Standard equipment for a hospital maternity ward. Organization of work of the maternity hospital (department) Guidelines

At the entrance to the maternity ward, a box with sterile masks (color-coded, four-layer masks) and a dark glass jar with a sterile forceps in a triple solution (for taking masks from the box) are placed on the bedside table. The bags and masks are changed every 4 hours. On the wall, near the bedside table, is an hourly schedule for changing masks, indicating color coding for each shift. In the nightstand there is an enamel pan with a lid with a 1% chloramine solution for used masks.

Prenatal wards.

The number of beds should be 12% of the estimated number of beds in the postpartum physiological department, but not less than 2 beds.

In the prenatal ward there are beds painted with white enamel or nickel-plated, preferably functional ones, bedpans (beds and bedpans are marked with letters of the alphabet), stands for bedsteads, bedside tables, chairs or stools, an anesthesia machine for labor anesthesia using nitrous oxide, a machine for measuring blood pressure , obstetric stethoscope, pelvis gauge, measuring tape, “Malysh”, “Lenar” devices, etc.

To work in the prenatal ward at the midwife's station, it is necessary to have a bottle with a ground-in stopper with ethyl alcohol 95%, sterile syringes and needles in individual bags made of baggy paper, water-resistant (GOST 2228-81) or in bags (each syringe with needles is wrapped in rags) , forceps (sterilization in air sterilizers), an enamel pan with disinfected tips for enemas, 1-2 Esmarch mugs, 9 separate boxes with sterile sheets, pads, pillowcases, shirts, cotton and gauze balls, rags, catheters, disinfected oilcloths. The prenatal ward should also have separate enamel containers for immersing syringes, enema tips, Esmarch mugs, containers with lids containing disinfectant solutions for treating medical instruments, equipment and hard equipment; an enamel saucepan with distilled water, a dark glass jar with a sterile forceps in a triple solution, a plastic or enamel jug for washing mothers in labor, a tray for waste material. Necessary medications are stored in a closet or safe.

The beds in the prenatal ward should be unmade, they are prepared immediately before the woman in labor enters. A disinfected mattress and pillow in a sterile pillowcase, a sterile sheet, a disinfected oilcloth and a sterile liner are placed on the disinfected bed. It is allowed to use mattresses in tightly sewn oilcloth covers, which are disinfected with disinfectant solutions. The blanket is processed in a steam-formalin chamber.

Upon admission to the prenatal clinic, 5-7 ml of blood from a vein is taken into a test tube from a woman in labor, the test tube is placed in a stand and the blood clotting time is noted on a strip of paper glued to the test tube, where the woman’s last name, first name and patronymic, birth history number, date and hour of collection are indicated. blood. The test tube is kept the entire time the mother is in the maternity ward in case serum is needed to conduct a compatibility test for blood transfusion.

If the exchange card or passport does not indicate the Rh status of the mother’s blood, it should be determined immediately after the woman’s admission to the maternity hospital.

To avoid serious errors, the Rh status of the blood of the mother or fetus, as well as the bilirubin content of the newborn, should be determined by laboratory doctors or laboratory assistants specially trained for this. It is unacceptable to determine the Rh status of the blood of the mother or fetus by obstetricians-gynecologists or midwives on duty who do not have special training.

In the prenatal ward, the midwife on duty and, if available, the doctor on duty constantly monitor the condition of the woman in labor: at least after 3 hours, it is mandatory to record a diary in the birth history, which indicates the general condition of the woman in labor, complaints ( headache, changes in vision, etc.), arterial pressure on both hands, pulse, character labor activity(duration of contractions, interval between contractions, strength and pain of contractions), position of the presenting part of the fetus in relation to the mother’s pelvis, fetal heartbeat (number of beats per minute, rhythm, character of the heartbeat). At the end of the diary, you should definitely indicate whether amniotic fluid is leaking or not, the nature of the leaking water (light, green, mixed with blood, etc.). Each diary must be signed by a doctor (midwife).

A vaginal examination must be performed upon admission with a preliminary smear taken for flora if the amniotic sac is intact, as well as when amniotic fluid is discharged. In the 1st stage of labor, a vaginal examination should be performed at least every 6 hours in order to determine the dynamics of labor, diagnose deviations from the normal course of labor and promptly begin the necessary therapeutic measures.

