What is observation in gynecology. Observation department in a maternity hospital - what is it? Indications for the observation department
Pregnant and postpartum women who have:
1.2. long anhydrous period (outpouring amniotic fluid 12 hours or more before admission to the hospital),
Inflammatory diseases kidneys and urinary tract(pyelonephritis, cystitis, asymptomatic bacteriuria - 10 CFU/ml urine or more)
Acute respiratory diseases (flu, sore throat, etc.)
Infectious processes birth canal(colpitis, cervicitis, condylomas)
Infections with high risk intrauterine and/or intrapartum infection of the fetus and less epidemiological danger for medical personnel(toxoplasmosis, listeriosis, cytomegaly, genital herpes, etc.)
Pregnant women giving birth with open form tuberculosis is hospitalized in specialized maternity hospitals (departments), if there are none - in boxes or isolation wards observational department followed by transfer after birth to an anti-tuberculosis dispensary,
1.5. for termination of pregnancy for medical and social reasons in the second trimester of pregnancy,
1.7. fetal developmental anomalies detected during pregnancy (in the absence of a specialized hospital),
1.9. unexamined and in the absence of medical documentation.
2.1. increase in body temperature during childbirth and early postpartum period up to 38 degrees C and above (with three measurements every hour),
2.3. postpartum inflammatory disease (endometritis, wound infection, mastitis, etc.),
3. If a newborn is transferred to the observation department, the postpartum mother is transferred along with him.
5. If a pregnant woman, woman in labor or postpartum is diagnosed with purulent inflammatory process In connection with which her further stay in the obstetric hospital poses an epidemiological danger, the woman must be transferred to a specialized hospital of the appropriate profile.
Indications for the transfer of premature and sick newborns from the maternity hospital to the appropriate departments of children's hospitals.
Newborns with suspected surgical pathology, requiring emergency assistance(esophageal atresia, anal atresia, diaphragmatic hernia and etc.). Urgently
Hemolytic disease newborn (in the absence of round-the-clock duty of a neonatologist in an obstetric hospital). Urgently
2. very low body weight (1000 g - less than 1500 g)
O emergency indications- at any age, but after 168 hours from birth - mandatory (for all groups of children)
no later than 168 hours from birth
Initial reception (registration) is carried out in the reception and examination department obstetric hospital after examination by a doctor. For each woman admitted to the ODPH, a birth history (f. 096/u) is filled out in the reception and examination department, and a corresponding entry is made in the pregnant women's reception register (f. 002/u) and in the alphabet book.
It is necessary to ensure isolation of the flow of pregnant women and women in labor entering the physiological and observational departments. To receive gynecological patients, it is necessary to have a separate room.
robe, washcloth), you are allowed to use your own new slippers and personal hygiene items.
0.5% alcohol (in 70% ethyl alcohol) (as amended by Order of the Ministry of Health of the Russian Federation dated November 24, 1998 N 338)
Other skin antiseptics approved for these purposes.
In postpartum physiological departments premises are allocated for the collection, pasteurization and storage of breast milk.
Collected breast milk pour into bottles of 30 - 50 ml for individual use, close and pasteurize in a water bath (no more than 5 - 7 minutes from the start of boiling water), the water level in which should not be lower than the level of milk in the bottles.
It is prohibited to feed several children from the same bottle. Water and drinking solutions must be sterile in individual, single-use packaging.
Indications for admission and transfer of women in labor and postpartum to the observation department of the maternity hospital.
1.1. febrile state(body temperature 37.6 degrees C or higher without clinically significant other symptoms),
1.3. infectious pathology, including:
Inflammatory diseases of other localization ( Chronical bronchitis in the acute stage, pneumonia, otitis media, etc.)
Skin diseases infectious etiology
Infections with a high risk of intrauterine and/or intrapartum infection of the fetus and a high epidemiological danger of infection of medical personnel (HIV infection, syphilis, viral hepatitis B, C, D, gonorrhea)
Tuberculosis ( closed form any location in the absence of a specialized hospital).
