of a woman with HIV infection is made by an obstetrician-gynecologist, leading childbirth, individually, taking into account the state of the mother and the fetus, comparing in a particular situation of the benefit of reducing the risk of infection of the child when conducting cesarean operation with probability The emergence of postoperative complications and features of the current HIV infection.
76. The newborn from HIV-infected mother immediately after birth is a blood pressure for testing for HIV antibodies using vacuum systems for blood intake. Blood is sent to the laboratory of the Center for the Prevention and Fight against AIDS of the constituent entity of the Russian Federation.
77. Antiretroviral prevention The newborn is appointed and is carried out by a neonatologist or pediatrician, regardless of the reception (refusal) of antiretroviral drugs by the mother during pregnancy and childbirth.
78. Indications for the appointment of antiretroviral prevention of newborn, born of a mother with HIV infection, a positive result of express testing on HIV antibodies in childbirth, unknown HIV status in obstetric hospital are:
a) the age of a newborn no more than 72 hours (3 days) of life in the absence of feeding with maternal milk;
b) in the presence of feeding with maternal milk (regardless of its duration) - a period of not more than 72 hours (3 days) from the moment the latter feeding with maternal milk (subject to subsequent cancellation);
c) Epidemiological testimony:
unknown HIV Mother's status that consumes parenteral psychoactive substances or having sexual contact with HIV-infected partner;
a negative result of the Mother survey on HIV infection that consumes parenterally during the last 12 weeks of psychoactive substances or having sexual contact with a partner with HIV infection.
79. A newborn is a hygienic bath with a chlorhexidine solution (50 ml of 0.25% chlorhexidine solution by 10 liters of water). If it is impossible to use chlorhexidine, a soap solution is used.
80. At discharge from the obstetric hospital, a neonatologist or a pediatrician in an affordable form explains the mother or persons who will carry out a newborn care, a further diagram of receiving chemotherapies by a child, issues antiretroviral drugs to continue antiretroviral prevention in accordance with the recommendations and standards.
When conducting a preventive course of antiretroviral drugs, emergency prevention methods, an extract from the maternity hospital of the mother and the child is carried out after the end of the preventive course, that is, not earlier than 7 days after delivery.
In obstetric hospital, women with HIV are counseling on the issue of breastfeeding, with the consent of the woman, measures are taken to stop lactation.
81. Data on a child born mother with HIV infection, carrying out antiretroviral prevention to a woman in childbirth and newborn, methods of delivery and feeding a newborn (with a contingent code) in the medical records of the mother and child and are transferred to the Center for the Prevention and Fight against AIDS Federation, as well as a children's clinic, in which the child will be observed.
- - Transformer bed;
- - Neonatal heated table;
- - anesthetically respiratory unit "Phase-23";
- - two consoles for resuscitation with centralized seeping of oxygen, nitrogen pump, vacuum and compressed air;
- - manipulative, instrumental tables;
- - bedside table, stool screw-shaped;
- - Stands for bikins, destructor;
- - fetal monitor;
- - Libra for a newborn;
- - electric cover for a newborn;
- - Medical stationary lamp;
- - Phone with internal communication;
- - Rack for systems;
- - trays for receiving newborns, for collecting placental blood, for manipulations, for waste groups "B"; Tanks for collecting used linen, for collecting waste "A", "B";
- - emergency call system
- - apparatus for measuring blood pressure;
- - Obstetric Stethoscope.
In a sterile bix for receiving childbirth:
- - 4 pelleys for a newborn;
- - wadded balls and gauze;
- - gauze napkins;
- - bracelets for a child;
- - tape measure;
- - Tools: anatomical tweezers, Kochher clamps, navelcale clamps, tweezers, Corncang, gynecological mirrors for inspection of the cervix of the girlfriend, amniotom.
The principle of organization of work is a stream. All branches are equipped with appropriate equipment and devices, medical tools, leases, medical furniture and equipment.
The work of the obstetric hospital is to provide qualified and specialized assistance to pregnant and maternity hospitals, care for healthy newborn during the adaptation period and providing timely qualified assistance to premature and sick children.
My job responsibilities include:
- 1. Care and monitor pregnancies and feminine and maternity hospitals on the basis of modern perinatal technologies in compliance with the principles of medical ethics and deontology.