If there are appropriate indications, vaginal examinations can be performed at any time interval.

Vaginal examinations should be performed in a specially designated room or in a small operating room in compliance with all rules of asepsis and antiseptics. In the presence of bloody discharge from the genital tract, when there is a suspicion of premature abruption of a normal or low-lying placenta, or placenta previa, a vaginal examination is performed with a full operating room.

• - transformable bed;
• - neonatal table with heating;
• - anesthesia-respiratory apparatus “Faza-23”;
• - Two consoles for resuscitation care with centralized supply of oxygen, nitrous oxide, vacuum and compressed air;
• - manipulation and instrumental tables;
• - bedside table, screw-shaped chair;
• - stands for bixes, destructor;
• - fetal monitor;
• - scales for a newborn;
• - electric suction for a newborn;
• - medical stationary lamp;
• - telephone with internal communication;
• - rack for systems;
• - trays for receiving newborns, for collecting placental blood, for manipulations, for waste of group “B”; containers for collecting used linen, for collecting waste of groups “A”, “B”;
• - staff emergency call system
• - apparatus for measuring blood pressure;
• - obstetric stethoscope.

The sterile delivery kit includes:

• - 4 diapers for a newborn;
• - cotton balls and gauze;
• - gauze napkins;
• - bracelets for a child;
• - tape measure;
• - instruments: anatomical tweezers, Kocher forceps, umbilical scissors, tweezers, forceps, gynecological speculum for examining the cervix of a woman in labor, amniotome.

The principle of work organization is flow. All departments are equipped with appropriate equipment and instruments, medical instruments, care items, medical furniture and equipment.

The work of the obstetric hospital is to provide qualified and specialized care to pregnant and postpartum women, care for healthy newborns during the adaptation period and provision of timely qualified care to premature and sick children.

In my job responsibilities includes:

• 1. Carry out care and monitoring of pregnant women and women in labor and postpartum on the basis of modern perinatal technologies in compliance with the principles of medical ethics and deontology.
• 2. Strictly implement the sanitary and anti-epidemic regime.
• 3. Follow all doctor’s orders in a timely and accurate manner. In case of non-compliance with the instructions, regardless of the reason, immediately report this to the doctor.
• 4. Observe the condition of women in labor throughout labor, as well as in early postpartum period. Immediately notify the doctor of any change in the patient’s condition.
• 5. Monitor the condition and carry out doctor’s prescriptions for women in the Meltzer box.
• 6. Monitor the work of the junior medical personnel, for carrying out current and final disinfection of premises.
• 7. Process all items medical purposes and technical equipment.
• 8. Accurately maintain medical records.
• 9. Use medical equipment, medicines, and instruments rationally and carefully.

My rights:

• 1. Obtain the information necessary to perform your duties.
• 2. Periodically improve your professional qualifications through refresher courses.
• 3. Make decisions within your competence.
• 4. Make suggestions to the manager. department for improving organization and working conditions.
• 5. Do not allow work to be carried out on faulty equipment, immediately notifying management about this.

Responsibility:

I am responsible for unclear or untimely fulfillment of duties provided for job description, internal regulations of the State Health Institution “PC SO”, regulations on the maternity ward, as well as for inaction or failure to make decisions within the scope of my competence.

I start my working day with a medical examination, which is carried out by the doctor on duty: I measure my body temperature, the doctor examines my character skin and pharynx Inspection data is entered into the Daily Log medical examinations staff, where I put my signature. Having received permission to work, I enter the department through a sanitary checkpoint and change into clean sanitary clothing and shoes. I put on a clean robe and go into the department.

Before starting work, I sanitize my hands. Guided by SANPiN 2.1.3.2630-10, hand hygiene can be carried out in two ways:

• - washing hands with liquid soap and water to remove contaminants and reduce the number of microorganisms;
• - treating hands with an alcohol-containing skin antiseptic to reduce the number of microorganisms to a safe level.

I use it to wash my hands liquid soap using a dispenser. I wash my hands with warm running water. I wash my hands and then rinse with water twice for two minutes. After washing my hands, I wipe them dry with disposable wipes. Then I treat my hands with a skin antiseptic by rubbing it into the skin of my hands. The amount of skin antiseptic required for hand treatment, the frequency of treatment and its duration are determined in the guidelines for the use of a specific product.

