MATERNITY HOME (obstetric department of hospital) — the treatment and prevention facility providing observation, treatment and the qualified medical care to the woman during pregnancy, childbirth in a puerperal period, at gynecologic diseases, and also observation and care of healthy newborns and rendering the qualified medical care to sick and premature children before their transfer in the relevant children's hospital.
About existence «public give rise - flax» is for the first time mentioned in the Egyptian papyruses of times of Pharaohs. In 13 century in Paris (at Hotel Dieu hospital) the chamber was open for women in labor, and in 16 century A. Paré organized the first school of midwives at this hospital. In 18 century R. and schools of midwifes were based at them in Strasbourg (1728), in Berlin (1751), in Paris (1797). In Russia the first R. and schools of obstetrics at them were organized in the second half of 18 century in Moscow (1764) and St. Petersburg (1771).
In 19 and the beginning of 20 centuries the number P. of in Russia increased slowly, and the coverage of the population stationary obstetric care was extremely low. State system protection of motherhood and childhood (see) it was created only after a victory of Great October socialist revolution (see. Health care ). The legislation of the USSR and federal republics guarantees health protection and the rights of mother and child, labor protection of female workers and mothers, encouragement of motherhood. In 1980 the number of beds (medical and obstetric) for pregnant women, women in labor and gynecologic patients reached 414,5 thousand that provides to all women an opportunity to give birth and receive the necessary help at gynecologic diseases in the conditions of a hospital (see. Obstetric aid ).
The main direction of modern development of network of institutions of obstetric aid in the USSR is large R.' construction and delivery rooms as a part of multi-field hospitals that allows to provide them with the modern diagnostic and medical equipment, laboratories, and women — the highly skilled help with involvement of doctors of other specialties; specialized hospitals for pregnant women with diseases of cardiovascular system, kidneys, endocrine system, about a Rhesus factor - conflict pregnancy, not incubation etc. are created.
Modern R. represents complex establishment, to-rogo are a part clinic for women (see) and obstetric and gynecologic hospital. Its design shall provide strict isolation of sick women and newborns, separate entrances and exits for receipt and an extract of women, certain ways of transportation of sterile materials and tools, food, fresh and dirty linen, the room for storage of reserves of blood and blood substitutes, desinfectants.
The river of or delivery rooms of multi-field hospitals depending on number of beds are divided into 4 categories: R. of numbering beds within 151 — 200, to the second — 101 — 150, to the third — 81 — 100, to the fourth — 60 — 80 belong to the first category; The Rubles of numbering St. 200 beds are carried to extra category and have individual states.
R.'s construction by is carried out according to the existing standard projects.
R.'s structure of provides existence of reception and the room of an extract of women in childbirth with newborns, physiological delivery room, department of pathology of pregnant women, observation department, gynecology department etc.
The quantity of beds in obstetric departments of hospitals (maternity homes) should be defined according to the data presented in the table.
Prenatal chambers, patrimonial, small operating rooms, as a rule, shall be in double set that allows to alternate their work about a dignity. processing every three days.
The reception consists of a reception, the filter, viewing and rooms for a dignity. processings in physiological department, and also viewing and rooms for a dignity. processings in observation department. In a reception kokhmnata each arriving woman takes off outerwear and goes to the filter where the general inspection of the woman is made: measurement of temperature, a research of pulse, short collecting the anamnesis for identification of existence of infectious diseases and contacts with infectious patients, and also survey for an exception of quinsy, flu, pustulous diseases of skin. At absence at the woman in labor of infectious diseases it goes in viewing physiological department. Here the doctor collects more profound general and obstetric anamnesis, makes an outside obstetric research, definition of the ABP, weighing, measurement of growth and the sizes of a basin of the woman in labor. Here make an approximate research of urine on protein, and if necessary define a hemoglobin content and time of coagulability of blood. After that the dignity is carried out. processing of the woman in labor.
Women in labor, at to-rykh infectious or pustulous skin diseases, temperature increase to 37,5 ° are revealed above, a dead fruit, translate in viewing observation department where pi the general and special obstetric examination and a dignity is conducted. processing.
After filling of history of childbirth, the woman in labor from viewing physiological department is transferred to logging of reception of pregnant women and women in labor and cleansing to prenatal chamber of the same department, and the pregnant woman — to department of pathology of pregnant women. From viewing observation department of all women send only to observation department.
Obstetric physiological department includes prenatal chambers, patrimonial chambers, chambers of an intensive care, postoperative chambers, handling for newborns. In prenatal chamber (hall) the woman in labor spends the first period childbirth (see). The patrimonial chamber on the device shall meet all requirements of the surgical operating room: to be light and spacious (it is reasonable to allocate 24 m for 1 patrimonial bed 2 , on 2 beds — 36 sq.m), floors and walls shall be from easily washing materials, optimum temperature in rooms within 20 ° — 22 °. In patrimonial chambers there have to be patrimonial beds of Rakhmanov, a case for obstetric tools and steam sterilizers with sterile material, a mobile little table with necessary set for carrying out childbirth, screw metal stools, electric mobile lamps, emergency lighting, the suction apparatus of slime and carrying out an artificial respiration by the newborn, devices for measurement of the ABP, for carrying out an electroanalgesia, a necessary set of medicines etc.
Since 1975 in a number of the large cities maternity homes with individual patrimonial chambers where the woman in labor spends the first and second periods of childbirth (tsvetn are constructed. fig. 1 — 6).
Transfer to patrimonial chamber of women in labor from the beginning of the second period of childbirth. In R. his presence in the delivery room is at the time of delivery obligatory for with the round-the-clock watch of the doctor of the obstetrician-gynecologist. At uncomplicated pregnancy the midwife can accept normal childbirth (under control of the doctor). All pathological childbirth is carried out by the doctor. After an otkhozhdeniye afterbirth (see) the woman in childbirth remains under observation of the midwife and doctor in patrimonial 2 — 3 hours, then it is transferred to puerperal department.
