In order to improve the effectiveness of prenatal diagnosis and prevent the birth of children with congenital and hereditary diseases, all pregnant women prenatal diagnosis.
The purpose of prenatal screening is to determine for each pregnant individual the risk of having a child with genetic disorders (Down syndrome, Edwards syndrome, Patau syndrome, neural tube defects), taking into account the woman's age, the level of biochemical markers and the thickness of the nuchal bone (nuchal translucency) nasal bone). Prenatal screening is carried out twice.
- I screening (11-14 weeks). At the gestational age of 11-14 weeks, the pregnant woman is sent to a medical organization that carries out the expert level of prenatal diagnostics for complex prenatal (prenatal) diagnosis of fetal development disorders involving ultrasound specialists who have received special training and have an admission (Fetal Medicine Foundation license) for ultrasound (US) screening in the first trimester, and the determination of maternal serum markers (pregnancy-associated plasma protein A, pregnancy-associated placental protein - PAPP-A and β-hCG - freedom hydrochloric fraction β-subunit of hCG) followed by the complex calculation program individual risk of having a child with the chromosomal anomaly (trisomy 21, 18 and 13 chromosomes).
- II screening (18-21 weeks). Includes ultrasound with an evaluation of all organs and fetal systems, as well as an evaluation of extraembryonic structures. When pregnancy is 18-21 weeks pregnant woman is sent to a medical organization that performs prenatal diagnosis, ultrasound to exclude late-manifesting anomalies of fetal development. When the pregnancy is 30-34 weeks, ultrasound is carried out at the place of observation of the pregnant woman.
Objective research. At the first examination of the pregnant woman, the character of her physique is assessed, the information on the initial body weight shortly before pregnancy, and the nature of nutrition are refined. Pay special attention to women with excessive and underweight.
During the examination of the pregnant woman, the body weight, blood pressure on both hands, pay attention to the color of the skin and mucous membranes, the presence of visible swelling, listen to heart tones, lungs, palpate the thyroid gland, mammary glands, regional lymph nodes; assess the condition of the nipples.
Conducted obstetrical examination: determine the external dimensions of the pelvis and lumbosacral rhombus, perform a vaginal examination with mandatory examination of the cervix and vaginal walls in the mirrors, as well as the perineal and anus areas, the presence of exostoses in the small pelvis, the size of the diagonal conjugate, the anomaly of the development of the genital organs. In women with a physiological course of pregnancy in the absence of changes in the vaginal and cervical region, the vaginal examination is performed once, and the frequency of subsequent studies is determined by the indications.Palpation of the abdomen allows you to determine the condition of the anterior abdominal wall and the elasticity of the muscles.
External obstetric examination. After increasing the size of the uterus, when it is possible to externalize her palpation (13-15 weeks), you can determine the height of the standing of the uterus (simphysis-fundal height - SFH), its tone, the size of the fetus, the amount of amniotic fluid volume (AFV), the present part, and then, as pregnancy progresses, the position of the fetus, the member position, position and appearance. Palpation is performed using 4 classic obstetric procedures (according to Leopold-Levitsky).
Auscultation of fetal heart tones carried out from the 20th week of pregnancy. Palpitation of the fetus is determined by a midwifery stethoscope or a pocket fetal monitor in the form of rhythmic double strokes with an average frequency of 130-140 per minute, and also with the help of ultrasound devices, with Doppler, with a fetal cardiac monitor, which significantly improves the accuracy of the study.
When an elevated blood pressure is established in the early stages of pregnancy, a study is needed to exclude or confirm GB. When referring a patient to a women's consultation late in pregnancy
differential diagnosis of GB and PE is complicated. Obviously, the earlier a woman visits a consultation, the more reliable the doctor will get.
Determination of the period of antenatal and postnatal leave is an extremely important factor that ensures the timeliness of diagnostic, preventive and curative interventions, depending on women's belonging to certain risk groups.
According to the legislation, working women, regardless of length of service, are granted maternity leave from the 30th week lasting 140 days (70 calendar days before the birth and 70 after the birth), and in case of multiple pregnancies, the pregnancy and maternity leave sheet is issued at a time from the 28th week of pregnancy with a duration of 194 calendar days (84 calendar days before delivery and 110 calendar days after birth).
During childbirth that occurred in the period of 23-30 weeks of pregnancy and the birth of a live child, the female disability certificate is issued by the women's consultation on the basis of an extract from the maternity ward (department) where delivery occurred, for 156 calendar days, and in case of the birth of a dead child or his death - during the first 7 days after childbirth (168 hours), for 86 calendar days.When a woman leaves the place of her permanent residence, the disability sheet is issued by the maternity hospital (department) where the birth took place.
In the case of complicated births, a leave sheet for 16 calendar days can be given by the maternity hospital (department) or the women's consultation at the place of residence on the basis of the documents from the treatment and prophylactic institution where the birth took place.
Disks of incapacity for work are registered in the "Book of registration of disability sheets". With the greatest accuracy, it is possible to determine the duration of pregnancy with ultrasound in the first trimester.
For information of the obstetric hospital on the state of the woman's health and the features of the course of pregnancy, the doctor of a woman's consultation gives to pregnant women with a gestation period of 22-23 weeks "an exchange card of the maternity hospital, the maternity ward of the hospital."