After cleaning my hands, I take my shift: I find out from the midwife on duty the number of women in labor in the delivery room, measure the mothers’ blood pressure, listen to the fetal heartbeat, determine the nature of the contractions, count the pulse, ask the patients for passport information, and check with the birth history. I check the availability and expiration dates of medications, sterile solutions, instruments, childbirth bags, the availability of disposable products (syringes, systems, catheters, systems for drawing blood for analysis, masks, caps, etc.), the availability of linen stock, I control documentation, kept in the department: “Journal of childbirth”, “Journal of bacterial cultures and histological studies placentas", "General cleaning log", "Work log quartz lamps" etc.

All work in the department is carried out in the interests of the mother and child. For this purpose, early attachment of the child to the mother’s breast has been introduced in the maternity unit; postpartum women are in the “Mother and Child” co-stay rooms, which is one of the components of the “Baby-Friendly Hospital” program. The “Prepared Childbirth” program is being widely introduced into practice.

Knowing the peculiarities of the mother's experiences and her personality, the midwife tactfully explains to the patient not only her rights, but also her responsibilities, and talks about her in a form accessible to the patient. necessary examinations, preparation for them, about the upcoming treatment.

Everything about a midwife should be pleasing to the patient, starting with her appearance(fitness, neatness, hairstyle, facial expression).

The midwife's duty is to be honest and truthful with the patient, but conversations about the diagnosis and the peculiarities of childbirth cannot go beyond the scope outlined by the attending physician. This also applies to conversations between midwives and patients’ relatives.

It is important to devote at least a couple of minutes to the patient before the manipulation - to admonish her with kind words, encourage her, and remind her of the need for calm behavior during the manipulation.

Therefore, when helping a doctor, a midwife must show high professionalism and deontological literacy. You must always remember that in front of you is a living person with the whole gamut painful sensations, worries, fears and worries about your health and the health of the baby, and direct your psychoprophylactic and psychotherapeutic activities to mitigate her suffering, mobilize physical and mental efforts in the fight against pain.

Each birth is carried out strictly individually, i.e. in a separate delivery room. The woman in labor is there from the moment she is admitted for delivery until the end of the early postpartum period. When a woman in labor enters the delivery room, the bed is made up with clean linen, and an individual bedpan is issued, which has the same number as the delivery room. The staff observes the mask regime: a 4-layer mask covers the nose and mouth, changes every 3 hours.

See also Regulations on the organization of activities maternity hospital(departments), approved by order of the Ministry of Health and Social Development of the Russian Federation dated March 27, 2006 N 197

Inpatient obstetric care is provided to the population in maternity hospitals(independent) or maternity wards included in hospitals or medical units. The organization of their work is based on a single principle in accordance with the current legislation on the status of the maternity hospital (department), orders, instructions, instructions, instructions from higher health authorities and these guidelines.

The maternity hospital has the following structural units: hospital, antenatal clinic, treatment and diagnostic units and administrative and economic part.

The structure of the maternity hospital (department) must comply with the requirements of building codes and rules of medical institutions: equipment - the equipment sheet of the maternity hospital (department); sanitary and anti-epidemiological regime - current regulatory documents.

In the maternity hospital (department) it is necessary to have: hot and cold water supply, oxygen, sewerage, stationary (portable) bactericidal irradiators. All departments must be equipped with appropriate equipment and instruments, medical instruments, care items, medical furniture and equipment, as well as utensils. Storing excess furniture and unused equipment in the maternity hospital (ward) is strictly prohibited.

Inpatient maternity hospital (department) includes: reception and examination rooms and rooms for discharge, obstetric physiological department (room of the birth block), department (wards) of pathology of pregnant women, postpartum physiological, observational, gynecological departments and newborn department. According to indications, they are hospitalized in the gynecological department for surgical treatment patients who do not suffer from purulent-inflammatory processes of the genitals or malignant neoplasms. As part of a maternity hospital or multidisciplinary hospital, it is recommended that the maternity and gynecological departments be located, if possible, in different buildings; the maternity ward building should be away from the infectious diseases hospital, laundry and catering department.

Only pregnant women and women in labor are admitted through the reception and examination rooms of obstetric departments. There is a separate reception room for receiving gynecological patients.

These guidelines set out specific recommendations for organizing the work of obstetric departments (wards) and newborn departments (wards).

