Chapter 10. Care for pregnant women, women in labor, postpartum women and gynecological patients (A. L. Kaplan, V. I. Kulakov)

Pregnancy

Pregnancy- the period during which a fertilized egg develops. This process is accompanied by various changes throughout the woman’s body. The main condition for the normal course of pregnancy and the prevention of possible complications is adherence to a rational regimen. During pregnancy, all hygiene measures that are mandatory for a woman are carried out, but with some changes and additions in each individual case.

Bandage used from the VI-VII months of pregnancy to support the abdomen, prevent the divergence of the fibers of the deep layers of the skin and the appearance of pregnancy scars, significant divergence of the rectus abdominis muscles. The bandage must be put on and laced while lying on your back; it should not put too much pressure on your stomach. As the volume of the abdomen increases, it is necessary to adjust the lacing. A bandage selected according to the size and volume of the waist is recommended to be worn after childbirth to prevent sagging of the abdominal wall; it helps maintain the correct position internal organs, preventing their omission. Elastic bands are attached to the bandage to hold the stockings in place.

Varicose veins peripheral veins are observed in pregnant women mainly on the legs, less often on the external genitalia and in the vagina. The reasons are pathological changes in the walls of the veins, damage to the venous valves, and sometimes their disappearance. At varicose veins veins on the legs, it is necessary to bandage the leg with an elastic bandage in the direction from the foot up the shin, and if necessary, then further along the thigh, or use a special elastic stocking.

Weighing allows you to promptly notice fluid retention in the body of a pregnant woman; weighing is carried out at each visit to a pregnant antenatal clinic or a feldsher-midwife station, at least once a month in the first half and every 2 weeks (at least) in the second half of pregnancy. The woman should be weighed undressed, leaving only her shirt on; a pre-pregnant woman must urinate; on the day of weighing, the pregnant woman should have stool (either on its own or after an enema). In the first weeks of a normal pregnancy, body weight does not increase, and sometimes even decreases slightly, especially with nausea and vomiting. From the 16th week of pregnancy, an increase in body weight is noted; from the 23-24th week the weekly increase reaches 200 g, and from the 29th week it does not exceed 300-350 g; a week before giving birth, body weight usually decreases by 1 kg, which is associated with tissue fluid loss. Throughout pregnancy, a woman’s body weight increases by 10 kg (mainly due to the weight of the fetus, amniotic fluid and placenta).

Listening to the fetal heartbeat(auscultation) is performed with an obstetric stethoscope. The heartbeat can be heard starting from the end of the 5th lunar month of pregnancy (20 weeks), but with increasing pregnancy, the heartbeat can be heard more and more clearly. It is better heard closer to the head and on the side where the back of the fetus is facing: with a cephalic presentation - below the navel, with a pelvic presentation - above the navel, with a transverse position of the fetus - at the level of the navel on the right or left, closer to the head. The frequency of audible fetal heartbeats at the end of pregnancy usually corresponds to 120-140 per minute. The fetal heartbeat is determined more accurately and earlier using electrocardiography and fetal electrophonocardiography.

Miscarriage- abortion early dates(up to 28 weeks). Predisposing factors: general diseases pregnant woman, diseases and developmental anomalies ovum, insufficient ovarian function ( corpus luteum) and other disorders of a nervous and endocrine nature; The possibility of early pregnancy termination as a result of injury (fall, bruises) cannot be ruled out. However, injuries usually lead to miscarriage in those women who have predisposing conditions. Ordinary household injuries themselves are extremely rarely accompanied by pregnancy disorders. A miscarriage without any intervention is called spontaneous, spontaneous, in contrast to an artificial miscarriage caused by various interventions; produced outside a medical institution - out-of-hospital miscarriage. When spontaneous threatened miscarriage a pregnant woman complains of slight, sometimes cramping pain in the lower abdomen; there is no bleeding. Special attention Women with a history of spontaneous miscarriages should be alerted to such complaints. Rest, hospitalization, complete abstinence from sexual activity for a more or less long period, and the use of progesterone sometimes allow pregnancy to be maintained. As an anti-plasma agent, suppositories with papaverine are prescribed, 0.02-0.03 g twice a day; no-shpu, vitamin E 1 teaspoon 2 times a day. At beginning miscarriage Along with cramping pain in the lower abdomen, there is also slight bleeding, which indicates that the ovum has begun to detach. At this stage, miscarriage is limited to bed rest (hospital, maternity hospital); sometimes further detachment is prevented and the pregnancy continues. To reduce the excitability of the uterine muscles, no-shpu, progesterone, and suppositories with papaverine are prescribed. Do not apply ice to the lower abdomen - this increases uterine contractions.

If the detachment of the ovum continues, the bleeding intensifies, blood clots are released, i.e. there is a progressive miscarriage, then in most cases it proceeds as incomplete miscarriage: part of the fertilized egg comes out, and part of it is retained in the uterus. As a rule, such a patient is immediately sent to the hospital, where she has the remains of the fertilized egg removed (scraping); Remnants of the fertilized egg lingering in the uterus prevent uterine contractions and support further bleeding.

It is worth mentioning the so-called complete miscarriage. At the same time, the fertilized egg came out of the uterus, the bleeding stopped and the uterus contracted. However, small pieces of the placenta may remain in the uterine cavity, which will subsequently lead to prolonged bleeding and the formation of so-called placental polyps. In such a case, a test curettage of the walls of the uterine cavity is necessary, and the patient must be urgently hospitalized; in all cases of miscarriage, the patient should be urgently sent to the hospital.

Ectopic pregnancy, in most cases tubal, in the first weeks it almost does not manifest itself with characteristic symptoms. A woman with suspected ectopic pregnancy must be urgently hospitalized. Tubal pregnancy is diagnosed using ultrasound. Termination of a tubal pregnancy can proceed as a tubal abortion: a pregnant woman complains of cramping pain in the lower abdomen, pain on palpation of the abdomen, especially on the side of the pregnant tube due to irritation of the peritoneum; dark, bloody, spotting discharge from the genitals appears. When the pregnant tube ruptures, a different picture is observed: the rupture of the tube in most cases is accompanied by shock and internal bleeding - the patient suddenly develops acute pain in the lower abdomen, and a short-term fainting state occurs; marked pallor skin, lips are pale, slightly cyanotic; pupils dilated; the stomach is slightly swollen and painful when touched; pulse is frequent, very weak filling; body temperature is normal, the patient complains of tinnitus, flickering in the eyes; in some cases there is pain radiating to the shoulder and scapula. On palpation of the abdomen - sharp pain in the lower part, Shchetkin's symptom is pronounced; with percussion of the abdomen - muffling of the percussion sound in the iliac regions and above the womb. The spilled blood accumulated in the pouch of Douglas protrudes the posterior vaginal vault - a uterine blood tumor. The presence of blood in the rectouterine cavity (pouch of Douglas) is determined by puncture through the posterior fornix. Only timely transsection - removal of a ruptured tube or tube with a fertilized egg with simultaneous blood transfusion (during and after surgery) - saves the patient’s life.

Prenatal care should be understood in a broad sense - as women’s hygiene and at the same time as prenatal, so-called antenatal, infant health care. It is wrong to talk about the hygiene of a pregnant woman in isolation from the hygiene of a woman before pregnancy, starting from her early childhood. The most favorable age for the first pregnancy in terms of the health of both the mother and her unborn child is considered to be 20-25 years old. Starting sexual activity too early and especially early pregnancy are unfavorable for both the mother and her unborn child. During the first sexual intercourse, the hymen breaks and bleeds. Sometimes this bleeding is significant and in very rare cases may require medical attention. After the first sexual intercourse, you should take a break for 2-3 days. Sexual excesses adversely affect the state of the nervous system of both spouses. Sexual intercourse during pregnancy should be limited in the first 2 months and, if possible, excluded in the last month of pregnancy. Frequent sexual intercourse in the first months of pregnancy can lead to miscarriage, and in the last month it is possible to introduce pathogenic microbes into the vagina, which threatens the risk of infection during childbirth. A woman's body during pregnancy is the environment in which the fetus develops from the embryo. From this environment the fetus extracts the nutrients necessary for its growth and development, and here it gives the final metabolic products it produces. The body of a pregnant woman provides the growing fetus with the necessary nutritional materials and at the same time neutralizes and removes the end products of fetal metabolism.

Through sanitary work carried out in antenatal clinics, in production, in the agro-industrial complex, the nurse ensures that every pregnant woman attends a consultation, a feldsher-midwife station from the first weeks of pregnancy, which allows for timely identification of possible pathology. Pregnancy represents a new qualitative state of the body, which during this period requires some changes and additions in the implementation of hygiene measures. A healthy woman who follows a rational regimen, combining work and rest (see. Occupational safety for pregnant women), eating normally (see. Nutrition for pregnant women), who takes sufficient advantage of fresh air, copes well with pregnancy. If the proper regimen is not followed, a physiological pregnancy can unnoticeably acquire a pathological course. By carefully monitoring a woman from the first month of pregnancy, it is possible to timely identify certain deviations in the state of her health, anticipate possible pathology during pregnancy and timely implementation of preventive and therapeutic measures to prevent pathology. This is what our doctors, midwives and nurses do, working in maternity hospitals and antenatal clinics in cities, and in rural areas - midwives and nurses at feldsher-obstetric stations with periodic consultation with a doctor.

Gymnastics for pregnant women and physiopsychoprophylaxis improve the general condition of a woman, strengthen nervous system, help prevent toxicosis, improve and facilitate the course of labor, contribute to the favorable course of childbirth and the postpartum period. Gymnastics strengthens the abdominal muscles and increases the elasticity of the pelvic floor muscles, which improves pushing during childbirth and prevents prolapse and prolapse of the internal genital organs. With the help of physical education, a woman learns to control her breathing during childbirth; Gymnastics enhances oxidative processes in the body, which contributes to the normal development of the fetus. The combination of systematic physical education and psychoprophylactic preparation of a pregnant woman for childbirth ensures a painless course of labor. Systematic monitoring of the implementation of physiopsychoprophylaxis begins in the antenatal clinic, and, once mastered, is further carried out at home by the pregnant woman herself. The method of psychoprophylaxis is based on the elimination of labor pain through a positive effect on the higher parts of the central nervous system. The purpose of physical and psychoprophylactic preparation for childbirth is to remove the psychogenic component of labor pain, eliminate the idea of ​​the inevitability of labor pain, and the oppressive feeling of fear. A woman is taught calm and active behavior during childbirth. Physical exercises and physiopsychoprophylactic preparation for childbirth are recommended for all women. Healthy pregnant women can practice physiopsychoprophylaxis on their own at home, and pregnant women with various diseases in the stage of compensation are under the supervision of a doctor and a visiting nurse, who monitors the well-being of the pregnant woman at each visit and brings this to the attention of the doctor.

Worm infestation negatively affects the condition of the pregnant woman (anemia, general malaise) and the fetus; can lead to pathological changes in the placenta, which, along with anemia, causes oxygen starvation of the fetus and termination of pregnancy. At the first consultation visit, the stool is examined for worm eggs and, if necessary, treatment is carried out.

Clinical examination- a method by which preventive medical examinations of the population are carried out to identify patients, register them, systematically monitor and improve their health.

Medical examination of pregnant women is carried out by antenatal clinics at the place of residence, and in rural areas - by district and local hospitals and clinics. Consultations register all pregnant women in their area and provide systematic dispensary monitoring of them. The most important task of the antenatal clinic is the early registration of all pregnant women and the identification of pregnancy complications (toxicosis, narrow pelvis, abnormal fetal position, bleeding, etc.), as well as diseases of the internal organs ( of cardio-vascular system, respiratory organs, liver, kidneys, etc.). During pregnancy, a woman should attend a consultation 10-14 times (in the first half of pregnancy, once every 3 weeks, from the 20th to the 32nd week of pregnancy - 2 times a month, after the 32nd week - every 10 days, and when more often if necessary).

Basic antenatal clinic provides not only advisory and therapeutic assistance, but also methodological assistance to all outpatient institutions, including medical units.

Shop obstetrics and gynecology areas are organized in territorial basic antenatal clinics. The shop doctor - obstetrician-gynecologist gets the opportunity to systematically go to industrial enterprises, to state farms, to study the working conditions of women, to work closely with the administration, party and trade union activists.

On-site antenatal clinics- a modern form of service for women agricultural workers. The tasks of these consultations include qualified examination by specialists of pregnant and gynecological patients, carrying out the necessary laboratory tests of preventive examinations, dispensary observation of certain groups of gynecological patients, identification and timely hospitalization of women with complicated pregnancy.

Teeth, oral cavity. Timely treatment of diseased teeth and oral cavity in a pregnant woman is especially important, since foci of infection in oral cavity are a source of constant infection and intoxication of the body and can cause infectious complications during childbirth and the postpartum period. During pregnancy, some women experience a significant depletion of calcium salts in the body, which also affects the condition of the teeth and leads to their rapid destruction. At the antenatal clinic, all pregnant women must be examined by a dentist and given the necessary treatment.

