Physiological department of childbirth. Obstetric physiological department with a joint stay of mother and child. Obstetric Physiological Department

A maternity hospital is a medical institution designed to provide outpatient and inpatient care to a woman during pregnancy, childbirth and gynecological diseases, as well as medical care for newborns from birth to discharge from the maternity hospital. The maternity hospital includes a antenatal clinic (see Consultation) and inpatient departments, laboratories, treatment and diagnostic rooms, and administrative and utility rooms.

Stationary part of the maternity hospital consists of the following mandatory departments and premises.
1. The reception and examination department, in which pregnant women and women in labor are admitted, consists of a reception room, a filter, an examination room and a shower room. In the admission and examination department, the midwife conducts a survey and examination of pregnant women and women in labor (measuring the pelvis, weighing, measuring growth, determining the position of the fetus, listening to it, etc.), as well as them. From this department, healthy women in labor are sent to the physiological maternity department, and pregnant women and women in labor with an infectious disease and suspected of an infectious disease are sent to the observational obstetric department. Pregnant women who need inpatient treatment or stay in a hospital for preventive purposes, or to clarify the diagnosis, are sent from the admission and examination department to the department of pregnancy pathology.

2. The Pregnancy Pathology Department is intended for hospitalization of pregnant women with a aggravated obstetric history, abnormal position of the fetus, polyhydramnios, multiple pregnancies, patients with cardiovascular and other non-communicable diseases. In large cities, some maternity hospitals specialize in providing medical care for a particular type of obstetric and extragenital pathology (for example, in case of miscarriage, cardiovascular diseases, etc.). In research institutes of obstetrics, specialized assistance is provided to pregnant women and women in childbirth in many types of pathology.

In the department, in addition to the wards, there are manipulation rooms, treatment rooms, bathrooms, rooms for staff, etc.

3. The physiological labor department consists of prenatal wards, labor wards (for 1-2 beds), rooms for the first toilet, small and large operating room with preoperative and sterilization; rooms with light and sound insulation for patients or preeclampsia; bathrooms and other facilities. The presence of two birth chambers allows their cyclic functioning: while one birth chamber is full, the second one is being cleaned and disinfected. The number of beds in the prenatal wards is approximately 12% of the total number of beds in the physiological postnatal ward, and in the delivery rooms - 8%.

4. The physiological postpartum department consists of wards for 1-4 beds, a manipulation room; rooms for expressing and storing breast milk; bathrooms, staff rooms, etc. The total number of beds in the wards of this department is 50-55% of all beds in the obstetric departments of the maternity hospital. In addition, 10% of the beds (in excess of the regular ones) are provided to comply with the cyclical filling and emptying of the wards and to comply with the sanitary and hygienic regime. This requirement also applies to the observation unit and the neonatal unit. Such a system makes it possible to completely empty certain wards during the discharge of puerperas and to carry out thorough cleaning (washing, irradiation, airing, etc.) of both maternal and children's wards. The puerperal is in the maternity hospital during the normal course of childbirth and the postpartum period of 7-8 days; her discharge from the maternity hospital with the child is carried out through the discharge room. At discharge, the mother is given a birth certificate, on the basis of which, in the antenatal clinic, the woman is given a sheet of temporary disability for the whole. The maternity hospital reports each discharged child to the nursery at the place of residence of the mother.

5. Observational obstetric department is intended for the reception of pregnant women, women in labor, delivery and treatment of puerperas and newborns who are or may be a source of infection (parturient women with fever, dead fetus, puerperas with, dead fetus, with skin pustular diseases, etc. .); puerperas are also transferred here from the physiological postpartum department in case of their illness or illness of the child. The department also admits women after childbirth at home or on the road. The department is strictly isolated from other departments and premises of the maternity hospital. It includes: a maternity ward, postpartum wards for 1-2 beds, a maternity ward with a separate external entrance for especially strict isolation of a pregnant woman, a woman in labor or a puerperal with a newborn. The total number of beds in the department is approximately 20-25% of all obstetric beds in the maternity hospital.

6. The department for newborns consists of two parts. One is intended for children whose mothers are in the physiological postpartum ward, and the second is for children whose mothers are in the observational ward. Each part is strictly isolated from each other and from the mother's chambers and other rooms. Separate rooms are provided for and children with. It is recommended to have locks in front of the wards (usually for a group of wards).