Equipment, equipment and organization of work of structural units (wards) of the maternity hospital (department) Filter room.

The filter room contains a couch covered with oilcloth, a table, chairs, a bedside table, a closet for temporary storage of clothes of a woman (before putting them into storage) entering the maternity hospital, a safe for storing valuables and money of pregnant women and women in labor.

On the bedside table there is a container with thermometers completely immersed in a disinfectant solution, and an enamel kidney-shaped basin * (1) for storing thermometers; disinfection boiler * (2) (preferably electric) with boiled metal spatulas (it is possible to use disposable wooden spatulas); a tray for used spatulas and a dark glass or porcelain sterile jar with a triple solution, in which there is a pre-sterilized (every 3 hours) forceps. The triple solution is changed 2 times a day. Inside the bedside table, disinfected slippers are stored in a bag. It is also necessary to have a round sterilization box * (3) with a sterile rag, a tightly closed enamel container (0.5-1.0 l) with a disinfectant solution, a reflector lamp for examining the skin.

In the filter room, the general condition of the incoming woman is assessed, body temperature is measured, the skin is examined using a reflector lamp, the throat is examined using a spatula, the pulse is counted, and blood pressure is measured in both arms. The doctor or midwife gets acquainted with the woman’s exchange card, finds out the infectious and inflammatory diseases she has suffered before and during this pregnancy, and especially before entering the maternity hospital (ward). The presence of chronic inflammatory diseases and the duration of the anhydrous interval are determined, after which the issue of hospitalization in a physiological or observational obstetric department is decided. If pregnant women and women in labor have diseases for which hospitalization in a maternity hospital (obstetric department) is contraindicated, you should be guided by the current regulatory documents.

The organization of work in obstetric hospitals is based on a single principle in accordance with the current regulations of the maternity hospital (department), orders, instructions, instructions and existing methodological recommendations.

How is an obstetric hospital organized?

1. The structure of the obstetric hospital must meet the requirements building codes and the rules of medical institutions;
2. Equipment - equipment list of the maternity hospital (department);
3. Sanitary and anti-epidemic regime - in accordance with current regulatory documents.

Currently, there are several types of obstetric hospitals that provide treatment and preventive care to pregnant women, women in labor, and postpartum women:

• Without medical care - collective farm maternity hospitals and first aid stations with obstetric codes;
• With a common medical assistance- local hospitals with obstetric beds;
• With qualified medical assistance - obstetric departments of the Republic of Belarus, Central District Hospital, city maternity hospitals; with multidisciplinary qualified and specialized assistance- maternity wards multidisciplinary hospitals, obstetric departments regional hospitals, interdistrict obstetric departments based on large central district hospitals, specialized obstetric departments based on multidisciplinary hospitals, obstetric hospitals united with departments of obstetrics and gynecology medical institutes, departments of specialized research institutes.

The variety of types of obstetric hospitals provides for their more rational use to provide qualified care to pregnant women.

Structure of obstetric hospitals

The distribution of obstetric hospitals into 3 levels for hospitalization of women depending on the degree of risk of perinatal pathology is presented in table. 1.7 [Serov V.N. et al., 1989].

The hospital of the maternity hospital - the obstetric hospital - has the following main divisions:

• reception and access block;
• physiological (I) obstetric department (50-55% of total number obstetric beds);
• department (ward) of pathology of pregnant women (25-30% of the total number of obstetric beds), recommendations: to increase these beds to 40-50%;
• department (wards) for newborns in the I and II obstetric departments;
• observational (II) obstetric department (20-25% of the total number of obstetric beds);
• gynecological department(25-30% of the total number of beds in the maternity hospital).

The structure of the premises of the maternity hospital should ensure the isolation of healthy pregnant women, women in labor, and postpartum women from the sick; compliance with the strictest rules of asepsis and antiseptics, as well as timely isolation of sick people. The reception and access block of the maternity hospital includes a reception area (lobby), a filter and examination rooms, which are created separately for women admitted to the physiological and observational departments. Each examination room must have a special room for sanitary treatment of incoming women, equipped with a toilet and shower. If there is a gynecological department in the maternity hospital, the latter must have an independent reception and access unit. The reception room or lobby is a spacious room, the area of ​​which (like all other rooms) depends on the bed capacity of the maternity hospital.

