Gynecologist appointment. Specialists Assistance from additional specialists

Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences, Professor
Honored Worker of Science of the Russian Federation, laureate of the Prize of the Government of the Russian Federation,
Member of the Presidium of the International Federation of Gynecological Endoscopy,
Member of the American Association of Gynecologists-Laparoscopists,
President of the Russian Endometriosis Association,
Vice-President of the National Association of Gynecologists-Endoscopists of Russia.
Chief specialist in obstetrics and gynecology of the Ministry
health care and social development of the Russian Federation.
Schedule
In 1972 she graduated from MMI. I.M. Sechenov. In 1977 she defended her thesis on the topic: "Reproductive function in patients with endometrioid ovarian cysts before and after treatment"; in 1985 - doctoral thesis on the topic: "The state of the reproductive system of patients with benign tumors of the internal genital organs and the principles of its recovery after reconstructive plastic surgery." From April 1989 to the present, L.V. Adamyan is the head of the Department of Operative Gynecology of the Scientific Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov. Since 2002 L.V. Adamyan - Head of the Department of Reproductive Medicine and Surgery, MSUMD..
In 1993 L.V. Adamyan was awarded the academic title of professor. In 1999 she was elected a corresponding member of the Russian Academy of Medical Sciences, in 2004 - a full member of the Russian Academy of Medical Sciences; member of the Bureau of the Department of Clinical Medicine of the Russian Academy of Medical Sciences. In 2002, L.V. Adamyan was awarded the title of "Honored Scientist of the Russian Federation" and awarded the Prize of the Government of the Russian Federation in the field of science and technology for the introduction of endoscopic techniques in gynecology.
Adamyan L.V. - one of the leading obstetrician-gynecologists of the country, whose scientific and practical interests cover all aspects of reproductive health from embryogenesis to postmenopause. She conducted fundamental scientific research into the pathogenesis of various aspects of pathological processes in the human reproductive organs. Perfectly mastering the techniques of traditional and the latest surgical techniques, L.V. Adamyan manages and coordinates scientific research to improve the technique of reconstructive plastic surgery in obstetrics and gynecology, actively develops the direction of minimally invasive surgery and the use of new technologies in operative gynecology. L.V. Adamyan has 19 copyright certificates for various inventions in the field of operative gynecology, she has developed her own methods of operations, which she has repeatedly demonstrated at international congresses in Italy, the USA, Great Britain, and Belgium. Adamyan L.V. conducts a lot of medical work, provides advisory and medical assistance in various medical institutions in Moscow and other cities, travels to difficult cases, participates in consultations.
The results of scientific activity of L.V. Adamyan are presented in 968 publications in domestic and foreign editions, including 14 monographs and manuals, 5 atlases, 11 chapters. L.V. Adamyan created a scientific and clinical school of gynecologists, recognized in 2006 as the leading school in the specialty within the framework of the federal targeted scientific and technical program "Research and development in priority areas of science and technology", whose representatives head the departments of medical universities, medical institutions and clinical units hospitals and medical centers both in Russia and in countries near and far abroad. Under the leadership of L.V. Adamyan, 48 candidate and doctoral dissertations were completed, 21 works are being carried out. L.V. Adamyan conducts a lot of scientific and organizational work as a member of the Academic Council of MSMSU, SC AGiP, Moscow Medical Academy, a member of the Problem Committee of the Scientific Council of the Russian Academy of Medical Sciences and the Ministry of Health and Social Development for obstetrics and gynecology. Under the leadership of L.V. Adamyan, joint scientific research is carried out with the universities of Oxford (Great Britain) and Leuven (Belgium).
L.V. Adamyan is President of the Society for Reproductive Medicine and Surgery and the Russian Association of Endometriosis, Vice President of the National Association of Gynecologists and Endoscopists of Russia. Under her leadership, over the past 16 years, these associations have organized and conducted 20 International Seminars and Congresses on various aspects of gynecology on the basis of the SC AGiP, and in 2006 the First International Congress on Reproductive Medicine.

Why are they going to combine maternity hospitals and antenatal clinics, what examinations are due to pregnant women for free and at whose expense visitors give birth in the capital

Change text size: A A

The chief freelance specialist in obstetrics and gynecology of the Department of Health told about this on the air of Radio Komsomolskaya Pravda (97.2 FM).

WOMEN'S HEALTH CENTERS MAY APPEAR IN THE CITY

Alexander Georgievich, ordinary city polyclinics have long been united with each other, and multidisciplinary hospitals with maternity hospitals. Now next in line is the merging of maternity hospitals with antenatal clinics. Why is this needed?

