Patronage for pregnant women: “Either visit the doctor as expected, or the doctor will visit you at home! Prenatal care for pregnant women: what is it and why are they carried out? Patronage for pregnant women.

Indeed, the resolution of the Ministry of Health of the Republic of Belarus on the organization of the activities of antenatal clinic No. 81 states that the antenatal clinic, in accordance with the tasks assigned to it, provides medical patronage to pregnant women and postpartum women.

As explained to Child BY in one of the clinics in Minsk, patronage, in accordance with internal regulations, must be carried out in relation to every pregnant woman at least once during pregnancy.

Decree of the President of the Republic of Belarus No. 18 requires identifying social disadvantage at the early stages, which is impossible without home visits. Women who refuse pregnancy management for any reason may be visited more often.

The interlocutor emphasized that responsibility for the pregnant woman and the newborn in any case lies with the doctors.

However a woman has every right to refuse to allow clinic representatives into her apartment. To refuse pregnancy, it is enough to write a statement. In this case, benefits for registration up to 12 weeks will not be paid, because medical recommendations were not followed.

Photo source: habinfo.ru

Patronage for Elena was carried out:

A midwife came to me, stood on the threshold and asked 3 questions:

1. How many rooms are there in the apartment?

2. Who lives in it besides me?

3. Are there any pets?

Before the visit, the clinic called me and agreed on a time. In general, there is no problem with this. But the fact remains: neither I nor my friends, including those served in the same antenatal clinic, knew anything about this phenomenon.

Catherine, mother of three children, who also knows nothing about foster care:

During my third pregnancy, I decided to rid myself of the regular “care” of the local gynecologist. From ten to twelve weeks, should I regularly spend a certain amount of time in the clinic? Find out your blood type again? Donate a “liter” of blood for tests? Delight laboratory technicians with a fresh portion of urine? Thanks, we had fun last time.

There were two alternatives: draw up an agreement at a paid center (but this meant doing the same thing for a lot of money, but without a queue) or “taking into account” your pregnancy yourself.

Probably every woman by a certain age has her own doctor whom she trusts. I continued to go to my trusted gynecologist, took the necessary tests, had an ultrasound - all this in a manner convenient for me and my family.

At 30 weeks, I came to the housing complex to obtain a sick leave certificate, provided a history of the course of my pregnancy and registered. Actually, from then on I was observed as a normal pregnant woman. The only thing is that I didn’t do any tests or go for medical examinations.

The doctor said: “You are still an unscrupulous pregnant woman, you don’t have to do this.” I didn’t hear about any patronage; representatives of the antenatal clinic made no attempts to visit me at home. Perhaps because until 30 weeks no one at the clinic knew about my situation, and after that I regularly visited the LC.

We were unable to communicate with other women who knew about patronage from personal experience. The obstetrician-gynecologist did not come to anyone’s home. Everyone knows about patronage for a newborn, but no one knows about patronage for pregnant women.

From French, the word patronage is translated as “patronage” or “support.” A reasonable question arises: is this always support for a pregnant woman or is it sometimes a way of influencing a woman who goes against established rules?

It is carried out when a pregnant woman registers at the antenatal clinic within 8–13 weeks. The task of the first prenatal care is to introduce the district nurse to the expectant mother, talk with her about the importance, happiness and great responsibility of being a mother. During the first prenatal care, the district nurse must find out the state of health of the pregnant woman, find out how the pregnancy is progressing, and in what conditions the expectant mother lives and works. Patronage should be particularly scrupulous, striving to identify as accurately as possible all the circumstances that could have a harmful effect on the health of the unborn child. Particular attention should be paid to the possibility of toxic effects on the fetus due to maternal use of nicotine, alcohol and other toxic substances.

Depending on the nature of filling out documentation in children's clinics, files of prenatal visits or development histories of future patients are created. In order to most fully cover all the necessary issues and save the nurse’s time, special schemes are used to perform prenatal care. When using any scheme, the nurse at the first prenatal care should give the pregnant woman the following advice:

· 1. Eliminate work hazards, if any.

· 2.Alternate work and home, work and rest.

· 3.Try to avoid conflict situations in the family and apartment.