For the filter, a room with an area of ​​14-15 m2 is allocated, where there is a midwife’s table, couches, and chairs for incoming women.

Examination rooms must have an area of ​​at least 18 m2, and each sanitary treatment room (with a shower, a toilet with 1 toilet and a vessel washing facility) must have an area of ​​at least 22 m2.

Operating principles of an obstetric hospital

Patient admission procedure

A pregnant woman or woman in labor, entering the reception area of ​​an obstetric hospital (lobby), takes off her outer clothing and goes into the filter room. In the filter, the doctor on duty decides which department of the maternity hospital (physiological or observational) she should be sent to. To correctly resolve this issue, the doctor collects a detailed medical history, from which he clarifies the epidemic situation in the mother’s home environment (infectious, purulent-septic diseases), the midwife measures body temperature, carefully examines the skin (pustular diseases) and pharynx. Women who do not have any signs of infection and have not had contact with infectious patients at home, as well as the results of testing for RW and AIDS, are sent to the physiological department and the department of pathology of pregnant women.

All pregnant women and women in labor who pose the slightest threat of infection to healthy pregnant women and women in labor are sent to the observation department of the maternity hospital (maternity ward of the hospital). After it has been established which department the pregnant or parturient woman should be sent to, the midwife transfers the woman to the appropriate examination room (I or II obstetric department), entering the necessary data in the “Register of admission of pregnant women in labor and postpartum” and filling out the passport part of the birth history. Then the midwife, together with the doctor on duty, conducts a general and special obstetric examination; weighs, measures height, determines the size of the pelvis, abdominal circumference, height of the uterine fundus above the pubis, position and presentation of the fetus, listens to its heartbeat, prescribes a urine test for blood protein, hemoglobin content and Rh status (if not on the exchange card) .

The doctor on duty checks the midwife’s data and gets acquainted with the “ Individual card pregnant and postpartum women,” collects a detailed history and identifies edema, measures blood pressure in both arms, etc. In women in labor, the doctor determines the presence and nature of labor. The doctor enters all examination data into the appropriate sections of the birth history.

After the examination, the mother in labor is given sanitary treatment. The scope of examinations and sanitization in the examination room is regulated general condition women and the period of childbirth. Upon completion of sanitary treatment, the woman in labor (pregnant) receives an individual package with sterile linen: towel, shirt, robe, slippers. From the examination room of the first physiological department, the woman in labor is transferred to the prenatal ward of the same department, and the pregnant woman is transferred to the pathology department. From the observation room of the observation department, all women are sent only to the observation room.

Department of pathology of pregnant women

Pathology departments of an obstetric hospital are organized in maternity hospitals (departments) with a capacity of 100 beds or more. Women are usually admitted to the pathology department through examination room I of the obstetric department, and if there are signs of infection, through the examination room of the observation department into the isolated wards of this department. The corresponding examination room is led by a doctor (during the daytime, department doctors, from 13.30 - doctors on duty). In maternity hospitals, where it is impossible to organize independent pathology departments, wards are allocated as part of the first obstetric department.

Pregnant women with extragenital diseases (heart, blood vessels, blood, kidneys, liver, endocrine glands, stomach, lungs, etc.), with complications (gestosis, threatened miscarriage, fetoplacental insufficiency, etc.), with abnormal fetal position are hospitalized in the pathology department , with a burdened obstetric history. In the department, along with an obstetrician-gynecologist (1 doctor for 15 beds), a maternity hospital therapist works. This department usually has an office functional diagnostics, equipped with devices for assessing the condition of the woman and the fetus (PCG, ECG, device ultrasound scanning and etc.). In the absence of their own office, general hospital departments of functional diagnostics are used for examining pregnant women.

In the obstetric hospital, modern technologies are used for treatment. medicines, barotherapy. It is desirable that women be assigned to the small wards of this department according to their pathology profile. The department must be continuously supplied with oxygen. The organization of rational nutrition and medical and protective regime is of great importance. This department is equipped with an examination room, a small operating room, and a room for physical and psychoprophylactic preparation for childbirth.

From the pathology department, the pregnant woman is discharged home or transferred to the maternity ward for delivery.

In a number of obstetric hospitals, pathology departments for pregnant women with a semi-sanatorium regime have been deployed. This is especially true for regions with high level fertility.

