From Big Medical Encyclopedia

OBSTETRIC AID — delivery of health care to the woman in labor.

The first steps of the organization P. in Russia belong to the middle of 18 century when povivalny schools for training of grandmas in povivalny business (began to open see. Midwives ). In 1757 «Babichyi of school» were open (one in Moscow, the second in St.-Petersburg). In 20 years at the Moscow school only 35 midwives were trained. In 1764 in Moscow the first educational house was founded (see. Educational house, children's shelter ), in Krom teaching obstetrics was conducted; at it the delivery room on 20 beds was organized. The second delivery room was open in 1771 at the St. Petersburg educational house. In 1797 in St. Petersburg one more maternity home intended for training of midwives was open. After this educational houses in other cities began to open (Saratov, Samara, etc.).

The first Russian scientific obstetrician-gynecologist — N. M. Ambodik-Maksimovich in 1784 — 1786 it issued the guide «Art of a povivaniye or science about babichy business». It was the first textbook on obstetrics in Russian.

In imperial Russia there was no uniform state system P. According to G. E. Rein, in Russia in 1902 there were only 9000 midwives (midwifes), from to-rykh 6000 lived and worked in the cities, and 3000 — in rural areas. In 1913 in Russia in all maternity homes there were 7,5 thousand beds, and in the territory of the present Armenian, Moldavian, Kyrgyz, Turkmen, Tajik republics there was in general no obstetric bed. Clinics for women actually were almost not (all over the country there were only 9 women's and children's consultations). The coverage stationary obstetric care reached in the city 2 — 4%, and in rural areas about 1,5%. Apprx. 95% of women gave birth without medical aid. Help in childbirth of hl. obr. the healers and midwives who did not have medical educations rendered. Level of maternal and child mortality was extremely high; annually perished from the complicated childbirth apprx. 30 thousand women, and from each one thousand newborns apprx. 270 died within the first year of life.

The Soviet R.'s basis is prevention, i.e. the prevention of complications, to-rye can arise in time pregnancies (see) and childbirth (see).

From the first days of establishment of the Soviet power the Soviet state adopted a number of acts on health protection of mother and child (see. Protection of motherhood and childhood ). The state system of the organization of medical aid to women was created during pregnancy, in labor and a puerperal period, labor protection and health of the working women, social measures of promotion of birth rate.

Obstetric and gynecologic care in the USSR is given maternity homes (see), obstetric gynecology departments of multi-profile BCs, clinics for women (see), functioning at maternity homes, policlinics or independently, and in rural areas, besides, medical assistant's and medical and obstetrical centers (see), collective-farm maternity homes.

Practically almost all pregnant women are under observation of clinics for women and give birth in medical institutions where they receive the necessary help. The coverage stationary R. (as of 1975) made 97,8%. It became possible in connection with development of network of obstetric and gynecologic institutions and sufficient providing the population obstetric a bed mi.

In parallel with development of network of maternity homes and clinics for women the number of doctors of obstetricians-gynecologists grew. By the beginning of 1976 in the USSR there were nearly 50 thousand doctors of obstetricians-gynecologists and more than 300 thousand midwifes and feldsherits-midwifes. In the 80th years their further growth is noted. For approach of medical aid to female workers in medical medical units at the industrial enterprises clinics for women, gynecologic offices are created; at territorial clinics for women so-called industrial offices will be organized. Broad development in the country was gained by use of sanatoria - dispensaries (see) the industrial enterprises for improvement of pregnant women, and also rest houses for pregnant women in system of the All-Union Central Council of Trade Unions, the network to-rykh constantly extends. Actions for improvement and improvement of working conditions of women, improvement of conditions of life are systematically carried out, material security and welfare of the people grows. In the USSR use of work of women on hard and harmful work is legislatively forbidden; pregnant women but are transferred to the conclusion of the doctor to easy work according to a gigabyte. recommendations about employment of pregnant women.

The ground mass of women from rural areas gives birth in medical obstetric departments of the central regional BCs. If necessary the stationary qualified medical aid to inhabitants of rural areas is rendered in large republican, regional, regional maternity homes. Approach of the medical out-patient and polyclinic assistance to inhabitants of rural areas is provided with mobile teams from the central regional hospital (see), to-rye come to medical and obstetrical centers but to in advance approved schedule. The doctor the obstetrician-gynecologist of a mobile team on site carries out mass routine gynecologic maintenances, medical overseeing by pregnant women and dispensary group of patients ginekol. diseases, reveals pregnant women with the increased risk of obstetric and perinatal pathology and determines terms and specific establishment for preventive hospitalization and carrying out childbirth depending on the state of health of the woman and the revealed obstetric pathology.

The main indicators of quality of activity of obstetric and gynecologic institutions are early (to 12 weeks of pregnancy) coverage medical observation of pregnant women, maternal mortality (see) and perinatal mortality (see).

Mortality of pregnant women, women in labor and women in childbirth (see. Maternal mortality ) in comparison with the same indicators of pre-revolutionary Russia decreased many times over and continues to decrease from year to year. Several times mortinatality and a neomortality of children decreased (see. Child mortality ).

To decrease mertvorozhdennost (see), perinatal mortality (see) and traumatism at childbirth (see) improvement of the anesteziologo-resuscitation help promotes. Now many childbirth carry out with anesthesia. For this purpose, in addition to physiopsychoprophylactic methods of a labor pain relief (see. Psychoprophylactic training of pregnant women ), apply also various pharmakol. means.

The early coverage pregnant with medical observation in clinics for women created conditions for early detection and rendering medical aid at various patol. deviations in an organism of the woman and during pregnancy (see. Patronage of pregnant women ).

The big role in improvement of quality of the obstetric and gynecologic help and the organization P. belongs kafedrakhm obstetrics and gynecology of medical in-t and institutes of improvement of doctors, and also scientific research institute of obstetrics and gynecology, protection of motherhood and the childhood in-there. In 1979 in Moscow the All-Union research center on health protection of mother and child of the Ministry of Health of the USSR is created; the similar republican centers are created in the Ukrainian and Moldavian republics.

All scientific institutions of this profile are occupied with development of a problem «Scientific bases of health protection of the woman, mother and child»; results of scientific works widely are implemented into practice of obstetric and gynecologic institutions.

See also Health care .

Bibliography: Kurylenko L. I. Organization of the specialized obstetric and gynecologic help, M., 1978; Levi M. F. History of obstetric aid in the USSR, M., 1950, bibliogr.; The multivolume guide to obstetrics and gynecology, under the editorship of L. S. Persianinov, t. 1, page 54, M., 1961; The Organization of obstetric aid and gynecologic help in the USSR, under the editorship of I. V. Ilyin, M., 1980; 60 years of the Soviet health care, glavn. edition B. V. Petrovsky, page 193, M., 1977.

V. V. Kochemasova.