· 4. Establish proper nutrition within the limits acceptable for a pregnant woman: raw and cooked vegetables, fruits, milk, cottage cheese, boiled meat, vitamins A, D, etc. as prescribed by the doctor.

· 5.Renovate the premises, purchase in a timely manner everything necessary for the newborn.

· 6. If there are Tbc patients in the family, think about where the mother and child will be for the first two months after discharge from the maternity hospital.

Second antenatal care

The district nurse performs the second prenatal visitation during the pregnant woman’s maternity leave at 31–32 weeks.

Local pediatricians provide prenatal care for pregnant women with severe extragenital pathology, toxicosis, and also in the presence of other indications.

The main goal of the second prenatal care for a pregnant woman is to monitor the implementation of the antenatal clinic doctor’s orders and recommendations given by the nurse at the children’s clinic during the first visit and at the school for expectant mothers.

During the second prenatal care, they find out the well-being of the pregnant woman, whether she has been transferred, if necessary, to light work, and the timing of maternity leave. During the second prenatal care, care for the unborn child is already visible: this includes preparing the mother’s mammary glands for lactation, organizing a corner for the newborn, preparing linen, clothes for him, etc. The address where the mother and child will live is being specified.

Third antenatal care

The third prenatal care is carried out by a local nurse or a local pediatrician, depending on the circumstances. Indications for this patronage are severe somatic pathology of the pregnant woman, poor obstetric history, severe toxicosis of the pregnant woman, as well as unfavorable social and living conditions. The head nurse of the antenatal clinic reports such patients to the children's clinic. In addition, indications for the third antenatal visit are formed on the basis of a study of previous antenatal visits performed by the district nurse. The third prenatal care is purely individual, and therefore is carried out according to an individual scheme for each case.

Based on the results of prenatal visits, the local pediatrician determines the “risk” group among pregnant women, i.e. identifies a contingent of expectant mothers whose children will need to be under especially close attention of the local doctor and doctors of relevant specialties. The “risk” group, of course, should include extragenital diseases of the expectant mother, occupational hazards and alcoholism of parents, acute diseases and surgical interventions during pregnancy, the age of the mother at the time of the birth of the child is younger than 18 and older than 30 years (fertile age, according to WHO, from 14 to 49), toxicosis of the first and second half of pregnancy, threat of miscarriage, bleeding, increase or decrease in blood pressure during pregnancy, i.e. factors the presence of which will determine the distribution of children into health groups.

The main tasks of the KZR are(Regulation No. 8 to the order of the USSR Ministry of Health No. 60 dated January 19, 1983):

· promoting a healthy lifestyle in the family;

· training parents in the basic rules of raising young children (regime, nutrition, physical education, hygienic care);

· health education of parents on the issues of hygienic education of children, disease prevention, preparation for admission to preschool education;

· control over children's academic development.

The responsibilities of the KZR nurse include:

· admission of children of the 1st year of life at least 5 times a year, of the 2nd year of life - at least 4 times a year, of the 3rd year of life - at least once every six months, over 3 years of age - once once a year;

· in accordance with doctor's prescriptions:

§ a) consultation of the mother on issues of raising and protecting the health of the child,

§ b) teaching the mother how to conduct massage and gymnastics,

§ c) carrying out control feeding, performing nutrition calculations,

§ d) fulfilling doctor’s prescriptions for the prevention of rickets,

§ f) diagnosing children with mental retardation.

· training parents in the methods and features of feeding;

· coverage of issues related to the prevention of bad habits;

· training in oral hygiene techniques;

· providing parents with teaching materials;

· consultation with district nurses on the issues of education and development of children, physical education and hardening of children, diagnosis of children’s developmental disabilities;

· assisting the local doctor in conducting classes for pregnant women, at school for a young family;

· participation in preparing children for admission to preschool education;

· maintaining constant communication with the local pediatric service;

· maintaining in the history of the child’s development f.112/u - an insert-card for visiting the KZR;

· arrangement of stands and exhibitions on the organization of living conditions, development and upbringing of children in the waiting room of the KZR;

· distribution of new teaching materials on health education issues.