- 2. Strictly perform sanitary-anti-epidemic mode.
- 3. Timely and accurately fulfill all the appointments of the doctor. In case of non-fulfillment of appointments, regardless of the cause, immediately report to the doctor.
- 4. Watch the condition of the fencers throughout the generic act, as well as in the early postpartum period. About any change in the state of the patients immediately inform the doctor.
- 5. Implement the condition and to fulfill the appointment of a doctor to women in Meltsovsky boxing.
- 6. Implement control over the work of the younger medical personnel, for carrying out the current and final disinfection of the premises.
- 7. Implement all medical supplies and technical equipment.
- 8. Clear medical records.
- 9. Rational and carefully use medical equipment, medicines, tools.
My rights:
- 1. Receive the information necessary to fulfill their duties.
- 2. Periodically increase their professional qualifications in improvement courses.
- 3. Take decisions within its competence.
- 4. Make sentences head. Department for the improvement of the organization and working conditions.
- 5. Do not allow the work of work on faulty equipment, immediately informing the manual.
A responsibility:
I am responsible for fuzzy or late fulfillment of duties stipulated by the official instructions, the rules of the internal regulation of the PC CO PC, the provisions on the generic department, as well as for the inaction or non-acceptance of the decisions within the scope of my competence.
I start my working day with a medical examination, which holds a duty officer: I measure the body temperature, the doctor inspects the nature of the skin and zev. The inspection data is entered into the daily medical examinations of personnel, where I put my signature. Having received admission to work, I carry out the entrance to the department through the SanPropuscan, I swallowed in clean sanitary clothes and shoes. I put on a clean bathrobe and flowing into the office.
Before starting work, I spend handling hands. Guided by Sanpin 2.1.3.2630-10, Hygienic handling of hands can be carried out in two ways:
- - washing hands with liquid soap and water to remove contamination and reduce the number of microorganisms;
- - Hand processing with an alcohol-containing skin antiseptic, to reduce the number of microorganisms to a safe level.
For hand washing, I use liquid soap using a dispenser. Hands my warm running water. Handicaping hands and subsequent rinse with water spend twice for two minutes. Upon completion of the washing of hands, I wipe it with a disposable napkins. Then I spend the handling of the hand with a skin antiseptic by rubbing it into the skin of the hands. The amount of skin antiseptic necessary for hand processing, multiplicity of processing and its duration is defined in guidelines for the use of a particular means.
After treating the hands, I take a shift: I learn from the duty officer of the midwife in the rozing, I measure the arterial pressure, I listen to the fetal heartbeat, I define the character of the fights, I consider the pulse, I ask patients with Passport details with the history of childbirth. I check the presence and terms of the shelf life of medicines, sterile solutions, tools, bikins for childbirth, the presence of disposable products (syringes, systems, catheters, systems for blood collection for analysis, masks, hats, etc.), the availability of laundry, controlling the documentation, Leading in the department: "Magazine of childbirth", "Magazine of Bakposev and histological research", "Journal of general cleaning", "Journal of accounting for quartz lamps", etc.
All work in the department is carried out in the interests of the mother and child. For this, the early attachment of the child to the breast of the mother, the parental is introduced in the Rablock, are in the co-stay of the "Mother and Child" boards, which is one of the components of the program "Hospital, friendly to the child." The program "Prepared Birth" is widely implemented.
Knowing the features of the experiences of the girlfriend, her personality, the midwife tactfully explains the patient not only its right, but also duties, tells in an appropriate examination for the patient about the necessary surveys, prepare for them, about the upcoming treatment.
All in the midwife should have a patient to them, starting with its appearance (tightness, accuracy, hairstyle, facial expression).
The duty of the midwife is to be honest and truthful in relation to the patient, but talk about the diagnosis, the peculiarities of childbirth can not go beyond the scope indicated by the attending physician. This applies to the conversations of the midwife with relatives of the patients.
It is important at least a couple of minutes to pay the patient before manipulation, - with good words to pass it out, encourage, remind about the need for calm behavior during manipulation.
Therefore, the midwife, helping the doctor, should exhibit high professionalism and deontological literacy. It should always be remembered that in front of you a living person with the whole range of painful sensations, experiences, fears and concerns about your health and health of the baby, and send their psychoprophylactic and psychotherapeutic activities to mitigate its suffering, mobilizing physical and mental efforts in the fight against pain.