We have undergone a major modernization of all health care in general. We are talking not only about the obstetric and gynecological service, but also about all the changes in urban medicine over the past five years. One of the first fundamentally important steps in this direction was the unification of maternity hospitals with multidisciplinary hospitals. This made it possible to significantly increase the effectiveness of specialized, including emergency, medical care for expectant mothers, reduce the number of complications during pregnancy and childbirth, and significantly reduce maternal mortality from the most common causes. That is, everything is done for the safety of patients and accurate diagnosis.

The connection of antenatal clinics to multidisciplinary hospitals should be completed in September this year. This will create a fully self-sufficient integrated model of medical support for a woman, from the first visit, observation during pregnancy and childbirth, to the provision of high-tech assistance in case of detection of certain gynecological diseases.

Expectant mothers can now be treated, observe pregnancy and give birth in one institution. I would call them women's health centers. Because, although it is believed that pregnancy and childbirth is a physiological process, different situations may arise when urgent help is needed not only for an unborn or born child, but also for his mother. So we can intervene quickly. Serious devices such as computed tomography (CT), magnetic resonance imaging (MRI), sophisticated medical equipment - all this is available in a multidisciplinary hospital, which includes a maternity hospital with all departments, and a women's clinic. Until the end of autumn we will complete their unification.

- And if the maternity hospital is far from the hospital?

Of course, this would be an ideal situation - a hospital and a maternity hospital on the same territory. But today there are separate maternity hospitals and separate multidisciplinary hospitals in the city. We tried to distribute them geographically so that patients and doctors do not have to go far. For example, if necessary, specialists from the hospital can come to the maternity hospital or transfer the patient to a general hospital for emergency care. All antenatal clinics remain at their address, where residents are used to visiting. Only doctors, obstetricians and gynecologists working in this antenatal clinic become employees of the nearest multidisciplinary hospital.

THE HUSBAND, THE "SLAVE" AND THE PHOTOGRAPHER WILL HELP AT THE BATTLE

It turns out that soon all maternity hospitals in the city will become the same as the elite clinical hospital "Lapino" and the Perinatal Center on Sevastopol Avenue?

Now every institution, in the structure of which there is a gynecological department and a maternity hospital, is trying as much as possible to increase the comfort of patients' stay.

By the way, about comfort. Some in the maternity hospital need a husband, others need vertical or water births. We also have a foreign chip - a doula (translated from Greek - a slave. This is an assistant during childbirth, which provides a woman with practical and psychological support. For example, she gives massage, brings water, soothes. - Approx.). Some pregnant women take even photographers with videographers with them at the most crucial moment. How do doctors feel about this?

Need a doula in a maternity hospital? Yes please, we did it. Does the patient want the presence of her husband during childbirth? In our country, all maternity hospitals are open so that not only the husband is at the birth, but also the mother and sister. Of course, not the whole family, but someone alone. To do this, a husband or other relative needs to do a fluorography so that we know that he does not have any changes in his lungs. Then the deputy chief physician of the maternity ward gives permission for the presence.

- And some husbands play the guitar in the delivery room ...

Still, let's not make some farce out of the maternity ward. We try to ensure that the patient chooses with whom she wants to share an important moment in her life, and this person will be present with her at the birth. It happens that this is a videographer too. But still, more often video and photography are done when the child and mother are discharged from the hospital.

- There are still supporters of home birth ...

I absolutely do not recommend home birth. This is the most dangerous if in such a situation the patient remains outside the medical facility. Someone gave birth at home and says that everything went well. But for some it will be completely different. Therefore, there is no need to risk your life and the life of your unborn child. We do everything to ensure that patients come to medical institutions. Now, after all, many people want not just childbirth, but the so-called natural childbirth. For example, in the maternity hospitals at the 68th hospital, and in the hospital named after Yudin, special baths have been installed. Patients often ask for a vertical delivery, when the woman is not lying, but standing. For example, Maternity Hospital No. 4 has been delivering vertically for ten years. Now it is in many maternity hospitals in Moscow. By the way, the expectant mother can, regardless of which district of Moscow she lives in, choose any maternity hospital convenient for her in the city for free under the CHI policy.

- And if there is no policy, registration, too, what to do?

We accept all patients in our maternity hospitals. Obstetrics are classified as emergency medical care. In Moscow, there are all the opportunities to give birth to both Muscovites and visitors. Therefore, any patient will receive all the necessary services and assistance during childbirth. Absolutely free. Even if at the time of contractions the patient does not have a compulsory medical insurance policy. Nobody gives birth on the street.

FREE EXAMINATIONS FOR EVERYONE

- What examinations are required for pregnant women to do for free?

All necessary tests, prenatal screenings and drugs are provided to our patients without any additional payments. It is enough to register for pregnancy and you do not have to pay a penny for anything.