Medical documentation KZR

1. Registration form No. 112/u - insert card for visiting the office for raising a healthy child.

2. Registration form No. 039/у - doctor’s working time sheet.

3. Registration form No. 038/у - nurse’s time sheet.

KZR equipment

Equipment for a healthy child’s office and necessary teaching materials:

Examination of a newborn baby

Period newborns- one of the most important periods of childhood. This is the period of adaptation of the child to new living conditions. Providing optimal care during the neonatal period newborn, improving methods of diagnosis and treatment of already existing diseases is necessary for the formation of health in all subsequent years.

General newborn examination has great diagnostic value. During inspection The doctor gets a general idea of ​​the child’s health, his development, and promptly identifies possible deviations.

If child If he is sleeping, you should not wake him up at the beginning of the examination. This will make your heart rate and breathing data more accurate.

To count breathing, the doctor brings the phonendoscope to the nose. baby and records the time. The respiratory rate is calculated in one minute, due to irregular breathing and periodic stops - apnea. The average respiratory rate is 40 per minute during sleep and 60 during wakefulness.

The examination is carried out on a semi-rigid changing table, at an ambient temperature of at least 22 degrees Celsius.

Newborn are examined no earlier than an hour after feeding, which allows you to create comfortable conditions for the child and carry out a thorough examination.

With warm hands and careful movements they completely undress him.

Bye child calm, examine the cardiac region. The apex beat is palpable. Auscultation of the heart is carried out according to a generally accepted method, at typical points. Heart sounds are clear and rhythmic. Quite often, a short systolic murmur is heard in the region of the heart, due to the development of hemodynamics.

Heart rate newborn is approximately 140 beats per minute.

The lungs are heard in symmetrical areas on both sides along the anterior and lateral surfaces. Breathing newborn vesicular, somewhat weakened. Breathing is then heard over the posterior surface.

The abdomen has a rounded shape and actively participates in the act of breathing. During quiet wakefulness, the abdominal organs are palpated. The anterior abdominal wall is elastic and firm, the abdomen is soft.

The edge of the liver is palpated along the midclavicular line. Protrudes from under the costal arch by 1-1.5 centimeters.

The spleen is identified in the left hypochondrium - normally it is not palpable.

The condition of the umbilical wound is assessed, which heals by the end of the second week of life. The umbilical veins and umbilical arteries are not normally palpable.

The skin is examined in detail. Palpation of the skin is carried out in different areas. Skin coloring newborn bright pink due to the thin epidermis and a well-defined network of capillaries. The skin is examined sequentially from top to bottom. Be especially careful behind the ears, in the folds of the neck, in the armpits, and in the groin areas - where diaper rash can develop.

The feel of the skin newborn soft, elastic, velvety. Physiological erythema disappears by the end of the first week of life.

The elasticity of the skin is checked: when you try to collect it, the fold instantly straightens out.

The development of subcutaneous fat is checked visually and by palpation on the limbs, on the abdomen and under the shoulder blades.

Soft tissue turgor is checked by feeling resistance when compressed on the inner surface of the shoulder and thigh.

INDEPENDENT WORK OF STUDENTS:

1. Work in the office of a local pediatrician. Rules for drawing up a form for the first patronage of a newborn.

Assignment for independent work:

1. Conducting the first prenatal care (together with the patronage nurse)

Antenatal protection of the fetus is one of the most important health problems, since all organs and systems are formed, developed and improved in utero. The development of the organs and systems of the fetus determines the state of health in subsequent stages of a person’s life. Critical periods of human fetal development are described, characterized by a sharp increase in sensitivity to pathogenic environmental factors.

The damaging effect occurs with a low intensity of exposure, which in other periods of ontogenesis does not have a negative effect on the development processes of the organism. It is believed that the first critical period is the period preceding the implantation of the fertilized egg. It lasts up to 2 weeks. The effect of harmful factors in the first 2 weeks. pregnancy very often leads to the death of the embryo and termination of pregnancy.

The second critical period is the period of placentation and the formation of the rudiments of the most important organs of the fetus. This period takes from 3 to 6 weeks.

The third critical period is the 3rd month of pregnancy (from 8 to 12 weeks), when the formation of the placenta ends and its functions reach a high degree of activity. The embryo turns into a fetus with organs and systems inherent in early human ontogenesis.

