Lecture: "The organization of ambulatory obstetric and gynecological services. The role

of general practitioners in reproductive health and family "

Lecturer Ph.D. G.M. MuldaevaDiscipline, "General medical practice"Specialty 051 301 "General Medicine"

course V

The purpose of the lecture: To study the strategy of modern obstetrics. Women's health in the RK.

• Plan lectures:• principles of organization of the gynecological

department, risk assessment in accordance with various nosologies;

• producing specialized inspection, to determine the indications for hospitalization and further formation of risk groups, foundations San clearance work on promoting healthy lifestyles.

• The main objectives of the antenatal clinic.

• The leading element in the system of health facilities providing outpatient obstetric care is the women's consultation. Most of the women's consultation is part of the maternity hospital, clinic or medical unit. Only a few consultations are separate entities.

• The work is based on antenatal clinic-territorial precinct to the principle that every physician assigned a specific area with a population of female population 4000-4500 people. Currently, there is a gradual downsizing of the territorial areas. On the site work obstetrician-gynecologist and a midwife (nurse).

The main objectives of the antenatal clinic are as follows:

• Curative and preventive care for pregnant and postpartum women;

• Physio-psychological prophylactic preparation for childbirth pregnant;

• treatment and preventive care for gynecological diseases;• health education;• study of the conditions of women working in industry, in

order to protect their health;• preventive examinations of the female population;• the fight against abortion;• social and legal assistance

• Some of the women's clinic premises consists of: entrance hall, cloakroom, reception, offices of district obstetricians, physicians, dentists and medical consultants, procedural for vaginal manipulation, procedural for intramuscular and intravenous injections, operating outpatient operations, colposcop, a room for processing and sterilization of instruments, room for physio-psycho prophylactic preparation for childbirth pregnant, studies of female head of the consultation, the senior nurse, a lawyer.

In the dispensary observation identified two groups of women based on pregnancy and general health.

• The first group consists of healthy women with physiological pregnancy. Among them, in consultation carried out mainly preventive work.

• The second group includes women with obstetric disease or extragenital diseases. This increased risk to mother and fetus need more research in counseling, clinic, and often specialized in maternity institutions. Individual maps of pregnant women at high risk are stored in a file cabinet signal to the general procedure, but they have special marking that is marked by special colored icons (flags) that are attached to the front page of the card.

• For every pregnant woman in the antenatal clinic, in addition to individual cards, get exchange card that issue in the hands of a woman with a pregnancy 30 weeks. Exchange card consists of 3 major passes and is designed for the mutual information antenatal and obstetric hospital on the nature of pregnancy and childbirth.

• In the first ticket, "Information about pregnant women's clinic" - reflects the clinical history, examination and monitoring during pregnancy. This ticket is stored in the history of childbirth.

• The second pass - "Information maternity ward, maternity ward of the hospital childbirth" - fill in the maternity hospital before discharge, women and give her hand to send to the antenatal clinic.

• The third card - "Information maternity ward, maternity department of the hospital of the newborn" - fill in the maternity hospital before you leave the baby and give the mother to transfer the children's clinic.

• The duties include the organization of prenatal care childbirth. The first woman in childbirth attendance in counseling is recommended in 7 to 10 days after discharge from hospital. If there is no indication for more frequent visits, repeat visits to designate a month after discharge.

• The most important task is to organize the prenatal care of gynecological patients.

• Identification of gynecological patients by a variety of ways:

• when handling the women themselves to the antenatal clinic,

• during routine inspections.

• The majority of patients subjected to screening and treatment in the antenatal clinic. When you contact a woman in an antenatal clinic completed an outpatient gynecological patient card. A certain group of women after diagnosis in a planned or emergency basis shall be sent for further examination and treatment in hospital.

• Patients in need of systematic observation and treatment, are subject to medical examination.

• The duties of physician prenatal direction is women abortion if they wish to terminate a pregnancy if the period of not more than 12 weeks for medical reasons or for diseases burdening during pregnancy, birth and fetal development.

• In the women's clinic performed abortions and prevention by education and outreach, advocacy, and contraceptive use. To educate women with contraceptive methods in consultation organize exhibitions of contraceptives. Currently in pre-natal appointment or arrange a special room for the training methods of contraception. Every woman, a convert to this study, recommend contraception, the most effective for her, harmless and affordable.