Maternity file carried out for the early and systematic identification of pregnant and postpartum women who do not appear for consultation at the appointed time. The file cabinet is available in the office of each local doctor and consists of the main medical document- individual cards for pregnant women (registration form No. 96). Pregnant women's cards are located in a special box according to the dates of the next scheduled visit. The charts of pregnant women with any diseases or complications are marked with a colored flag, since these women need to be given special attention and examined more often. Cards remaining in the file cabinet at the end of the working day indicate that pregnant women did not show up for appointments; the latter are subject to urgent patronage. The file for gynecological patients is compiled from control cards of patients undergoing dispensary observation (registration form No. 30). The cards are arranged by disease, and within groups - by the date of scheduled appearance, which allows you to immediately identify a patient who did not appear on time and carry out the necessary patronage. The file is kept by a nurse and systematically checked by a doctor.

Blood. A clinical blood test is performed several times during pregnancy, especially in the second half of pregnancy; Repeated blood tests make it possible to promptly identify diseases that require special treatment. For all pregnant women, blood is taken from the ulnar vein twice (in the first and second half of pregnancy) for serological testing (Wassermann, Sachs-Georgi reaction). Treatment of patients identified in this way is carried out at a venereology clinic with the obligatory involvement of the father of the unborn child in treatment.

All patients must have their blood type and Rh status determined; With Rh-negative blood, the mother often experiences hemolytic disease of the newborn. If Rh-negative blood is detected in a pregnant woman, it is necessary to examine the blood of her husband as well. If the father has Rh-positive blood and the fetus inherits the father’s Rh-ness, then during such a pregnancy a Rh conflict arises between the mother and the fetus: the fetus may die in utero, be born prematurely or with signs of hemolytic disease. To increase the fetus's resistance to the harmful effects of Rh antibodies and improve placental blood circulation, all pregnant women with Rh-negative blood undergo desensitizing treatment (at 12-14, 22-24, 32-34 weeks of pregnancy). Therapeutic and preventive measures are designed to create the most favorable conditions for the development of the fetus: food should be rich in proteins and vitamin C (up to 1 g per day during pregnancy with short breaks).

The Coombs test is used to detect antibodies in the mother's blood. When antibodies appear in the mother's blood long before birth, the most severe forms of fetal disease occur. In approximately 30% of newborns from such mothers, hemolytic disease begins in the prenatal period.

Bleeding in early pregnancy cm. Miscarriage.

Bleeding in late pregnancy may be associated with abruption of the placenta at the beginning of labor, with its low location in the uterus, or with placenta previa, if the placenta is located above the internal os of the uterus (in this case, bleeding usually appears without any noticeable labor, without contractions), or associated with premature abruption normally placenta located in the uterus (usually there are contractions). All women in labor with bleeding should be urgently hospitalized in the nearest hospital, accompanied by a nurse, or a doctor or midwife should be urgently called to see them.

Mammary gland. During pregnancy, the mammary glands are prepared for the upcoming feeding of the child so that the mammary glands develop correctly, the nipples become stronger and cracks do not form on them. Every day, with cleanly washed hands, it is necessary to wash the mammary glands with water at room temperature and soap (preferably baby soap) and wipe with a shaggy towel. If the skin of the nipples is dry, they should be lubricated with sterile petroleum jelly. With flat or inverted nipples, a kind of gymnastics is performed on the latter. To do this, the nurse thoroughly washes her hands (nails should be cut short), lightly sprinkles her fingers and nipples with sterile talcum powder, grabs the nipple at its base with two fingers and pulls it in the direction from the areola to the top of the nipple with a simultaneous light massage; This is done daily once or twice a day for 5 minutes. If the massage does not achieve the goal, it should be stopped and subsequently used when feeding the child, if necessary, with a special pad. Air baths for the mammary glands for 15-20 minutes are very useful. This strengthens the nipple and skin; It is advisable to carry out air baths in the morning and evening.

Urine. The kidneys function under great strain during pregnancy, as they remove waste products from the body of both the pregnant woman and the growing fetus. Therefore, a pregnant woman’s urine must be examined every time she visits a antenatal clinic. If protein appears in the urine, the pregnant woman is taken into special registration, and if the protein increases, she must be hospitalized.

Maternity clothes should be comfortable, light and free. You should not wear tight belts, round garters, or tight bras. Stockings should be held in place with long elastic bands that are attached to a belt or bandage. It is better for a pregnant woman to wear loose dresses or a sundress with straps so that the weight of the clothes falls on the shoulders. Cleanliness of clothing during pregnancy is especially important. Shoes should be comfortable, with low heels.

A maternity bra should be made of rough material or lined with canvas and should not put too much pressure on the mammary glands. This contributes to the roughening of the skin of the nipples, which to a certain extent prepares them for feeding. The bottom edge of the bra should be at least 5-6 cm wide. The mammary glands in the bra should be slightly raised and moderately pressed. A bra of the same cut is recommended for postpartum women. A bra with straps should be fastened in the front so that it is convenient to expose the mammary glands when washing them and feeding the baby. Bras need to be clean, so you should have several and change them often.

Maternity and child care leave is provided for a duration of 56 calendar days before childbirth and 56 calendar days after childbirth with payment of state social insurance benefits for this period. In case of complicated pregnancy and childbirth or the birth of two or more children, leave after childbirth is granted for 70 calendar days. Since the duration of maternity leave is calculated in calendar days, this leave counts not only working days, but also weekends and holidays.

Postpartum leave is calculated from the day of birth, including the day of birth. After childbirth, at the request of a woman with a total work experience of at least one year, partially paid leave to care for a child is granted until the child reaches the age of one year with the payment of state social insurance benefits for these periods. For mothers studying in vocational schools educational institutions, in courses and schools for advanced training and training, partially paid leave is provided regardless of length of service. In addition to the specified leaves, a woman, upon her application, is granted additional leave without pay to care for a child until the child reaches the age of one and a half years. Additional leave without pay is counted towards the total and continuous work experience, as well as into the work experience in the specialty and, in particular, the length of service giving the right to annual leave. Before maternity leave or immediately after it, a woman, upon her application, is granted annual leave, regardless of length of service at the enterprise, as well as, if desired, leave without pay.

Occupational safety for pregnant and breastfeeding women. Pregnant women from the fifth month of pregnancy and breastfeeding women are allowed only to do light work (excluding overtime and night work). Women cannot be sent on business trips without their consent. When transferred to an easier job, the pregnant woman retains her average salary based on the last 6 months. It is prohibited to dismiss a pregnant or breastfeeding woman from work. Breastfeeding mothers and women with children under 1 year of age are provided, in addition to a general break for rest and nutrition, additional breaks for feeding the child - at least every 3 hours, lasting at least 30 minutes each. If there are two or more children under the age of 1 year, the duration of the break is set to at least 1 hour. Breaks for feeding the child are included in work time and are paid according to average earnings. The timing and procedure for providing breaks are established by the administration together with the factory, factory, and local trade union committee, taking into account the wishes of the mother. It is prohibited to refuse to hire women and reduce their wages for reasons related to pregnancy or breastfeeding. The dismissal of pregnant women, breastfeeding mothers, and women with children under the age of 1 year is not allowed at the initiative of the administration.

Patronage for pregnant women aims to monitor them at home. The tasks of patronage include: clarifying the general condition and complaints of a pregnant woman, a postpartum woman or a patient with gynecological diseases; familiarization with the life of a pregnant and postpartum woman, teaching her the rules of hygiene and caring for a newborn; education of sanitary and hygienic skills and assistance in improving the hygienic environment, based on specific living conditions; checking the implementation of the assigned mode; sanitary educational work. When caring for pregnant and postpartum women, it is necessary to pay special attention to balanced nutrition and compliance with all doctor’s recommendations. The sister records the data received during the first visit in detail on the visitation sheet, which she pastes into the pregnant woman’s individual card. During repeated visits, the nurse notes on the visitation sheet everything that has been done to eliminate the noticed shortcomings, and reports her observations to the doctor.

Nutrition for pregnant women. Proper nutrition during pregnancy is extremely important for maintaining the health of the mother and the normal development of the fetus. In the first half of a normal pregnancy special diet not required. Food should be varied and tasty prepared. Nutrition in the second half of pregnancy should take into account the physiological characteristics of the body. The diet must include proteins up to 100-120 g per day. Among products containing complete proteins, we should recommend kefir, yogurt, milk, cottage cheese, eggs, cheese, lean meat (100-120 g per day), fish (150-250 g per day). The amount of carbohydrates in the diet should not exceed 500 g per day, and if overweight pregnant woman's body - 300 g. It is necessary to include fruits, berries, vegetables, and bread in the diet. Fats are recommended in the amount of 100-110 g per day, mainly in the form of butter, sour cream and vegetable oils. The amount of liquid is limited to 1-1.2 liters, and the amount of table salt, especially in the second half of pregnancy, to 8-5 g per day. During pregnancy, food should contain vitamins A, B, C, D, E. Vitamin A increases the body's resistance to infection. It is found in the liver of fish. Carrots contain carotene, which is converted into vitamin A in the body; You can also use a ready-made synthetic preparation in the form of pills or liquid. Vitamin B 1 prevents the development of vomiting in a pregnant woman. A lack of vitamin B 1 in the body leads to rapid fatigue, the development of neuromuscular weakness, and weakness of labor. Vitamin B1 is found in black bread, yeast and beans; You can also use ready-made preparations in the form of dragees. Vitamin C ( ascorbic acid) helps maintain pregnancy; If there is a deficiency of this vitamin in a pregnant woman’s body, pregnancy termination often occurs. Vitamin C is found in large quantities in rose hips, black currants, cabbage and other vegetables, berries and fruits, which a pregnant woman should consume widely. If this is not possible (in winter, spring), it is recommended to take vitamin C in the form of ascorbic acid with glucose or in the form of proprietary tablets. Vitamin D, otherwise called antirachitic, prevents the development of rickets in the fetus and plays an important role in the regulation of calcium and phosphorus metabolism in a pregnant woman. Contained in fish oil (use 1 tablespoon 2 times a day before meals). Vitamin E helps maintain pregnancy, especially indicated for women with a history of premature pregnancies; promotes normal development of the embryo and fetus. Vitamin E is found in sprouted wheat grains and salad. There is a ready-made complex of vitamins specifically for pregnant women - gendevit; it is taken 2-3 tablets per day. Food should be taken in small portions, in the first half of pregnancy 4 times with three-hour breaks: first breakfast - 25-30% of the diet, second breakfast - 10-15%, lunch - 40-45%, dinner - 10-15%. IN recent months during pregnancy, food is taken 5-6 times a day, dinner - 1-1.5 hours before bedtime (tea with milk, a glass of milk or curdled milk with a roll or cookies). Night break - 8-9 hours.

Treatment-protective regime in the care of pregnant women, women in labor and postpartum, in addition to observing the strictest asepsis and antisepsis, includes the creation of a favorable, calm, benevolent environment, timely, accurate, painless execution of all appointments, attentive and helpful attitude to the patient’s requests, a calm tone in conversation, concern for cleanliness around the patient , in the room, clean linen, delicious food, etc.; vanity and bustle in the work of medical personnel are eliminated. All of these are the most important tasks of a nurse working in an obstetric hospital, in a antenatal clinic and a clinic. Positive emotions contribute to increased reactivity of the body and faster recovery. And, conversely, negative emotions lower the overall tone and reduce the body’s resistance to infection. There are known cases of miscarriage and premature birth due to severe nervous experiences. Pregnant women, especially with a pathological pregnancy, and postpartum women, after undergoing great physical and mental stress, such as childbirth, need favorable conditions for rest and sleep. Sleep restores the performance of a tired, exhausted body. It is necessary to eliminate noise in the department; the clicking of heels, creaking doors, etc. is unacceptable; it is necessary to maintain the appropriate temperature in the room. The postpartum mother should be provided with at least 8-9 hours of good night with mandatory continuous night sleep of at least 6 hours. All manipulations, diagnostic and therapeutic procedures must be carried out by a nurse painlessly. It is necessary to try to ensure that every pregnant woman is promptly prepared at the antenatal clinic, at the feldsher-midwife station for a painless course of labor by conducting special classes - conversations using the method of psychoprophylactic training. To assimilate ourselves and systematically introduce junior medical staff to the principles of the medical and protective regime - these are the tasks of nurses at the antenatal clinic, maternity hospital and feldsher-obstetric station.

Gestational age. The average duration of pregnancy for a woman is 280 days, i.e. 40 weeks, or 10 obstetric (lunar) months. The gestational age in the first months is determined by simply counting the time that has passed since the last menstruation. To calculate the due date from the first day of the last menstruation, count 3 months ago and add 7 days. For example, the first day of the last menstruation is December 10, 1987: count 3 months ago (November, October, September), it turns out - September 10; add 7 days - it turns out September 17, 1988. This will be the expected due date, which in some cases may vary between September 10 and 20. To more accurately calculate the gestational age, along with anamnesis data, they use the determination of the size of the pregnant uterus, the height of its fundus above the symphysis, the position of the head, its size, the length of the fetus and the circumference of the pregnant woman’s abdomen.

