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Maternity hospital equipment standard. Structure of obstetric hospitals and provision of care to pregnant women

  • - transformable bed;
  • - neonatal table with heating;
  • - anesthesia-respiratory apparatus “Faza-23”;
  • - Two consoles for resuscitation with centralized supply of oxygen, nitrous oxide, vacuum and compressed air;
  • - manipulation and instrumental tables;
  • - bedside table, screw-shaped chair;
  • - stands for bixes, destructor;
  • - fetal monitor;
  • - scales for a newborn;
  • - electric suction for a newborn;
  • - medical stationary lamp;
  • - telephone with internal communication;
  • - rack for systems;
  • - trays for receiving newborns, for collecting placental blood, for manipulations, for waste of group “B”; containers for collecting used linen, for collecting waste of groups “A”, “B”;
  • - staff emergency call system
  • - apparatus for measuring blood pressure;
  • - obstetric stethoscope.

The sterile delivery kit includes:

  • - 4 diapers for a newborn;
  • - cotton balls and gauze;
  • - gauze napkins;
  • - bracelets for a child;
  • - measuring tape;
  • - instruments: anatomical tweezers, Kocher forceps, umbilical scissors, tweezers, forceps, gynecological speculum for examining the cervix of a woman in labor, amniotome.

The principle of work organization is flow. All departments are equipped with appropriate equipment and devices, medical instruments, care items, medical furniture and equipment.

The work of the obstetric hospital is to provide qualified and specialized care to pregnant and postpartum women, care for healthy newborns during the adaptation period and provision of timely qualified care to premature and sick children.

My job responsibilities include:

  • 1. Carry out care and monitoring of pregnant women and women in labor and postpartum on the basis of modern perinatal technologies in compliance with the principles of medical ethics and deontology.
  • 2. Strictly implement the sanitary and anti-epidemic regime.
  • 3. Follow all doctor’s orders in a timely and accurate manner. In case of non-compliance with the instructions, regardless of the reason, immediately report this to the doctor.
  • 4. Monitor the condition of women in labor throughout labor, as well as in the early postpartum period. Immediately notify the doctor of any change in the patient’s condition.
  • 5. Monitor the condition and carry out doctor’s prescriptions for women in the Meltzer box.
  • 6. Monitor the work of junior medical personnel and the ongoing and final disinfection of premises.
  • 7. Handle all medical supplies and technical equipment.
  • 8. Accurately maintain medical records.
  • 9. Use medical equipment, medicines, and instruments rationally and carefully.

My rights:

  • 1. Obtain the information necessary to perform your duties.
  • 2. Periodically improve your professional qualifications through refresher courses.
  • 3. Make decisions within your competence.
  • 4. Make suggestions to the manager. department for improving organization and working conditions.
  • 5. Do not allow work to be carried out on faulty equipment, immediately notifying management about this.

Responsibility:

I am responsible for unclear or untimely fulfillment of duties stipulated by the job description, internal regulations of the State Health Institution “PC SO”, regulations on the maternity department, as well as for inaction or failure to make decisions within the scope of my competence.

I start my working day with a medical examination, which is carried out by the doctor on duty: I measure my body temperature, the doctor examines the nature of the skin and pharynx. The examination data is entered into the Staff Daily Medical Examination Log, where I sign. Having received permission to work, I enter the department through a sanitary checkpoint and change into clean sanitary clothing and shoes. I put on a clean robe and go into the department.

Before starting work, I sanitize my hands. Guided by SANPiN 2.1.3.2630-10, hand hygiene can be carried out in two ways:

  • - washing hands with liquid soap and water to remove contaminants and reduce the number of microorganisms;
  • - treating hands with an alcohol-containing skin antiseptic to reduce the number of microorganisms to a safe level.

To wash my hands I use liquid soap using a dispenser. I wash my hands with warm running water. I wash my hands and then rinse with water twice for two minutes. After washing my hands, I wipe them dry with disposable wipes. Then I treat my hands with a skin antiseptic by rubbing it into the skin of my hands. The amount of skin antiseptic required for hand treatment, the frequency of treatment and its duration are determined in the guidelines for the use of a specific product.

After washing my hands, I take my shift: I find out from the midwife on duty the number of women in labor in the delivery room, measure the mothers’ blood pressure, listen to the fetal heartbeat, determine the nature of the contractions, count the pulse, ask the patients for passport information, and check with the birth history. I check the availability and expiration dates of medications, sterile solutions, instruments, childbirth bags, the availability of disposable products (syringes, systems, catheters, systems for drawing blood for analysis, masks, caps, etc.), the availability of linen stock, I control documentation, kept in the department: “Journal of childbirth”, “Journal of bacterial cultures and histological studies of placentas”, “Journal of general cleaning”, “Journal of recording the operation of quartz lamps”, etc.

All work in the department is carried out in the interests of the mother and child. For this purpose, early attachment of the child to the mother’s breast has been introduced in the maternity unit; postpartum women are in the “Mother and Child” co-stay rooms, which is one of the components of the “Baby-Friendly Hospital” program. The “Prepared Childbirth” program is being widely introduced into practice.

Knowing the peculiarities of the mother's experiences and her personality, the midwife tactfully explains to the patient not only her rights, but also her responsibilities, talks in a form accessible to the patient about the necessary examinations, preparation for them, and the upcoming treatment.

Everything about the midwife should attract the patient, starting with her appearance (fitness, neatness, hairstyle, facial expression).

The midwife's duty is to be honest and truthful with the patient, but conversations about the diagnosis and the peculiarities of childbirth cannot go beyond the scope outlined by the attending physician. This also applies to conversations between midwives and patients’ relatives.

It is important to devote at least a couple of minutes to the patient before the manipulation - to admonish her with kind words, encourage her, and remind her of the need for calm behavior during the manipulation.

Therefore, when helping a doctor, a midwife must show high professionalism and deontological literacy. You must always remember that in front of you is a living person with the whole range of painful sensations, experiences, fears and worries about your health and the health of the baby, and direct your psychoprophylactic and psychotherapeutic activities to mitigate her suffering, mobilize physical and mental efforts in the fight against pain.

