CLINIC FOR WOMEN — the structural division of a maternity home or policlinic intended for rendering all types of the ambulatory obstetric and gynecologic care. In work. to. fullestly the philosophy of the Soviet health care — unity of prevention and treatment is reflected.
Main objectives. to. are: rendering qualified obstetric ginekol, the help to the population of the attached territory; carrying out to lay down. - the prof. of the actions directed to the prevention of the complicated pregnancies puerperal ginekol. diseases; implementation in practice of modern methods of prevention and treatment of pregnant women and ginekol. patients; rendering social legal aid to women according to the legislation on health protection of mother.
Work. to. is based on the principle of an uchastkovost. Usually one obstetrician-gynecologist services up to 2000 — 2500 people of female population. The local principle allows the obstetrician-gynecologist to carry out a continuous communication with the local therapist, the therapist Zh. to. and other specialists.
In pre-revolutionary Russia the state system of obstetric aid was not. In 1913 there were 9 private women's and children's consultations. In 1975 quantity. to. in the USSR reached 10 227.
Enlargement. to., carried out in the 70th, created premises for improvement of their material and technical resources and upgrading of medical aid to women. Feature of work. to. the 70th expansion of the obstetric and gynecologic specialized help is. In addition in. to. offices (receptions) on prevention of not incubation, infertility, endocrine frustration, contraception etc. are organized.
The advisory receptions in an office of marriage and a family organized in large. to., attract a large number of married couples («family visits»), both young people, and more advanced age.
Service of pregnant women. to. register all pregnant women and watch them throughout all duration of gestation.
An early appearance of the pregnant woman in. to. promotes the correct solution of a question of estimated duration of gestation, reduction of the mistakes in definition of prenatal issue, definition of extragenital pathology accompanying ginekol, diseases and a possibility of further continuation of pregnancy.
At the normal course of pregnancy the woman in the first and second trimester visits. to. 1 — 2 time, and in the third trimester 3 — 4 times a month, at emergence of complications — are much more often.
At the first visit. to. rules of hygiene, the mode of work, rest and food are explained to pregnant women, measurement of growth, weight, the ABP, and also special obstetric inspection is taken (size discrimination of a basin, a diagonal conjugate, circle of a stomach, height of standing of a uterus over a bosom); the wedge, analyses of urine, blood are made, the blood group and a Rhesus factor accessory (in the presence of a Rh-negative blood the Rhesus factor of blood at the husband is defined) and if necessary an antiserum capacity at the pregnant woman is defined. Besides, degree of purity and character of vaginal flora is defined, in the first and second half of pregnancy Wassermann reaction is put.
At each new visit monitor increase in weight, change of the ABP, make a wedge, analyses of urine and according to indications necessary additional researches.
One of sections of work. to. is physical. and psychoprophylactic training of pregnant women for childbirth, edges includes the complex defined for different durations of gestation physical. exercises, uv radiation, acquaintance of the woman with rules of conduct at the time of delivery, including ability to relieve pain.
For upgrading and efficiency of medical aid doctors. to. distinguish from pregnant women of the site so-called group of the increased risk, i.e. persons with the menacing complications at pregnancy and in labor, persons with weakness of patrimonial forces, a possible injury of the patrimonial ways which underwent earlier an operation of Cesarean section, sewing up of fistulas, a large number of abortions, with extragenital pathology primapara advanced age, pregnant women in whose anamnesis death of a fruit or the newborn, and also predisposed to development of toxicosis, not incubation, bleeding was noted. Behind them conduct more strict and especially careful observation, carry out periodic hospitalization (to prenatal department) etc. For this group dispensary observation is entered by the therapist and the obstetrician-gynecologist.
All results of the conducted researches and overseeing of the pregnant woman are entered in the exchange and notifying prenatal record and women in childbirth. On the 28th week of pregnancy this card is issued to the woman, and with it it comes to a maternity home (an obstetric hospital). Succession in overseeing of the pregnant woman is so carried out in. to and a maternity home.
The decisive factor determining the level and quality of rendering medical aid in. to., creation of optimum conditions for work of district doctors, providing them is the modern portable medical equipment, means for express diagnosis and the emergency therapy.