1.4. intrauterine fetal death,
1.6. malignant neoplasms,
1.8. mothers in labor in case of childbirth outside medical institution(within 24 hours after birth),
2. Pregnant women, women in labor and postpartum women who have:
2.2. fever unknown origin(body temperature above 37.6 degrees C), lasting more than 1 day;
2.4. manifestations of extragenital infectious diseases that do not require transfer to a specialized hospital (acute respiratory, viral infection, sore throat, herpes, etc.).
4. Pregnant women in labor and postpartum women suffering from infectious diseases are subject to hospitalization and transfer to the appropriate infectious diseases hospitals.
6. In the observation department, patients must be placed in wards according to nosological forms of diseases, pregnant women - separately from postpartum women.
Most expectant mothers are probably afraid of ending up in an “observation” or “infectious diseases” unit. What is the observational department of a maternity hospital and in what cases future mom can it go here?
Specialized observational (or infectious diseases) maternity hospitals, or observational departments of ordinary maternity hospitals (such departments are also called second obstetric departments) exist in order to separate healthy women in labor and women in labor with infectious diseases. It is impossible to list all the diseases for which a woman is hospitalized infectious diseases department. This and these serious illness such as tuberculosis or AIDS, as well as influenza, acute respiratory infections, intestinal infections, birth canal infections and even common diarrhea. In addition, it is in the observation department that women end up after home births and, in general, births that occurred outside the walls medical institutions. Those expectant mothers who were not observed anywhere during pregnancy, whose exchange card is missing or does not have marks about negative tests for HIV, hepatitis and syphilis. If the waters broke more than 12 hours ago, such a woman in labor will also be admitted to the infectious diseases department, because in this case there is a high risk of infection for both mother and child. And even an increase in temperature above 37.6 degrees without any other symptoms may be a reason to be placed in “observation”.
The observation department, which usually occupies a separate floor of the maternity hospital, has its own pathology department, maternity, pediatric and postpartum, operating rooms and diagnostic rooms. Everything here is more isolated than in a regular maternity hospital. For women, most often, individual rooms are provided, because one may have chronic illness, and the other has an infection in acute form. Children in such departments are usually kept separately from their mothers, also in separate boxes. Question about possibility breastfeeding is decided in each case individually.
What to expect when you get to the observation department? First of all, you should not think that this is a place where women in labor are simply isolated from others. There is much more attention to patients here than in a regular maternity hospital. Each woman is constantly monitored by two doctors - an obstetrician-gynecologist and an infectious diseases specialist; they make all decisions regarding therapy jointly. In general, it is believed that doctors in such departments are more qualified and experienced, because they are much more likely to deal with complex and atypical cases. There are also more nurses and aides here, since many patients must adhere to strict bed rest. At serious illnesses(syphilis, hepatitis, etc.) patients undergo not only symptomatic treatment, but also therapy that increases the chances of birth healthy child. And in case of diseases such as acute respiratory infections or acute respiratory viral infections, future and existing mothers will relieve symptoms and carry out restorative therapy, give vitamins and other drugs that increase immunity, and take measures to avoid intrauterine hypoxia, which is possible in the case high temperature moms.
Well, what can you do to avoid ending up in the observation department? Try to avoid infectious diseases during pregnancy. It is not for nothing that doctors advise expectant mothers to avoid crowded places, not be shy about wearing masks during epidemics, eat right, get all the necessary vaccinations and strengthen the immune system even at the stage of pregnancy planning.
The observation department is usually called “infectious” in conversations and stories about childbirth. Observation (from the Latin observatio - observation) is the isolation of sick or healthy (after contact with infectious patients) people in a special room. This quarantine measure is aimed at preventing the spread of infections. In obstetrics, this is the name given to the department or maternity hospital where pregnant women, women in labor and postpartum women are hospitalized, who can be a source of infection for others. Many expectant mothers are very afraid to go to this department, since there are many negative myths and speculations about it. Let's try to understand them.
Myth No. 1. Mostly women from disadvantaged sections of the population are admitted to the observation department
This myth is connected with the fact that women are admitted to observation for childbirth without medical documents about examination, carriers of infections such as HIV, hepatitis, syphilis and others venereal diseases, as well as women in labor suffering from tuberculosis.
IN major cities To provide care to women with active, contagious forms of these diseases, specialized observational maternity hospitals or maternity wards at infectious diseases hospitals have been created. There are no such women in the observation department of ordinary maternity hospitals. If there is one maternity hospital in the city and region, then such patients are hospitalized in specialized maternity units, isolated from the entire department.