Each birth is carried out strictly individually, i.e. in a separate delivery room. The woman in labor is there from the moment she is admitted for delivery until the end of the early postpartum period. When a woman in labor enters the delivery room, the bed is made up with clean linen, and an individual bedpan is issued, which has the same number as the delivery room. The staff observes the mask regime: a 4-layer mask covers the nose and mouth, changes every 3 hours.

At the entrance to the maternity ward, a box with sterile masks (color-coded, four-layer masks) and a dark glass jar with a sterile forceps in a triple solution (for taking masks from the box) are placed on the bedside table. The bags and masks are changed every 4 hours. On the wall, near the bedside table, is an hourly schedule for changing masks, indicating color coding for each shift. In the nightstand there is an enamel pan with a lid with a 1% chloramine solution for used masks.

Prenatal wards.

The number of beds should be 12% of the estimated number of beds in the postpartum physiological department, but not less than 2 beds.

In the prenatal ward there are beds painted with white enamel or nickel-plated, preferably functional ones, bedspreads (beds and bedsteads are marked with letters of the alphabet), stands for bedsteads, bedside tables, chairs or stools, an anesthesia machine for labor anesthesia using nitrous oxide, a machine for measuring blood pressure , obstetric stethoscope, pelvis gauge, measuring tape, “Malysh”, “Lenar” devices, etc.

To work in the prenatal ward at the midwife's station, it is necessary to have a bottle with a ground-in stopper with ethyl alcohol 95%, sterile syringes and needles in individual bags made of baggy, water-resistant paper (GOST 2228-81) or in bags (each syringe with needles is wrapped in rags) , forceps (sterilization in air sterilizers), an enamel pan with disinfected tips for enemas, 1-2 Esmarch mugs, 9 separate boxes with sterile sheets, padded diapers, pillowcases, shirts, cotton and gauze balls, rags, catheters, disinfected oilcloths. In the prenatal ward there should also be separate enamel containers for immersing syringes, enema tips, Esmarch mugs, containers with lids containing disinfectant solutions for treating medical instruments, equipment and hard equipment; an enamel saucepan with distilled water, a dark glass jar with a sterile forceps in a triple solution, a plastic or enamel jug for washing mothers in labor, a tray for waste material. Necessary medications are stored in a closet or safe.

The beds in the prenatal ward should be unmade, they are prepared immediately before the woman in labor enters. A disinfected mattress and pillow in a sterile pillowcase, a sterile sheet, a disinfected oilcloth and a sterile liner are placed on the disinfected bed. It is allowed to use mattresses in tightly sewn oilcloth covers, which are disinfected with disinfectant solutions. The blanket is processed in a steam-formalin chamber.

Upon admission to the prenatal clinic, 5-7 ml of blood from a vein is taken into a test tube from a woman in labor, the test tube is placed in a stand and the blood clotting time is noted on a strip of paper glued to the test tube, where the woman’s last name, first name and patronymic, birth history number, date and hour of collection are indicated. blood. The test tube is kept the entire time the mother is in the maternity ward in case serum is needed to conduct a compatibility test for blood transfusion.

If the exchange card or passport does not indicate the Rh factor of the mother's blood, it should be determined immediately after the woman's admission to the maternity hospital.

To avoid serious errors, the Rh status of the blood of the mother or fetus, as well as the bilirubin content of the newborn, should be determined by laboratory doctors or laboratory assistants specially trained for this. It is unacceptable to determine the Rh status of the blood of the mother or fetus by obstetricians-gynecologists or midwives on duty who do not have special training.

In the prenatal ward, the midwife on duty and, if available, the doctor on duty constantly monitor the condition of the woman in labor: at least after 3 hours, it is mandatory to record a diary in the birth history, which indicates the general condition of the woman in labor, complaints (headache, changes in vision, etc. .), blood pressure in both arms, pulse, nature of labor (duration of contractions, interval between contractions, strength and pain of contractions), position of the presenting part of the fetus in relation to the mother's pelvis, fetal heartbeat (number of beats per minute, rhythm, character of the heartbeat). At the end of the diary, you should definitely indicate whether amniotic fluid is leaking or not, the nature of the leaking water (light, green, mixed with blood, etc.). Each diary must be signed by a doctor (midwife).

A vaginal examination must be performed upon admission with a preliminary smear taken for flora if the amniotic sac is intact, as well as when amniotic fluid is discharged. In the 1st stage of labor, a vaginal examination should be performed at least every 6 hours in order to determine the dynamics of labor, diagnose deviations from the normal course of labor and promptly begin the necessary therapeutic measures.

If there are appropriate indications, vaginal examinations can be performed at any time interval.

Vaginal examinations should be performed in a specially designated room or in a small operating room in compliance with all rules of asepsis and antiseptics. In the presence of bloody discharge from the genital tract, when there is a suspicion of premature abruption of a normal or low-lying placenta, or placenta previa, a vaginal examination is performed with the operating room in full swing.


Main functions and tasks obstetric hospital(AS) - provision of qualified inpatient medical care to women during pregnancy, childbirth, the postpartum period, and gynecological diseases; provision of qualified medical care and care for newborns during their stay in the maternity hospital.

The organization of work in the AS is based on a single principle in accordance with the current regulations of the maternity hospital (department), orders, instructions, and methodological recommendations.

The structure and equipment of the plant must comply with the requirements of building codes and rules of medical institutions.

Currently, there are several types of speakers:

Without medical care (collective farm maternity hospitals and medical and obstetric centers);

With general medical care (local hospitals with obstetric beds);

With qualified medical care (RB, CRH, city maternity hospitals, obstetric departments of multidisciplinary hospitals, specialized obstetric departments based in multidisciplinary hospitals, obstetric hospitals united with departments of obstetrics and gynecology of medical institutes, research institutes, centers).

AS has the following main divisions:

Reception and access block;

Physiological (I) obstetric department (50-55% of the total number of obstetric beds);

Pregnancy pathology department (ward) (25-30%);

Newborn department (wards) in obstetric departments I and II;

Observational (II) obstetric department (20-25%);

-gynecological department (25-30%).