Until 3 months, the uterus is still in the pelvic cavity - pregnancy is determined by vaginal examination. Starting from the fourth month of pregnancy, the fundus of the uterus emerges from the small pelvis and at the end of the fourth obstetric month of pregnancy (16 weeks) stands three transverse fingers (5 cm) above the symphysis pubis; at the end of the fifth obstetric month of pregnancy (20 weeks), the fundus of the uterus is in the middle between the womb and the navel (11 cm above the womb); at the end of the VI obstetric month of pregnancy (24 weeks) - at the level of the navel (22 cm above the womb); at the end of the VII obstetric month of pregnancy (28th week) - 26 cm above the womb; at the end of the 8th obstetric month of pregnancy (32 weeks) - 30 cm above the womb; at the end of the 9th obstetric month of pregnancy (36 weeks) - 36 cm above the womb. By the end of the X obstetric month of pregnancy (40 weeks), the fundus of the uterus drops approximately to the level at which it stood at the end of the VIII obstetric month, i.e., 30 cm above the womb.

Toxicoses of pregnant women- a multi-symptomatic disease manifested by dysfunction of metabolism, the cardiovascular system, kidneys, liver, central and peripheral nervous system; often occur against the background of existing chronic diseases of internal organs.

Early toxicoses may appear from the first days and weeks of pregnancy and disappear in the second half. Some early toxicoses of pregnant women do not completely disappear and persist until the end of pregnancy. Early toxicosis of pregnant women can manifest as dermatoses, a rash similar to urticaria, itching of the external genitalia, eczema, and herpes. Early toxicoses include vomiting and salivation. Many women, from the first days and weeks of pregnancy, develop intolerance to certain smells and tastes (an aversion to some foods and a need for others). Vomiting of pregnancy- the most common form of toxicosis; in most cases does not require special treatment. More severe forms are accompanied by rapid loss of body weight, dry skin, rapid pulse, and low-grade fever. Uncontrollable vomiting- severe form of early toxicosis of pregnant women; vomiting is repeated 20 or more times a day and leads to exhaustion of the body, and in some cases, especially if untreated, can lead to death. As a result of fasting, pregnant women with indomitable vomiting develop severe dystrophy, diuresis sharply decreases, protein, hyaline and granular casts, and acetone appear in the urine. The patient’s mouth smells of acetone (smells like apples), and the general condition deteriorates greatly. A pregnant woman with excessive vomiting should definitely be hospitalized. If treatment is not started immediately, the patient is at risk of death due to profound (irreversible) changes in the organs (kidneys, liver). Sometimes the only salvation There can only be a timely termination of pregnancy.

Drooling (ptialism) manifested by almost continuous secretion of saliva, often causing irritation and maceration of the skin of the chin, and significant weight loss. To measure the daily amount of saliva secreted (and vomit), use a graduated glass mug with a lid. The nurse records the amount of saliva (and vomit) collected in the medical record; large loss of fluid is compensated by drip infusion of fluid (glucose, vitamins, isotonic solutions).

Late toxicosis of pregnant women. At dropsy of pregnancy fluid accumulates mainly in the subcutaneous fat layer. Fluid accumulation depends on disruption of water-salt metabolism and increased capillary permeability. The disease begins in the second half of pregnancy. First, pastiness occurs, and then swelling of the feet and legs. With edema, body weight increases by 500-700 g or more per week. In mild cases of dropsy in pregnancy, bed rest and a diet with limited fluid and salt and the inclusion of complete proteins (boiled lean meat, boiled fresh fish, cottage cheese, kefir), vitamins, light dairy and vegetable foods, diuresis control. If the pregnant woman's treatment is incorrect, dropsy can progress to a more severe stage of toxicosis - nephropathy.

Nephropathy of pregnancy (kidney of pregnant women)- a disease accompanied by edema, the appearance of protein in the urine, and increased blood pressure. Treatment for nephropathy is aimed at increasing diuresis, reducing and completely eliminating edema, lowering blood pressure, improving cardiac activity, and preventing seizures. Intravenous infusions of glucose are used, calcium chloride is administered orally, and magnesium sulfate is administered intramuscularly. Treatment is carried out with intermittent sleep.

The diet for nephropathy consists of excluding table salt, limiting fluids (up to 500 ml per day until swelling disappears); in food - at least 100 g of proteins (cottage cheese or lean meat, boiled or steamed, or boiled fish), animal fats or vegetable oil in the amount of 50 g per day; sufficient amount of sugar and vitamins. The use of soda is prohibited, which is replaced if necessary with magnesium compounds. The nurse very carefully monitors the general condition of the patient, the symptoms of nephropathy (blood pressure, albuminuria, edema, condition of the fundus vessels according to the ophthalmologist). Timely recognized nephropathy can be suspended with proper nursing care for the patient (diet, treatment, medical and protective regimen).

Preeclampsia. If treatment and preventive measures do not stop nephropathy, then the amount of protein in the urine increases, swelling increases, blood pressure rises, and complaints of pain in the epigastric region, headache, and “veil” before the eyes often occur; at this stage, hemorrhage into vital organs, premature placental abruption and other complications dangerous for the pregnant woman and the fetus are possible. Treatment of preeclampsia comes down to an appropriate regimen - the patient is placed in a separate room, providing her with peace and individual, constant care from a nurse. The windows in the ward are covered to avoid harsh light irritation. Magnesium sulfate is administered, the diet is strictly followed (see above), treatment is carried out with long sleep, and the necessary care is provided; This prevents the transition of preeclampsia to the convulsive stage of eclampsia. The nurse must perform all manipulations and injections under general anesthesia.

Eclampsia- the most severe stage of late toxicosis. The growing symptoms of preeclampsia as a result of increased intracranial pressure are accompanied by severe headache, sometimes vomiting, blurred vision, agitation. Convulsions in eclampsia begin with twitching of the facial muscles; First, blinking of the eyelids appears, then fibrillar twitching of the facial muscles occurs, then the spasms spread to the muscles of the trunk and limbs, turning into tonic spasms of the muscles of the whole body. The neck muscles are tense, the veins in the neck are dilated, a sharp cyanosis of the face and upper extremities appears (due to respiratory distress); consciousness is lost; pupils are dilated. A convulsive attack can last from 30 seconds to 1 minute, then the convulsions gradually stop, the patient exhales deeply, foam is released from the mouth, sometimes stained with blood due to biting the tongue, then breathing is gradually restored, the cyanosis disappears, and after a while consciousness returns. The amount of protein in the urine increases sharply. Sometimes, with frequently recurring seizures, the blood supply to the central nervous system progressively deteriorates and the patient, without regaining consciousness, may die from asphyxia, cerebral hemorrhage or pulmonary edema. Eclampsia can occur in pregnant women, women in labor and postpartum women in the first days of the postpartum period.

The nurse must constantly remain with the patient. Before the onset of a seizure, the patient experiences increased agitation, slight twitching of the eyelids, the pulse becomes more intense, and blood pressure rises. At this moment, you need to insert the handle of a spoon wrapped in gauze into the patient’s mouth from the side between the molars (to avoid biting the tongue), and keep the spoon in the mouth until the seizure ends. If possible, the patient is immediately given anesthesia. Before the doctor or midwife arrives, in order to prevent the next seizure, the nurse injects the patient intramuscularly with 20 ml of a 25% solution of magnesium sulfate (this can be repeated every 4 hours, but not more than 4 times a day). If this drug is not available, you can inject 1 ml of a 1% morphine solution under the skin. A patient with eclampsia cannot be transported. The nurse, while staying with the patient, is obliged to provide everything possible to create a therapeutic and protective regime (see. Treatment-protective regime).

Prevention of toxicosis in pregnant women includes correct and qualified management of a pregnant woman from the first weeks of pregnancy; rational nutrition, abstaining from large amounts of fluids and food, limiting salt, regulating physical and mental labor, staying in the fresh air, getting a good night's sleep, following all the recommendations of the antenatal clinic. Those who have suffered toxicosis must be under medical supervision after childbirth.

Toilet external genitalia during pregnancy, it is done with warm water and soap (preferably baby soap). You must first wash your hands thoroughly. They wash themselves over the basin, pouring water from a jug or a kettle with their left hand, or in the bath with warm water from a hose; movements of the washing hand are made from the womb to the anus (but not in the opposite direction).

A nurse washes a bedridden pregnant woman: an oilcloth is laid under the woman and an individual bedpan is placed; use sterile cotton swabs on a forceps. In the second half of pregnancy, a woman washes herself while lying down from Esmarch's mug with a not very strong stream. When washing, water should not pour into the vagina; only the external genitalia are washed.

A balanced diet contributes to the normal course of pregnancy and fetal development. A woman must adapt her diet to the needs of her growing body. What kind of diet is needed for pregnant women depends on the period, characteristics of the constitution and state of health expectant mother.

A woman’s diet should include a variety of foods containing proteins, carbohydrates, fats, and vitamins. The need for these essential substances depends on the individual characteristics of the body. The developing fetus needs proteins, and the pregnant woman’s body has insignificant reserves. They are the basis of cells, tissues, and metabolism is associated with them.

Squirrels

High-molecular compounds consist of amino acids, but only 20 are contained in nutrients. Proteins perform the following functions:

• construction;
• regulatory;
• catalytic;
• contractile;
• transport;
• protective.

During the period of bearing a child, a protein diet for pregnant women is optimal. It ensures normal development of the fetus and placenta. Thanks to protein nutrition:

• woman getting ready for breastfeeding and childbirth;
• transport of nutrients occurs;
• immune protection of the pregnant woman from viruses and bacteria is provided;
• blood supply improves;
• swelling does not occur and blood thickening does not occur;
• bleeding and blood clots are prevented.

Food contains a huge variety of proteins, but their importance is unequal. It is preferable for pregnant women to eat animal products. The amino acid composition of egg whites is considered ideal. The expectant mother's diet should include meat, fish, eggs, and dairy products. They are the main sources of protein.

Protein diet

Such nutrition during pregnancy does not harm the unborn child and maintains the woman’s normal weight. Protein diet for pregnant women differs from weight loss systems. It contains carbohydrates (porridge, vegetables). A pregnant woman's diet includes following products:

• meat (beef, lamb, turkey, rabbit, chicken);
• seafood;
• porridge;
• vegetable salads;
• dairy products(especially cottage cheese).

A pregnant woman should receive per day:

• 100-120 gamma proteins;
• 300-400 gamma carbohydrates;
• 80-100 grams of fat.

A protein diet for pregnant women requires 5 meals a day. Portions are divided as follows. At the first dose, the pregnant woman receives 30% of the calories of the daily diet. In the third - 40%, and in the second, fourth and fifth - 10% each. Nutrition according to this scheme is the best option.

The following products should be excluded from the menu:

• fast food;
• pastries and white bread;
• sweets;
• herring;
• mayonnaise;
• coffee and strong tea;
• mushrooms.

Menu

Sample diet during pregnancy.

1. The first breakfast consists of eggs and cheese.
2. For second breakfast, fruits, juices or dairy products are served.
3. Lunch consists of soups and hot dishes. The menu must include meat or fish, vegetables.
4. In the afternoon you can do without protein. We recommend juice, tea or a glass of kefir.
5. For dinner, meat or fish with vegetables is preferable.

Which cooking method is better? Steamer and grill. Frying is strictly prohibited, and boiling and stewing are not recommended. What fruits and vegetables are best to eat? Nutritionists say that preference should be given to products that are grown in our geographic area.

Diet for a week

A diet during pregnancy by day of the week may look like this:

• Monday.
  • For the first breakfast - muesli with milk or porridge with water and fruit.
  • The second breakfast consists of an apple and kefir. You can eat cottage cheese with apple, banana, dried apricots, prunes.
  • For lunch they offer a vegetable salad. They fill it up vegetable oil. The first is soup or borscht. For the second course, we recommend vegetable stew, stewed or baked meat.
  • Afternoon snack: bun, yogurt.
  • For dinner, it is recommended to serve a steamed meat cutlet, mashed potatoes, an apple and green tea.
• Tuesday
  • The first breakfast consists of milk porridge and yogurt.
  • On the second, they offer a boiled egg and tea.
  • Lunch – porridge with meat, cheese, banana, white bread, juice.
  • The afternoon snack consists of cottage cheese casserole, yogurt and cocoa.
  • Dinner – steamed fish, vinaigrette, rose hip decoction.
• Wednesday
  • For the first breakfast, meat, apple or banana, and tea are recommended.
  • Second breakfast – cottage cheese and kefir.
  • Lunch consists of vegetable salad, soup, beans or lentils.
  • Afternoon snack – bun, kefir.
  • Dinner - meat, rice, rye bread, dried fruit compote.
• Thursday
  • Breakfast consists of cheese, bread and butter, grapes.
  • Second breakfast – cottage cheese, green tea.
  • For lunch they offer vegetable salad, borscht, meat, and dried fruit compote.
  • Afternoon snack – cottage cheese and apple.
  • Dinner consists of fish, vegetable salad and fruit juice.
• Friday
  • For the first breakfast, the following products are offered: boiled egg, fresh cucumber, white bread and kefir.
  • The second breakfast consists of cottage cheese and tea.
  • Lunch – vegetable salad, soup, fish, fruit drink.
  • Afternoon snack – cake, yogurt, tea.
  • For dinner, boiled meat, cheese, vegetables, and tea are recommended.
• Saturday
  • The first breakfast consists of cottage cheese and green tea.
  • Second breakfast – diet cookies and milk.
  • For lunch they offer vegetable salad with meat and soup.
  • Afternoon snack – bun, honey, yogurt.
  • Dinner consists of fish, banana and fruit juice.
• Sunday
  • Breakfast – muesli, apple and banana.
  • Second breakfast – yogurt, diet cookies.
  • For lunch they offer vegetable salad, fish with stewed vegetables, and soup.
  • Afternoon snack – cottage cheese, nuts, kefir.
  • Dinner – meat, vegetable salad, apple, honey, tea.

