Structure of obstetrics in Russia

Structure of obstetrics in Russia

The main maternity hospitals in the cities are clinics and maternity hospital. Previously, these institutions have been merged. In some areas, these associations persist or renewed, many women's clinics are a structural subdivision of outpatient services. Women's consultation can be an independent institution.

Maternity hospitals, like any public health facilities (GOOSE), subject to regional, territorial or municipal committee on health. Municipal Committee under the Ministry of Health. Similar structures exist in the control regions, territories, republics of Russia. But the main body of the health care system is the Ministry of Health of Russia. Each institution has a department head for the protection of mothers and children, established the office of the chief specialist in obstetrics and gynecology. Russian chief obstetrician is currently Academician VI Kulakov.

Clinic medical institutions, perinatal centers republican and federal report directly to the Ministry. There obstetric institutions subordinated to the Academy of Medical Sciences, other departments such as the Ministry of Railways.

The main document on which work was organized antenatal is Order number 50 dated 10 February 2003 "On improvement of obstetric care in outpatient clinics." It sets out the problem of female consultation, forms of work and documentation. Position given by the organization of supervision and care for pregnant women, childbirth, gynecologic patients, including women workers of industrial enterprises and resident of the village. Recommendations for evaluation of prenatal risk factors.
Organization of work maternity hospital built by the Order № 55 of January 9, 1986 "On the organization of maternity homes (units)." It is prescribed in order hospitalization maternity hospital, maternity home organization of work detailing offices, describes some methods of examination techniques used during delivery.

Despite the fact that these orders are essentially obsolete, they contain a lot of rational recommendations.

Women's consultation is the medical institution providing outpatient obstetric care.
The main purpose of consultation is to protect women's maternal and child health by providing qualified outpatient obstetric care during pregnancy and the postpartum period, family planning services and reproductive health, women's health.

Organisation antenatal are
• provide obstetrical care for women during pregnancy and the postpartum period, in preparation for pregnancy, childbirth and the postpartum period;
• preventive gynecological examinations to detect gynecological, gynecological cancer and sexually transmitted diseases, sexually transmitted infections;
• the use of additional diagnostic methods to clarify the nature of obstetric and gynecological pathology;
• providing treatment and medical examination of gynecological patients;
• providing counseling and services in family planning, contraception, prevention of abortion;
• provide social and legal assistance in accordance with the legislation on the protection of maternal and child health;
• activities to enhance knowledge in the field of sanitary ware culture and reproductive health;
• providing obstetric care in a day hospital and specialized obstetrical techniques.

Working in the antenatal clinic obstetricians-gynecologists and midwives to serve the district principle of land with all the women of their gynecological and obstetric problems. The plot where the lives of the adult population 6000, served one doctor and one midwife. Typically, women's clinic runs from 10 to 20 sites.
To advise pregnant women in antenatal clinics are state therapist, optometrist, dentist. At the clinic, offices should be receiving obstetric, gynecological, and treatment rooms, a study of ultrasound diagnostics, physiotherapy, laboratory space for classes with pregnant to prepare them to leave, facilities for day care professionals' offices, operating small outpatient gynecological operations, reception, Closet, lobbies for visitors, sanitary and service offices and other premises.

Spearheading antenatal main enemy (or head), directs the work of midwives senior midwife.

On the site operates under the supervision of a midwife doctor, along with the doctor is receiving patients, following the registration of medical records, clinical examination of pregnant women, postpartum women, gynecological patients, conducts nursing and health education, makes a report, study and prepare to receive the tools and is responsible for ensuring sanitary-epidemic regime. With regard to pregnant women with normal pregnancy midwife permitted to self-administration, if necessary - to consult with your doctor.
Midwives can and should conduct classes to prepare pregnant women for childbirth, hygiene pregnant. Midwife can work in the treatment room, day hospital, in the office of family planning.

Obstetric hospitals, institutions for inpatient obstetric care: maternity or obstetric departments of hospitals.
Tasks obstetric hospital: assessment and treatment of pregnant women with pathology, pregnant women for childbirth preparation, assisting women and newborns during childbirth and the postpartum period.

Maternity hospital has the following departments:
• receiving and transmission unit;
• antenatal department or the department of pathology pregnant;
• maternity ward;
• physiological postpartum unit;
• Newborn (or wards for newborns, because in modern maternity hospitals in rooming mother and child need to separate the newborn disappears);
• observational obstetric department (and its maternity wards, neonatal wards, postnatal wards) - is the separation of internal observation, since knowingly infected women should act maternity homes with external observation;
• in some maternity hospitals may be gynecological departments;
• in addition to the clinical departments should be operational unit, laboratory, pharmacy, physiotherapy department, central sterilization department (CSSD) housekeeping part.

Structure obstetric units such as general hospitals, but instead of branches - the posts, units or wards. In the context of multi-disciplinary hospital more difficult to prevent nosocomial infection, but it is easier to organize the help of experts in every field, any complex examination, provision of medicines, blood, diagnostic and surgical equipment.

Pregnant in the first half of pregnancy may provide treatment not only in obstetrics, but also in the gynecological hospital or office.
Obstetric hospitals differ in the number of beds, offices and on the profile. Distinguish maternity (Branch):
- For healthy women surveyed (maternity general);
- For the examined women with obstetric and ekstragenitalnoy pathology, but without infection (specialized maternity hospitals);
- For unsurveyed and infected women (maternity homes with external observation). Infected women with especially dangerous infections in the acute stage (syphilis, AIDS, tuberculosis, hepatitis, intestinal infections, diphtheria, and others) should be sent to obstetric department of infectious hospital.