In addition to the above patients, women with purulent and fungal lesions of the skin, mucous membranes, hair and nails, other skin diseases(psoriasis, dermatitis, eczema) and even with infected bruises and abrasions. Women with complicated hemorrhoids and varicose veins veins
In addition, after examination in the emergency room, women in labor are sent to observation with a temperature above 37.5 ° C (even if the potential infection does not manifest itself in any other way), with an infection of the birth canal (colpitis, vaginitis, genital herpes and changes in smears for flora), sharp respiratory diseases(even if the only manifestation is a common runny nose), changes in urine analysis characteristic of inflammation, diarrhea.
It turns out that no one is safe from childbirth in observation. Of course, to be surrounded various infections, even hypothetical ones, no one wants. But, if you yourself are sick, unfortunately, you have to admit that it would be inhumane to infect others healthy women and newborn babies. Therefore such wide indications for isolation are justified, and all sick women in labor (women in the process of childbirth) are separated in advance from healthy ones. The same happens in cases where a postpartum woman (a woman who recently gave birth) fell ill after childbirth.
Myth No. 2. You can become infected with an infectious disease in the observation ward
The likelihood of catching an additional infection in the observation department is very low. This is due to the special structure of the department and the special anti-epidemic regime that is observed there. The observation department is designed so that patients with “flying” infections do not overlap with others.
During the first stage of labor, the woman is in a separate prenatal ward, usually designed for 1-2 people with a separate bathroom. Childbirth takes place in the delivery room, which also has separate boxes. Women in labor with dangerous infections, as mentioned above, are placed in separate isolated boxes, where all examinations, procedures are carried out and births are performed.
To prevent the spread of infections in such departments, there is a certain time division for examinations of women. First, patients without volatile infections are invited to treatment rooms and examination rooms, and only at the end are potentially dangerous ones examined. Women with easily contagious infections are examined and treated in a boxed room.
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In addition, the sanitary observation regime is stricter than usual obstetric department. The wards are cleaned 3 times a day: 1 time - from detergents and 2 times - with disinfectant solutions and subsequent quartz treatment and ventilation. Bed linen must be changed 2 times a week and as needed.
Myth No. 3. There are no healthy women in the observation department
Sometimes absolutely healthy women in labor are admitted to the observation department. Most often these are women without the necessary medical documents confirming the examination. This applies to expectant mothers who avoid medical management of pregnancy with the delivery of all necessary tests for HIV, hepatitis and other tests included in the list required for your region.
I would like to emphasize the word “region”. Women who travel to other regions or countries for childbirth often fall victim to differences in regional requirements. Thus, repeated testing for HIV and hepatitis is often required before childbirth. Failure to note these examinations on the exchange card may lead you to the ward of the observation department.
Observation also threatens supporters. Medical regulations prescribe hospitalization in observational maternity hospitals postpartum women with childbirth outside a medical institution. Expectant mothers who want to stay at home longer during the onset of labor should remember that if 12 hours have passed since the rupture of amniotic fluid, then you will also be hospitalized in the observation department.
Myth No. 4. If you were not placed under observation upon admission, it means that you will not be transferred to it.
It happens that a pregnant woman is admitted to the department of pathology of pregnant women or gives birth in a normal maternity ward, but then she was transferred to observation due to complications that arose. Indications for transferring women in labor and postpartum to the observation department are as follows:
- the appearance of signs of an infectious disease in a pregnant woman, a woman in labor or a postpartum woman staying in a regular ward (sore throat, influenza, ARVI, pyelonephritis, etc.);
- increase in body temperature to 38°C and above;
- an increase in body temperature after childbirth above 37.6°C or an increase in temperature up to 37.5°C, lasting more than 3 days;
- purulent discharge from the genital tract, endometritis (inflammation of the uterine mucosa);
- divergence of seams on the perineum, purulent plaques at the seams;
- mastitis, congestion in the mammary gland, as well as redness of the skin in the mammary gland area during the first 2–3 days after birth;
- appearance infectious lesion skin and mucous membranes of a newborn baby (in this case, he is transferred together with his mother to the observation department).