7. The gynecological department consists of a surgical department and a department that uses conservative methods of treatment. The gynecological department is completely isolated from obstetrics, has its own reception and examination room, discharge room and other rooms.

The medical staff of the physiological department, the department of pathology of pregnancy, the department of newborns does not come into contact with the staff of the observational department. All employees of the maternity hospital, upon entering the duty, take a shower, put on a light (not woolen) dress, a clean dressing gown, a hat, and slippers. In addition to medical work, the staff of the maternity hospital conducts a lot of sanitary and educational work among women - they conduct lectures and talks on nutrition of a nursing mother, care for the mammary glands, sexual hygiene, etc.

Obstetrics and Physiology Department of the branch "Perinatal Center" GKB im. M. P. Konchalovsky (formerly City Clinical Hospital No. 3) is a department for the joint stay of mother and child. In the postpartum department, puerperas are provided with qualified medical care. Joint stay of mothers and newborns is organized in the absence of contraindications.

Each room has the conditions for a comfortable stay. There is everything you need - a comfortable shower, a toilet, a modern functional bed for mom, a comfortable changing table and a crib for a baby.

2 hours after physiological childbirth, a woman with a child is transferred to the postpartum department (women after complicated childbirth enter the postpartum department from the intensive care unit)

In the postpartum ward, you must have with you:

• a package of documents with which they were at birth (exchange card, compulsory medical insurance policy, passport, birth certificate)
• washable slippers
• hygiene items (soap, shampoo, toothpaste and brush, toilet paper);
• cutlery: mug, spoon

Highly qualified specialists around the clock monitor the health of puerperas and newborns.

Active management of the postpartum period is now accepted, which consists in early rising of women (if there are no complications). This helps to improve blood circulation, accelerate the processes of involution of the reproductive system, normalize the function of the bladder and intestines.

Great attention in the postpartum period is given to breastfeeding. The staff of the department conducts individual sessions with each patient, teaching the rules of attachment to the breast, feeding on demand, hygiene of the mammary glands, as well as proper handling of the newborn.

The department has the latest medical equipment and a full range of modern medicines, which allows for a full examination of puerperas, including mandatory ultrasound, to effectively prevent postpartum diseases, as well as their diagnosis and treatment. Due to the fact that the department is part of a multidisciplinary hospital, consultations of narrow specialists are possible.

Diagnostic options:

• X-ray and ultrasound examinations in full,
• clinical laboratory tests of blood and urine,
• bacteriological research.

All women are examined daily from 10:00 to 12:00 by an obstetrician-gynecologist. An on-call midwife provides 24-hour follow-up for women after childbirth.

Before discharge from the maternity hospital, all mothers receive advice on contraception and a full range of recommendations for further outpatient follow-up at the antenatal clinic of the GKB. M. P. Konchalovsky (formerly City Clinical Hospital No. 3) and other medical facilities.

In the obstetrics and physiology department Branch "Perinatal Center" GKB im. MP Konchalovsky (formerly City Clinical Hospital No. 3) employs highly qualified specialists. Experienced and friendly staff who help mother and baby adapt to new living conditions.

Department head: Novikova Valentina Vyacheslavovna, operating doctor obstetrician-gynecologist of the first category, intern of the maternity department.
Higher education: Russian State Medical University (Moscow). She was trained in clinical residency at the Department of Therapeutic Faculty of Obstetrics and Gynecology at City Clinical Hospital No. 8, City Clinical Hospital No. 55.
She has been working in the Zelenograd Perinatal Center since 2013.
Total work experience - more than 13 years.

Senior midwife:
Polivanova Svetlana Dmitrievna, midwife of the highest category.
Work experience - over 30 years.

All midwives of our department have a high level of professional training and education. The junior staff is conscientious, hardworking and treats their work with great responsibility.

Branch Profile

The main activity of the obstetric physiological departments is the provision of obstetric care to women in childbirth - patients after childbirth. Since October 2016, after the reorganization, the patients after childbirth are in two obstetric physiological departments. Obstetrics and Physiology Department (AFO) No. 1 is located on the 5th floor of the maternity hospital, deployed for 40 beds, it houses patients mainly after surgical and complicated births. Obstetrics and Physiology Department (AFO) No. 2 is located on the 6th floor of the maternity hospital. It is deployed with 45 beds and accepts patients after physiological childbirth - all beds are shared

AFO No. 1 is headed by the head of the departmentEvgrafova Alla Borisovna

In 1990 she graduated from the medical faculty of the Moscow Medical Dental Institute named after A.I.