The structure of the premises of the maternity hospital must ensure the isolation of healthy pregnant women, women in labor, postpartum women and newborns from the sick, the strictest adherence to the rules of the sanitary-epidemiological regime, and the isolation of the sick. The plant is closed twice a year for routine disinfection, including once for cosmetic repairs. Visits to the AS by relatives and presence at childbirth are allowed only if appropriate conditions are met.

Persons entering work in the maternity hospital subsequently undergo a full medical examination in accordance with the order of the USSR Ministry of Health No. 555 dated September 29, 1989. All personnel were taken for clinical observation for the timely detection and treatment of chronic inflammatory diseases of the nasopharynx, skin, identification and caries treatment. Personnel examination by specialists (therapist, surgeon, neurologist, ophthalmologist, otolaryngologist, dentist) is carried out once a year, examinations by a dermatovenerologist - quarterly. Medical personnel take blood tests for HIV twice a year and RW tests quarterly; twice a year - for the presence of Staphylococcus aureus.

Medical personnel with inflammatory or pustular diseases, malaise, or fever are not allowed to work. Every day before work, the staff puts on clean special clothes and shoes. The staff is provided with individual lockers for storing clothes and shoes. In the maternity ward and operating rooms, medical staff wear masks, and in the neonatal ward - only during invasive procedures. Wearing masks is mandatory in case of epidemic problems in the maternity hospital.

FIRST (PHYSIOLOGICAL) OBSTETRIC DEPARTMENT

The first (physiological) obstetric department includes a reception block, a delivery block, postpartum wards, a neonatal department, and a discharge room.

RECEPTION UNIT

The reception block of the maternity hospital includes a reception area (lobby), filter and examination rooms. Examination rooms exist separately for the physiological and observational departments. Each examination room has a room for processing incoming women, a toilet, a shower, and a vessel washing facility. If there is a gynecological department in the maternity hospital, then it must have a separate reception and access block.

Rules for maintaining reception and examination rooms: wet cleaning twice a day using detergents, cleaning once a day using disinfectants. After wet cleaning, turn on the bactericidal lamps for 30-60 minutes. There are instructions on the rules for processing instruments, dressings, equipment, furniture, walls (Order of the USSR Ministry of Health No. 345).

A pregnant woman or woman in labor, entering the reception area, takes off her outer clothing and goes into the filter. In the filter, the doctor decides whether a given woman should be hospitalized in a maternity hospital and in which department (pathology wards, obstetric departments I or II). To resolve this issue, the doctor collects an anamnesis to clarify the epidemic situation at work and at home. Then he examines the skin and pharynx (purulent-septic diseases), listens to the fetal heartbeat, and finds out the time of rupture of amniotic fluid. At the same time, the midwife measures the patient’s body temperature and blood pressure.

Pregnant or postpartum women without signs of infectious diseases and who have not had contact with infection are sent to the physiological department. All pregnant or parturient women who pose a threat of infection to women's health are hospitalized either in the II obstetric department or transferred to specialized hospitals (fever, signs of an infectious disease, skin diseases, dead fetus, anhydrous interval of more than 12 hours, etc.).

After deciding on hospitalization, the midwife transfers the woman to the appropriate examination room, recording the necessary data in the “Register of Pregnant Women, Maternity Women and Postpartum Women” and filling out the passport part of the birth history.

Then the doctor and midwife conduct a general and special obstetric examination: weighing, measuring height, pelvic size, abdominal circumference, height of the uterine fundus, determining the position of the fetus in the uterus, listening to the fetal heartbeat, determining the blood type, Rh status, conducting a urine test for the presence of protein (test with boiling or with sulfosalicylic acid). If indicated, blood and urine tests are performed in a clinical laboratory. The doctor on duty gets acquainted with the “Individual Card of the Pregnant and Postpartum Woman,” collects a detailed anamnesis, determines the timing of delivery, the estimated weight of the fetus, and enters the survey and examination data into the appropriate columns of the birth history.

After the examination, sanitary treatment is carried out, the volume of which depends on the general condition of the patient or on the period of childbirth (shaving the armpits and external genitalia, cutting nails, cleansing enema, shower). A pregnant woman (mother in labor) receives an individual package with sterile linen (towel, shirt, robe), clean shoes and goes to the pathology ward or prenatal ward. From the examination room of the II department - only to the II department. Women admitted to the maternity hospital are allowed to use their own non-fabric shoes and personal hygiene items.

Before and after examining healthy women, the doctor and midwife wash their hands with toilet soap. If there is an infection or during examination in department II, hands are disinfected with disinfectant solutions. After the appointment, each woman is treated with disinfectant solutions on instruments, bedpans, couches, showers, and toilets.

GENERAL BLOCK

The birth block includes prenatal wards (ward), intensive care ward, delivery wards (halls), a room for newborns, an operating room (large and small operating rooms, preoperative room, room for storing blood, portable equipment), offices and rooms for medical staff, bathrooms, etc.

Prenatal and delivery rooms can be presented as separate boxes, which, if necessary, can be used as a small operating room or even a large operating room if they have certain equipment. If they are presented as separate structures, then they must be in a double set in order to alternate their work with thorough sanitary treatment (work for no more than three days in a row).

IN prenatal a centralized supply of oxygen and nitrous oxide and appropriate equipment for labor anesthesia, cardiac monitors, and ultrasound machines are required.

In the prenatal room, a certain sanitary and epidemic regime is observed: room temperature +18 ° C - +20 ° C, wet cleaning 2 times a day using detergents and 1 time a day - with disinfectant solutions, ventilating the room, turning on bactericidal lamps for 30-60 minutes.

Each woman in labor has an individual bed and bedpan. The bed, vessel and vessel bench have the same number. The bed is covered only when a woman in labor enters the prenatal ward. After transfer to childbirth, the linen is removed from the bed and placed in a tank with a plastic bag and lid, and the bed is disinfected. After each use, the bedpan is washed with running water, and after the woman in labor is transferred to the delivery room, it is disinfected.