If a woman gains more than normal during this period, it is necessary to reduce caloric intake. There is a special diet during pregnancy with overweight.

In the first trimester

In the first trimester, fetal organs are formed in the woman's body. During this period, good nutrition is important. The protein requirement in the first trimester is 1.5 g per 1 kg per day. Nutrition during this period of pregnancy is no different, but it must be balanced. In the first months, you can eat pickles and sauerkraut.

In the 1st trimester, do not increase the caloric content of food. The daily diet of a short woman weighing 50 kg during this period is 2100-2300 kcal. A pregnant woman often gains excess weight in this trimester, so you should not overeat.

Nutrition in the second trimester

At this stage of pregnancy, the fetus is actively growing. In the second trimester, caloric intake is increased to 2600 kcal. Avoid sweets (sweets, jam, condensed milk).

In the second trimester, you should not consume fats such as cream and sour cream. Limit salt intake to avoid swelling. It retains water in tissues and fat layers, and the woman gains weight. You should not add enough salt to your food if you have swelling. It is recommended to limit the consumption of foods that contain allergens (exotic fruits, citrus fruits, strawberries).

In the second trimester, fresh vegetables and fruits are included in the daily menu. A woman should be responsible for the food she eats. You need to carefully ensure that your daily diet includes foods containing vitamins A, B, and E.

Increase the consumption of vegetable fats. In the second trimester, a pregnant woman’s menu includes 2 tablespoons of vegetable oil daily.

Diet in the third trimester

Dietary nutrition is especially important in the third trimester. During this period, do not eat fried, salty, sweet foods. Fried and smoked foods are not food for a pregnant woman. Meat and fish are included in the diet in the first half of the day, and in the second half preference is given to dairy and plant foods.

In the third trimester, products containing vitamins, calcium, and iron are recommended. How the formation of the fetus and the course of labor will be completed depends on this. In the third trimester, pay attention to the calorie content of foods so as not to gain weight. There are special diets for weight loss.

Losing weight during pregnancy

During this period, some women indulge their weaknesses by consuming sweets that affect their weight. In order to lose weight during pregnancy, it is enough to eat right. The following products should not be included:

• chips, crackers, any fast food;
• roast;
• sweet;
• baking;
• carbonated drinks, coffee, tea, alcohol.

Food should be eaten in small portions 5 times a day. In order to lose weight, cook it by steaming or grilling. Plant foods must be included in the diet. Must be consumed sea ​​fish. Those who want to lose weight should not forget about fruits. It is useful to include wholemeal bread in your daily diet. To lose weight, eat foods such as yogurt and kefir. It is enough to eat a few pieces of cheese a day.

Monitor your salt intake

Proper nutrition and an active lifestyle (walks, group exercises) are what a woman needs during pregnancy. All this will keep her physically fit, and she will not need to go on special diets to lose weight. If you are overweight, you can have fasting days (cottage cheese, apple, kefir) several times a week, but only with the permission of your doctor.

During pregnancy, a woman should monitor her salt intake. IN Everyday life people oversalt their food. The sodium intake rate is 1–15 grams per day. For edema, a salt-free diet during pregnancy is recommended. If there is fluid retention in the tissues, avoid foods with added salt. The following products should be excluded:

• mayonnaise;
• ketchup;
• salted fish;
• sauerkraut;
• semi-finished products;
• kvass;
• saline mineral water.

For edema, it is recommended to prepare food yourself. It is healthy to eat apple and pumpkin salad. For edema, the diet should include foods that thin the blood - birch sap, onions. A pregnant woman's diet must include meat, fish, dairy products, fruits and vegetables. For edema, it is recommended to include foods with diuretic properties.

Fluid consumption in the 3rd trimester is justified. A pregnant woman's tissues almost always swell, but this should be controlled. Nutrition for edema should be correct. A salt-free diet helps in this case. If you have edema, you should not completely give up salt, but only limit its use.

The doctor will help the pregnant woman adjust her diet. She can create a menu for edema on her own. In this case, the menu should include:

• egg whites;
• cottage cheese;
• fish (seafood);
• meat;
• milk or kefir.

For swelling, eat 5 times a day.

A special diet may be prescribed for pyelonephritis in pregnant women. The following foods are prohibited on this diet:

• onion garlic;
• mustard;
• cocoa, tea;
• confectionery;
• mushrooms;
• spinach, sorrel, radish;
• legumes

Diabetes mellitus in a pregnant woman

Gestational diabetes mellitus during pregnancy is a signal that you should definitely monitor your diet. Here are some dietary guidelines for gestational diabetes:

1. Eat food in small portions.
2. Eat at the same time.
3. For gestational diabetes mellitus, the diet includes porridge;
4. Vegetables and fruits are eaten.
5. If you have gestational diabetes, your diet must include whole grain products.
6. A patient with gestational diabetes mellitus needs to consume 1.5 liters of fluid daily.

With this disease, a pregnant woman must monitor her blood glucose levels. The amount of calories consumed for gestational diabetes is 25–30 per kilogram of weight. A diet for this disease is prescribed by a doctor. For gestational diabetes mellitus, the following foods are prohibited:

• easily digestible carbohydrates;
• fried foods;
• fatty foods;
• fast food.

The diet for diabetes includes the following foods:

• vegetarian borscht, or with weak broth;
• vegetable soups;
• meat (beef, lamb, chicken);
• fish (pike perch, pike, pollock);
• kefir, cottage cheese, yogurt, sour cream;
• rosehip, mineral water;
• fruits (sweet and sour).

The diet is agreed upon with an endocrinologist. Your daily diet should contain the same amount of carbohydrates. Meals for diabetes must be divided (up to 8 times). The diet includes plant fiber. For diabetes, up to 30 grams of sweetener per day is allowed. Limit salt intake (up to 4 grams). The doctor individually draws up a menu for a pregnant woman with diabetes.

Topic No. 10 Pregnancy.

1. Pregnancy. Anamnesis of life. Special anamnesis.

2. Signs of pregnancy. Diagnostic methods.

3. Physiological course of pregnancy.

4. Features of nursing supervision of a pregnant woman.

Pregnancy (gestation) is the condition of a woman in the period between fertilization and childbirth. It is important to know that pregnancy is not a disease. The state of pregnancy is a set of biological changes occurring in the mother's body. The normal development of pregnancy is associated with a complex of adaptive reactions of a woman aimed at optimal development of the fetus.

Anamnesis of life.

An examination of a woman who has applied to an antenatal clinic about pregnancy begins with a survey to find out the state of her health and the health of the child’s father in the present and past (previous diseases and their complications), social status and the presence of occupational hazards. Particular attention should be paid to the inadmissibility of smoking, drinking alcohol, and drugs for a pregnant woman.

For timely preventive and therapeutic measures, it is necessary to have information about tuberculosis, including in close relatives, syphilis, gonorrhea, mental illness, etc.

Special anamnesis

Its purpose is to collect information about the presence of pregnancies in the past and their course.

Were there any disturbances in the early and late stages of pregnancy in the form of drooling, nausea, vomiting, and was the woman hospitalized due to these disturbances?

Did the pregnancy end in the birth of a normal full-term fetus or in a state of asphyxia or stillbirth?

How was the postpartum period?

All this is entered into the pregnant woman’s chart to draw up a management plan for the pregnant woman, prevent and treat pregnancy complications, and reduce the risk of having a child with health problems.

Signs of pregnancy

Doubtful (subjective):

- nausea and vomiting

- heartburn

- constipation

- fatigue

Possible signs which usually occur during pregnancy, but sometimes a single symptom can be observed in non-pregnant women.

- delay of menstruation for at least 10 days and dyspeptic symptoms

- swelling of the mammary glands, brown pigmentation around them, discharge of colostrum from the nipple when pressed

- pigmentation of the white line of the abdomen, frontal tubercles, cheekbones, labia majora

- enlargement and change in the shape of the uterus. Vaginal two-manual examination allows you to establish pregnancy (sign of pregnancy according to Snegirev, according to Horwitz and Hegar)

To establish pregnancy in the early stages, it is advisable to examine the woman again a week after treatment.

Laboratory methods for testing for the presence of pregnancy in the early stages:

Radioimmunological method for determining hemoglobin X in blood serum 5-7 days after conception

Enzyme immunoassay tests 1-2 weeks after conception

Ultrasound at 2-3 weeks of pregnancy. Registration of fetal s/w from 4-5 weeks.

Special tests are systems that allow women to determine the presence of pregnancy on their own.

Establishing pregnancy in the early stages – an important point for determining the expected time of birth. With a 28-day menstrual cycle with ovulation on days 14-15, it is necessary to add 9 months and 7 days to the date of the first day of the last menstruation, or subtract three months from the first day of the last menstruation and add seven to the resulting number.

The duration of pregnancy is 280 days or 40 weeks from the first day of the last menstrual period. If menstrual cycle exceeds 28 days, then the duration of pregnancy increases by approximately 1 day for each day of the menstrual cycle.

Reliable signs:

Unquestionably confirm pregnancy and are diagnostic late dates pregnancy.

Sensation of fetal movements between 16-20 weeks after the last menstrual period

Listening to the fetal heartbeat using auscultation from 17-19 weeks, heart rate 120-140 per minute, ECG, FCG, cardiotachography from 12-14 weeks

Identification of fetal parts by palpation of the abdomen

Determining the length, weight of the fetus and the size of its head in various ways

At the first visit to the antenatal clinic in order to establish pregnancy, in accordance with the order of the Ministry of Health of the Russian Federation of 2003 No. 50, return to the doctor and obtain laboratory tests after 7-10 days, and then visit at least once a month until 28 n\a after 28 n\r g 2 times a month. At each visit, the pregnant woman’s body weight, A/D, heart rate are measured, an external obstetric examination is performed, the position, position and presentation of the fetus are determined, heart sounds are listened to, and the frequency of fetal movements is counted (normally three movements in 30 minutes). Clinical blood test at the first visit, on 22 and 32 n/a. Clinical urine analysis at each examination (at least 4-15 times). Blood on RW at the first examination and 32 weeks of gestation. Blood on HIV infection 3 times during pregnancy. Determination of blood group and Rh factor at the first visit. If a woman has a Rh negative factor and if her husband has a positive Rh factor, the blood of the body is tested for Rh on a monthly basis. Bacterial examination of the discharged vagina at the first visit and 32 weeks. During pregnancy, a woman should be examined by a therapist 2 times, an ophthalmologist, an ENT specialist, and a dentist once and according to indications.

Physiological course of pregnancy

By the end of pregnancy, a woman’s body weight increases by 10-12 kg. The weekly weight gain in the second half of pregnancy is 300- 400 gr.

The tone of the parasympathetic nervous system increases - nausea, vomiting, changes in taste and smell, hypersalivation, a tendency to dizziness, and constipation appear.

Complex changes in the body are caused by the appearance of new endocrine glands - the corpus luteum, the placenta, which produces human chorionic gonadotropin, placental lactogen, estrogens and progesterone. The placenta provides transport, storage, excretory, fetal nutrition, respiratory functions, and immunobiological protection of the fetus. The placenta together with the fetus forms the fetoplacental complex. Towards the end of pregnancy placenta weight is 500-600 gr., diameter 15-18 cm, thickness 2-3 cm. The placenta is connected to the fetus by the umbilical cord, which contains two arteries and one vein. The length of the umbilical cord at the end of pregnancy is on average 50 cm. The placenta + umbilical cord and fetal membranes form the afterbirth. The fertilized egg forms two membranes: the villous chorion and the aqueous one. The cavity of the aqueous membrane is filled with amniotic fluid, their accumulation helps to increase the volume of the egg and protects against injury from the outside. They contain salt protein, vitamins, and hormones. In the cavity of the egg, the fetus is actively moving. Normal quantity amniotic fluid from 1 to 1.5 liters.

Respiratory system. During pregnancy, the load on the lungs increases. For the normal supply of oxygen to the fetus, the respiratory rate increases by 10% with an unchanged vital capacity.

The cardiovascular system– an increase in the network of blood vessels in the uterus, the appearance of placental circulation, displacement of the heart upward by the diaphragm, can lead to partial hypertrophy of the heart muscle, physiological tachycardia appears. Systolic and diastolic blood pressure decreases by 5-15 mm in the second trimester. RTST. Lowest at 28 weeks. Then it increases and by the end of pregnancy it corresponds to the pre-pregnancy levels.