N.A. Semashko, and in 1992 - clinical residency of the above-named institute, specializing in obstetrics and gynecology.

Doctor of the highest qualification category. Experience of practical work since 1992 (26 years).

After completing her residency, she worked in the maternity hospital of the City Clinical Hospital No. 15, certified for the first, and then for the highest qualification category.

From 2007 to 2010, during the closing of the maternity hospital for major repairs, she worked as an obstetrician-gynecologist at the 12th gynecological department of the City Clinical Hospital No. 15. Since 2010 - Head of the Obstetric Physiological Department of City Clinical Hospital No. 15.

He has an acknowledgment from the head of the Moscow Health Department (2014).

AFO No. 2 leadsdepartment head Mednikova Elena Gennadievna

She graduated from the Arkhangelsk State Medical Academy in 1998 with a degree in general medicine. In 1999, she completed her clinical internship in obstetrics and gynecology. 13 years of experience in obstetrics and gynecology. Has the 1st qualification category. From 01.10. 2016 - Head of the Obstetrics and Physiology Department (AFO) No. 2.

Priority areas of activity

The department provides a set of measures to provide highly qualified assistance to puerperas both after physiological and after complicated childbirth, patients with obstetric pathology, somatic burden, after surgical childbirth.

In the postpartum (obstetric physiological) department, the physiological course of the postpartum period is monitored, and complications are diagnosed in a timely manner. If necessary, surgical interventions are performed (for example, vacuum aspiration of the contents of the uterus in violation of its contractility).

If necessary, control during these manipulations, ultrasound is used using a portable ultrasound machine. In connection with the profiling of the obstetric department as a whole to help patients with diseases of the cardiovascular system, the postpartum department is equipped for the stay of puerperas with severe heart defects, prosthetic valves, and other cardiac pathologies from the moment they are transferred from the intensive care unit to discharge. There is a centralized oxygen supply to all postpartum wards, distribution using flowmeters, a two-way communication system with a round-the-clock obstetric post. Perfusors and lineamats are used for fractional administration of drugs.

Achievements

During his work, tens of thousands of women after childbirth have passed through the obstetric physiological department. Many of the current mothers themselves were born in our maternity hospital.

The science

Together with the clinical departments, scientific and practical classes, conferences for doctors and staff are regularly organized and conducted. All employees of the department have certificates of specialists, undergo regular re-certification. Three of the doctors of the Obstetrics and Physiology Department have a certificate of ultrasound diagnostics doctor.

High tech

Despite the fact that the postpartum department, due to its specifics, is not the main user of high technologies, we believe that the human factor in an obstetric hospital is no less important. Therefore, systematic work is being carried out with doctors, middle and junior staff to establish adequate communication with patients, teamwork is encouraged and developed in every possible way.

Team

AFO-1
Department doctors:
Korshunova Natalya Valerievna, doctor of the first category
Mironova Margarita Vladimirovna
Baraeva Anna Alexandrovna

AFO-2
Department doctors:
Demina Alla Alexandrovna, doctor of the highest category
Kosolapova Nina Dmitrievna, doctor of the highest category
Yurchenko Svetlana Nikolaevna, doctor of the highest category

Chambers

The department deployed AFO-1 40 beds, 20 of them - co-stay "mother - child". There are 45 beds in AFO-2 - all of them are mother-child cohabitation.

KRASNOPOLSKY VLADISLAV IVANOVICH

Doctor of Medical Sciences, Professor of the Russian Academy of Sciences

In 1961 he graduated from the 2nd Moscow State Medical Institute named after N.I. Pirogov. From August 1961 to the present he has been working at MONIAG. From 1961 to 1963 studied in clinical residency in obstetrics and gynecology, after which he worked as a junior researcher, since 1967 - a senior researcher, since 1973 - the head of a gynecological clinic. Since 1985 he has been the director of GBUZ MO MONIIAG. On the Academic Council of the Institute on March 16, 2017, he was elected as the President of MORIAH.