In the prenatal ward, blood is taken from a vein from a woman in labor to determine clotting time and Rh factor. The doctor and midwife constantly monitor the woman in labor and the course of the first stage of labor. Every 2 hours, the doctor makes an entry in the birth history, which reflects the general condition of the woman in labor, pulse, blood pressure, the nature of contractions, the condition of the uterus, the fetal heartbeat (in the first period it is listened to every 15 minutes, in the second period - after each contraction, pushing), the relationship of the presenting part to the entrance to the pelvis, information about amniotic fluid.

During childbirth, medicinal pain relief is carried out using antispasmodic analgesics, tranquilizers, ganglion blockers, neuroleptics, narcotics, etc. Childbirth anesthesia is carried out by an anesthesiologist-resuscitator or an experienced nurse anesthetist.

A vaginal examination must be performed twice: upon admission to the maternity hospital and after the rupture of amniotic fluid, and then - according to indications. These indications must be indicated in the birth history. A vaginal examination is carried out in compliance with all the rules of asepsis and antisepsis and taking smears for flora. The woman in labor spends the entire first stage of labor in the prenatal period. Subject to conditions, the presence of the husband is allowed.

Intensive care ward intended for pregnant women, women in labor and postpartum women with severe forms of gestosis and extragenital diseases. The ward must be equipped with the necessary tools, medicines and equipment to provide emergency care.

At the beginning of the second stage of labor, the woman in labor is transferred to maternity room after treating the external genitalia with a disinfectant solution. In the delivery room, the woman in labor puts on a sterile shirt and shoe covers.

Maternity rooms should be bright, spacious, equipped with equipment for administering anesthesia, the necessary medications and solutions, instruments and dressings for childbirth, toileting and resuscitation of newborns. The room temperature should be +20 ° C -+2 2 ° C. The presence of an obstetrician and a neonatologist is required during childbirth. Normal births are attended by a midwife; pathological and breech births are attended by an obstetrician. Delivery is carried out alternately on different beds.

Before delivering a baby, the midwife washes her hands as if for a surgical operation, puts on a sterile gown, mask, gloves, using an individual delivery bag. Newborns are received in a sterile, warmed tray covered with sterile film. Before the secondary treatment of the umbilical cord, the midwife re-processes the hands (prevention of purulent-septic infection).

The dynamics of labor and the outcome of childbirth are recorded in the birth history and in the “Inpatient Birth Recording Journal”, and surgical interventions are recorded in the “Hospital Surgical Interventions Recording Journal”.

After birth, all trays, cylinders for suctioning mucus, catheters and other items are washed with hot water and soap and disinfected. Disposable tools, items, etc. are thrown into special bins with plastic bags and lids. Beds are treated with disinfectant solutions.

The birthing rooms function alternately, but no more than 3 days, after which they are washed according to the type of final disinfection, disinfecting the entire room and all objects in it. The date of such cleaning is recorded in the journal of the senior midwife of the department. If there is no birth, the room is cleaned once a day using disinfectants.

Small operating rooms in the delivery unit (2) are designed to perform all obstetric aids and surgical interventions that do not require transection (obstetric forceps, vacuum extraction of the fetus, obstetric turns, extraction of the fetus by the pelvic end, manual examination of the uterine cavity, manual separation of the placenta, suturing of traumatic injuries soft birth canal) and examination of the soft birth canal after childbirth. The large operating room is designed for abdominal sections (major and minor caesarean sections, supravaginal amputation or hysterectomy). The rules of the sanitary and epidemiological regime are the same.

After a normal birth, the mother and the newborn stay in the maternity ward for 2 hours, and then they are transferred to the postpartum ward for a joint stay (separate rooms for mother and newborn or box wards for the mother and child to stay together).

POSTPARTUM DEPARTMENT

Postpartum department includes wards for postpartum women, a treatment room, a linen room, sanitary rooms, a toilet, a shower, a discharge room, and staff offices.

The wards should be spacious, with 4-6 beds. Temperature in the rooms +18 ° C - +20 ° C. The wards are filled cyclically in accordance with the wards for newborns for 3 days and no more, so that all postpartum women can be discharged simultaneously on the 5th - 6th day. If it is necessary to detain 1-2 postpartum women in the maternity hospital, then they are transferred to "unloading" chambers. For postpartum women who, due to complicated labor, extragenital diseases and operations, are forced to stay in the maternity hospital for a longer period, a separate group of wards or a separate floor in the department is allocated.

Each postpartum woman is assigned a bed and a bedpan with one number. The mother's bed number corresponds to the newborn's bed number in the neonatal unit. In the morning and evening, wet cleaning of the wards is carried out, after the third feeding of newborns - cleaning with using disinfectants. After each wet cleaning, turn on the bactericidal lamps for 30 minutes. A change of linen is carried out before wet cleaning of the premises. Bed linen is changed once every 3 days, shirts - daily, lining - the first 3 days after 4 hours, then 2 times a day.

Currently accepted active management of the postpartum period. After a normal birth, after 6-12 hours, postpartum women are allowed to get out of bed, go to the toilet independently, starting from three days, take a shower daily with a change of linen. To conduct exercise therapy classes in the postpartum period and to give lectures, radio broadcasts to the wards are used. Staff in the postpartum ward wash their hands with soap and, if necessary, treat them with disinfectant solutions. After transfer of the postpartum woman to the II department or discharge of all postpartum women, the wards are treated according to the type of final disinfection.

The feeding regimen of newborns is important. The rationality has now been proven exclusive feeding, which is only possible when mother and child stay together in the ward. Before each feeding, the mother washes her hands and mammary glands with baby soap. Treatment of nipples to prevent infection is currently not recommended.

If signs of infection appear, the mother and newborn should be immediately transferred to the II obstetric department.

NEWBORN DEPARTMENT

Medical care for newborns begins in the maternity ward, where in the room for newborns they are not only cared for, but also resuscitation measures are performed. The room is equipped with special equipment: joint changing and resuscitation tables, which are sources of radiant heat and protection against infection, devices for suctioning mucus from the upper respiratory tract and devices for artificial ventilation of the lungs, a children's laryngoscope, a set of tubes for intubation, medications, sterile material, bags for secondary processing of the umbilical cord, sterile kits for changing children, etc.