The pathology department is usually closely associated with sanatoriums for pregnant women.

One of the discharge criteria for all types of obstetric and extragenital pathologies is normal functional status the fetus and the pregnant woman herself.

The main types of studies, average examination time, basic principles of treatment, average treatment time, discharge criteria and average length of hospital stay for pregnant women with the most important nosological forms of obstetric and extragenital pathology are presented in the order of the USSR Ministry of Health No. 55 of 01/09/86.

Physiological department

The first (physiological) department of the obstetric hospital includes a sanitary checkpoint, which is part of the general admission block, a delivery block, postpartum wards for the joint and separate stay of mother and child, and a discharge room.

The birth block consists of prenatal wards, intensive observation wards, and delivery wards ( maternity wards), manipulation room for newborns, operating room (large operating room, preoperative anesthesia room, small operating rooms, rooms for storing blood, portable equipment, etc.). The maternity block also houses offices for medical staff, a pantry, sanitary facilities and other utility rooms.

VI. Procedure for provision medical care women with HIV infection during pregnancy, childbirth and the postpartum period

51. The provision of medical care to women with HIV infection during pregnancy, childbirth and the postpartum period is carried out in accordance with sections I and III of this Procedure.

52. Laboratory examination of pregnant women for the presence of antibodies to the human immunodeficiency virus (hereinafter referred to as HIV) in the blood is carried out when registering for pregnancy.

53. If the first test for HIV antibodies is negative, women planning to continue the pregnancy are re-tested at 28-30 weeks. Women who used parenteral psychoactive substances during pregnancy and/or had sexual contact with an HIV-infected partner are recommended to be examined additionally at 36 weeks of pregnancy.

54. Molecular biological examination of pregnant women for HIV DNA or RNA is carried out:

a) upon receipt questionable results testing for HIV antibodies obtained using standard methods ( linked immunosorbent assay(hereinafter referred to as ELISA) and immunoblotting);

b) upon receipt of negative test results for HIV antibodies obtained using standard methods if the pregnant woman belongs to the group high risk for HIV infection (intravenous drug use, unprotected sex with an HIV-infected partner within the last 6 months).

55. Blood sampling when testing for antibodies to HIV is carried out in treatment room antenatal clinic using vacuum systems for blood collection with subsequent transfer of blood to the laboratory medical organization with direction.

56. Testing for HIV antibodies is accompanied by mandatory pre-test and post-test counseling.

Post-test counseling is carried out for pregnant women regardless of the result of testing for HIV antibodies and includes a discussion of the following issues: the significance of the result obtained taking into account the risk of contracting HIV infection; recommendations for further testing tactics; routes of transmission and methods of protection against HIV infection; risk of HIV transmission during pregnancy, childbirth and breastfeeding; methods of preventing mother-to-child transmission of HIV infection available to a pregnant woman with HIV infection; possibility of chemoprophylaxis of transmission HIV for a child; possible outcomes pregnancy; the need for follow-up of mother and child; the ability to inform your sexual partner and relatives about the test results.

57. Pregnant women with positive result laboratory examination for antibodies to HIV, an obstetrician-gynecologist, and in his absence, a doctor general practice(family doctor), medical worker at the paramedic and obstetric station, refers the subject to the Center for Prevention and Control of AIDS Russian Federation for additional examination, registration at the dispensary and prescription of chemoprophylaxis for perinatal HIV transmission ( antiretroviral therapy).

Information received medical workers about a positive result of testing for HIV infection of a pregnant woman, a woman in labor, a postpartum woman, antiretroviral prevention of mother-to-child transmission of HIV infection, joint observation of a woman with specialists from the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation, perinatal contact of HIV infection in a newborn, not subject to disclosure, except for cases provided for by current legislation.

58. Further observation of a pregnant woman with an established diagnosis of HIV infection is carried out jointly by an infectious disease specialist at the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation and an obstetrician-gynecologist at the antenatal clinic at the place of residence.

If it is impossible to refer (observe) a pregnant woman to the Center for Prevention and Control of AIDS of a constituent entity of the Russian Federation, observation is carried out by an obstetrician-gynecologist at the place of residence with methodological and advisory support from an infectious disease specialist at the Center for Prevention and Control of AIDS.