Since 1990, V.I. Krasnopolsky is the head of the Department of Obstetrics and Gynecology of the Faculty of Advanced Training of Doctors of the Moscow Region at the M.F. Vladimirsky.

Labor activity of V.I. Krasnopolsky is multifaceted and combines medical, research, organizational and methodological work. In 1967, Vladislav Ivanovich defended his Ph.D. thesis on the topic "Caesarean section after the outflow of water", in 1978 - his doctoral dissertation on the topic "Modern aspects of diagnosis, surgical treatment and prevention of purulent formations of the uterine appendages."

In the field of gynecology, scientific research by V.I. Krasnopolsky made it possible to form the concept of connective tissue failure in case of prolapse of internal genital organs. He proposed original methods of surgical treatment of stress urinary incontinence, ureteral transplantation, correction of pelvic floor muscle failure, prolapse and prolapse of the uterus and vaginal walls, methods of preventing severe postoperative complications in purulent lesions of the pelvic organs, peritonitis, with extensive endometriosis, for which the author's certificates and patents.

In the field of obstetrics under the guidance of V.I. Krasnopolsky developed the problems of diagnosis, treatment and prevention of postpartum purulent-septic complications, as well as various aspects of the caesarean section. Fundamental research is being carried out in diabetes mellitus in pregnant women, diabetic fetopathy, the cellular-molecular and pathophysiological foundations of dysmetabolism and angiopathy, methods for their prevention and correction have been developed.

IN AND. Krasnopolsky and his students developed and presented scientific data on the management of pregnancy, childbirth and the postpartum period in women in ecologically unfavorable areas exposed to radioactive contamination as a result of the Chernobyl accident. We proposed a scheme for organizing obstetric care for women in these regions, providing for the prevention of complications in the mother, fetus and newborn, as well as the rehabilitation of the reproductive health of the female population.

IN AND. Krasnopolsky created a school of obstetricians-gynecologists, which develops not only topical issues of gynecological and laparoscopic operations, caesarean sections, but also the most important issues of spontaneous childbirth in women of high-risk groups.

Author of 350 scientific papers, including 14 monographs, many guidelines and manuals for practitioners. Under his leadership, 16 doctoral and 32 master's theses were completed and defended.

In 2012 V.I. Krasnopolsky was elected Academician of the Russian Academy of Sciences.

Member of the Interdepartmental Scientific Council of the Russian Academy of Medical Sciences (1993), member of the bureau of the Academic Medical Council of the Ministry of Health of the Russian Federation (1993), chairman of the section and member of the expert council on obstetrics and gynecology of the Problematic Scientific Center of the Ministry of Health of the Russian Federation (1993), chairman of the scientific council of MONIIAG (1995), chairman of the dissertation Council at MONIIAG (1990), Vice-President of the Russian Association of Obstetricians and Gynecologists (1993), Member of the Coordinating Council for Health under the President of the Russian Federation in the Central Federal District (2001), Member of the Bureau of the Department of Clinical Medicine of the Russian Academy of Sciences (2002), Member of the Scientific and Expert Council under the chairman of the Council of the Federal Assembly of the Russian Federation (2002), member of the editorial board of the journal "Obstetrics and Gynecology" (1989), member of the editorial board of the journal "Bulletin of the Russian Association of Obstetricians and Gynecologists" (1994-2000), editor-in-chief of the journal "Russian Bulletin of the Obstetrician-Gynecologist" (2001), member of the editorial board of the journal "Obstetrics and Women's Diseases" (1997), head of the department of obstetrics and gi necology of FUV at GBUZ MO MONIKI named after M.F. Vladimirsky (1990).

Laureate of the Prize of the Government of the Russian Federation (2002) for the development and implementation of endoscopic methods in gynecology, Honored Doctor of Russia (1995). He was awarded the Order "For Merit to the Fatherland" IV degree (1998), the Order "For Merit to the Fatherland" III degree (2007). Honorary Citizen of the Moscow Region (2003).

The first (physiological) obstetric department includes a check-in block, a birth block, post-natal wards, a neonatal department, and an discharge room.

RECEPTION UNIT

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

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

A pregnant woman or a woman in labor, entering the reception, takes off her outer clothing and passes into the filter. In the filter, the doctor decides whether this woman is to be hospitalized in the maternity hospital and in which department (pathology wards, I or II obstetric departments). 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, finds out the time of the outflow of amniotic fluid. At the same time, the midwife measures the patient's body temperature and blood pressure.