- That is, it is not necessary to conclude a contract for childbirth for 100 - 200 thousand rubles?

It is not at all necessary to spend big money on childbirth. The contract is usually concluded because the patient wants to see one doctor both during pregnancy and childbirth. She communicates with him for a long time, she is already used to it, the doctor has become for her a close person who is trusted.

- The topic of refusing screenings is often discussed on the Internet in the forums of expectant mothers ...

Screening of the unborn child in due time should be carried out. With prenatal diagnosis, you can find out if the child has, for example, Down's syndrome or an incurable heart disease. Then the parents have the right to decide for themselves what to do next.

Of course, not on the forums to talk about it. You need to come to your outpatient center and ask the professionals about what worries you. Obstetricians are not enemies to patients. I am aware of everything that is happening on the forums. We have a special service monitoring them. One patient missed the screening, she writes on the Internet to others that she doesn’t need to go to the doctors, they say, I’m fine. We deal with this all the time in our work. Therefore, I ask expectant mothers - instead of discussing on the forum, come for a consultation with a doctor.

- Radio listener Vladimir asks: "Why was the 16th maternity hospital closed in the artists' village in the north of the city?"

We have to close some maternity hospitals, as they are old buildings from the 30s with wooden ceilings. Reconstruction will no longer help such buildings. Instead, a maternity hospital at hospital No. 36 was opened after reconstruction in the area of the artists' village, with modern operating rooms, comfortable boxes for women in labor.

Of course, where possible, we make major repairs. In addition, two maternity hospitals will open in Moscow this summer. This year, after reconstruction, we will launch the former 5th maternity hospital, and now it is a maternity hospital at the city clinical hospital No. 40. Another new maternity hospital will appear on the territory of the infectious diseases clinical hospital No. 2.

IT IS RUMORED THAT…

Muscovites have more twins and triplets due to IVF procedures

In vitro fertilization (IVF) was included in the list of services under the compulsory health insurance policy two years ago. Any patient diagnosed with infertility, in the absence of contraindications and without age restrictions, can make two IVF attempts for free within one year. To do this, you need to contact your antenatal clinic and enroll in the IVF registry. Then choose one of the 30 city, federal or commercial clinics that carry out this procedure under compulsory medical insurance (more on this on the website of the Moscow Department of Health).

One of the reasons for multiple pregnancy in a certain percentage, of course, is IVF. The increase in the number of such patients is certainly connected with this. According to the Moscow Bureau of Medical Statistics, in 2015 there were only 1,798 multiple births in the city. Of these, 1776 twins and 22 triplets. And in 2016, those numbers increased. In total, there were already 1875 multiple births. Of these, 1852 twins and 23 triplets.

QUESTION-EDGE

At whose expense do migrants give birth in Moscow maternity hospitals?

A question from the readers of our site: “At whose expense do visitors in the city give birth? After all, some of them get to doctors without insurance and compulsory medical insurance policies.”

There are no more visitors among women in labor than Muscovites. Is the Moscow region newcomers? And we have a fairly high percentage of deliveries of patients from the Moscow region. Five modern perinatal centers will open in the Moscow region in the near future. Of course, married couples who live in the Moscow region will no longer come to Moscow to give birth.

I repeat once again, we accept childbirth free of charge for everyone who comes to us with contractions. This is emergency help. Further, the Compulsory Medical Insurance Fund conducts mutual settlements with the regions.

DOSSIER "KP"

Konoplyannikov Alexander Georgievich was born in Tbilisi in 1962.

“I held the patient’s hand for two days”

Rules of life of the chief obstetrician-gynecologist of the country

Anastasia Gnedinskaya

The working day of the chief obstetrician-gynecologist of Russia Leyla Adamyan starts at seven in the morning. In the elevator, she takes off her watch and rings, puts on surgical pajamas as she goes. Ten minutes later, surgery. There are few such titled women in Russian medicine. Leyla Adamyan is an academician, an honored worker of science, a holder of the orders "For Merit to the Fatherland" IV, III and II degrees. But every day, like forty years ago, she performs several complex operations.

On January 20, Leyla Vladimirovna has her birthday. RIA Novosti correspondent spent one day with this amazing woman.

"Responsibility for two lives"

Leyla Adamyan appoints an interview at nine in the morning. By this time she has been on her feet for four hours. In order to do everything, he gets up at five. “I sleep for four or five hours, no more. I can't afford to waste precious time. But I have no problems sleeping, as soon as my head touches the pillow, I switch off, ”while we walk along the corridors of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Leila Vladimirovna speaks on abstract topics. There are several tense hours ahead - she was urgently called to see a woman with a severe form of uterine fibroids.