Headed by the chief enemy of the maternity ward, which are substituents on medical work (nagmed) and administrative part. Home midwife is also the Deputy Chief Medical Officer for the organization of middle and junior staff, infection control, control for a medical equipment and many other important issues. It should have a high level of education, qualifications and extensive experience, administrative abilities.

At the head of each department are heads of departments, which are generally responsible for the operation of medical office and supervise the work as Vice - senior midwife in charge of the work of middle and junior staff, equipment and procedure at the department.
Practical enemies carry medical-diagnostic (examination, surgery) and preventive (conversation sessions with staff) work.

Midwives working in all departments, performing under the supervision of a physician treatment and preventive work: conduct general and specialized care, obstetrical benefits, sanitation conversation, perform prescription, provide emergency first aid, assisted by the doctor at his diagnostic and surgical work, and prepare diagnostic treatment rooms and operating responsible for the prevention of nosocomial infection.

Midwife first meets a woman at the front desk and watches her last before discharge from postpartum staff. The duties of a midwife includes registration and storage of large quantities of medical records. In maternity hospitals in large cities due to sufficient medical staff work largely controlled by doctors. However, the midwife, as well as a doctor, a specialist in obstetrics, women performing at delivery major obstetrical benefits. In obstetrics each performing their duties, working in concert, and the doctor, midwife trusting more autonomy when dealing with healthy women (care, educational work) and perform those benefits obstetric owned midwife, more attention can be given to women with pathology.

Janitorial work, handling tools, transportation, nutrition patients carries junior staff. Midwife monitors the work of junior staff.
There are large perinatal centers, research institute and hospital obstetric and gynecological, which carried out the research work, assisted patients with the most complex pathology of instruction and improvement of doctors and midwives.

Recently there were self-supporting obstetric department, which provided a large selection of health care providers to create a more comfortable environment than public institutions. However, in our country is and should remain a guarantee of free, accessible, quality skilled care to women in connection with pregnancy and childbirth, and self-sustained development of unacceptable forms of service to the detriment of the free, because it infringes on the rights of women unsecured. Job antenatal and maternity closely linked not only among themselves but also with the work sanepidemstantsii, STI clinic, ambulance and child health clinics.

Help women living in the area.

- 1st stage. Felshersko and obstetric point (FAP), which has a pre-medical first aid. Midwife FAP provides preventive and emergency care to pregnant women, women, childbirth, newborn. FAP works only on the nursing staff. For medical advice or a pregnant woman goes to the next stage, or from the area are invited to consult the doctor. All mothers, especially at risk, living in remote areas should be routinely hospitalized in advance obstetric department.

- 2nd stage. District Hospital - at this stage can be provided medical obstetric care as an outpatient and inpatient. However, in these hospitals can be only one obstetrician-gynecologist. Therefore, both the first and second stages are very important and responsible activity midwife who often work independently to carry out emergency care, especially in remote areas under difficult weather or road conditions, it is not possible to transport the woman to hospital or to provide medical assistance call.

Third stage. Central District Hospital, where there OBGYN department. Here around the clock specialized obstetric care.
At the 2nd and 3rd stages can be arranged antenatal clinics and maternity homes.

4 - Stage. Regional District Hospital, where there are specialized obstetrical and gynecological departments. In such offices hospitalized women with severe pathology, in which consultation is necessary not only highly qualified specialists in obstetrics, but also in other medical specialties. Regional hospitals - centers to provide preventive and curative care to patients with the most severe pathology, but it is also a center for research and training.

Performance of obstetric services. The main indicators by which one can judge the quality of maternity services are maternal and perinatal mortality.

Maternal mortality is calculated per 100 thousand live births of children (live births). A maternal death is defined as caused by pregnancy (regardless of its duration and location) woman's death occurring during pregnancy or within 42 days of termination from any cause related to pregnancy, aggravated by or its management but not from accidental or incidental causes.

Among the causes of maternal mortality, the most probable are obstetric hemorrhage, gestational toxicosis, extragenital pathology, ectopic pregnancy, septic complications, etc.

Annually in the world due to complications of pregnancy and childbirth kills about 600 thousand women. Average mortality rates in the world - about 430-450 cases per 100 thousand live births born children. Particularly high mortality in Africa (mainly in Eastern and Western), where these more than 1000 cases per 100 thousand,
ie, almost 1% of pregnant women dies. This is due to the lack of skilled care in these areas. Least of all women from complications of pregnancy and childbirth killed in Northern Europe, North America, Australia and New Zealand, where the figures are 11-12 per 100 thousand live births.

In Russia, the average maternal mortality rate in recent years is about 55 per 100 thousand, and these figures are lower in Karelia, Yaroslavl, Bryansk, Lipetsk, Voronezh, Penza, Arkhangelsk Oblast, Komi Republic, in St. Petersburg and Leningrad region. Higher rates of maternal mortality in Sakhalin, in the Republic of Tuva, in the Far East. This is due to severe environmental conditions, problems of huge territories. In such areas, especially great responsibility midwives.

Perinatal mortality is calculated on 1000 births. It includes stillbirth (fetal death during pregnancy and childbirth), and early neonatal death (death of the newborn within 168 hours after birth, or 7 days).

Average perinatal mortality rate in the world is 60 per 1,000. Above all perinatal mortality in less developed countries, especially in East Africa, where the rate is higher than 100 in 1000, ie 10%, and lowest - in the Nordic countries, where perinatal mortality is equal to 3.7 by 1000. in Russia, the average perinatal mortality rate is 14 per 1,000. Deviations for better and worse - in the same areas as the maternal mortality ratio. Perinatal mortality in St. Petersburg is 7 per 1000, and maternal - 14 100 thousand

Therefore, you must continue to improve to assist women and children to reduce perinatal and maternal morbidity and mortality. A huge responsibility in this work rests with the midwives.