Hematopoietic system. Hemoglobin content. Decreases by the third trimester. The lowest value for a period of 32-34 weeks is 110 g. per liter

Kidneys. Their function changes significantly during pregnancy. The renal pelvis dilates, the ureters lengthen and dilate. At the beginning of pregnancy, women begin to complain of frequent urination, which is caused by the pressure of the pregnant uterus on the bladder. Towards the end of pregnancy, these phenomena may intensify and some women may experience involuntary leakage of urine when coughing and sneezing.

Support- motor system. Changes in it occur under the influence of relaxin formed in the placenta. A discrepancy of the pubic bones of 0.5 cm is considered normal.

Mammary gland. The mass increases due to an increase in the number and volume of lobules.

Nursing monitoring of pregnancy development consists of several stages:

Knowledge of and implementation of standards for the management of pregnant women prescribed in the orders of the Russian Ministry of Health.

Knowledge about the long-term consequences if a woman or a married couple works in unfavorable conditions or lives in an area contaminated with industrial waste.

At the first visit to the antenatal clinic, it is necessary to determine the degree of possible risk of disturbances in the course of pregnancy, the health of the fetus and newborn. For this purpose, the midwife fills out a questionnaire, and the doctor determines the level of risk for each individual woman. Based on risk indicators, a forecast is made for the health of the fetus and newborn with the development of preventive and therapeutic measures.

If there is a threat of termination of pregnancy, pregnancy with a negative Rh factor, the pregnant woman is hospitalized in a hospital and the nurse carries out actions according to the doctor’s prescriptions, and also conducts conversations with the pregnant woman about proper nutrition, daily routine, the dangers of alcohol, smoking, prepares a pregnant woman for childbirth, teaches special breathing techniques, self-anesthesia during labor and behavior during childbirth.

When a woman works in harmful and dangerous working conditions, a medical worker is obliged to resolve the issue of transferring the pregnant woman to easy and harmless work. (according to Article 264 of the Labor Code of the Russian Federation and hygienic recommendations for the rational employment of pregnant women.)

The employer must bear social responsibility for the health of women of reproductive age. A woman must be employed during the first 11 days of pregnancy, since fetal malformations form during this time. To transfer to another job, she is given a medical certificate (form 084\u).

A pregnant woman is obliged to follow the rules of healthy lifestyle and not harm the unborn child.

Antenatal prevention of the health of the unborn child is also carried out by the nurse at the children's clinic during prenatal care.

Control questions and assignments on topics No. 3 and 10

1. Describe the process of fertilization, stages of fetal development.

2. Name the critical periods intrauterine development

3. Indicate the reasons that cause disturbances in the development of the fetus and newborn.

4. How to diagnose pregnancy? Name reliable signs of pregnancy.

5. What changes occur in a woman’s body during pregnancy?

6. What measures should a medical professional take if a pregnant woman works in harmful and dangerous working conditions?

7. Compile material for a conversation with a pregnant woman on nutrition, physical activity, and preparation of the breast for lactation.

During pregnancy in healthy body all organs function normally, but with increased load. If the rules of nutrition, hygiene, or overwork are not followed, the body’s functions are disrupted and various complications arise. Therefore, pregnant women must carefully follow all hygiene rules aimed at preserving and strengthening the woman’s health, the proper development of the fetus, the normal course of childbirth and the postpartum period, and preparing the woman’s body for breastfeeding.

All this information is explained to pregnant women during classes on psychoprophylactic preparation for childbirth. Their main goal is to eliminate fear and unpleasant emotions during pregnancy and childbirth, to prepare the body for childbirth and breastfeeding. Usually these are 5-6-8 classes, which consistently cover the regime, diet, hygiene of the pregnant woman, the physiology of pregnancy, possible complications, the course of labor and methods of pain relief, the course of the postpartum period and child care.

Prenatal care.

Body care - necessary condition for the activity of the whole organism. During pregnancy, the skin works under increased load - it performs an excretory function in conjunction with the kidneys. Showers, rubbing, washing, gymnastics, and air baths are of great importance.

Pregnant women are recommended to take a shower at least once a week and wipe their body daily with water at room temperature. When showering daily, use pH-neutral soap. Toilet of the oral cavity and teeth, sanitation of carious teeth is very important. Mandatory hygiene procedures include shaving the hair in the armpits and washing them daily with warm water. Thrush fungi can grow there.

Toilet the external genitalia 1-2 times a day with warm water and pH-neutral soap. Vaginal douching is not recommended.

Air baths should be carried out from 5-10 minutes to 15-20 minutes. at T 22-24 deg. Undosed sunbathing is contraindicated; it is better to use ultraviolet radiation as prescribed by a doctor, especially for residents of the North. Swimming in the sea and river is allowed, but limited in the last 2 months of pregnancy - there is a danger of ascending infection.

Sleep at least 8-9 hours at night and rest for 2 hours during the day, walks in the air before bed are required. Air flights and long-distance travel are not recommended.

Mandatory physiotherapy, 15 minute morning exercises. During pregnancy, exercises such as “bicycle”, “scissors”, bending forward, squats, and standing for a long time with your arms raised up are prohibited. Limit exercises to strengthen the abdominals; the main load should be on the shoulder girdle, chest, hips and perineum. “Movement is life!” Move every 2 hours to prevent stagnation lower limbs.

Preparing the mammary glands for lactation, see above.

Clothing – comfortable and loose, preferably not made of synthetics, avoid elastic knitted fabrics, center of gravity on the shoulders, avoid tightness of the stomach and chest. The bandage prevents overstretching of the abdominal wall and skin and supports the fetus in the correct position in the womb. Comfortable shoes with wide heels no more than 5 cm high.

For varicose veins:

Avoid staying in one position for a long time;

· during sleep and prolonged stay in one position, the legs should be at a higher level than the body;

· Wear elastic stockings or wrap your legs with an elastic bandage, but they should be removed during sleep;

Avoid wearing knitwear with elastic bands;

· avoid heat sources near the feet, sunbathing, hair removal with hot wax;

With an increase in vaginal leucorrhoea:

· do a test to detect a vaginal or fungal infection;

· in case of detection of bacterial vaginosis or infection, carry out pathogenetic treatment.

For cramps in the calf muscles perform muscle massage; recommend magnesium and calcium preparations during pregnancy and lactation (Magne B 6, Additiva calcium, Upsavit calcium, Calcium-B 3 Nycomed); Remember that the bioavailability of calcium gluconate is very low.

Sexual life at risk of miscarriage is limited, individually - abstinence or a condom in the last 4 weeks of pregnancy - the danger of ascending infection.

Do not take medications without the advice of your doctor or midwife. Avoid diagnostic or therapeutic x-ray exposure. Avoid contact with infectious patients with rubella, cytomegalovirus and herpes infections, chickenpox

Diet.

Nutrition should be rational and, to a certain extent, individualized in accordance with family and household conditions and characteristics of the woman’s body. In the first half, 4 meals a day are recommended: 1 breakfast - 25-30% of the diet, 2 breakfast - 10-15%, lunch - 40-50%, dinner - 15-20%. In the second half of pregnancy, 5-6 meals a day, serving size – 200g. Nutrition in the first half of pregnancy under the motto: “Eat whatever you want, and remember the adverse effects of alcohol, smoking, drugs, medications.” A varied and deliciously prepared diet rich in protein and vitamins is recommended.

ü from the moment of a positive hCG test:

Iodine - 200 mcg;

ü 8 weeks after the last menstrual period:

Iron - 50 mg;

Calcium - 1000 mg.

Proteins should account for an average of 20-25% of the total calorie intake (in the 2nd half - 30-35%), fats - 25-30%, carbohydrates - 40-45%. Daily requirements for normal weight:

· calories - 1800-2500 kcal;

· proteins - 60-90 g;

· carbohydrates - 325-450 g;

Limit fat to 50-70 g.

In the 2nd half of pregnancy, you should follow a predominantly dairy-vegetable diet, alternating meat, fish and vegetable days. Raw fruits, berries and vegetables are very useful. Meat - 2-3 times a week, fish more often. Supplement the amount of animal proteins with cottage cheese, eggs, cheeses, and dairy products. Liquid - up to 1200 ml per day. Natural juices without preservatives, still mineral water, tea with milk, and whey are recommended. Spicy, salty foods and marinades, alcohol, spices, and coffee are prohibited.

In the North-West region it is recommended food pyramid: first floor– grains. They contain a lot of vitamin B. Coarse bread with bran, porridge - oatmeal, rice, buckwheat, it is better to cook them from whole grains due to the high iron content, pasta. Fibromed and flake (germ grains) are also useful, which contain all the microelements, vitamins and iron. Second floor- vegetables and fruits, walnuts. Green ones contain a lot of vitamin C, red ones have a lot of vitamin A. Strawberries and citrus fruits in moderation due to the possibility of allergies. Third floor- meat, fish and seafood, and milk and dairy products. Lamb and pork are difficult to digest and are difficult foods for pregnant women. Eggs no more than 3 times a week. Fourth floor– sweets and baked goods. There are very few of them.

Fasting days are useful for pregnant women: it is easiest to abstain from food from 18.00 one day to 18.00 the next. On this day, eat only one type of fruit - most often it is apples in the amount of 1-1.5 kg or drink one type of natural juice. After fasting day It is advisable to eat only light food - porridge with water, boiled vegetables.

On average, a woman gains 9-12 kg during pregnancy. Average weekly weight gain is 300-350 grams.

If you are prone to constipation:

· dairy products

Avoid a sedentary lifestyle

· overnight yogurt or kefir, dried fruits, 100-150 gr. prunes, apples, raw carrots, give preference in the diet to green vegetables, bran supplements and fruits;

· after waking up, drink a glass of still water;

Avoid eating foods containing starch, with the exception of rice;

· you can use laxatives (duphalac, mucofalk, forlax);

· use with caution during pregnancy and lactation senosides A+B (regulax, bekunis, tisasen), bisacodyl, guttalax;

· It is not recommended to use oils as laxatives: they promote the absorption of fat-soluble vitamins.

For heartburn:

• recommend eating small meals more frequently;
• try not to take carbonated drinks, coffee, hot sauces;
• prevent sudden bends;
• do not take antacids containing sodium bicarbonate (causes constipation);
• does not cause constipation when taking antacid medications containing aluminum hydroxide in combination with magnesium (Gastal, Alumag, Coalgel 60): they have a protective effect for the gastrointestinal mucosa; do not cause constipation;
• It is advisable to use drugs only with aluminum hydroxide (phosphalugel, tisacid, alumag).

For hemorrhoids: prevent constipation, regulate stool; prescribe topically aurobin ointments and/or rectal suppositories (procto-glivenol, proctosedyl).

For hypersalivation carry out oral hygiene; try to swallow or spit out saliva; stop smoking; if necessary, to reduce salivation, use metacin 0.002 g 2-3 times a day.

Approximate daily diet in the first half of pregnancy:

• up to 200 g of milk or its derivatives (preferably fermented milk products); eggs -1-2 pcs.;
• vegetables - 500 g;
• fruits - 200-500 g;
• 2 pieces of meat, cutlets, replaced during the week with sea fish, liver (120-150 g);
• bread and its products - 200 g;
• cereals or pasta - 50 g;
• limiting strong coffee and tea;

Approximate daily diet in the second half of pregnancy:

· up to one liter of milk or its derivatives (preferably fermented milk products);

· eggs - 1-2 pcs.;

· vegetables - 500 g;

· fruits - 200-500 g;

· 2 pieces of meat, cutlets, replaced during the week with sea fish, liver (200 g);

· bread and its products - 200 g;

· cereals or pasta - 50 g;

Limiting strong coffee and tea;

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CARE FOR PREGNANT AND MATERNAL WOMEN.