• The leading element in the system of health facilities providing outpatient obstetric care is the women's consultation. Most of the women's consultation is part of the maternity hospital, clinic or medical unit. Only a few consultations are separate entities.

• The work is based on antenatal clinic-territorial precinct to the principle that every physician assigned a specific area with a population of female population 4000-4500 people. Currently, there is a gradual downsizing of the territorial areas. On the site work obstetrician-gynecologist and a midwife (nurse).

The main objectives of the antenatal clinic are as follows:

• curative and preventive care for pregnant and postpartum women;

• physio-psychological prophylactic preparation for childbirth pregnant;

• treatment and preventive care for gynecological diseases;• health education;• study of the conditions of women working in industry, in

order to protect their health;• preventive examinations of the female population;• the fight against abortion;• social and legal assistance.

• Some of the women's clinic premises consists of: entrance hall, cloakroom, reception, offices of district obstetricians, physicians, dentists and medical consultants, procedural for vaginal manipulation, procedural for intramuscular and intravenous injections, operating for ambulance operations, colposcopal, a room for processing and sterilization of instruments, room for physio-psycho prophylactic preparation for childbirth pregnant, studies of female head of the consultation, the senior nurse, a lawyer.

• One of the achievements of mothers and children in our country is a medical check-up of all women during pregnancy and after childbirth.

• This means that a district gynecologist takes account of all pregnant women of their district and provide supervision for them by assigning exact dates of attendance. All information entered in the pregnant woman a special card - "Individual card pregnant and postpartum women." These cards are in the office of the local doctor roster are the signal, the main purpose of which - to signal non-attendance of pregnant women's clinic at the appointed time.

• Card is recommended to have on days scheduled next visit. Box (or shelf) to store the individual cards is divided into 33 cells, which bear a number from 1 to 31. These figures correspond to the numbers of the month. After visiting cards pregnant transferred into the cell, the corresponding day of the regular turnout. At the end of the reception is easy to identify pregnant women that did not appear at the reception. These cards are placed in the 32th cell in the box marked "Patronage." Maps of birth and patient care to be placed in the 33 th cell marked "woman in childbirth."

• In the dispensary observation identified two groups of women based on pregnancy and general health.

• The first group consists of healthy women with physiological pregnancy. Among them, in consultation carried out mainly preventive work.

• The second group includes women with obstetric disease or extragenital diseases. This increased risk to mother and fetus need more research in counseling, clinic, and often specialized in maternity institutions. Individual maps of pregnant women at high risk are stored in a file cabinet signal to the general procedure, but they have special markings, ie, the designated special colored icons (flags) that are attached to the front page of the card.

For every pregnant woman in the antenatal clinic, in addition to individual cards, get exchange card that issue in the hands of a woman with a pregnancy 30 weeks.

Exchange card consists of 3 major passes and is designed for the mutual information antenatal and obstetric hospital on the nature of pregnancy and childbirth.

• In the first ticket, "Information about pregnant women's clinic" - reflects the clinical history, examination and monitoring during pregnancy. This ticket is stored in the history of childbirth.

• The second pass - "Information maternity ward, maternity ward of the hospital childbirth" - fill in the maternity hospital before discharge, women and give her hand to send to the antenatal clinic.

• The third card - "Information maternity ward, maternity department of the hospital of the newborn" - fill in the maternity hospital before you leave the baby and give the mother to transfer the children's clinic.

• Working women in the 30 weeks of pregnancy, women's consultation shows "Designed for temporary disability," which is issued on the basis of pre-natal leave.

• One important objective of the antenatal clinic is physio-psycho prophylactic preparation for childbirth pregnant. This training is a system of measures aimed at eliminating negative emotions, the removal of the pregnant fear of childbirth, involving the active participation in a family act.

• Physio-psychological prophylactic training is from the very beginning of pregnancy, especially during the intense pre-delivery leave.

• The duties include the organization of prenatal care childbirth. The first woman in childbirth attendance in counseling is recommended in 7 to 10 days after discharge from hospital. If there is no indication for more frequent visits, repeat visits to designate a month after discharge.

• The most important task is to organize the prenatal care of gynecological patients.