First prenatal care carried out to a healthy pregnant woman district nurse children's clinic after receiving information about the pregnant woman from the antenatal clinic (8 – 13 weeks). This patronage is household or social, and its purpose is to find out the living and working conditions of the expectant mother, the state of health, and the presence of bad habits in the mother and father. At this patronage, the children's nurse teaches the woman methods of preparing the mammary glands for lactation, gives recommendations on organizing her work and rest regime, nutrition, and hardening. The nurse pays special attention to conversations with the pregnant woman, her husband, and close relatives to create a calm, friendly environment in the family. At the end of the patronage, the nurse invites the pregnant woman to attend classes at the full-time school for young mothers at the children's clinic.

According to Order No. 102 (D) of the Ministry of Health and Social Development of the Russian Federation dated February 9, 2007 “On the passport of the medical area (pediatric)” second prenatal care to a healthy pregnant woman local pediatrician carried out in 30 - 32 weeks pregnancy in the amount approved in the order of dispensary (preventive) observation of the child during the first year of life.

For medical and social reasons it is carried out third antenatal patronage pregnant women from medium and high risk groups and from socially disadvantaged families during pregnancy 37 – 38 weeks(medical).

SCHEME FOR REGISTRATION OF ANTENATUAL PARTONAGE

Date of birth _________________________________ Gestational age _____________________

FULL NAME. pregnant ____________________________________________________________________

Age ___________ Address ____________________________________________________________

Woman's education ________________ Profession ________________________________________ place of work __________________________ prof. harmfulness _______________________________

Are you married (registered, divorced, first marriage, second marriage)___________________________

FULL NAME. husband ___________________________________________________________________________

His profession _________________________________ Occupational hazard _________________________

Other family members _____________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________

Pregnancy desired, unwanted _____________________________________________________

Material security (above or below the subsistence level)________________________

Living conditions of the family _________________________________________________________________

Genealogical history ________________________________________________________________

Allergy history ____________________________________________________________

Bad habits of parents ___________________ smoking, ____________________ alcoholism.

Total pregnancies __________ births __________ abortions ___________ miscarriages __________

living children _____________ stillborn ____________________ causes of death

____________________________________________________________________________________

Infertility in marriage ____ years, gynecological pathology (scar on the uterus after surgery, narrow pelvis, inflammatory diseases)______________________________________________________________

The course of this pregnancy (preeclampsia, threatened miscarriage, polyhydramnios, pathology of the placenta, signs of fetal hypoxia) ____________________________________________________________

Acute diseases suffered during pregnancy (acute - during pregnancy), treatment_________________________________________________________________________________,

exacerbation of chronic ____________________________, trauma, surgery __________________

What medications did you receive? ________________________________________________________________

Prof. excluded harmfulness _____________________________________________________

Does the woman attend _________, her mother’s school ________, does she follow the daily routine ________

Nutrition: frequency of meals per day _____, daily use of milk, meat, cottage cheese, butter, fruits in the diet _________________________________________________________________

Conclusion __________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

characteristics of intrauterine development of the fetus, antenatal risk, direction of risk.

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date " ______ " _______________ 20____. Signature _______________

PRIMARY PATRONAGE SCHEME

Pregnancy and the development of fetal organ systems is a very important period in the life of the expectant mother and her baby. Not only the health of the child, but also of the mother depends on how the pregnancy proceeds.

What is prenatal care?

Prenatal care for a pregnant woman is a process carried out in a health care facility (health care facility), the purpose of which is to preserve the health of the fetus and the expectant mother.

The first prenatal care is carried out after the pediatric department receives data from the antenatal clinic of the gynecological department, usually within 7 to 12 days.

First antenatal care 8-13 weeks

This event is carried out by a pediatrician and a nurse at the home of a pregnant woman. And so, the tasks of patronage of pregnant women:

1. Inspection of living and sanitary conditions in the house;
2. Identification, through anamnesis (collection of information), of the health status and prediction of the development of the unborn child, that is, to identify the risk of diseases, primarily hereditary;
3. Informing a pregnant woman about the development of possible pathologies of the baby;
4. Select a plan for certain recommendations for prevention, namely diet, sleep patterns, physical activity, eliminate bad habits, hygiene tips, etc.;
5. Education and preparation for the moment when the child is born, that is, talk about the “School of Future Parents”, advise to lead a correct lifestyle, etc.;
6. Determine and set the date for the next visit to pregnant women;
7. Complete medical documentation.