During the period of observation of a pregnant woman with HIV infection, an obstetrician-gynecologist at a antenatal clinic sends information about the course of pregnancy to the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation, concomitant diseases, pregnancy complications, results laboratory research to adjust schemes for antiretroviral prevention of mother-to-child transmission of HIV and (or) antiretroviral therapy and requests from the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation information about the characteristics of the course of HIV infection in a pregnant woman, the regimen for taking antiretroviral drugs, and coordinates the necessary methods of diagnosis and treatment taking into account the woman’s health condition and the course of pregnancy.

59. During the entire period of observation of a pregnant woman with HIV infection, the obstetrician-gynecologist of the antenatal clinic, in conditions of strict confidentiality (using a code), notes in medical documentation the woman's HIV status, presence (absence) and taking (refusal to take) antiretroviral drugs necessary to prevent mother-to-child transmission of HIV infection, prescribed by specialists from the Center for Prevention and Control of AIDS.

If a pregnant woman does not have antiretroviral drugs or refuses to take them, the obstetrician-gynecologist at the antenatal clinic immediately informs the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation so that appropriate measures can be taken.

60. During the period dispensary observation For a pregnant woman with HIV infection, it is recommended to avoid procedures that increase the risk of infection of the fetus (amniocentesis, chorionic villus biopsy). The use of non-invasive methods for assessing the condition of the fetus is recommended.

61. When admitted for childbirth to an obstetric hospital, women who have not been examined for HIV infection, women without medical documentation or with a one-time examination for HIV infection, as well as those who used psychoactive substances intravenously during pregnancy, or had unprotected sex with an HIV-infected partner, recommended laboratory examination rapid method for antibodies to HIV after obtaining informed voluntary consent.

62. Testing of a woman in labor for antibodies to HIV in an obstetric hospital is accompanied by pre-test and post-test counseling, including information about the importance of testing, methods of preventing the transmission of HIV from mother to child (use of antiretroviral drugs, method of delivery, features of feeding the newborn (after birth the child is not put to the breast and is not fed with mother's milk, but is transferred to artificial feeding).

63. Testing for HIV antibodies using diagnostic rapid test systems approved for use on the territory of the Russian Federation is carried out in a laboratory or reception department obstetric hospital by medical workers who have undergone special training.

The study is carried out in accordance with the instructions attached to the specific rapid test.

Part of the blood sample taken for the rapid test is sent for testing for antibodies to HIV using standard methods (ELISA, if necessary, immune blot) in a screening laboratory. The results of this study are immediately transmitted to the medical organization.

64. Each HIV test using rapid tests must be accompanied by a mandatory parallel study of the same portion of blood using classical methods (ELISA, immune blot).

If a positive result is obtained, the remaining part of the serum or blood plasma is sent to the laboratory of the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation to conduct a verification study, the results of which are immediately transferred to the obstetric hospital.

65. If a positive HIV test result is obtained in the laboratory of the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation, a woman with a newborn, after discharge from the obstetric hospital, is sent to the Center for Prevention and Control of AIDS of a constituent entity of the Russian Federation for counseling and further examination.

66. B emergency situations, if it is impossible to wait for the results of standard testing for HIV infection from the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation, the decision to conduct a preventive course of antiretroviral therapy for mother-to-child transmission of HIV is made when antibodies to HIV are detected using rapid test systems. A positive result of the rapid test is the basis only for prescribing antiretroviral prevention of mother-to-child transmission of HIV infection, but not for making a diagnosis of HIV infection.

67. To ensure the prevention of mother-to-child transmission of HIV infection, the obstetric hospital must always have the necessary supply of antiretroviral drugs.

68. Antiretroviral prophylaxis for a woman during childbirth is carried out by an obstetrician-gynecologist leading the birth, in accordance with recommendations and standards for the prevention of mother-to-child transmission of HIV.

69. A preventive course of antiretroviral therapy during childbirth in an obstetric hospital is carried out:

a) in a woman in labor with HIV infection;

b) with a positive result of rapid testing of a woman during childbirth;

c) in the presence of epidemiological indications:

inability to conduct rapid testing or timely obtain results of a standard test for HIV antibodies in a woman in labor;

presence in the anamnesis of the woman in labor during the period real pregnancy parenteral substance use or sexual contact with a partner with HIV infection;

with a negative test result for HIV infection, if less than 12 weeks have passed since the last parenteral use of psychoactive substances or sexual contact with an HIV-infected partner.