The surgeon exchanges high-heeled shoes for clogs on high wedges only at the entrance to the operating room. He believes that even in the most difficult work a woman should remain elegant. Comes out after an hour and a half. She puts on a white coat and flies back to the waiting room, where patients are already waiting for her ...

Unlike most famous doctors, Leyla Adamyan was born in a family that has nothing to do with medicine. His father is a master engineer at a factory, his mother is a primary school teacher.

Raising two girls, they could not imagine that both would then wear white coats. The neighbors chose the profession for the sisters. More precisely, not even the neighbors - the yard. In Tbilisi, the family lived in a house united by a typical courtyard-well. In total, 17 “cells of society” huddled there, and in each there was a huge number of grandmothers, grandfathers, aunts. Not surprisingly, the ambulance visited them with frightening regularity.

“I always ran out to meet doctors. While they listened to the patient, gave him injections, stood by and watched, - Leila Vladimirovna recalls during an interview with RIA Novosti. - For me, people in white coats were real angels who came to a sick person, and left a healthy one. Over time, the doctors got used to me so much that they asked me to write down something in the map, count the pulse, and help in bandaging the wound. And I did it with great pleasure.”

By the age of eleven, Leila clearly knew which symptoms required an injection of magnesia, and which - mustard plasters.

It so happened that from the third grade, only her mother raised her and her sister. “We clearly agreed with her: she works, I study. And I tried very hard. Suffice it to say that at school she was the only medalist for four graduation classes, ”the obstetrician-gynecologist notes.

Leyla Adamyan's second hobby was sports: despite her short stature, she was the captain of the youth women's volleyball team.

“Even then, I got used to teamwork, to the fact that the success of the game largely depends on my decisions and cohesion in the team. I took responsibility and got a drive from it. When choosing a profession, this was one of the decisive factors. I needed a job, wherever I was on the sidelines, wherever the fate of a person depended on me. Obstetrics is such a fateful specialty. And here the risk is multiplied in two, because you take responsibility for two lives at once - a woman and an unborn baby. Or, which is also very significant, you give the opportunity to experience the feeling of motherhood to those who were deprived of it due to various diseases.

Leyla Adamyan was accepted to the Medical Institute based on the results of a single exam - as a medalist. And it didn't last long.

“I remember that I didn’t even want to leave the office, I kept waiting for more questions to be asked. The voiced ones seemed too easy, ”recalls the interlocutor of the agency.

Leyla Adamyan came to work at the Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov 47 years ago

She initially did not want to be a gynecologist - she saw herself as a surgeon. But my husband was categorically against it. “At that time, he was already working as a surgeon at the Vishnevsky Institute. And two operating doctors in the family is too much, - explains Leila Vladimirovna. - I obeyed, went to gynecology. And then, it just so happened, I still chose surgery.

“I didn’t leave the patient for two days”

Leyla Adamyan came to the Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov 47 years ago - in 1971. At first I was a subordinator, then an intern. In the morning, together with the nurses, she personally took blood from all the patients. Once a week I set myself a duty in the birthing room. “I took on everything. I think that a real doctor, and even more so an obstetrician-gynecologist, should be able to take birth and stop bleeding.

After night shifts, she hurried home to two daughters, whom she gave birth to while studying at the 1st Moscow Medical Institute named after I.M. Sechenov. One for the winter holidays, the other for the summer.

“By the way, we have a phenomenal family: my father, my daughter and I were born on January 20 at the same time,” the interlocutor cites a curious fact.

Leyla Adamyan will never forget one of the night shifts. She was urgently called into the operating room: a woman in labor named Marina started bleeding. As it turned out, the woman hid from the doctors that she had a serious illness in which the blood did not clot. “When I was called into the operating room, she had already lost two liters. Over the next two days, another 23. Just think about it: 25 liters of blood. An adult has only five. We transfused her with blood, she lost it ... ”the doctor explains.

Donors for Marina were cadets from the police school opposite the hospital - they lined up to donate blood for a dying young mother.

For two days, Leila Vladimirovna did not leave the patient: she held her hand. Even lunch was brought to her in the intensive care unit. “Something had to be done, because it couldn’t go on like this. And I called my husband. He then headed the department of dressings, suture and polymeric materials of the A.V. Vishnevsky Institute of Surgery, where the first embolizations were just begun (that is, “blockages” of the arteries by a minimally invasive method. - Approx. ed.). True, before this case, the technology was used mainly for cerebral hemorrhages or during operations on the brain.

I remember how I begged into the phone: “A woman is dying in my arms, do something, because she won’t survive another operation!” He asked if the patient was transportable. And we took responsibility for the transportation."