Sample of necessary medical documentation - scheme for filling out a prenatal care document:

• Passport part - includes the surname, first name, patronymic of the pregnant woman (in full), actual address of residence, date of birth.
• Education and profession, address of place of work.
• The passport part of the father of the unborn child, this also includes education and place of work.
• Accommodations.
• List of other relatives.
• Financial security.
• The health of parents and other family members for the presence of diseases such as tuberculosis, sexually transmitted diseases, allergies, mental disorders, alcoholism and smoking.
• Description of advice given during the first visit to a pregnant woman.

The frequency of prenatal care by a nurse is equal to three visits throughout the entire pregnancy process.

Prenatal medical patronage comes after medical patronage. nurse of the pediatric department. Having collected all the necessary information, honey. The nurse passes it on to the local pediatrician. Thus, the specialist evaluates and thinks through possible risk factors for the future woman in labor. Having made a conclusion, the doctor enters, if necessary, drug treatment into the patient’s medical record, and if the treatment is not medicinal, then in this case he conscientiously transfers it to the woman.

Second antenatal care 30-32 weeks

The second prenatal care is carried out at 30-32 weeks of pregnancy, in the same way as the first, by a doctor and a nurse. Tasks and goals: to check whether the expectant mother is doing everything as prescribed by the doctor after the first prenatal care, as well as to analyze and make any other recommendations. It is worth noting that during this period, close attention is paid to how psychologically prepared a pregnant woman is for the arrival of a baby in her life, that is, visiting a psychologist or school for expectant mothers and fathers.

Tasks of the second prenatal care:

1. Analyze the information received, find out about the current course of pregnancy, establish exact risk factors, and also find out about all previous diseases, such as chicken pox, etc.
2. Monitor how the expectant mother complies with the doctor’s and nurse’s orders.
3. Carry out hypogalactia, namely, evaluate the functioning of the mammary glands.
4. If at this stage any risk to the unborn newborn is identified, certain adjustments should be made.
5. Prepare a pregnant woman for long-term breastfeeding and for the birth of the child.
6. Fill out the medical form.

According to the plan, it looks the same, that is, the second one is filled in exactly the same way as the first. However, there is a difference. The second form indicates the risk of perinatal pathology and the prognosis of hypogalactia. It is worth taking into account that the same form also indicates the consequences for a pregnant woman with preeclampsia.

Third antenatal care 37-38 weeks

The doctor’s third visit to the expectant mother’s home is carried out only if the woman has a difficult pregnancy or possible risks that were identified during previous visits. A paramedic can visit your home; the frequency of prenatal care depends on the condition of the pregnant girl.

Main factors and subsequent division of newborns into risk groups

Factors include:

• Alcoholism of parents and presence of other bad habits,
• Development of acute diseases during pregnancy,
• Pregnant girls under the age of majority and women over 35 years of age,
• Bleeding and risk of miscarriage.

Risk groups for newborns:

1. Development of diseases of the central nervous system,
2. Infection of the fetus from the mother,
3. Development of endocrine abnormalities,
4. Development of malformations of the child’s organ systems,
5. Social instability.

How to prepare for the doctor's arrival

1. Firstly, as a rule, medical personnel never take off their shoes when visiting a patient’s home, so the ideal option would be to prepare clean shoe covers in the hallway.
2. Secondly, the doctor will definitely go wash his hands, even if he just came to conduct a survey. Therefore, it is worth preparing clean soap and a clean towel. Liquid soap is best, as solid soap can carry dirt.
3. Thirdly, pets, if any, should be removed.
4. It is worth preparing a place in advance so that the doctor has somewhere to sit and fill out medical documents.