Pregnant women or women in labor without signs of infectious diseases and not having contact with the infection are sent to the physiological department. All pregnant women or women in labor 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, a dead fetus, an anhydrous interval of more than 12 hours, etc.).

After resolving the issue of hospitalization, the midwife transfers the woman to the appropriate examination room, recording the necessary data in the "Journal of registration of pregnant women, women in childbirth and puerperas" 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, standing height of the fundus of the uterus, determine the position of the fetus in the uterus, listen to the fetal heartbeat, determine the blood type, Rh affiliation, conduct a urine test for the presence of protein (test with boiling or with sulfosalicylic acid). If indicated, blood and urine tests are performed in the clinical laboratory. The doctor on duty gets acquainted with the "Individual card of the pregnant woman and the puerperal", collects a detailed anamnesis, determines the timing of childbirth, the estimated weight of the fetus and enters the data of the survey and examination in the appropriate columns of the history of childbirth.

After the examination, sanitization is carried out, the volume of which depends on the general condition of the incoming woman or on the period of childbirth (shaving the armpits and external genitalia, cutting nails, cleansing enema, shower). A pregnant woman (maternity) receives an individual package with sterile underwear (towel, shirt, gown), clean shoes and goes to the pathology ward or to the prenatal ward. From the observation room of the II department - only to the II department. Women entering the maternity hospital are allowed to use their own non-cloth shoes, personal hygiene items.

Before examination and after examination of healthy women, the doctor and midwife wash their hands with toilet soap. In the presence of an infection or when examined in the II department, the hands are disinfected with disinfectant solutions. After the reception, each woman is treated with disinfectant solutions for instruments, a vessel, a couch, a shower room, and a toilet.

GENERAL BLOCK

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

Prenatal and delivery rooms can be represented by 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 represented by separate structures, then they should be in a double set in order to alternate their work with thorough sanitation (work no more than three days in a row).

AT prenatal a centralized supply of oxygen and nitrous oxide and appropriate equipment for labor pain relief, heart monitors, ultrasound machines are needed.

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

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

In the prenatal ward, blood is taken from a woman in labor from a vein to determine the clotting time and the Rh factor. The doctor and midwife are constantly monitoring the woman in labor, the course of the first stage of labor. Every 2 hours, the doctor makes a record in the history of childbirth, which reflects the general condition of the woman in labor, the pulse, blood pressure, the nature of contractions, the condition of the uterus, the fetal heartbeat (in the I period, it is heard every 15 minutes, in the II period - after each contraction, attempts), the ratio of the presenting part to the entrance to the small pelvis, information about the amniotic fluid.

In childbirth, drug anesthesia is carried out with the help of antispasmodics, tranquilizers, ganglionic blockers, antipsychotics, narcotic drugs, etc. Anesthesia of childbirth 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 outflow of amniotic fluid, and then - according to indications. In the history of childbirth, these indications must be indicated. Vaginal examination is carried out in compliance with all the rules of asepsis and antiseptics with the taking of smears on the flora. In the prenatal period, the woman in labor spends the entire first stage of labor. The presence of the husband is permitted under conditions.

Intensive Care Ward It is intended for pregnant women, women in childbirth and puerperas with severe forms of preeclampsia and extragenital diseases. The ward must be equipped with the necessary tools, medicines and equipment for emergency care.

At the beginning of the second stage of labor, the woman in labor is transferred to delivery room after treatment of 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 giving anesthesia, necessary medicines and solutions, instruments and dressings for childbirth, toilet and resuscitation of newborns. The room temperature should be +20С -+22С. At birth, the presence of an obstetrician and a neonatologist is mandatory. Normal births are performed by a midwife, abnormal and breech births are performed by an obstetrician. Delivery is carried out alternately on different beds.

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

The dynamics of childbirth and the outcome of childbirth are recorded in the history of childbirth and in the "Journal of records of childbirth in the hospital", and surgical interventions - in the "Journal of records of surgical interventions in the hospital".

After childbirth, all trays, mucus suction balloons, catheters, and other items are washed with hot water and soap and disinfected. Disposable tools, objects, etc. are thrown into special containers with plastic bags and lids. Beds are treated with disinfectant solutions.