Each childbirth is carried out strictly individually, i.e. In a separate rhodtle. There feminizers is from the date of receipt of the delivery to the completion of the early postpartum period. Upon receipt of the guinea to the roar of the bed, the bed is refilled, an individual vessel is issued having the same room with a spring. The staff complies with mask mode: mask4-layer closes the nose and mouth, changes every 3 hours.
See also the Regulation on the organization of the activities of the maternity hospital (separation), approved by the Order of the Ministry of Health and Social Development of the Russian Federation of March 27, 2006 N 197
Stationary obstetric assistance to the population is in maternity hospitals (independent) or maternity departments that are part of hospitals or health parts. The organization of their work is based on a single principle in accordance with applicable law on the situation of the maternity hospital (separation), orders, orders, instructions, instructions, instructions of higher health authorities and these guidelines.
The maternity hospital has the following structural units: hospital, female consultation, medical and diagnostic divisions and an administrative and economic part.
The structure of the maternity hospital (separation) must comply with the requirements of the construction standards and the rules of therapeutic and preventive institutions: equipment - the equipment table of the maternity hospital (separation); Sanitary and anti-epidemiological regime - existing regulatory documents.
In the maternity hospital (separation), it is necessary to have: eyeliner of hot and cold water, oxygen, sewage, stationary (portable) bactericidal irradiators. All branches should be equipped with appropriate equipment and devices, medical instruments, care objects, medical furniture and equipment, as well as dishes. Storing unnecessary furniture and unused equipment in the maternity hospital (separation) is strictly prohibited.
Hospital of the maternity hospital (separation) Includes: Receiving and Viewing Rooms and Discharge Premises, Generic Physiological Branch (Room Block Room), Department of Pathology of Pregnant women, postpartum physiological, observative, gynecological department and branch of newborns. The gynecological department according to indications is hospitalized for the operational treatment of patients who do not suffer from purulent-inflammatory processes of genitals or malignant neoplasms. As part of a maternity hospital or a multidisciplinary hospital, the maternity and gynecological department is recommended, if possible, be placed in different buildings; The body of the maternity departments should be aside from the infectious hospital, laundry and food processor.
Through the reception and observation premises of the obstetric departments, only pregnant and feminine are coming. For receiving gynecological patients, a separate receiving room is functioning.
In these guidelines, specific recommendations for organizing the work of the obstetric departments (chambers) and departments (chambers) of newborns are presented.
Equipment, equipment and organization of the work of structural divisions (chambers) of the maternity hospital (separation) Filter room.
In the filter room, there is a couch covered with a glue, a table, chairs, a bedside table, a wardrobe for temporary storage of women's clothing (before renting to the warehouse) entering the maternity hospital, safe for the storage of values \u200b\u200band money of pregnant women and women in labor.
The bedside table has a container with thermometers, fully immersed in a disinfecting solution, and an enameled kid's basin * (1) for storing thermometers; Disinfection boiler * (2) (desirable electric) with boiled metal spatulas (it is possible to use wooden spatulas of disposable use); The tray for used spatulas and a dark glass or porcelain sterile jar with a triple solution, which contains pre-sterilized (every 3 hours) Corncang. Triple solution change 2 times a day. Inside the bedside table stored disinfixed slippers. It is also necessary to have a round sterilization box. * (3) With a sterile rag, a tightly closing enamel container (0.5-1.0 l) with a disinfectant solution, a reflector lamp for skin inspection.
The filter room is estimated with the general state of the incoming woman, the body temperature is measured, the skin inspection using a reflector lamp, zea with a spatula, is counted with a pulse, the blood pressure on both hands are measured. The doctor or midwife get acquainted with a woman's exchange card, find out infectious inflammatory diseases to and during real pregnancy and especially before entering the maternity hospital (separation). Find out the presence of chronic inflammatory diseases, the duration of anhydrous gap, after which the issue of hospitalization in physiological or in the observed obstetric department is solved. If pregnant and fencers have diseases in which hospitalization in the maternity hospital (obstetric department) is contraindicated, the current regulatory documents should be guided by existing regulatory documents.
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