1. Balanced diet – the expectant mother’s diet should contain vitamins and beneficial microelements;
2. Hygiene and sanitary conditions of the home - that is, the house should be clean, the nurse can advise doing wet cleaning every day, since germs and fungi are found in large quantities in dust, and mites are in bed linen;
3. Getting rid of bad habits - when smoking and drinking alcoholic beverages, the fetus becomes intoxicated, which in turn increases the risk of developing pathologies after birth in the baby;
4. Drug treatment - when any diseases of a pregnant woman are detected, for example, thrush, the nurse prescribes a drug (usually suppositories - vaginal suppositories) so that there are no bacteria in the vagina and birth canal.

Legislative regulation

Basic laws on the rights of pregnant women:

1. Article 52 of Federal Law No. 323 “On the fundamentals of protecting the health of citizens in the Russian Federation”
2. Decree of the President of the Russian Federation dated November 5, 1992 N 1335 (as amended on October 5, 2002) “On additional measures for the social protection of pregnant women and women with children under three years of age dismissed due to the liquidation of organizations”
3. Order of the Ministry of Health of the Russian Federation N 345 ​​“On improving measures for the prevention of nosocomial infections in obstetric hospitals”
4. Order of the Ministry of Health of the Russian Federation No. 242 of June 11, 1996 “On the list of social indications and approval of instructions for artificial termination of pregnancy”
5. Order of the Ministry of Health of the Russian Federation N 302 “On approval of the list of medical indications for artificial termination of pregnancy”
6. Appendix No. 1 to the order of the regional health department No. 251 of 04.29.86 “Principles of distribution of pregnant women according to the degree of risk of maternal mortality” (in accordance with the order of the Ministry of Health of the RSFSR No. 83-DSP of 02.5.86)

Prenatal care is one of the most important activities in antenatal prevention. Since antenatal clinics do not actively patronize pregnant women, this section of antenatal prevention is carried out by the pediatric local service. In conditions of optimal organization of the work of a children's clinic for antenatal care of the fetus, 3 patronages are indicated. The first and 2nd visits are carried out by a visiting nurse, and the 3rd - by a local pediatrician.

FIRST ANTENATUAL PATRONAGE

The first prenatal care is carried out when a pregnant woman is registered at the antenatal clinic at 8-13 weeks of pregnancy. During the first prenatal care, the local nurse meets the expectant mother, talks with her about the importance, happiness and great responsibility of being a mother. During the first prenatal care, the local nurse must find out the state of health of the pregnant woman, find out how the pregnancy is progressing, and in what conditions the expectant mother lives and works. Patronage should be particularly scrupulous, striving to identify as accurately as possible all the circumstances that could have a harmful effect on the health of the unborn child. Particular attention should be paid to the possibility of toxic effects on the fetus from nicotine, alcohol and other toxic substances.

During the first visit, they clarify the duration of the pregnancy, how it is progressing in comparison with the previous one, and the expected due date. Particular attention is paid to a history of miscarriages and their causes. They find out the well-being of the pregnant woman, her sleep, appetite, compliance with the regime, check the implementation of the recommendations of the obstetrician-gynecologist, and determine the presence of occupational hazards. At the end of the patronage, the nurse invites the expectant mother to the KZR to attend classes at the school for expectant mothers.

In a number of children's clinics, the developmental history of the future patient is filled out immediately after receiving a signal about a pregnant woman from the antenatal clinic. In such cases, all data on antenatal prevention (prenatal care, attendance of pregnant mothers at school, gynecological history and other data) are entered directly into the development history of the unborn child.

During the first prenatal care, the nurse should give the pregnant woman the following advice: eliminate occupational hazards,

ty, if any, alternate work and rest, avoid conflict situations, establish the correct nutrition acceptable for a pregnant woman as prescribed by the doctor (raw and cooked vegetables, fruits, milk, cottage cheese, boiled meat, vitamins A, D and other products), purchase in a timely manner everything necessary for a newborn, and if there are tuberculosis patients in the family, think about where the mother and child will be in the first 2 months after discharge from the hospital.

SECOND ANTENATUAL CARE

The district nurse performs the 2nd prenatal care during the pregnant woman's maternity leave at the 31st-32nd week of pregnancy.

The main goal of the 2nd prenatal care for a pregnant woman is to monitor the implementation of the doctor’s prescriptions at the antenatal clinic and the recommendations given by the nurse at the children’s clinic during the first visit and at the school for expectant mothers.