Birthing rooms operate alternately, but not 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. In the absence of childbirth, the room is cleaned once a day using disinfectants.

Small operating rooms in the birth unit (2) are designed to perform all obstetric aids and surgical interventions that do not require abdominal surgery (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 abdominoplasty (large and small caesarean section, supravaginal amputation or extirpation of the uterus). The rules of the sanitary-epidemic regime are the same.

After normal delivery, the mother and the newborn are in the maternity unit for 2 hours, and then they are transferred to the postpartum unit for joint stay (separate wards for the mother and the newborn or ward-boxes for the joint stay of the mother and child).

POSTPARTUM DEPARTMENT

Postpartum department includes wards for puerperas, procedural, linen, sanitary rooms, toilet, shower, discharge room, offices for staff.

The wards should be spacious, with 4-6 beds. The temperature in the wards is +18С - +20С. The wards are filled cyclically in accordance with the wards for newborns within 3 days and no more, so that all puerperas can be discharged simultaneously on the 5th - 6th day. If it is necessary to detain 1-2 puerperas in the maternity hospital, they are transferred to "unloading" chambers. For puerperas who, due to the complicated course of childbirth, 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 are allocated.

Each puerperal is assigned a bed and a ship with one number. The mother's bed number corresponds to the newborn's bed number in the neonatal unit. In the morning and in the evening, wet cleaning of the wards is carried out, after the third feeding of newborns - cleaning using disinfectants. After each wet cleaning, bactericidal lamps are turned on for 30 minutes. Change of linen is carried out before wet cleaning of the premises. Bed linen is changed 1 time in 3 days, shirts - daily, linens - the first 3 days after 4 hours, then - 2 times a day.

currently accepted active management of the postpartum period. After normal delivery, after 6-12 hours, women in childbirth are allowed to get out of bed, make a toilet on their own, starting from three days, take a shower daily with a change of clothes. For conducting exercise therapy in the postpartum period and for lecturing, radio broadcasting to the wards is used. The staff in the postpartum ward washes their hands with soap and, if necessary, treats them with disinfectant solutions. After the transfer of the puerperal to the II department or the discharge of all puerperas, the wards are treated according to the type of final disinfection.

The feeding regimen of newborns is important. Rationality has now been proven exclusive feeding, which is possible only with the joint stay of the mother and child in the ward. Before each feeding, the mother washes her hands and breasts with baby soap. Teat treatment to prevent infection is currently not recommended.

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

DEPARTMENT OF NEWBORN

Medical assistance to newborns begins to be provided from the maternity unit, where in the room for newborns they not only care for them, but also perform resuscitation. 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 lung ventilation, a children's laryngoscope, a set of tubes for intubation, medicines, sterile material, umbilical cord reprocessing bags, sterile baby changing kits, etc.

Chambers 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 in asphyxia, with impaired cerebral circulation, respiratory disorders, after surgical delivery. 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, inventory.

The department observes the same cycle of filling the chambers, in parallel with the mother's chambers. If the mother and child are detained in the maternity hospital, then the newborns are placed in " unloading Wards for newborns should be provided with centralized oxygen supply, bactericidal lamps, warm water. The temperature in the wards should not be lower than +20С - +24С. incubators, changing and resuscitation tables, equipment for invasive therapy, ultrasound machine.

In the children's department, the strictest observance of the rules of the sanitary and epidemic regime: hand washing, disposable gloves, processing of tools, furniture, premises. The use of masks by staff is indicated only for invasive manipulations and in case of an unfavorable epidemiological situation in the maternity hospital. During the entire stay in the maternity hospital, only sterile underwear is used for newborns. In the wards, wet cleaning is carried out 3 times a day: 1 time per day with a disinfectant solution and 2 times with detergents. After cleaning, bactericidal lamps are turned on for 30 minutes and the room is ventilated. Ventilation and irradiation of the wards with open bactericidal lamps is carried out only during the absence of children in the wards. Used diapers are collected in containers with plastic bags and lids. Balloons, catheters, enemas, gas outlet tubes after each use are collected in separate containers and disinfected. The instruments used must be sterilized. Unused dressings must be re-sterilized. After discharge, all bedding, cribs and wards are disinfected.

The department conducts a total screening for phenylketonuria and hypothyroidism. On days 4-7, healthy newborns are given primary anti-tuberculosis vaccination.

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

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