Myth No. 5. Observation births often lead to poor outcomes for the baby
This myth confuses cause with effect. A poor birth outcome is not a consequence of being admitted to observation, but an indication for hospitalization in such a department. In particular, in the observation department, women give birth with signs of intrauterine infection of the baby, a long anhydrous period (outflow of water 12 hours or more before admission to the hospital).
Often women with premature birth are admitted to this department, as infection is often also the cause. It is clear that all this can lead to complications during childbirth, their unfavorable course and, as a result, to a deterioration in the baby’s condition, which is, apparently, the reason for such misconceptions about the observation department.
Myth No. 6. I couldn’t breastfeed because I gave birth in an observation room.
Observation does not exclude the possibility of breastfeeding. This issue is resolved individually depending on the causative agent of the infectious disease.
Some pathogens do not penetrate, and the woman is allowed a free feeding regime, and the presence of mother and child together helps to quickly establish lactation. For some diseases, breast milk requires pasteurization. This is necessary in acute stage inflammatory process (for example, with serous mastitis). In departments where there are no conditions for pasteurization of milk, the baby is temporarily transferred to formula, and the mother is taught pumping techniques to prevent lactostasis and stimulate milk production for breastfeeding the baby after recovery. And only very in rare cases lactation has to be stopped. This is necessary during development severe forms infectious disease, sepsis, purulent mastitis, at high concentration virus in the blood of women with viral hepatitis and HIV.
Now that many myths about the observational department have been dispelled, it is clear that there is nothing terrible about it. The department is intended to provide qualified assistance woman in difficult situation combinations of pregnancy and infectious processes, protect her, as well as other pregnant women, women in labor and newborns from infection.
What symptoms and diseases are they sent there for, why are they doing it, what is the regime and rules there, the structure of the observation, is it possible to lie down with the child?
If she is admitted to the maternity hospital with signs of an infectious disease, she is hospitalized in the observation department. Why do they do this? The observation (or, as it is also called, the second obstetric) department is in miniature. To comply observation order pregnant women, women in labor and postpartum women are hospitalized in this department, who can be a source of infection for others (fever unknown reason, carriage of antibodies to viruses B and C, long anhydrous period - more than 12 hours, any infection, postpartum purulent-septic diseases- endometritis, suppuration of sutures, etc.). Also, sick pregnant women from the first obstetric department are hospitalized in this department. There are also children here in the second obstetric department, children whose mothers were transferred from the first obstetric department, and children born outside the maternity hospital. The structure of the observation department differs from the structure of the first (main) obstetric department. It definitely has its own maternity unit, its own operating room and its own department for newborns. At the same time, postpartum women are always in separate rooms. The rooms are usually designed for two people. The sanitary regime here is more strict than in the first obstetric department: the wards are cleaned 3 times a day: 1 time with detergents and 2 times with disinfectant solutions and subsequent bactericidal irradiation. Surgical instruments, used in the department, are disinfected in two stages - the first time in the department itself, and the second time in the central sterilization room or sterilization department. In observational departments, disposable materials are widely used - scalpels, towels, etc.
A certain regime also exists for medical personnel. A daily change of gown is required. Masks are changed every 4 hours. Replaceable shoes are wiped daily with disinfectant solutions (therefore, wearing woven shoes is not allowed). Doctors from other departments change their gown, mask and shoes when visiting the observation department. Pregnant and postpartum women have their bed linen changed twice a week. The neonatal ward also adheres to stricter sanitary regime, similar to that in the observation department itself. In the second obstetric department, the presence of mother and mother together is excluded. This is explained by the fact that the mother has an acute infectious disease or purulent-septic postpartum complication and exists Great chance child infection. The issue of breastfeeding in the second obstetric department is decided strictly individually. Some pathogens, even during pasteurization of breast milk, can be transmitted to the baby, while others, on the contrary, do not penetrate into breast milk. If there are contraindications for breastfeeding, women express breast milk to prevent lactostasis and stimulate milk production for further feeding the baby (after recovery). In this way, the infection of a pregnant woman in the observation department with any other disease is prevented, the transmission of infection to other pregnant and postpartum women is prevented, and complications and infection of the child are prevented.