70. The obstetrician-gynecologist takes measures to prevent the water-free period from lasting more than 4 hours.

71. When managing vaginal childbirth birth canal vaginal treatment is carried out 0.25% aqueous solution chlorhexidine upon admission for childbirth (during the first vaginal examination), and in the presence of colpitis - at each subsequent vaginal examination. If the anhydrous interval is more than 4 hours, the vagina is treated with chlorhexidine every 2 hours.

72. During labor management in a woman with HIV infection and a living fetus, it is recommended to limit procedures that increase the risk of infection of the fetus: labor stimulation; labor intensification; perineo(episio)tomy; amniotomy; application of obstetric forceps; vacuum extraction of the fetus. These manipulations are performed only for health reasons.

73. Planned caesarean section to prevent intrapartum infection of the child with HIV infection is carried out (in the absence of contraindications) before the onset of labor and effusion amniotic fluid if at least one of the following conditions is present:

a) concentration of HIV in the mother’s blood ( viral load) before childbirth (at no earlier than 32 weeks of pregnancy) more than or equal to 1,000 kopecks/ml;

b) the mother’s viral load before birth is unknown;

c) antiretroviral chemoprophylaxis was not carried out during pregnancy (or was carried out in monotherapy or its duration was less than 4 weeks) or it is impossible to use antiretroviral drugs during childbirth.

74. If it is impossible to carry out chemoprophylaxis during childbirth, cesarean section can be an independent preventive procedure that reduces the risk of contracting a child with HIV infection during childbirth, but it is not recommended for an anhydrous interval of more than 4 hours.

75. The final decision on the method of delivery of a woman with HIV infection is made by the obstetrician-gynecologist leading the birth on an individual basis, taking into account the condition of the mother and fetus, weighing in a specific situation the benefits of reducing the risk of infection of the child during the operation caesarean section with the probability of occurrence postoperative complications and features of the course of HIV infection.

76. Immediately after birth, blood is collected from a newborn from an HIV-infected mother for testing for HIV antibodies using vacuum blood collection systems. The blood is sent to the laboratory of the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation.

77. Antiretroviral prophylaxis for a newborn is prescribed and carried out by a neonatologist or pediatrician, regardless of the mother’s intake (refusal) of antiretroviral drugs during pregnancy and childbirth.

78. Indications for prescribing antiretroviral prophylaxis to a newborn born from a mother with HIV infection, a positive result of rapid testing for HIV antibodies during labor, or an unknown HIV status in an obstetric hospital are:

a) the age of the newborn is no more than 72 hours (3 days) of life in the absence of breastfeeding;

b) in the presence of breastfeeding (regardless of its duration) - a period of no more than 72 hours (3 days) from the moment of the last breastfeeding (subject to its subsequent cancellation);

c) epidemiological indications:

unknown HIV status a mother who uses parenteral psychoactive substances or has sexual contact with an HIV-infected partner;

a negative test result for HIV infection of a mother who has used psychoactive substances parenterally within the last 12 weeks or has had sexual contact with a partner with HIV infection.

79. A newborn is given hygienic bath with chlorhexidine solution (50 ml of 0.25% chlorhexidine solution per 10 liters of water). If it is not possible to use chlorhexidine, a soap solution is used.

80. Upon discharge from the obstetric hospital, the neonatologist or pediatrician explains in detail in an accessible form to the mother or persons who will care for the newborn, the further regimen of chemotherapy drugs for the child, hands out antiretroviral drugs to continue antiretroviral prophylaxis in accordance with the recommendations and standards.

When conducting a prophylactic course of antiretroviral drugs using emergency prophylaxis methods, the mother and child are discharged from the maternity hospital after completing the prophylactic course, that is, no earlier than 7 days after birth.

In the obstetric hospital, women with HIV are consulted on the issue of giving up breastfeeding, and with the woman’s consent, measures are taken to stop lactation.

81. Data on a child born to a mother with HIV infection, antiretroviral prophylaxis for the woman during labor and the newborn, methods of delivery and feeding of the newborn are indicated (with a contingent code) in the medical documentation of the mother and child and transferred to the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation Federation, as well as to the children's clinic where the child will be observed.