Wards for newborns are allocated in the physiological and observational departments. Along with wards for healthy newborns, there are wards for premature babies and children born with asphyxia, with cerebrovascular accidents, respiratory disorders, and after surgical birth. For healthy newborns, a joint stay with the mother in the same room can be arranged.

The department has a dairy room, rooms for storing BCG, clean linen, mattresses, and equipment.

The department observes the same cyclical filling of wards, in parallel with the maternal wards. If mother and child are detained in a maternity hospital, then newborns are placed in " unloading" wards. Wards for newborns should be provided with a centralized oxygen supply, bactericidal lamps, warm water. The temperature in the wards should not be lower than +20 ° C - +24 ° C. The wards are equipped with the necessary medicines, dressings, instruments, incubators, changing and resuscitation tables, equipment for invasive therapy, ultrasound machine.

In the children's department, the strictest adherence to the rules of the sanitary-epidemiological regime: hand washing, disposable gloves, cleaning of instruments, furniture, premises. The use of masks by staff is indicated only during invasive manipulations and in unfavorable epidemiological conditions in the maternity hospital. During the entire stay in the maternity hospital, only sterile linen is used for newborns. The wards are wet cleaned 3 times a day: 1 time a day with disinfectant solution and 2 times with detergents. After cleaning, turn on the bactericidal lamps for 30 minutes and ventilate the room. Ventilation and irradiation of wards with open bactericidal lamps is carried out only when children are not in the wards. Used diapers are collected in bins with plastic bags and lids. Cylinders, catheters, enemas, gas outlet tubes are collected in separate containers after each use and disinfected. The instruments used must be sterilized. Unused dressing material must be re-sterilized. After discharge, all bedding, cribs and wards are disinfected.

The department conducts total screening for phenylketonuria And hypothyroidism. On days 4-7, healthy newborns receive primary anti-tuberculosis vaccination.

If the mother has an uncomplicated course of the postpartum period, the newborn can be discharged home with the remnant of the umbilical cord falling off and positive changes in body weight. Sick and premature newborns are transferred to neonatal centers, children's hospitals for Stage 2 of nursing .

The discharge room is located outside the children's department and should have access directly to the lobby of the obstetric hospital. After all children are discharged, the discharge room is disinfected.

II OBSTETRIC (OBSERVATION) DEPARTMENT

The second department is an independent miniature maternity hospital, i.e. it has a full set of all necessary premises and equipment.

Pregnant women, women in labor and postpartum women who can be a source of infection for others (fever of unknown etiology, ARVI, dead fetus, anhydrous interval of more than 12 hours, giving birth outside the maternity hospital) are hospitalized in the II department. Also, sick pregnant women from the pathology department and postpartum women from the physiological postpartum department with a complicated course of the postpartum period (endometritis, suppuration of perineal sutures, sutures after cesarean section, etc.) are transferred to the department. In the observation department there are children born in this department, children whose mothers were transferred from the first obstetric department, children transferred from the maternity unit with congenital vesiculopustulosis, deformities, “abandoned” children, children born outside the maternity hospital.

Rules for maintaining the observation department. The wards are cleaned 3 times a day: 1 time with detergents and 2 times with disinfectant solutions and subsequent bactericidal irradiation, the wards are disinfected once every 7 days. Instruments are disinfected in the department and then transferred to the central sterilization room. When medical staff moves to the observation department, they change their gown and shoes (shoe covers). Expressed milk is not used to feed babies.

DEPARTMENT OF PATHOLOGY OF PREGNANT WOMEN

The pathology department is organized in maternity hospitals with a capacity of more than 100 beds. Pregnant women enter the pathology department through the examination room of the first obstetric department. If there is an infection, pregnant women are hospitalized in maternity wards at infectious diseases hospitals. Pregnant women with extragenital problems are subject to hospitalization in the pathology department diseases (cardiovascular system, kidneys, liver, endocrine system, etc.) and with obstetric pathology (gestosis, miscarriage, fetoplacental insufficiency (FPI), abnormal fetal positions, pelvic narrowing, etc.). The department employs obstetricians, a therapist, and an ophthalmologist. The department usually has a functional diagnostics room, equipped with a cardiac monitor, an ultrasound machine, an examination room, a procedure room, and an FPPP room for childbirth. When their health improves, pregnant women are discharged home. With the onset of labor, women in labor are transferred to the first obstetric department. Currently, sanatorium-type pathology departments are being created.

To provide qualified care to pregnant women with extragenital diseases, maternity wards at clinical hospitals operate according to a specific profile (diseases of the cardiovascular system, kidneys, infectious diseases, etc.).

The organization of work in obstetric hospitals is based on a single principle in accordance with the current regulations of the maternity hospital (department), orders, instructions, instructions and existing methodological recommendations.

How is an obstetric hospital organized?

  1. The structure of the obstetric hospital must comply with the requirements of building codes and rules of medical institutions;
  2. Equipment - equipment list of the maternity hospital (department);
  3. Sanitary and anti-epidemic regime - in accordance with current regulatory documents.

Currently, there are several types of obstetric hospitals that provide treatment and preventive care to pregnant women, women in labor, and postpartum women:

  • Without medical care - collective farm maternity hospitals and first aid stations with obstetric codes;
  • For general medical care - local hospitals with obstetric beds;
  • With qualified medical assistance - obstetric departments of the Republic of Belarus, Central District Hospital, city maternity hospitals; with multidisciplinary qualified and specialized care - obstetric departments of multidisciplinary hospitals, obstetric departments of regional hospitals, interdistrict obstetric departments based on large central district hospitals, specialized obstetric departments based on multidisciplinary hospitals, obstetric hospitals united with the departments of obstetrics and gynecology of medical institutes, departments of specialized research institutes.

The variety of types of obstetric hospitals provides for their more rational use to provide qualified care to pregnant women.