BASICS OF OBSTETRIC PHYSIOLOGY AND

PATHOLOGIES

ECTOPIC PREGNANCY

MARRIAGE OF PREGNANCY

HYGIENE FOR PREGNANT WOMEN

MONITORING THE PREGNANT WOMAN

NUTRITION FOR PREGNANT WOMEN

TOXICOSES IN PREGNANT WOMEN

MOTHERS

POSTPARTUM THROMBOPHLEBITIS

TREATMENT AND SANITARY REGIME OF AN OBSTETRIC HOSPITAL

DETERMINING THE DATE OF PREGNANCY AND DELIVERY
How long is a normal pregnancy?
A woman's pregnancy lasts on average 280 days, i.e. 40 weeks, or 10

obstetric months. Often pregnancy lasts less than this period

(230-240 days).
How is the estimated due date calculated?
To calculate the due date, add 280 to the 1st day of the last menstruation

days, i.e. 10 obstetric (or 9 calendar) months, and 7 days. Usually the calculation

produced more simply - count backwards from the date of the 1st day of the last menstruation 3

calendar months and add 7 days. For example, if the last menstruation

began on 12/11, then, counting 3 months ago (11/11, 10/11, 09/11) and adding 7 days,

determine that the due date should be September 18.
What signs are used to determine the duration of pregnancy?
When determining the duration of pregnancy and childbirth, the time of the first movement is taken into account

fetus In primigravidas this happens at 20 weeks, in multiparous women - at 18

weeks To the date of the first fetal movement in primigravidas, 5 obstetrics are added

months (20 weeks), for multiparous women - 5 and a half obstetric months (22

weeks). Fetal movement is a subjective sign that is taken into account as

auxiliary
To determine the gestational age great importance have objective data

examinations: size and shape of the uterus, abdominal volume, length of the fetus, its size

heads. In the first 3 months of pregnancy, its duration is determined by the size of the uterus,

after 4 months - according to the height of the uterine fundus. Later, the abdominal volume is measured and

size of the intrauterine fetus.
How does the size of the uterus change during a normal pregnancy?
At the end of the first obstetric month, the size of the uterus corresponds approximately

chicken egg, at the end of the P month - a goose egg, at the end of the W month the uterus reaches

size of the newborn's head. Starting from the fourth month, the size of the uterus is judged by

height of the uterine fundus. At the end of the IV month (16 weeks), the fundus of the uterus is located at

the middle between the pubis and the navel (4 transverse fingers above the symphysis); by the end of V

month (20 weeks) - located 2 transverse fingers below the navel; by the end of VI

month (24 weeks) - at the level of the navel, at the end of the VH month (28 weeks) - at 2-3

finger above the navel, at the end of the Vni month (32 weeks) - in the middle between the navel and

xiphoid process. The navel begins to smooth out, the abdominal circumference is at the level

the navel is 80-85 cm. At the end of the 9th month (36 weeks) the fundus of the uterus is at the xiphoid

process ( highest level position of the uterus), abdominal circumference 90 cm, navel

smoothed out By the end of the X month (40 weeks), the uterine fundus is determined at the level of the VIU month

(midway between the navel and the xiphoid process). The navel is protruding

abdominal circumference 95-98 cm.
With the same position of the uterine fundus in VHI and X obstetric months, the abdominal circumference

different, the position of the head is different: in the 8th month the head stands high above the entrance

into the small pelvis; in the X month, as a rule, it is lowered, and in primigravidas it is pressed

or a small segment is located at the entrance to the small pelvis.
How is the length and head of the fetus measured?
The length of the fetus is measured with a tazometer: one button of the tazometer is placed on the lower pole

head, the other - to the bottom of the uterus, the resulting value is multiplied by 2 and from it

subtract 2-3 cm (depending on the thickness of the abdominal wall). Setting the length

fetus, divide this number by 5 and get the gestational age (in the second half).
The fetal head is measured with a pelvis gauge: the pelvis gauge buttons are set to the most

protruding points of the head (usually the forehead and back of the head). Fronto-occipital size

the head at the VIII month is on average 9.5 cm, at the end of the IX month - 11 cm, at the end of the X

months - 11.5-12 cm.
ECTOPIC PREGNANCY
What are the causes of ectopic pregnancy?
An ectopic pregnancy develops when a fertilized

The egg is implanted outside the uterine cavity. Depending on the implantation site

There are tubal, ovarian and abdominal pregnancies (very rare).
The main cause of ectopic pregnancy is changes associated with

inflammation of the tubes, preventing the normal movement of the egg into the uterus:

the egg settles in the tube and is implanted into its wall. Usually ectopic

pregnancy is terminated at 5-6 weeks, less often - at the 8th or at the beginning of the 12th

weeks.
What are the signs of an ectopic pregnancy?
Until an ectopic pregnancy is terminated, it is characterized by a delay

menstruation, nausea and other symptoms of normal pregnancy.
Kvass signs of spontaneous termination of ectopic pregnancy?
Termination of pregnancy occurs as a tubal abortion and as a rupture

pipes. When a pipe ruptures, its entire wall is destroyed, causing severe

bleeding, quickly leading to severe anemia, threatening life.
When a pipe ruptures suddenly or after slight physical stress

there is an attack of severe pain in the lower abdomen, accompanied by fainting or

half-fainting state. The pain radiates to the shoulder, shoulder blade, anus. Due to

heavy bleeding in abdominal cavity anemia increases rapidly: skin and

visible mucous membranes turn pale, breathing increases, blood pressure increases

falls, the pulse becomes frequent and soft. The abdomen may be swollen, painful,

Palpation reveals a positive Blumberg-Shchetkin sign.
What is emergency care?
If an ectopic pregnancy is suspected, a woman should immediately

hospitalized by the most convenient means of transport, accompanied by

medical personnel. When a diagnosis is made, immediate

operation. In case of large blood loss, blood and blood substitute fluids are transfused,

cardiac medications are used.
MARRIAGE OF PREGNANCY
What forms of miscarriage are identified in clinical practice?
Pregnancy can spontaneously terminate at any time. Interrupt

pregnancy up to 28 weeks is called miscarriage, or abortion, and at 28-38

weeks - premature birth. Abortions are divided into early (up to 16 weeks) and

late (16-27 weeks). If miscarriage recurs more than 2 times,

this indicates recurrent miscarriage.
What are the causes of miscarriage?
The causes of miscarriage are numerous, complex and cannot always be

be clarified. Etiological factors include infectious and

non-communicable diseases of the mother, infantilism, neuroendocrine disorders,

induced abortions, body intoxication, pregnancy complications,

chromosomal and gene abnormalities, diseases and abnormal development of reproductive organs

organs, immunological incompatibility of the blood of mother and fetus, trauma,

spermatogenesis disorders. Currently the main cause of miscarriage

consider hormonal disorders, primarily functional

ovarian and placental insufficiency, as well as infectious factors, in particular

inflammatory processes of the genitals.
What are the common symptoms of miscarriage?
In case of premature termination of pregnancy during early abortion, the fetal

the egg gradually exfoliates from the walls of the uterus, dies and under the influence of contractions

the muscles of the uterus are expelled from its cavity entirely or in parts. At the same time, how

As a rule, bleeding appears and intensifies. Late abortion And

premature birth proceeds like a normal birth: smoothing occurs

and dilation of the cervix, rupture of amniotic fluid, birth of the fetus and placenta.
At the beginning of termination of pregnancy, a feeling of heaviness or dullness occurs, and in some cases

cases of cramping pain in the lower abdomen and lower back. This is the most

frequent symptoms of miscarriage. The sensation of pain may vary intermittently

relative peace. Pain indicates irritation of the neuromuscular system

uterus as a result of increased tone or contractions. Second

symptom - bloody discharge from the genital tract, indicating

the beginning of detachment of the placenta - usually happens with early abortions, with

late abortions and premature births are observed in cases of presentation

placenta. The amount of discharge depends on the degree of placental abruption.
How is the threat of premature termination of pregnancy treated?
Treatment of the threat of premature termination of pregnancy is carried out in

hospital. The patient is prescribed bed rest, suppositories with papaverine 0.02-

0.03 g 2 times a day, no-spa, vitamin B. If placental abruption continues,

bleeding intensifies, then, as a rule, the cavity is curetted

uterus to remove remnants of the fertilized egg, pieces of the placenta.
HYGIENE FOR PREGNANT WOMEN
What is pregnancy hygiene?
Hygiene during pregnancy should include activities aimed at

preserving and strengthening the health of a woman whose body is experiencing

increased loads, antenatal fetal protection, preparation of the woman’s body

to the normal course of childbirth and the postpartum period, to lactation and breastfeeding

feeding.
What personal hygiene rules should a pregnant woman follow?
A pregnant woman should take a shower 1-2 times a week and dry herself daily

body with a towel soaked in water at room temperature, wash 2 times a day

external genitalia with warm water and soap (vaginal douching is not

sunbathing. Air baths are taken at an air temperature of 20-22

°C, starting from 5-10 minutes - and gradually increasing their duration to

20-30 minutes. In summer, short sunbathing is beneficial, and in winter and autumn -

ultraviolet irradiation. Swimming is allowed in warm weather,

for a short time if the pregnancy is progressing normally.
What is prohibited during pregnancy?
Smoking and drinking alcohol are strictly prohibited, as they are poisonous.

tobacco smoke products and wine alcohol pass through the placental barrier and

can cause irreparable harm to the fetus, including the development of deformities. .
In the first 3 and last 2 months of pregnancy, sexual activity is prohibited in order to

prevent infections, miscarriage and premature birth.
What does breast hygiene include in pregnant women?
A pregnant woman needs to systematically prepare her nipples for

future feeding to prevent their cracks and mastitis. Bras should be

comfortable, made from natural fabrics, matching the size and shape of the glands. Glands and

nipples are washed daily with soap and water at room temperature and wiped

hard towel. If your nipples are flat or inverted, in the last 2 months

during pregnancy they are massaged: daily after lubrication with boron

With Vaseline, the nipple is grabbed with the index finger and thumb and pulled back

for 3-4 minutes (2-3 times).
What are the basic requirements for maternity clothing?
Pregnant women's clothing should be comfortable and loose, not constricting the chest.

cage, stomach, do not squeeze the lower limbs. For varicose veins

Elastic sanitary stockings must be worn or placed on the thighs and

shins elastic bandage. From the 7th-8th month of pregnancy for prophylaxis

bandage. Shoes should be true to size and have wide heels.
What are the features of the work regime during pregnancy?
The mode of operation during the normal course of pregnancy is normal with alternation

physical, mental labor and rest. A pregnant woman should not lift weights

make sudden movements, experience psycho-emotional trauma. In everyday life and at

work around her needs to create an environment of attention, care and respect.

Before going to bed, which should last at least 8 hours,

Walking in the fresh air, airing the room, and air baths are required.
MONITORING THE PREGNANT WOMAN
What is the role clinical tests blood during pregnancy?
A clinical blood test is performed several times during pregnancy,

especially in the second half of pregnancy; repeated blood tests give

the ability to promptly identify diseases requiring special treatment.

Blood is taken from all pregnant women twice (in the first and second half of pregnancy)

from the ulnar vein for serological research (Wassermann reaction,

Sachsa-Georgi). Treatment of identified patients is carried out in the venereological department

dispensary with the mandatory involvement of the father of the unborn child in treatment.
All patients must have their blood type and Rh status determined; at

mother with Rh negative blood often has hemolytic disease

newborn If a pregnant woman has Rh-negative blood,

blood needs to be tested
and my husband. If the father has Rh-positive blood and the fetus inherited

the Rh-belonging of the father, then during such a pregnancy between the mother and the fetus

Rhesus conflict occurs: the fetus may die in utero, be born

prematurely or with signs of hemolytic disease.
What measures are taken when there is a threat of Rh conflict between the mother and

fruit?
To increase the resistance of the fetus to the harmful effects of Rh antibodies and

improving placental blood circulation in all pregnant women with Rh-negative

desensitizing treatment is carried out with blood (at 12-14, 22-24, 32-34

weeks of pregnancy). Therapeutic and preventive measures are designed for

creating the most favorable conditions for fetal development: food should be

rich in proteins, vitamin C (up to 1 g per day during pregnancy with

short breaks).
What is the role of clinical urine tests during pregnancy?
The kidneys function under great strain during pregnancy, as they

remove metabolic products from the body of both the pregnant woman herself and

growing fetus. Therefore, a pregnant woman’s urine must be examined at every

visiting a antenatal clinic. If protein appears in the urine of a pregnant woman

They are taken into special registration, and if the protein increases, they must be hospitalized.
How is weight gain monitored in a pregnant woman?
The pregnant woman is weighed at every visit to the antenatal clinic, not

less than once a month in the first half of pregnancy and every 2 weeks in the second

half of pregnancy. Weighing a pregnant woman without clothes after urinating

and bowel movements.
What are the normal weight gain rates during pregnancy?
In the first weeks of pregnancy, body weight should not increase. From 16th week

weight gain occurs during pregnancy; from the 23-24th week the increase is 200 g per

week, and from the 29th week does not exceed 300-350 g. A week before birth, the weight is usually

decreases by 1 kg, which is associated with tissue loss of fluid. For the entire pregnancy

body weight should increase by about 10 kg (due to the weight of the fetus, amniotic

waters and placenta).
NUTRITION FOR PREGNANT WOMEN
What are the basic principles of rational nutrition for a pregnant woman?
A balanced diet contributes to the normal development of pregnancy, the fetus, and

also prevents the development of large fruits, which significantly complicates

during pregnancy, childbirth, the postpartum period, neonatal and

postnatal development of newborns.
In the first half of pregnancy, a special diet is not required. Food must be

varied, containing sufficient amounts of proteins, carbohydrates, fats, salts

and vitamins. In the first months of pregnancy are not excluded, if necessary,

spicy and salty dishes, in the second half it is recommended mainly

dairy-vegetable food. Meat and fish should be consumed 3-4 times a week.