It was the first embolization in obstetrics and gynecology in the Soviet Union. The blood was stopped - Marina survived. “When we gave material about this operation to the Izvestia newspaper, the journalists even decided to correct the volume of blood loss: instead of 25.5 liters, they wrote 2.55. No one could believe that a person can lose so much blood and stay alive,” Adamyan notes.

An article in Izvestia dedicated to the rescue of Marina

It's been 34 years. Marina periodically calls Leila Vladimirovna. And recently she brought her son and said that she had come for her grandchildren.

"I will pray for her"

For forty-six years in a row, Professor Adamyan has hosted on Thursdays. But on other days, a queue forms in front of her office. In the corridor of the department of operative gynecology, which she heads, a visitor in a flowery dressing gown and a scarf rushes to Leila Vladimirovna. “Every day I will pray for you that they didn’t refuse,” she thanks the doctor in broken Russian.

She asks not to take pictures of her and not to mention her name. In the Tajik city of Khujand, where they came from, no one knows that her daughter has a rather rare gynecological problem - the girl was born with an undeveloped uterus and vagina. This pathology is called aplasia.

“If someone in our city hears about this, they won’t marry. And she is my fifth child, a beauty, ”the mother almost cries.

He explains that over the years dozens of doctors in Tajikistan have been visited, but no one has been able to help. “Everyone says that this is a congenital defect, you can’t treat it, you need to live like that. How so? She needs to get married...

One of the doctors advised me to go to Moscow, to see Leyla Adamyan. “I read the Internet, found everything about her. She is a doctor from God. She told me: “Don't cry, I'll do the operation myself, everything will be fine. Now my girl is already being prepared, in two hours Leila Vladimirovna will take her.”

In the office, the obstetrician-gynecologist clarifies that such a malformation of the female body is not at all unique. It is diagnosed in three percent of girls. And it was Leila Vladimirovna who developed the author's method for eliminating this defect. Moreover, in the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov, more such operations were performed than in the whole world. “We create a vagina from the peritoneum, we do everything so that the patient becomes a full-fledged woman,” the doctor explains.

One of the priority areas for improving the health care system has traditionally been the protection of motherhood and childhood. So, in the capital region, work in this direction has always been carried out, however, especially noticeable structural changes in this area have occurred over the past few years.

The Chief Obstetrician-Gynecologist of the Moscow Department of Health, Professor of the Department of Obstetrics and Gynecology at the Russian National Research Medical University named after M.V. N.I. Pirogova Alexander KONOPLYANNIKOV.

- Alexander Georgievich, you have been supervising the work of the obstetric and gynecological service of the capital for more than 4 years, so all the changes taking place in this area are taking place with your direct participation. What are they and what are their goals?

- If we go back in history, changes began almost 4.5 years ago. The first thing we did as part of the modernization of our service was to combine free-standing maternity hospitals with multidisciplinary hospitals. At that time, the very structure of providing obstetric and gynecological care in the city was arranged in such a way that only a part of maternity hospitals was located in the structure of multidisciplinary hospitals. Others existed separately, they did not have all the capabilities of a hospital with powerful resuscitation, surgical, vascular, therapeutic departments, departments of functional diagnostics, which the city authorities have equipped with the most modern equipment over the past 5 years.

If there was any situation related to complications and pathologies, then a specialized team - resuscitation, vascular, etc. - went to the aid of this maternity hospital. After all obstetric hospitals were administratively attached to multidisciplinary hospitals, when a critical situation occurs, all services of the multidisciplinary hospital help the maternity hospital. The need for previously formed mobile specialized teams has lost its relevance. Therefore, the service has been repurposed to perform other tasks.

Now, not only the deputy chief physician for obstetrics, but the chief physician himself is responsible for each pregnant woman entering the maternity hospital. The provision of medical care to pregnant women is a litmus test for the availability of medical care in general. It is the chief physician who must ensure the correct organization of medical care in the institution subordinate to him. Accordingly, his motivation to improve the skills of the staff, the introduction of new technologies has increased.

As a result, safety has increased for both the patient and the fetus. The successful implementation of the first stage of the reform of the system of obstetric and gynecological care in Moscow has made it possible to qualitatively improve the level of medical care for both pregnant women and patients with gynecological diseases in general.

We managed to improve the situation with such complications as massive obstetric bleeding during childbirth, which is still one of the main causes of maternal death in Russia. Thanks to the introduction of evidence-based medicine using only modern technologies (for example, X-ray surgery), the use of effective drugs and equipment (for example, in every maternity hospital in Moscow there are cell savers that minimize the use of donor blood by using their own) over the past years in medical organizations Moscow, not a single puerperal died from bleeding ...

– How were these changes perceived by the professional community?