During the 2nd prenatal care, they find out the well-being of the pregnant woman, whether she was transferred, if necessary, to light work, and the timing of maternity leave. During the 2nd prenatal care, it is already possible to assess the care of the unborn child (preparing the mother’s mammary glands for lactation, organizing a corner for the newborn, preparing linen and clothes for him), and also clarify the address where the mother and child will live.

THIRD ANTENATUAL PATRONAGE

The 3rd prenatal care is carried out by the local pediatrician. Indications for this patronage include severe somatic pathology of the pregnant woman, poor obstetric history, severe toxicosis of the pregnant woman, as well as unfavorable social and living conditions. The senior nurse at the antenatal clinic reports such patients to the children's clinic. In addition, indications for the 3rd prenatal care are formed based on a study of previous prenatal visits performed by the local nurse. The 3rd prenatal care is carried out according to an individual scheme for each case.

Prenatal care has now become an integral part of the work of the children's clinic for antenatal care of the fetus and newborn

Based on the results of prenatal visits, the local pediatrician determines the risk group among pregnant women, that is, identifies the contingent of expectant mothers whose children will need to be under the close attention of the local doctor and doctors of relevant specialties.

Risk factors include extragenital diseases of the expectant mother, occupational hazards and alcoholism of parents, acute diseases and surgical interventions during pregnancy, the age of the mother at the time of birth of the child is younger than 18 and older than 30 years (fertile age, according to WHO, from 14 to 49 years ), toxicoses of pregnancy, threat of miscarriage, bleeding, increased or decreased blood pressure during pregnancy, i.e. factors on the basis of which children will be divided into health groups

Analysis of data on the listed factors allows the local pediatrician to influence the health status of the unborn child by developing a set of medical measures aimed at reducing the harmful effects of risk factors and achieving a higher level of health for children in the future.

The following measures will contribute to reducing child mortality in the antenatal period.

Creation of a system of juvenile centers that will be developed
give recommendations on proper hygiene and sexual education
tania of girls and young women, provide them with outpatient or inpatient care
traditional treatment of genital diseases and hormonal correction
ny violations.

Introduction of perinatal screening studies
Double ultrasound of the fetus from the 15th to the 22nd week of pregnancy

(including using intravaginal sensors).

Determination of the concentration of markers in the blood of a pregnant woman, in particular alpha-fetoprotein human chorionic gonadotropin, etc.

Implementation of a program to prevent the development of congenital defects
kov development of the central nervous system with the complex use of folic acid,
iron and vitamin B 12 preparations.

In order to reduce pathology during childbirth, the widespread introduction of the system
physiopsychoprophylactic training of pregnant women based on feather beds
tal centers and antenatal clinics.

Organization of prevention rooms in antenatal clinics
ke miscarriage.

For the prevention of severe forms of hemolytic disease, new
births, examination for Rh factor in pregnant women of childbearing age
age with first pregnancy referred for abortion.

Examination of pregnant women for chlamydia, herpes virus, cy-
tomegalovirus infection, toxoplasmosis.

Throughout the entire antenatal period, the pediatrician needs to remember about background diseases of childhood (rickets and

anemia) and carry out appropriate preventive work with the pregnant woman.

The child's nutrition before birth occurs in utero, and, therefore, depends on the quality of nutrition of the expectant mother. Various disturbances in a woman’s diet during pregnancy can negatively affect the health of the child: along with insufficient body weight, mental retardation, various anomalies may form.

The principles of rational nutrition for pregnant women are given below.

In the first half of pregnancy, a woman, along with optimal
high amount of protein (up to 90 g/day), a sufficient amount of
content of vitamins (folic acid, A, C, B, D), minerals
(calcium, phosphorus), microelements (iodine, magnesium, iron, selenium, zinc).
The calorie content of the diet should be 2600-2900 kcal/day. In the 2nd
half of pregnancy, the need for basic food increases
solids, especially in protein (up to 100 g/day), minerals
bah (especially in calcium, necessary for building the skeleton). Kahlo
The nutritional density of the diet should be increased to 3000-3200 kcal/day.