Structure of obstetric hospitals

The distribution of obstetric hospitals into 3 levels for 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:

  • reception and access block;
  • physiological (I) obstetric department (50-55% of the total number of obstetric beds);
  • department (ward) of pathology of pregnant women (25-30% of the total number of obstetric beds), recommendations: to increase these beds to 40-50%;
  • department (wards) for newborns in the I and II obstetric departments;
  • observational (II) obstetric department (20-25% of the total number of obstetric beds);
  • gynecological department (25-30% of the total number of beds in the maternity hospital).

The structure of the premises of the maternity hospital should ensure the isolation of healthy pregnant women, women in labor, and postpartum women from the sick; compliance with the strictest rules of asepsis and antiseptics, as well as timely isolation of sick people. The reception and access block of the maternity hospital includes a reception area (lobby), a filter and examination rooms, which are created separately for women admitted to the physiological and observational departments. Each examination room must have a special room for sanitary treatment of incoming women, equipped with a toilet and shower. If there is a gynecological department in the maternity hospital, the latter must have an independent reception and access unit. The reception room or lobby is a spacious room, the area of ​​which (like all other rooms) depends on the bed capacity of the maternity hospital.

For the filter, a room with an area of ​​14-15 m2 is allocated, where there is a midwife’s table, couches, and chairs for incoming women.

Examination rooms must have an area of ​​at least 18 m2, and each sanitary treatment room (with a shower, a toilet with 1 toilet and a vessel washing facility) must have an area of ​​at least 22 m2.


Operating principles of an obstetric hospital

Patient admission procedure

A pregnant woman or woman in labor, entering the reception area of ​​an obstetric hospital (lobby), takes off her outer clothing and goes into the filter room. In the filter, the doctor on duty decides which department of the maternity hospital (physiological or observational) she should be sent to. To correctly resolve this issue, the doctor collects a detailed medical history, from which he clarifies the epidemic situation in the mother’s home environment (infectious, purulent-septic diseases), the midwife measures body temperature, carefully examines the skin (pustular diseases) and pharynx. Women who do not have any signs of infection and have not had contact with infectious patients at home, as well as the results of testing for RW and AIDS, are sent to the physiological department and the department of pathology of pregnant women.

All pregnant women and women in labor who pose the slightest threat of infection to healthy pregnant women and women in labor are sent to the observation department of the maternity hospital (maternity ward of the hospital). After it has been determined which department the pregnant or parturient woman should be sent to, the midwife transfers the woman to the appropriate examination room (I or II obstetric department), entering the necessary data in the “Register of admission of pregnant women in labor and postpartum” and filling out the passport part of the birth history. Then the midwife, together with the doctor on duty, conducts a general and special obstetric examination; weighs, measures height, determines the size of the pelvis, abdominal circumference, height of the uterine fundus above the pubis, position and presentation of the fetus, listens to its heartbeat, prescribes a urine test for blood protein, hemoglobin content and Rh status (if not on the exchange card) .

The doctor on duty checks the midwife’s data, gets acquainted with the “Individual Card of the Pregnant and Postpartum Woman,” collects a detailed history and identifies swelling, measures blood pressure in both arms, etc. For women in labor, the doctor determines the presence and nature of labor. The doctor enters all examination data into the appropriate sections of the birth history.

After the examination, the mother in labor is given sanitary treatment. The scope of examinations and sanitary treatment in the examination room is regulated by the general condition of the woman and the period of childbirth. Upon completion of sanitary treatment, the woman in labor (pregnant) receives an individual package with sterile linen: towel, shirt, robe, slippers. From the examination room of the first physiological department, the woman in labor is transferred to the prenatal ward of the same department, and the pregnant woman is transferred to the pathology department. From the observation room of the observation department, all women are sent only to the observation room.

Department of pathology of pregnant women

Pathology departments of an obstetric hospital are organized in maternity hospitals (departments) with a capacity of 100 beds or more. Women are usually admitted to the pathology department through examination room I of the obstetric department, and if there are signs of infection, through the examination room of the observation department into the isolated wards of this department. The corresponding examination room is led by a doctor (during the daytime, department doctors, from 13.30 - doctors on duty). In maternity hospitals, where it is impossible to organize independent pathology departments, wards are allocated as part of the first obstetric department.

Pregnant women with extragenital diseases (heart, blood vessels, blood, kidneys, liver, endocrine glands, stomach, lungs, etc.), with complications (gestosis, threatened miscarriage, fetoplacental insufficiency, etc.), with abnormal fetal position are hospitalized in the pathology department , with a burdened obstetric history. In the department, along with an obstetrician-gynecologist (1 doctor for 15 beds), a maternity hospital therapist works. This department usually has a functional diagnostics room, equipped with devices for assessing the condition of the woman and the fetus (PCG, ECG, ultrasound scanner, etc.). In the absence of their own office, general hospital departments of functional diagnostics are used for examining pregnant women.

In the obstetric hospital, modern medications and barotherapy are used for treatment. It is desirable that women be assigned to the small wards of this department according to their pathology profile. The department must be continuously supplied with oxygen. The organization of rational nutrition and medical and protective regime is of great importance. This department is equipped with an examination room, a small operating room, and a room for physical and psychoprophylactic preparation for childbirth.

The pregnant woman is discharged home from the pathology department or transferred to the maternity ward for delivery.

In a number of obstetric hospitals, pathology departments for pregnant women with a semi-sanatorium regime have been deployed. This is especially true for regions with high birth rates.

The pathology department is usually closely associated with sanatoriums for pregnant women.

One of the criteria for discharge for all types of obstetric and extragenital pathology is the normal functional state of the fetus and the pregnant woman herself.

The main types of studies, average examination time, basic principles of treatment, average treatment time, discharge criteria and average length of hospital stay for pregnant women with the most important nosological forms of obstetric and extragenital pathology are presented in the order of the USSR Ministry of Health No. 55 dated 01/09/86.

Physiological Department

The first (physiological) department of the obstetric hospital includes a sanitary checkpoint, which is part of the general admission block, a delivery block, postpartum wards for the joint and separate stay of mother and child, and a discharge room.