Identification of gynecological patients by a variety of ways:

• when handling the women themselves to the antenatal clinic.• during routine inspections.

• The majority of patients subjected to screening and treatment in the antenatal clinic. When you contact a woman in an antenatal clinic completed an outpatient gynecological patient card. A certain group of women after diagnosis in a planned or emergency basis shall be sent for further examination and treatment in hospital.

• Patients in need of systematic observation and treatment, are subject to medical examination.

• These include women who have been identified neoplasms of genital organs, background and precancerous lesions (polyps, cervical erosion, leukoplakia, etc.), recurrent chronic inflammatory disease of the uterus and appendages, menstrual disorders, etc.

• The duties of physician prenatal direction is women abortion if they wish to terminate a pregnancy if the period of not more than 12 weeks for medical reasons or for diseases burdening during pregnancy, birth and fetal development.

• In the women's clinic performed abortions and prevention by education and outreach, advocacy, and contraceptive use. To educate women with contraceptive methods in consultation organize exhibitions of contraceptives. Currently in pre-natal appointment or arrange a special room for the training methods of contraception. Every woman, a convert to this study, recommend contraception, the most effective for her, harmless and affordable.

• Social and legal assistance. The duties of a lawyer on the staff of the antenatal clinic, is to explain to women the Soviet law on the protection of the rights and maternal and child health, control over observance of all the benefits provided by law. In addition, a lawyer in the administration of the company shall take measures in respect of employment of pregnant women, nursing mothers and women patients.

• The work of nurses in the antenatal clinic.• The entire volume of therapeutic and preventive care physicians

perform prenatal conjunction with midwives or nurses, who, like doctors, are assigned to a particular site.

• It is the responsibility of district midwives or nurses is an active provider in the organization and conduct of all work on the site. For this district nurses should be familiar with features of the site and actively involve women to visit a doctor.

• The nurse helps the local doctor during the reception of pregnant women and gynecologic patients. Before you start taking it prepares the cabinet, tools, and medical records. By the time the doctor arrived in the office should be measure the pelvis, measuring tape, obstetrical stethoscope, stethoscope, the apparatus for measuring blood pressure, oilcloth or paper chock. On the table for instruments should be placed sterile vaginal mirror, forceps, long tweezers, probes for pap smears. On a separate table should be prepared in sterile material slut - cotton balls, swabs, sticks, gloves, and glasses for the taking of smears needed medicines: 96 ° ethanol, 5% solution of tincture of iodine, 5% solution of potassium permanganate, furatsilin (1 5000), 1% solution of brilliant green alcohol, sterile solutions for the medical swabs.

• Before taking the nurse must bring to the office of the registry hospital records to make an appointment gynecologic patients and to pick up the signal from filing individual cards of pregnant and postpartum women who are assigned to this day attendance in antenatal clinics.

• The nurse is obliged to prepare forms for recipes, directions for tests on the advice of specialists, hospitalization, paper accompanying notes. It should weigh and measure them pregnant blood pressure (both arms) to examination by a doctor, and the data written in the individual map. During the reception nurse actively helps the doctor: women's causes in turn, participates in the inspection, gives tools, complete as directed by the physician medical records.

• Precinct sister has to master some of the diagnostic methods and technique of the individual treatments. She alone makes the measurement of the pelvis pregnant abdomen circumference and height of uterine fundus standing, applies special techniques outdoor obstetrical examination. One of the duties of a nurse is a women's clinic smears from different parts of the urogenital system of the woman and holding of medical gynecologic procedures.

• In a large antenatal clinics provided with separate treatment rooms. They specially trained nurses work alone treatment.

• After receiving a nurse prepares for the next sterilization tools and material checks for drugs and supplements them sent to a laboratory for the analysis of combined materials. Medical records from the glued tests again placed in the files according to the day following the appearance or the reception.

• A nurse directs the work of nurses, in particular, checks the quality of cleaning the cabinet.

• Under the patronage of the nurse should ensure the correct implementation of the sick doctor's prescription, to attract women to the inspection of an obstetrician-gynecologist and get acquainted with the living conditions of women in her area.

• Nurse while visiting women at home have to perform not only preventive but also therapeutic and diagnostic work, and therefore she must have with them a bag of patronage tonometer, phonendoscope, obstetric stethoscope, measuring tape, tubes for boiling urine.