Pregnant women should consume the following milk products,
fermented milk products (kefir, fermented baked milk, yogurt) up to 1 liter per day,
cheese, cottage cheese, liver, meat, seafood, poultry, butter and vegetables
vegetable oil, fruits, vegetables, especially cabbage (including sauerkraut),
soy, nuts, cereals, bread, greens, eggs. Limit easily digestible
carbohydrates, allergenic foods (chocolate, coffee, honey, mushrooms, citrus
russets, nuts).

Considering the lack of iodine in water and products in Russia
they recommend eating iodized salt and bread products
ducts, and according to indications - iodine preparations.

You can use a dietary product to correct your diet
"Femilak-1" (dry milk mixture enriched with protein, vitamin
mi, minerals), as well as vitamin and mineral
complexes “Materna”, “Infa-mama”, “Mama-plus”

In case of insufficient consumption of proteins, micronutrients, take
It is possible for them to develop various pathological processes
children

■ Protein-calorie deficiency before and during pregnancy.

♦ Consequences for the pregnant woman: high risk of premature birth, decreased quality of milk produced and lactation period.

♦ Consequences for the newborn: high risk of congenital
anomalies, low birth weight, generalized
infections, prolonged anemia in infancy.

I Zinc deficiency.

♦ Consequences for the pregnant woman: spontaneous abortions, toxemia
pregnant women.

♦ Consequences for the newborn: low fetal weight,
abnormalities of neural tube formation

I Copper deficiency.

♦ Consequences for the newborn: increased frequency of births
data anomalies, connective tissue dysplasia,
increased fragility of bones and blood vessels.

I Calcium deficiency.

♦ Consequences for a pregnant woman: preeclampsia and eclampsia, ar
maternal hypertension, premature birth,
damage to the pelvic bones.

♦ Consequences for the newborn - low birth weight
Denia, convulsions, rickets.

i Fluoride deficiency.

♦ Consequences for the newborn: increased risk of caries
milk and permanent teeth.

I Iodine deficiency.

♦ Consequences for the newborn: a sharp lag in
mental development.

I Magnesium deficiency.

♦ Consequences for the pregnant woman: neuromuscular disorders,
weakness of labor.

♦ Consequences for the newborn: seizures
I Sodium deficiency.

♦ Consequences for the pregnant woman, damage to the kidneys and adrenal glands.

♦ Consequences for the newborn - tendency to swelling and swelling
cerebral depression in newborns.

I Selenium deficiency.

♦ Consequences for the newborn" congenital dysplasia
okarda, cardiac arrhythmia, risk of cardiopathy in afterbirth
current periods of life.

I Iron deficiency.

♦ Consequences for the pregnant woman: anemia of pregnant women, risk of blood
flow during labor

♦ Consequences for the newborn: neonatal anemia,
risk of fetal and newborn hypoxia.

I Deficiency of essential fatty acids.

♦ Consequences for the newborn: impaired growth and myeli-
nization of the brain pathways, network disruption
buds with decreased visual acuity, pathological changes
reduction of electrogenesis in the heart muscle with an increased risk of aritis
Mia and sudden death.

I Vitamin B deficiency^

♦ Consequences for a pregnant woman: vomiting, encephalopathy.

♦ Consequences for the newborn." anxiety, insomnia,
anorexia, gastrointestinal pathology, neurological disorders,
cardiomegaly, heart failure, metabolic
disorders.

I Ascorbic acid deficiency.

♦ Consequences for the pregnant woman: preeclampsia, risk of early pregnancy
rupture of membranes.

♦ Consequences for the newborn: risk of infection
born with the development of generalized infections.

I Vitamin B deficiency 6.

♦ Consequences for a pregnant woman: nausea, vomiting during pregnancy
minorities.

♦ Consequences for the newborn: low rates of new
born according to the Apgar scale (with subsequent restrictions
problems in breastfeeding, care and discharge timing), plo
high weight gain, gastrointestinal disorders, increased
irritability, convulsions, anemia, allergic dermatoses, conjugation
nctivites.

I Vitamin A deficiency.

♦ Consequences for the newborn: respiratory risk
disorders.

I Vitamin D deficiency.

♦ Consequences for the newborn: rickets in the early stages, under
late development of tooth enamel.

I Folic acid deficiency.

♦ Consequences for the newborn: abnormalities of formation
neural tube.