The birth block consists of prenatal wards, an intensive observation ward, labor wards (delivery rooms), a manipulation room for newborns, an operating room (large operating room, preoperative anesthesia room, small operating rooms, rooms for storing blood, portable equipment, etc.). The birth block also houses offices for medical personnel, a pantry, sanitary facilities and other utility rooms.

VI. The procedure for providing medical care to women with HIV infection during pregnancy, childbirth and the postpartum period

51. The provision of medical care to women with HIV infection during pregnancy, childbirth and 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) in the blood is carried out when registering for pregnancy.

53. If the first test for HIV antibodies is negative, women planning to continue the pregnancy are re-tested at 28-30 weeks. Women who used parenteral psychoactive substances during pregnancy and/or had sexual contact with an HIV-infected partner are recommended to be examined additionally at 36 weeks of pregnancy.

54. Molecular biological examination of pregnant women for HIV DNA or RNA is carried out:

a) upon receipt of questionable results of testing for antibodies to HIV obtained by standard methods (enzyme-linked immunosorbent assay (hereinafter referred to as ELISA) and immunoblotting);

b) upon receipt of negative test results for HIV antibodies obtained by standard methods if the pregnant woman belongs to a high-risk group for HIV infection (intravenous drug use, unprotected sex with an HIV-infected partner within the last 6 months).

55. Blood collection when testing for antibodies to HIV is carried out in the treatment room of the antenatal clinic using vacuum systems for blood collection with subsequent transfer of blood to the laboratory of a medical organization with a referral.

56. Testing for HIV antibodies is accompanied by mandatory pre-test and post-test counseling.

Post-test counseling is carried out for pregnant women regardless of the result of testing for HIV antibodies and includes a discussion of the following issues: the significance of the result obtained taking into account the risk of contracting HIV infection; recommendations for further testing tactics; routes of transmission and methods of protection against HIV infection; the risk of HIV transmission during pregnancy, childbirth and breastfeeding; methods of preventing mother-to-child transmission of HIV infection available to a pregnant woman with HIV infection; the possibility of chemoprophylaxis of HIV transmission to a child; possible pregnancy outcomes; the need for follow-up of mother and child; the possibility of informing the sexual partner and relatives about the test results.

57. Pregnant women with a positive laboratory test result for antibodies to HIV are referred by an obstetrician-gynecologist, and in his absence, a general practitioner (family doctor), a medical worker at a paramedic-obstetric station, to the Center for the Prevention and Control of AIDS of the subject Russian Federation for additional examination, registration at the dispensary and prescription of chemoprophylaxis for perinatal HIV transmission (antiretroviral therapy).

Information received by medical workers about the positive result of testing for HIV infection of a pregnant woman, a woman in labor, a postpartum woman, antiretroviral prevention of mother-to-child transmission of HIV infection, joint observation of a woman with specialists from the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation, perinatal contact with HIV- infections in a newborn are not subject to disclosure, except as provided by current legislation.

58. Further observation of a pregnant woman with an established diagnosis of HIV infection is carried out jointly by an infectious disease specialist at the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation and an obstetrician-gynecologist at the antenatal clinic at the place of residence.

If it is impossible to refer (observe) a pregnant woman to the Center for Prevention and Control of AIDS of a constituent entity of the Russian Federation, observation is carried out by an obstetrician-gynecologist at the place of residence with methodological and advisory support from an infectious disease specialist at the Center for Prevention and Control of AIDS.

During the period of observation of a pregnant woman with HIV infection, an obstetrician-gynecologist at a antenatal clinic sends information about the course of pregnancy, concomitant diseases, complications of pregnancy, laboratory test results to the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation, to adjust the regimens of antiretroviral prevention of HIV transmission from mother-to-child and (or) antiretroviral therapy and requests from the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation information about the characteristics of the course of HIV infection in a pregnant woman, the regimen for taking antiretroviral drugs, coordinates the necessary methods of diagnosis and treatment, taking into account the woman’s health condition and the course of pregnancy .

59. During the entire period of observation of a pregnant woman with HIV infection, the obstetrician-gynecologist of the antenatal clinic, in conditions of strict confidentiality (using a code), notes in the woman’s medical documentation her HIV status, presence (absence) and admission (refusal to admission) antiretroviral drugs necessary to prevent mother-to-child transmission of HIV infection, prescribed by specialists from the Center for Prevention and Control of AIDS.

If a pregnant woman does not have antiretroviral drugs or refuses to take them, the obstetrician-gynecologist at the antenatal clinic immediately informs the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation in order to take appropriate measures.

60. During the period of clinical observation of a pregnant woman with HIV infection, it is recommended to avoid procedures that increase the risk of infection of the fetus (amniocentesis, chorionic villus biopsy). The use of non-invasive methods for assessing the condition of the fetus is recommended.

61. When admitted for childbirth to an obstetric hospital, women who have not been tested for HIV infection, women without medical documentation or with a one-time examination for HIV infection, as well as those who used psychoactive substances intravenously during pregnancy, or had unprotected sex with an HIV-infected partner, Laboratory testing using a rapid method for HIV antibodies is recommended after obtaining informed voluntary consent.

62. Testing of a woman in labor for antibodies to HIV in an obstetric hospital is accompanied by pre-test and post-test counseling, including information about the importance of testing, methods of preventing the transmission of HIV from mother to child (use of antiretroviral drugs, method of delivery, features of feeding the newborn (after birth the child is not put to the breast and is not fed with mother's milk, but is transferred to artificial feeding).

63. Testing for HIV antibodies using diagnostic rapid test systems approved for use on the territory of the Russian Federation is carried out in a laboratory or emergency department of an obstetric hospital by medical workers who have undergone special training.

The study is carried out in accordance with the instructions attached to the specific rapid test.

Part of the blood sample taken for the rapid test is sent for testing for HIV antibodies using standard methods (ELISA, if necessary, immune blot) in a screening laboratory. The results of this study are immediately transmitted to the medical organization.

64. Each HIV test using rapid tests must be accompanied by a mandatory parallel study of the same portion of blood using classical methods (ELISA, immune blot).