Hot and spicy foods are prohibited and limited within reasonable limits.

carbohydrates, flour products, starch and liquid.
What amount of proteins, fats, carbohydrates and microelements should be in

daily diet for a pregnant woman?
The amount of proteins and fats is introduced into the daily diet at the rate of 1.5-2 g per 1 kg

woman's body weight. Carbohydrates as the main energy material and source

fat formation should be no more than 500 g per day (for obesity

the amount of carbohydrates is reduced to 300-400 g per day). For prevention

late toxicosis of pregnant women table salt in the second half of pregnancy

it is necessary to limit to 5 g per day, liquid to 1-1.2 lavas in recent weeks -

up to 0.8 l per day. The amount of microelements, the sources of which are milk,

cottage cheese, eggs, liver, meat, bread, nuts, buckwheat and barley, beets, peas,

the second half of pregnancy should be: calcium - 1.5-2 g, phosphorus - 2 g,

magnesium - 0.5 g, iron - 15-20 mg per day.
What is the importance of vitamins for a pregnant woman?

In the diet of a pregnant woman, the vitamins included in the composition are especially necessary.

a number of enzymes and performing the function of process catalysts in the body

metabolism. If there is a lack of vitamins entering the body of a pregnant woman with

products of dairy-vegetable origin, ready-made

dosage forms.
What is the importance and daily requirement of vitamins A, PP, C, E for a pregnant woman?
Vitamin A (carotene) has an effect on the uterine mucosa, promotes

its regeneration, which is especially important in the postpartum period. Daily dose - 5000

ME, in the last months of pregnancy - 10,000-20,000 ME.
Vitamin PP (nicotinic acid) is involved in the metabolic processes of reproductive

hormones, in small concentrations has an inhibitory effect on the contractile

function of the pregnant uterus. The daily dose is 18-25 mg.
Vitamin C (ascorbic acid) - a powerful catalyst

redox processes in the body, potentiates the effect

estrogen, enhances the effect of pituitrin and mammophysin on uterine contraction.

Daily dose - 100-200 mg.
Vitamin C is involved in the regulation of calcium and phosphorus metabolism and is used in

obstetric practice for the prevention of rickets in the fetus. The daily dose is 1000 ME.
Vitamin E (tocopherol) plays an important role in the normal course of pregnancy

(fertility vitamin), its deficiency leads to dysfunction of the reproductive organs

organs, sometimes to fetal death and miscarriage. Daily dose - 20-25 mg.
What is the importance and daily requirement of B vitamins for a pregnant woman?
Vitamin Bj (thiamine) is involved in the regulation of estrogen hormone metabolism, synthesis

acetylcholine, promotes proper metabolism in the nervous system, liver,

regulates water-salt metabolism. The daily dose is 10-20 mg.
Vitamin B2 (riboflavin) contributes to the normal course of pregnancy and childbirth,

used to prevent threatened miscarriage, enhances

redox processes in the body. Daily dose - 2-3 mg.
Vitamin B6 (pyridoxine) is necessary for the metabolism of essential amino acids

(histamine and tryptophan). Daily dose - 5 mg.
Vitamin B12 (cyanocobalamin) is effective for anemia caused by diseases

gastrointestinal tract and liver, enhances the release of growth hormone.

Used for fetal malnutrition. Daily dose - 0.003 mg.
TOXICOSES IN PREGNANT WOMEN
What are the main symptoms and causes of toxicosis in pregnant women?
Toxicoses of pregnant women are multi-symptomatic conditions that occur when

disruption of the woman’s body’s adaptation to pregnancy. Wherein

There may be significant changes in metabolism, gland function

internal secretion, cardiovascular and other systems, in the content

electrolytes, hormones.
Various diseases that have been transmitted predispose to the occurrence of toxicosis.

before or during pregnancy, unhealthy diet, nervous tension,

overwork, lack of sleep.
The development of late toxicosis is based on changes in the capillary

blood circulation and vascular-tissue permeability, i.e. the main disorders

occur in the vascular system. Toxicoses of pregnant women are distinguished

half of pregnancy, or early, and second half of pregnancy, or

late.
What applies to early toxicosis of pregnant women?
Vomiting, salivation, jaundice, dermatoses.
What is vomiting during pregnancy?
Vomiting of pregnant women - the most common form of early toxicosis - is repeated

several times a day, most often after meals, accompanied by nausea,

decreased appetite. There are mild, moderate (or moderate) and

excessive (or severe) vomiting. In mild cases, vomiting occurs 3-5 times a day.

day, usually after meals, does not affect the general condition of the pregnant woman, easily

treatable and goes away on its own after 2-3 months

pregnancy. The moderate form is characterized by increased vomiting that occurs

regardless of food intake, up to 10-12 times a day and is accompanied by a decrease

body weight, general weakness, tachycardia, dry skin, decreased diuresis. At

in an excessive form, vomiting is repeated up to 20 or more times a day and causes severe

condition of the patients. Hunger and dehydration lead to exhaustion and collapse

body weight, loss of strength.
How does drooling manifest in pregnant women?
Drooling can accompany vomiting and occur as an independent early

toxicosis of pregnant women. Daily salivation varies, sometimes reaching 1 liter and

more. Drooling depresses the patient’s psyche, causes maceration of the skin and

mucous membrane of the lips. With significant salivation, symptoms appear

dehydration of the body.
What treatment is prescribed for vomiting and drooling in pregnant women?
For vomiting and drooling in pregnant women, psychotherapy is carried out,

therapeutic and protective regime, physiotherapy (ultraviolet irradiation,

electrosleep), drug treatment(bromine with caffeine, vitamins A, group B). IN

In severe cases, hospitalization is indicated.
What is jaundice in pregnancy?
Jaundice of pregnant women is rare and is manifested by icteric discoloration of the skin,

itching, and the liver is affected. Pregnant women with jaundice urgently

hospitalized to determine its cause.
What are dermatoses of pregnancy?
Dermatoses of pregnant women include a group of skin diseases that appear during

pregnancy and disappearing after its end. The most common itching is

pregnant women, which covers the entire body (usually localized in the area of ​​the external

genital organs), causes insomnia and irritability. Eczema is less common

pregnant women, affecting the skin of the mammary glands or abdomen, thighs, arms. Sometimes

dermatoses of pregnant women can occur in the form of scarlet-like rashes in

skin or hives.
What conditions are classified as pretoxicosis in pregnant women?
Severe forms of late toxicosis in pregnant women are usually preceded by

conditions called pre-toxicosis. The antenatal clinic doctor together with

the nurse identifies such conditions and takes measures to treat them,

to prevent more severe forms of toxicosis.
Pretoxicosis in pregnant women includes conditions in which the following are observed:

1) increase in maximum blood pressure by 10-20 mmHg. Art.,

minimum - by 5-10 mm Hg. Art. compared to baseline before pregnancy or

in the first 9-10 weeks of pregnancy; 2) pastiness of the legs or feet; 3) traces of protein

in urine. A state preceding toxicosis is indicated by a decrease in daily

diuresis up to 500 ml, negative diuresis, increased calf circumference,

measured at 10 cm above the outer ankle, 8-10% in relation to its

sizes in the first half of pregnancy.
How is pretoxicosis treated?
For the treatment of pretoxicosis in pregnant women, a rational daily regimen is recommended,

appropriate diet, medications. Required as much as possible

exclude stressful situations, ensure daytime rest and night sleep

lasting more than 8 hours. The amount of liquid is limited to 1 liter,

table salt up to 3-5 g. Unloading is carried out once or twice a week

g and glucose 1.0 g orally 3 times a day, oxygen cocktails or oxygen

tent. Light diuretics are used for 3-4 days.
What applies to late toxicosis of pregnant women?
Edema, nephropathy, preeclampsia, eclampsia.
What is pregnancy edema?
Retention of water and sodium in tissues during pregnancy is clinically manifested by edema,

which are initially localized on the legs and feet, then can spread to

thighs, external genitalia, abdominal wall, face, upper limbs

(often observed simultaneously on the lower extremities and face). Sometimes

hidden edema forms, which is indicated by an increase in body weight over

300-400 g per week. In 20-24% of cases, edema in pregnant women turns into nephropathy.
What is nephropathy in pregnancy?
Nephropathy in pregnant women is characterized by a triad of symptoms: swelling, increased

blood pressure, the appearance of protein in the urine.
Nephropathy in pregnant women often occurs against the background of extragenital diseases

(hypertension, chronic nephritis, heart defects, diabetes mellitus).

Nephropathy most often develops at 32-36 weeks of pregnancy, although combined

its forms can be observed as early as 24-25 weeks.
What are the basic principles of treatment of nephropathy?
Treatment of all forms of nephropathy in pregnant women, including therapeutic and protective

regimen, rational diet, use of antihypertensives, diuretics,

antihistamines, improvement of microcirculation, carried out only in

hospital.
What is preeclampsia in pregnancy?
Preeclampsia is characterized by the addition of signs to nephropathy

functional disorders of the central nervous system arising in

as a result of increased intracranial pressure due to cerebral edema. Basic

symptoms of preeclampsia: headache, blurred vision (flickering or “fog” in the

eyes), pain in the epigastric region. Patients are usually agitated, restless, or

on the contrary, they are inhibited. Sometimes there is nausea or vomiting, the face is flushed

with cyanosis of the lips and wings of the nose. Most often, preeclampsia occurs against the background of severe

forms of nephropathy. Preeclampsia can be complicated by cerebral hemorrhage and

other vital organs, and also move, sometimes quite quickly, into

eclampsia. Preeclampsia must be differentiated from acute

gastrointestinal disease and hypertensive encephalopathy. At

When diagnosing preeclampsia in the antenatal clinic, the patient should be taken

to the hospital under anesthesia for treatment. Early treatment is often indicated

abortion.
What are the symptoms of eclampsia in pregnancy?
Eclampsia is the final stage of development of late toxicosis and

characterized by an attack of convulsions. Usually occurs against the background of preeclampsia. For

Provoking a seizure is sufficiently harsh light, noise, painful stimuli.

The seizure lasts 1-2 minutes and develops in a certain

sequences. In the first period (20-30 seconds) - preconvulsant -

small fibrillary twitching of the facial muscles appears, spreading to

muscles of the upper limbs. In the second period (20-30 seconds) occurs

tonic contraction of all skeletal muscles, the body stretches and tenses,

the spine bends. Breathing and consciousness are absent, pupils are dilated,

cyanosis of the skin and mucous membranes increases. In the third period (30-60 seconds)

clonic muscle spasms occur continuously following each other

torso and limbs, the face becomes purple-blue. By the end of the attack

hoarse breathing appears, foam mixed with blood is released from the mouth

(biting tongue). In the fourth period, the seizure resolves: convulsions

stop, breathing is restored, the face turns pink. The patient is in

comatose state, which can vary in duration, sometimes up to

next seizure. Consciousness is restored slowly. About what happened

the patient does not remember.
How is treatment and care provided for eclampsia in pregnant women?
Treatment is only inpatient. During a seizure, the nurse should

be near the patient, as it is necessary to prevent tongue biting and

bruises from a fall. To prevent the patient from biting the tongue into the mouth from the side

A spoon wrapped in gauze is inserted between the molars. If appears

breathing, short-term oxygen administration is indicated to eliminate hypoxia and

general anesthesia.
How is the prevention of toxicosis in pregnant women carried out?
Prevention of toxicosis in pregnant women includes the whole range of necessary

hygiene measures, which in some cases must be carried out even before

pregnancy. To prevent early toxicosis, they are of particular importance

fight against abortion, treatment of chronic diseases, creation of a pregnant woman

emotional peace. In the prevention of late toxicosis, compliance with

rational nutrition in the second half of pregnancy, especially abstinence from

plenty of fluids and salt, proper work and rest schedule,

elimination of mental and physical overload.
PHYSIOPSYCHOPREVENTIVE PREPARATION FOR BIRTH
What does physiopsychoprophylaxis of childbirth include?
Preparing pregnant women for childbirth is a complex of activities,

including physical therapy, ultraviolet irradiation and special

classes.
What is the essence of psychoprophylactic preparation for childbirth?
The method of psychoprophylactic preparation of pregnant women for childbirth is based on the doctrine of

labor pain, the formation of which involves not only irritation of the nerves

endings from the uterus and other genital organs, but also conditioned reflex

component associated with impacts on the second signaling system. Wherein

It is recognized that the leading role in the occurrence of pain belongs to the cortex

brain.
The essence of the method is to create through verbal influence

more correct functional relationships between the cerebral cortex and

subcortical formations, reduce excitation in the subcortical centers and

balance the processes of excitation and inhibition in the cerebral cortex.
What is the purpose of psychoprophylactic preparation for childbirth?
The purpose of psychoprophylactic training is to eliminate fear of childbirth and other

develop and consolidate negative emotions that arise during pregnancy

ideas about the birth act as a physiological and non-painful process,

to cultivate a new positive feeling associated with upcoming motherhood.
How is psychoprophylactic preparation for childbirth carried out?
Psychoprophylactic preparation of pregnant women for childbirth begins with the first

visits to antenatal clinic.
For classes on psychoprophylactic preparation of pregnant women for childbirth, which

carried out by a doctor or specially trained midwife, a special room is allocated,

equipped with couches and teaching aids (drawings, posters, dummies). Total

5 classes are held.
What is the role of exercise in the normal development of pregnancy?
Systematic physical exercise increases the body's resistance,

create a feeling of vigor, strengthen the nervous system, improve general condition,

appetite, sleep, functioning of the cardiovascular system, breathing, gastrointestinal

tract. Physical exercise strengthens the muscles of the abdominal wall, pelvic floor,

eliminate congestion in the pelvis and lower extremities, promote

correct positioning of the fetus in the uterine cavity, normal course of labor and

postpartum period. Physically trained women know how to manage their

breathing, which allows you to saturate the body with oxygen faster and more fully.
How are physical education classes conducted?
Physical education classes are conducted primarily in a group manner in the women's

consultations under the guidance of an instructor physical therapy or

a specially trained midwife under constant medical supervision. Allowed

performing physical exercises after appropriate training

individually at home with the condition of visiting the antenatal clinic every 10

days to check the correctness of the exercises.
Physical activity should be modified depending on the stage of pregnancy.