- A bit wary at first. The medical community is quite conservative, so any innovation that completely changes the usual scheme of work finds some resistance. No less important is the fact that earlier in each maternity hospital there was a chief physician, who, in the new scheme, became the deputy chief physician of the hospital for obstetrics and gynecology - that is, there was a decrease in his functional capabilities.

On the other hand, having started working in the system of multidisciplinary hospitals, both the management and staff of maternity hospitals realized that fundamentally new opportunities were now opening up before them. They have a kind of "big brother" who will come to the aid of this institution in any situation. For example, if a patient requires further observation, diagnostics and cannot receive them inside the maternity hospital for some objective reasons (for example, there is no opportunity to perform CT or MRI), then a multidisciplinary hospital has it all. That is, if necessary, the patient can be transported to the hospital for further examination and treatment. Thus, everyone understood the benefits of the innovation: both doctors and patients.

- This summer, the process of combining multidisciplinary hospitals with antenatal clinics began ...

- Quite right. Moreover, a pilot project in this direction has already been worked out in the capital's Center for Family Planning and Reproduction, to which 9 antenatal clinics were attached. In Moscow, there used to be 131 antenatal clinics, where pregnant women or patients with complaints of some kind of illness or complications came for the first time.

But the first ones who see patients are outpatient doctors. This is the most crucial moment: the first meeting with the patient, competent history taking, identification of risks and resolution of issues related to the observation and treatment of pregnant women and patients with gynecological diseases. That is why it was so important not only to solve organizational and administrative issues, but also to raise the professional level of the staff of antenatal clinics.

Having set ourselves such a goal, we created the Moscow School of Obstetrician-Gynecologist 3 years ago. I invited polyclinic doctors there to raise their educational level and so that they treat all patients equally and treat all forms of diseases equally.

In June of this year, an order was signed by the capital's Department of Health to merge multidisciplinary hospitals, which include obstetric departments, with women's consultations. On a territorial basis, we have attached antenatal clinics to 17 multidisciplinary hospitals. The implementation of this approach will ensure the provision of medical care to our patients - from contacting the antenatal clinic and ending with the provision of specialized care both during pregnancy and childbirth, and with gynecological diseases. If necessary, receive treatment in one medical organization: from the diagnosis of the disease to rehabilitation after surgical treatment. One medical organization, not several, will be responsible for it.

It is important to note that nothing changes for patients: they still apply to the LCD at the place of residence (territorially everything remains in its place). For doctors, only the employer changes: now they are employees of a particular hospital, but physically come to their previous workplace.

The unification process will be completed in full in September of this year.

– Work according to this model imposes completely different requirements on the professional training of the doctors involved in it. How will this process be ensured?

– In modern conditions, representatives of our profession need to become real all-rounders, able to provide assistance at the same high level both in the outpatient department, and in the gynecological hospital, and in the process of accompanying pregnancy and childbirth.

The diplomas of both antenatal clinics and hospital doctors contain one specialty - an obstetrician-gynecologist. Unfortunately, we gradually lost our universality, dividing ourselves according to the place of work. When all these doctors become doctors of structural subdivisions of multidisciplinary hospitals, the city will have the main obstetric and gynecological section, including an outpatient clinic, a hospital and a maternity hospital. Such a structure will ensure constant professional communication of doctors, exchange of experience, creation of conditions under which a doctor, for example, an outpatient department, can enter both the maternity and gynecological departments, to see if hospitalization is justified for a particular patient. The same applies to his colleagues from the maternity hospital or hospital. Currently, together with the Moscow Department of Health, we are solving the issue of having all obstetricians and gynecologists work according to the same clinical protocols after the completion of the merger process.

- Provided that the new model of organizing medical care will include all the "links" - from the antenatal clinic to the specialized department of the hospital - will there be a risk that at a certain stage the patient will want to apply to another medical organization? Indeed, in this case, it will be possible to forget about maintaining continuity in treatment ...

- At the system level, the management of a medical organization will be interested in patients receiving medical care in this particular structure - from the first visit to the antenatal clinic and ending with childbirth or receiving specialized care. There are no other levers other than creating comfortable conditions for the patient, attracting the most qualified personnel and increasing the efficiency of the institution. Patients, according to the current legislation, have the right to choose a medical organization. How this work will be organized and how effective it will be is also an indicator of the professionalism of the head of a medical organization.

By the way, if we have already mentioned the financial topic, then it is worth noting that the salary level of the medical staff of antenatal clinics will not change when changing employers. To ensure this condition, the issue of increasing the tariffs for pregnancy care in antenatal clinics is currently being considered to ensure the wage fund. There is every reason to believe that this issue will be resolved positively.