If a positive result is obtained, the remaining part of the serum or blood plasma is sent to the laboratory of the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation to conduct a verification study, the results of which are immediately transferred to the obstetric hospital.

65. If a positive result of testing for HIV is received in the laboratory of the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation, a woman with a newborn, after discharge from the obstetric hospital, is sent to the Center for Prevention and Control of AIDS of a constituent entity of the Russian Federation for counseling and further examination.

66. In emergency situations, if it is impossible to wait for the results of standard testing for HIV infection from the Center for Prevention and Control of AIDS of a constituent entity of the Russian Federation, the decision to conduct a preventive course of antiretroviral therapy for mother-to-child transmission of HIV is made when antibodies to HIV are detected using a rapid test -systems A positive result of the rapid test is the basis only for prescribing antiretroviral prevention of mother-to-child transmission of HIV infection, but not for making a diagnosis of HIV infection.

67. To ensure the prevention of mother-to-child transmission of HIV infection, the obstetric hospital must always have the necessary supply of antiretroviral drugs.

68. Antiretroviral prophylaxis for a woman during childbirth is carried out by an obstetrician-gynecologist leading the birth, in accordance with recommendations and standards for the prevention of mother-to-child transmission of HIV.

69. A preventive course of antiretroviral therapy during childbirth in an obstetric hospital is carried out:

a) in a woman in labor with HIV infection;

b) with a positive result of rapid testing of a woman during childbirth;

c) in the presence of epidemiological indications:

the inability to conduct rapid testing or timely obtain results of a standard test for HIV antibodies in a woman in labor;

a history of parenteral use of psychoactive substances or sexual contact with a partner with HIV infection during the current pregnancy;

with a negative test result for HIV infection, if less than 12 weeks have passed since the last parenteral use of psychoactive substances or sexual contact with an HIV-infected partner.

70. The obstetrician-gynecologist takes measures to prevent the water-free period from lasting more than 4 hours.

71. When conducting childbirth through the natural birth canal, the vagina is treated with a 0.25% aqueous solution of chlorhexidine upon admission to childbirth (during the first vaginal examination), and in the presence of colpitis - at each subsequent vaginal examination. If the anhydrous interval is more than 4 hours, the vagina is treated with chlorhexidine every 2 hours.

72. During labor management in a woman with HIV infection and a living fetus, it is recommended to limit procedures that increase the risk of infection of the fetus: labor stimulation; childbirth; perineo(episio)tomy; amniotomy; application of obstetric forceps; vacuum extraction of the fetus. These manipulations are performed only for health reasons.

73. A planned caesarean section to prevent intrapartum infection of a child with HIV infection is carried out (in the absence of contraindications) before the onset of labor and the rupture of amniotic fluid if at least one of the following conditions is present:

a) the concentration of HIV in the mother’s blood (viral load) before childbirth (at no earlier than 32 weeks of pregnancy) is more than or equal to 1,000 kopecks/ml;

b) the mother’s viral load before birth is unknown;

c) antiretroviral chemoprophylaxis was not carried out during pregnancy (or was carried out in monotherapy or its duration was less than 4 weeks) or it is impossible to use antiretroviral drugs during childbirth.

74. If it is impossible to carry out chemoprophylaxis during childbirth, cesarean section can be an independent preventive procedure that reduces the risk of contracting a child with HIV infection during childbirth, but it is not recommended for an anhydrous interval of more than 4 hours.

75. The final decision on the method of delivery of a woman with HIV infection is made by the obstetrician-gynecologist leading the birth on an individual basis, taking into account the condition of the mother and fetus, weighing in a specific situation the benefit of reducing the risk of infection of the child during a cesarean section with the probability the occurrence of postoperative complications and features of the course of HIV infection.

76. Immediately after birth, blood is collected from a newborn from an HIV-infected mother for testing for HIV antibodies using vacuum blood collection systems. The blood is sent to the laboratory of the Center for Prevention and Control of AIDS of a constituent entity of the Russian Federation.

77. Antiretroviral prophylaxis for a newborn is prescribed and carried out by a neonatologist or pediatrician, regardless of the mother’s intake (refusal) of antiretroviral drugs during pregnancy and childbirth.

78. Indications for prescribing antiretroviral prophylaxis to a newborn born from a mother with HIV infection, a positive result of rapid testing for HIV antibodies during labor, or an unknown HIV status in an obstetric hospital are:

a) the age of the newborn is no more than 72 hours (3 days) of life in the absence of breastfeeding;

b) in the presence of breastfeeding (regardless of its duration) - a period of no more than 72 hours (3 days) from the moment of the last breastfeeding (subject to its subsequent cancellation);

c) epidemiological indications:

unknown HIV status of the mother who uses parenteral psychoactive substances or has sexual contact with an HIV-infected partner;

a negative test result for HIV infection of a mother who has used psychoactive substances parenterally within the last 12 weeks or has had sexual contact with a partner with HIV infection.

79. A newborn is given a hygienic bath with a chlorhexidine solution (50 ml of a 0.25% chlorhexidine solution per 10 liters of water). If it is not possible to use chlorhexidine, a soap solution is used.

80. Upon discharge from the obstetric hospital, the neonatologist or pediatrician explains in detail in an accessible form to the mother or persons who will care for the newborn, the further regimen of chemotherapy drugs for the child, hands out antiretroviral drugs to continue antiretroviral prophylaxis in accordance with the recommendations and standards.

When conducting a prophylactic course of antiretroviral drugs using emergency prophylaxis methods, the mother and child are discharged from the maternity hospital after completing the prophylactic course, that is, no earlier than 7 days after birth.

In the obstetric hospital, women with HIV are consulted on the issue of giving up breastfeeding, and with the woman’s consent, measures are taken to stop lactation.

81. Data on a child born to a mother with HIV infection, antiretroviral prophylaxis for the woman during labor and the newborn, methods of delivery and feeding of the newborn are indicated (with a contingent code) in the medical documentation of the mother and child and transferred to the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation Federation, as well as to the children's clinic where the child will be observed.