Handling for newborns it is equipped with a swaddling table with heating, the couveuse for temporary stay of the premature child (cm. Premature children ) and all necessary for assistance at asphyxia (see. Asphyxia of a fruit and newborn ). In this room the toilet of the newborn (processing of skin, the funic rest), certification then the child with history of development is transferred to «department of newborns is carried out.
The chamber of an intensive care is intended for observation and treatment of pregnant women and women in labor with the most severe forms of complications of pregnancy (a preeclampsia, an eclampsia) or extragenital diseases. This chamber is expected 1 — 2 beds, the area it not less than 26 m 2 ; it shall be equipped with the platform (lock) for isolation from noise and a curtain, impenetrable for light, at windows for blackout of the room, functional beds, is provided with the centralized supply of oxygen, the necessary equipment, tools, medicines for rendering acute management.
Physiological puerperal department includes chambers for women in childbirth, the room for decantation and gathering breast milk, procedural, linen, shower and other utility rooms. Chambers are expected 2 — 4 beds, not less than 7 m shall fall on each place 2 areas. Small chambers create conditions for their cyclic filling and observance of the medical and guarding mode. Cyclic filling of chambers consists in filling of chambers with the women in childbirth who gave rise for one days and, therefore, written out in the same day. Temperature in puerperal chambers shall be within 18 — 22 °.
Chambers (department) of newborns are a component of physiological and observation puerperal departments.
Chambers for newborns shall be small (no more than 4 beds), it facilitates differentiation of newborns (healthy, injured, premature), and also promotes cyclic filling of chambers.
Rooms for department of newborns shall be light, warm, with the windows coming to South side. It is necessary to air chambers not less than 6 — 7 times a day 25 — 30 min.; the area is at 1 newborn not less than 5 m 2 . In chambers for the full-term newborns temperature needs to be maintained in limits 21 — 22 °, in chambers for premature — 23 — 24 °. Enters the equipment of each chamber: individual cribs, swaddling tables, children's scales, bedside tables for material, a case for fresh linen, tanks for dirty linen, quartz installations for uv radiation of chambers, wheelchairs, on to-rykh carry children on feeding; in chambers for premature — couveuses, the centralized supply of oxygen. Except chambers, shall be handling for carrying out by the newborn intravenous injections and other procedures.
In department of newborns for the child the round-the-clock observation of the nurse, and in the afternoon — the pediatrician (neonatolog) is established.
Experience of joint stay of the newborn with mother gained distribution that exerts beneficial effect on a condition of the woman and newborn and reduces their incidence. Outward of chamber for joint stay of mother with the newborn is given on tsvetn. fig. 3.
In observation puerperal department for newborns there have to be boxed chambers, number not less than three: for the healthy children transferred to observation department together with sick mother for sick children and children, mothers to-rykh came directly to observation department.
Observation department renders medical aid to pregnant women, women in labor, women in childbirth and newborns with diseases, to-rye can become a source of an infection and constitute danger to people around (see. Intrahospital infections ). It shall be provided with reliable isolation from other departments of a maternity home. In each observation department existence of a reception and viewing part, prenatal, patrimonial, puerperal chambers, chambers for newborns, operational, handling and other utility rooms is provided. In large R. in observation department create patrimonial boxes on 1 bed with an outside entrance for hospitalization of women in labor with active tuberculosis, infectious hepatitis and others inf. diseases.
Department of pathology of pregnant women intends for prenatal hospitalization and treatment of pregnant women" with various diseases accompanying pregnancy (diseases of cardiovascular system, kidneys, a liver, closed glands, etc.), and complications of pregnancy (toxicoses, threat of premature births, immunological incompatibility of blood of mother and a fruit, etc.). It includes chambers for patients, handling, procedural, an office of functional diagnosis, the room for day stay of patients, utility rooms. Chambers shall be on 1 — 2, at most 4 beds with the centralized eyeliner of oxygen. In department of pathology of pregnant women along with treatment of a basic disease physio-psychoprophylactic training of pregnant women for childbirth, preparation of mammary glands for feeding is carried out, classes of school of mothers are given. In view of long stay of women in these departments the organization of walks in the fresh air on specially constructed balconies and verandahs is necessary. Special departments for treatment of women with patholologically the proceeding pregnancy and improvements of pregnant women with a semi-sanatorium regime are created. These departments are located in a favorable environment, have communication (phone, transport) with a maternity home (department).
Gynecology department of R. of shall be isolated from obstetric and have the reception. In gynecology department hospitalize the patients needing surgical or conservative treatment. The number of beds shall make V3 of total number of beds of R. of (obstetric department of hospital). Chambers are expected 2 — 4 beds, in department there have to be two viewing rooms, 2 small operating rooms and the big operating room for carrying out band operations.
The medical personnel of R. of are obliged to provide the appropriate level of observation, inspection and treatment of women and newborns, the most strict observance a dignity. - a gigabyte. and protivoepid. duty of establishment, carrying out dignity. - educational work.
See also Medical and obstetrical center .
Table. Determination of bed capacity of obstetric departments of hospitals (maternity homes)
Bibliography: Obstetric and gynecologic institutions of Russia, SPb., 1910; The Multivolume guide to obstetrics and gynecology, under the editorship of L. S. Persianinov, t. 1, page. And, M., 1961; The Organization of obstetric aid and gynecologic help in the USSR, under the editorship of I. V. Ilyin, M., 1980; Practical obstetrics, under the editorship of. Ya. P. Sol-sky, Kiev, 1976.
V. V. Kochemasova.