- In addition to organizational changes, a qualitative technological leap took place in the obstetric and gynecological service of the capital, so to speak. Can you tell me more about this?

– One of the most noticeable positive results of the modernization of the obstetric and gynecological care service was the creation of a network of perinatal rooms. It was the work of specialists in these offices that made it possible to ensure that the diagnosis is made during pregnancy. After providing information about the possibility of correcting this disease, a married couple decides on the possibility of maintaining the pregnancy. There are fewer and fewer unpleasant situations when a diagnosis is made to a baby after childbirth, when for parents it is like “thunder in the blue”.

When the issue of creating this network was discussed, I advocated that there should be at least one of them per district - that is, at least 11 in Moscow, given that each administrative district is, in fact, a city with a million inhabitants. As a result, on the initiative of the chief district obstetrician-gynecologists, based on the principle of territorial accessibility, a total of 37 such rooms were created. A clear prenatal diagnostic service has been built.

All antenatal clinics are sent to the offices of prenatal diagnostics of pregnant women at 11-14 weeks, as well as at 18-21 weeks for prenatal screening to not only detect fetal malformations, but also predict the risk of fetal growth retardation, the development of such a formidable pregnancy complications like preeclampsia. During the first prenatal screening (11-14 weeks), not only ultrasound, but also biochemical examination is performed, since the study of these markers (PAPP-a and -hCG) allows you to more accurately calculate the individual risk of developing not only fetal pathology, but also placental insufficiency .

Now all prenatal diagnostic rooms are united into a single information network. If abnormalities are detected, pregnant women are referred for medical genetic counseling, where, after an expert ultrasound examination, a decision is made on the need for invasive diagnostics.

Obstetrician-gynecologists work in the prenatal diagnostic rooms, having not only a certificate of an ultrasound diagnostic doctor, but also an international certificate. Also, KPD doctors undergo monthly audits (correctness of ultrasound).

Previously, from taking the analysis to receiving the result, 2 weeks passed. Now thanks to this system - 2 days. This is a very important indicator, as we are limited by a strict time frame for deciding whether to terminate a pregnancy in the event of a fetal malformation.

– How do you assess the decision to introduce the status of “Moscow doctor” in relation to obstetricians and gynecologists?

– My personal position on the question of how and to whom the status of “Moscow Doctor” can be assigned may well cause some dissatisfaction among my colleagues. However, I fundamentally believe that this status should not become widespread and should not be available to everyone. It should be prestigious and truly represent the professional distinction of a particular specialist and be awarded not “according to the totality of merit”, but according to objective criteria.

An obstetrician-gynecologist with the status of "Moscow doctor" should not be a narrow specialist in some area. He must be equally well versed not only in his own, but also in related specialties - both in accompanying pregnancy, and in childbirth, and in the treatment of gynecological pathology, urogynecology, oncogynecology, etc. That is why, when developing materials for passing the exam for obtaining this status, we proceeded from the fact that they should be general and universal for all areas of obstetrics and gynecology. Moreover, in my opinion, test tasks, along with the correct answers, must be in open access, regardless of whether the doctor decides to go for the exam, the knowledge gained when getting acquainted with the tickets will not be superfluous.

The second stage of the exam involves the use of simulation technologies: the applicant must deliver, perform vacuum extraction, demonstrate knowledge of laraproscopic surgical techniques and the ability to conduct and interpret the results of ultrasound of pregnant women, etc. I repeat, all this regardless of the actual place of work and position. "Moscow doctor" should be able to do everything ...

Finally, during the third stage, the applicant will be asked to solve a situational problem, during which he must demonstrate not only professional skills, but also the ability to act in a non-standard situation. A very important point: the chief physician of a medical organization must be present at the exam. After all, it is he who ultimately needs to represent the level of competence of his employee - at least in order to understand his potential.

In general, if we talk about my vision of the profession, then it lies in the fact that a doctor should not limit his professional duties to work only in an outpatient clinic or in a gynecological department. We are certified obstetricians and gynecologists. This implies that a specialist, if necessary, should be equally effective in the field of gynecology and obstetrics. He should be a generalist who can come to the reception, and take delivery, and perform an operation in the gynecological department. Then it will be a full-fledged obstetrician-gynecologist, and we must strive for this ...