Medical care to women in childbirth. In a puerperal period the woman needs constant observation of the obstetrician-gynecologist, and in the presence of extragenital diseases also observation of the therapist of policlinic. Special attention is paid on character of a lactation, lokhiya, reductions of a uterus, recommendations about a diet, sex life are made, postnatal issue is made out.
Medical care by the gynecologic patient. to. renders preventive and to lay down. help ginekol, patient. Early identification ginekol, diseases, timely out-patient inspection and pathogenetic reasonable treatment of patients are one of the main objectives. to. Apprx. 15% ginekol, patients address in. to. concerning disturbance of menstrual function; in out-patient conditions examination according to tests of functional diagnosis and other techniques for establishment of genesis of these disturbances and the rational scheme of treatment is conducted.
V Zh. to. work on early detection of precancerous diseases of a vulval part of a neck of uterus, tumors of a uterus, ovaries is carried out. Treatment of precancerous diseases of a neck of uterus is carried out in conditions. to. At establishment of the diagnosis of a dysplasia or at difficulty in diagnosis patients go to specialized institutions (onkol, a clinic, in-t). Patients with precancerous diseases of a vulval part of a neck of uterus, tumors it is also long the current inflammatory processes of generative organs, «adhesive desease», disturbances of menstrual function, by infertility are registered and behind them dispensary observation is carried out.
Patronage of pregnant women, women in childbirth, ginekol, patients is the essential section of work at home. to., it is carried out by midwifes and according to indications doctors and includes control of the state of health of the pregnant woman, the nursing mother, ginekol, the patient and observance of the mode by them (see. Patronage ).
Work on production. to. carries out preferential rendering obstetric ginekol. the help to the women working at the industrial enterprises in state farms. The obstetrician-gynecologist works at a factory by the shop principle established for all doctors, servicing from 1500 to 2000 women. He keeps account of the women working at the enterprise. Usually the obstetrician-gynecologist builds the work, alternating receptions in morning and evening hours. Scheduled maintenance on the site is carried out in the days which are specially allocated for this purpose, 3 — 4 times a month. Studying of influence of professional production factors on specific functions of workers is one of fundamental obligations of the obstetrician-gynecologist at the enterprise. For specification of communication between the revealed pathology and production factors a necessary condition is comprehensive examination: obstetricians-gynecologists, pediatricians, hygienists, pathologists and other specialists.
The important place in work is allocated for routine gynecologic maintenances. to. Their purpose — early identification of patients with ginekol, diseases and their timely treatment. At routine maintenances modern methods of inspection of patients — kolposkopichesky, kolpotsitologichesky, tsistokhimichesky and others are widely applied.
One of forms of preventive inspection of women is the organization of sick inspection rooms in policlinics which number by the beginning of 1975 reached 10 632.
Service of country people. In rendering the specialized help to female residents of the village the important role belongs to exit. to., which will be will organized by the central regional. Exit. to. conduct examination and render the qualified medical aid to pregnant women, ginekol, the patient directly on places. Obstetricians-gynecologists exit. to. 1 — 2 time a month would conduct receptions on the basis of local and medical and obstetrical center, and also medical assistant's and medical health centers.
Specialized receptions of obstetricians-gynecologists central regional-tsy and regional (regional, republican) BC provide approach of the qualified medical aid to rural inhabitants. At identification of the woman with this or that disease demanding treatment in a hospital it would be directed in central regional or specialized department regional (regional, republican)-tsy.
Sanitary and educational work is carried out according to the plan, training of women in necessary skills in personal hygiene, acquaintance with a diet of pregnant women, care of newborns, prevention of inflammatory diseases, rules of use of contraceptives, hygiene of sex life, an explanation of harm of abortions is provided in Krom. . to. also carries out educational work among the young men and girls marrying.
For assistance in questions of protection of the rights of mothers and children social and legal offices in which specialists work are created.
Bibliography: Bazhenova K. M. Organization of work of city clinic for women, L., 1971, bibliogr.; Clinic for women, under the editorship of L. S. Persianinov, Minsk, 1966; Petrovsky B. V. Achievements of the Soviet health care for years of the ninth five-years period, M., 1976; With ER of e of N to about A. F., Ermakov V. V. and Petrakov B. D. Bases of the organization of the polyclinic help to the population, M., 1976.
L. N. Vasilevskaya.