• Nurses can carry out physio-psycho prophylactic preparation for childbirth pregnant, having previously specialized training.

• A nurse must take an active part in health education antenatal clinic. The nurse as a doctor at least 4 hours per month to spend on this section of work.

• Nurses trained in legal matters in the field of maternal and child participate in social and legal assistance to women.

• The entire volume of therapeutic and preventive care physicians perform prenatal conjunction with midwives or nurses, who, like doctors, are assigned to a particular site.

• It is the responsibility of district midwives or nurses is an active provider in the organization and conduct of all work on the site. For this district nurses should be familiar with features of the site and actively involve women to visit a doctor.

• The nurse helps the local doctor during the reception of pregnant women and gynecologic patients. Before you start taking it prepares the cabinet, tools, and medical records. By the time the doctor arrived in the office should be measuring of pelvis, measuring tape, obstetrical stethoscope, stethoscope, the apparatus for measuring blood pressure, oilcloth or paper chock. On the table for instruments should be placed sterile vaginal mirror, forceps, long tweezers, probes for pap smears. On a separate table should be prepared in sterile material slut - cotton balls, swabs, sticks, gloves, and glasses for the taking of smears needed medicines: 96 ° ethanol, 5% solution of tincture of iodine, 5% solution of potassium permanganate, furatsilin (1 5000), 1% solution of brilliant green alcohol, sterile solutions for the medical swabs.

• The nurse is obliged to prepare forms for recipes, directions for tests on the advice of specialists, hospitalization, paper accompanying notes. It should weigh and measure them pregnant blood pressure (both arms) to examination by a doctor, and the data written in the individual map. During the reception nurse actively helps the doctor: women's causes in turn, participates in the inspection, gives tools, complete as directed by the physician medical records.

• Precinct sister has to master some of the diagnostic methods and technique of the individual treatments. She alone makes the measurement of the pelvis pregnant abdomen circumference and height of uterine fundus standing, applies special techniques outdoor obstetrical examination. One of the duties of a nurse is a women's clinic smears from different parts of the urogenital system of the woman and holding of medical gynecologic procedures.

• In a large antenatal clinics provided with separate treatment rooms. They specially trained nurses work alone treatment.

• A nurse must take an active part in health education antenatal clinic. The nurse as a doctor at least 4 hours per month to spend on this section of work.

• Nurses trained in legal matters in the field of maternal and child participate in social and legal assistance to women.

• Gynecological inpatient care provided in the gynecology department, which is usually part of the somatic hospital, health unit or maternity home. In some major cities are independent gynecological hospital. Depending on the profile of the gynecology department may enter into various specialized hospitals: Cancer, tuberculosis, endocrinology, etc.

Gynecology department general is usually divided into two isolated one from another department:

• for patients needing surgical treatments• for patients requiring conservative treatment methods.• In the gynecology department also allocated a separate bed for termination of pregnancy.• Any gynecological clinic should have• separate receiving part,• Chamber• observation,• bandaging,• treatment (manipulation)• dining room,• room of personnel• on duty nurses• room for washing and drying boats ,• lavatories and other facilities.• In the Department to provide surgical care includes operating unit:• large and small operating,• endoscopic,• preoperative and• postoperative ward.

Literatures• Handbook of obstetrics and gynecology for medical assistants and

midwives: ed. V.N. Prilepsky, V.E. Radzinsky - Moscow, 2007. - 688.• Radzinsky V.E. Obstetrics: a textbook + CD. M., 2008. - 432.• more:• Mukhina S.A., Tarnovskaya I.I. Practical guide to the subject

"Fundamentals of Nursing", Moscow, 1998.• Ivanov V.I., Matveychik T.V. The organization of nursing, Minsk,

2006.• The magazine "Nurse."• The journal "Medical Care."• The journal "Nursing".

Control questions

• The structure of the prenatal• Organization of prenatal• The structure of genetic counseling• Performance data structures• Formation of dispensary groups• Prevention of maternal mortality• Identifying levels of risk pregnant women on maternal mortality• Prevention of perinatal mortality• Identifying levels of risk for perinatal mortality of pregnant• Fundamentals of genetic counseling as the basis of prevention

of hereditary diseases