Recently I was discharged from the clinic, where I had an operation under the mandatory medical insurance quota. From what I saw and heard - I have a SHOCK!!! I thought that this happens only in Western American films: clean, modern, stylish; the rooms are spacious, TV, comfortable furniture, large bathrooms, air purifiers, antiseptics, water coolers are everywhere….
But, most importantly, it is the staff: always with a smile, care, sympathy, goodwill (where have you seen nurses just walking past you in the morning asking you, “How did you sleep?”, “How are you feeling?”)
And doctors are a special caste; I am impressed with their hard work and professionalism. Many patients who arrived from different regions, even for a lot of money, could not get qualified help in their city (especially in matters of preserving the reproductive function), but here they found understanding and an individual approach ... At work since 7 o'clock, all day operations, examinations , receptions ... (and so sometimes until 9 pm). When do they sleep and rest? Amazing dedication and dedication!!!
As I understand it, it all starts with the "head". Early in the morning, at 7.15, several times, leaving the ward, I saw the incomparable, amazing Leila Vladimirovna Adamyan - already “in shape” - slender, beautiful, beautifully dressed, makeup, hairstyle, gait, blooming look (as if she had just returned from the resort ), and she also operates all day, accepts, examines ....
And my doctor is a magician in general, MAESTRO - Andrey Vladimirovich Kozachenko (“golden hands”) - calm, sensitive, he will explain everything, tell, warn, answer all questions ... After the operation there was no pain at all; (I even doubted: Was there an operation? Maybe I just slept soundly?)
A separate topic is food: tasty, easy, varied (someone would cook like this at home!)
But, I repeat, the most remarkable thing is the attitude towards patients (ALL medical workers). Low bow to YOU!!! The most positive, bright emotions - Olga Muratova (with gratitude)

In this clinic, according to the quota, I gave birth and performed surgery on my newborn child. Despite all the difficulties, the birth went wonderfully, thanks to the obstetrician Timoshina Irina Vladimirovna. Also, many thanks to the department of surgery and pathology of newborns, within the walls of which my baby lay for more than a month. They saved our lives! The only thing that darkened the impression of the clinic was a mammologist, whom I had to turn to for a fee. The prices are expensive, but they still could not cure me.

I want to express my deep gratitude to the team on duty, who was on duty from 30.06 to 01.07, and in particular to doctor Karimova Galia Nasibullaevna, midwife Koroleva Galina for their high professionalism, for their coherence in work, for respect for the patient, for love for their work. Received 30.06 for 39 weeks with bleeding after examination by Kuznetsova. She was admitted to the Rodblok for diagnostics (with suspicion of placental abruption). There I was connected to a CTG, after which an ultrasound was brought to my ward, where they told me that everything was fine. Doctor Maria Gracheva and Galiya Karimova will answer all your questions. They looked at me and said that it was cervical bleeding and not the placenta. That soon I will enter into labor, since the opening is 2 cm, but when, they could not say, the other day. I was upset, because lying with CTG in an empty ward and listening to how babies were born was very boring. Since my stomach pulled quite a bit, Gracheva said that I needed to prepare the neck and put a candle on me, after which the contractions became a little sick, or is it a coincidence. I was sent for an enema at 12 am, where even there the nurses were very kind and attentive (even the enema is now disposable), there I called my husband. My husband arrived, I was already lying in the prenatal room in compression stockings (it’s just trash to put them on), the contractions grew very quickly, at that moment it was impossible to lie down with CTG. Karimova Galiya did not leave me for a second, although she could have left me. But for this I am very grateful to her, she constantly supported me. She sat with me when I could no longer lie down. I did a neck massage, as it opened very poorly after erosion. Thanks to this massage, although painful during contractions, I did not tear. When the turn came to the midwife Galina, then I realized that I was surrounded by only specialists. They held my legs. Galina encouraged me in time, and when necessary, she shouted so that during painful attempts, I could at least hear someone. And thanks to two girls (women), I gave birth to my baby on 8/9 Apgar without a single tear. After giving birth, I sat, walked after 3-4 hours. Thank you! To the leaders of the Kulakov Research Institute for such well-chosen doctors. Doctors with a capital letter. Thanks again to the doctor Galiyushechka and the midwife Galinochka, I bow to you.

I want to express my gratitude, MD, Head of the Breast Pathology Department, a doctor with golden hands! Thank you very much for your attention and responsiveness! On June 7, I had a breast operation, on the 8th I was already at home. The seam is almost invisible. Valery Vitalievich is very courteous, caring, professional in his field. Rodionova M. V. mammologist-oncologist, I bow to you, thank you for experiencing their problems together with patients, you will always find the right words.

I can call this institution the institution of hope, where it is born, after many years of struggle. I had my first hCG today, the result is excellent 737 mIU / ml. And it's all thanks to Vladimirova Inna Vladimirovna! It all started on May 16th. To say that it was easy - I can’t, in the first place - it was very hard morally. The attitude of all the specialists was excellent, but I went on the compulsory medical insurance program. I really hope everything goes well in the future. For those who have not yet decided, I want to say that it is here that you can get competent help and support. Here you can get the opportunity to become a mother and feel truly happy.