The duration of classes should not exceed 15-20 minutes. Study

well-ventilated and lit room in a special, non-confining

movement of clothes. If physical exercise cause a feeling of fatigue,

difficulty breathing, increased heart rate - it is necessary to alleviate them and

consult your doctor. Jumping should be excluded from the set of exercises,

significant straining, sudden movements.
Physical education can only be recommended for healthy women with

normal course of pregnancy.
MOTHERS
How are postpartum women cared for?
The postpartum period lasts 6-8 weeks. Postpartum cleansing, or

lochia, the first 4 days are bloody, and then turn pale, their number

gradually decreases; they have a characteristic damp smell. Appearance

a foul odor indicates an incorrect postpartum period and

the need for appropriate therapeutic measures. Postpartum uterine contractions

They are often painful, especially while breastfeeding. If

they are very painful, they can be given to a woman in labor as a painkiller

analgin, antipyrine, or use a suppository with papaverine. External genitalia

the organs are washed, then dried with a dry sterile swab on a forceps, in

Then (at home) dry it with a special towel. If urination is

the first days after birth are somewhat difficult, hexamethyleptetramine and

bearberry decoction. If a postpartum woman cannot urinate on her own,

apply a heating pad to the bladder area, give a warm bath, subcutaneously

magnesium sulfate and pituitrin are administered. If these measures are unsuccessful, within 7-8 hours

After childbirth, catheterization is carried out as prescribed by the doctor.
In the first postpartum days, independent bowel function is difficult. On the 3rd

the day after childbirth, they give an enema or cleanse the intestines with a laxative.
Underwear and bed linen should be changed every 4-5 days. If a woman is very

sweats, underwear should be changed more often. It is also necessary to change the litter frequently (4-5

once a day), especially if the discharge is heavy.

A postpartum mother can sit up in bed from the 2nd day of normal postpartum

period, and walking - from the 3rd day. IN Lately healthy postpartum women can walk

allowed from the 2nd day after birth.
What are the nutritional features in the postpartum period?
On the first day, the postpartum woman receives liquid food, and in subsequent days she goes

on a regular table. Food should be well prepared, tasty, rich

vitamins. From liquids you can give tea, weak coffee, mineral water, fruit juice,

boiled water in cool or warm form at the request of the woman.
Products passed on by relatives must be strictly controlled

nurse The number of products transferred and the range are usually

are indicated in the rules of the obstetric hospital. Products must be in new condition

plastic bag or wrapped in a clean napkin (clean paper).
How is gymnastics performed for postpartum women?
In the postpartum period, gymnastics are performed by a nurse collectively in

ward with all healthy postpartum women. Gymnastic exercises haunt

the goal is to teach the postpartum mother to breathe correctly and deeply, to strengthen the abdominal muscles

press and pelvic floor, activate the muscular system and, along with early

standing up promotes more vigorous blood circulation. Gymnastics

carried out daily in the morning, starting from the 2nd day after birth, after breakfast,

in summer - with the windows open, in winter - after thoroughly ventilating the room.

Duration of classes - from 5 to 15 minutes depending on how you feel

(pulse, respiratory rate) postpartum women. It is important that every postpartum mother continues

and systematically do gymnastics at home.
What regimen should a postpartum woman follow after discharge from the maternity hospital?

hospital?
In the maternity hospital, the postpartum woman is instructed about the rules of the home regime,

the implementation of which is checked by a nurse during patronage

home visits.
Sexual activity during a normal postpartum period is possible

resume no earlier than 8 weeks after birth, first

after consulting your doctor.
The postpartum woman should observe the correct work and rest schedule: at home

work starts gradually; sleep less than 8 hours a day and be sure to rest

during the day; avoid heavy lifting and work involving great physical activity

load; carry out gymnastics first according to the scheme received in the maternity hospital, and

belts with water at room temperature and soap (baby soap), while washing and

mammary gland; Every other day, wash in the shower with warm water, soap and a washcloth.

You can visit the bathhouse or use the bath no earlier than 7-8 weeks after

childbirth The postpartum mother should wash her hands thoroughly before each feeding.

child and before eating, after cleaning the room, using the restroom, etc.

You need to cut your nails short and do not cover them with varnish. Morning and evening should

wash with warm water and baby soap or calendula solution (1 teaspoon

spoon of calendula tincture per 1 liter of boiled water); dry the genitals after

washing with a special towel. It is necessary to maintain hygiene of linen and clothing;

change underwear every 3-4 days and bed linen at least once a week; on

put on a nightgown at night; wear a bra that is supportive and not too much

compresses the mammary glands, change it often; wear the brace for 4

months after childbirth, and in some cases (with a very distended, saggy belly)

Constantly. You should spend at least 3-4 hours in the fresh air every day,

thoroughly ventilate the room and bedding.
What diet should a postpartum mother follow after discharge?

from the maternity hospital?
It is necessary to eat fresh food. Buckwheat and

oatmeal with milk, kefir, yogurt, Varenets, cottage cheese, honey, jam, tea with

milk, fruit and vegetable juices, berries, boiled and raw fruits after

washing them with boiled water. Do not eat spicy foods or alcoholic

beverages. It is important to monitor your daily bowel movements.
How many days after giving birth does a postpartum woman visit the antenatal clinic?
A postpartum woman should visit the local antenatal clinic doctor approximately

7-10 days after discharge from the maternity hospital. If any

complications (fever, bleeding, excessive engorgement

mammary glands, the appearance of painful nipple cracks, etc.) should be immediately

contact an antenatal clinic.
MASTITIS
What causes mastitis in the postpartum period?
In the postpartum period, acute mastitis (inflammation of the mammary gland) most often

is caused by Staphylococcus aureus, which is resistant to many antibiotics.

Infectious agents enter the mammary gland mainly through

nipple cracks (lymphogenic) or through the milk ducts.
What forms of mastitis are identified in clinical practice?
The inflammatory process involves individual lobules of the gland, and often entire ones

lobes (serous mastitis). If the infiltrate does not resolve, then it occurs

suppuration (purulent mastitis). In severe cases it comes to phlegmonous

mastitis.
What are the main symptoms of mastitis?
Symptoms of the disease depend on the stage of the process. Characteristic feature

mastitis in modern conditions is its late onset, mainly

after the postpartum mother is discharged from the hospital (2-3 weeks after birth). Mastitis

begins acutely with the appearance of pain in the affected mammary gland, a sharp rise

temperatures up to 38-39 "C. Characterized by chills and poor general health. Pain in

mammary gland gradually intensifies, especially when feeding a child. Gland

increases in volume, the skin in the affected area is somewhat hyperemic. At

Palpation in the thickness of the gland reveals areas of dense elastic tissue

consistency, painful. After 1-3 days, serous mastitis turns into

infiltrative. It begins to be palpated under the changed area of ​​skin

dense, sedentary infiltrate, painful on palpation; often

There is an increase and pain in the axillary lymph nodes.
When the infiltrate suppurates, the general condition worsens significantly, high

the temperature becomes constant, severe pain is noted in the

affected mammary gland, chills.
What is urgent Care and treatment for mastitis?
In case of serous and infiltrative forms of mastitis, it is necessary to empty the breast

gland (expressing milk by hand or with a breast pump). To improve churn

milk is injected intramuscularly with 1 ml of oxytocin solution. In the initial stage

diseases, short-term use of a local ice pack is permissible - for

20-30 minutes with breaks of 20 minutes. Subsequently they move on to treatment

warm compresses with Vishnevsky ointment or butadiene ointment.

Taking into account the dominant role of Staphylococcus aureus in

in initial forms of mastitis, semi-synthetic penicillins are prescribed:

oxacillin sodium salt, or ampicillin sodium salt, or

Ampiox sodium. If antibiotic therapy is insufficiently effective

sulfonamides are additionally prescribed. In addition, means are used

increasing the specific immunological reactivity of the body:

antistaphylococcal gamma globulin 5 ml (100 IU) every other day intramuscularly;

antistaphylococcal plasma 100^200 ml intravenously;

adsorbed staphylococcal toxoid 1 ml subcutaneously at intervals of 3-4

days, 3 injections per course; blood plasma transfusion of 150-300 ml. Enter

antihistamines.
POSTPARTUM THROMBOPHLEBITIS
What is general characteristics postpartum thrombophlebitis?
Postpartum thrombophlebitis is an inflammation of the vein wall followed by

the formation of a blood clot in this area, completely or partially covering

lumen of the vessel.
According to localization, thrombophlebitis is divided into thrombophlebitis of the uterine veins, pelvic veins and veins

hips. Thrombophlebitis of the uterine veins occurs due to endomyometritis.
What are the main symptoms of this complication?
The patient's general condition worsens, the pulse becomes frequent and superficial.

The discharge is bloody and quite profuse. Under unfavorable conditions

the process spreads to the veins of the pelvis. With further progression of the process

thrombophlebitis of the femoral veins occurs, which clinically manifests itself on the 2-3rd

week after birth. Initially, chills, rapid pulse, heat,

pain in the legs, especially in the calf muscles. Smoothness is determined locally

groin area, thickening and pain along the vein, swelling of the leg, sometimes sharply

expressed. Elevated temperature lasts 2-3 weeks, swelling lasts 1-2 months.
What are the possible complications of thrombophlebitis?
If the course is unfavorable, thrombophlebitis can fester and be the main

source of septicopy. Pulmonary embolism due to soil is dangerous

thrombophlebitis.
What treatment do patients receive?
Patients are shown absolute rest with a high position of the legs (for thrombophlebitis

hips). Intravenous infusions should not be used. Placed on the lower abdomen

an ice pack, leeches along the affected leg vein are shown. Antibiotics

combined with the use of antispasmodics (promedol, papaverine). In some cases

surgical operation - thrombectomy is indicated.
After thrombophlebitis, it is recommended to bandage the legs with elastic

bandage or wearing elastic stockings.
MEDICAL-PROTECTIVE AND SANITARY REGIME OF OBSTETRIC

HOSPITAL
What is a protective treatment regime?
The therapeutic and protective regime implies attentive and precautionary

attitude towards patient requests, calm tone in conversation, maintaining cleanliness. This

all are the most important tasks of a nurse working in an obstetric hospital,

in the antenatal clinic and clinic. Positive emotions contribute

increased reactivity of the body, faster recovery. Pregnant,

especially with a pathological pregnancy, postpartum women after

endured great physical and mental stress, such as childbirth,

need favorable conditions for rest and sleep. Needs to be supported

appropriate air temperature in the room. The postpartum mother should be provided with

throughout the day, at least 8-9 hours of good sleep with mandatory continuous

sleep at least 6 hours at night. All manipulations, diagnostic and therapeutic

procedures must be carried out painlessly by a nurse.
It is necessary to try to ensure that every pregnant woman is promptly prepared for

antenatal clinic, at the medical and obstetric station for painless

the course of childbirth through special classes - conversations on the method

psychoprophylactic training.
What sanitary, hygienic and disinfection measures are carried out in

maternity ward?
The sanitary and hygienic maintenance of the maternity bed plays an important role in

prevention of postpartum infections. The couch in the examination room must be made

oilcloth, which must be treated with a disinfectant solution after

examination of each woman. Before the examination, each woman is given a clean

padding diaper.
In the maternity room, the oilcloth mattress is wiped with warm water after each birth.

soapy water to remove blood, then a solution of mercury dichloride (sublimate) or

lysoform and cover with a clean lining oilcloth, and place it under the woman in labor

sterile diaper. The lining oilcloth is washed in the washing room on an installed

inclined board under running warm water with soap and a brush, then wash

solution of mercury dichloride (sublimate) and dried on a special rack.
Each postpartum mother should have an individual bedpan with a number,

corresponding to the number of a given bed, which is boiled once a day, and after each

use is washed with water and a disinfectant solution.
What sanitary-hygienic and disinfection measures are carried out?

after postpartum women are discharged from the hospital?
After the mother is discharged, the bed and oilcloth are washed with water and disinfectant.

solution, the mattress, pillow and blanket are ventilated for at least 24 hours. Disinfected

her. individual vessel, for which they first rinse with water under the tap, and then

sterilize with steam or boil. Underwear removed from the patient should be

separately, before sending it to the laundry, it is soaked in a solution of Lysol in

special tank with a lid.
In the obstetric department, as well as after febrile or deceased mothers

the treatment is carried out especially carefully: the beds are washed and treated with a solution

mercury dichloride, mattresses are ventilated for 2 days.