Organization of obstetric and gynecological care

Evolution of Obstetrics and the Emergence of Perinatology

Historically, reducing maternal and infant mortality required a systematic approach. The introduction of antisepsis (I. Semmelweis proposed washing hands with chlorinated lime) and anesthesia (J. Simpson used chloroform) laid the foundation for safe childbirth. Cesarean section techniques improved: from uterine removal to save the woman to suturing the incision (F. Kehrer, 1881). In domestic practice, a huge contribution was made by V.V. Stroganov, who created an effective eclampsia treatment regimen, and D.O. Ott, a pioneer of endoscopic surgery. During the USSR period, a large-scale network of women's wellness clinics (zhenskiye konsultatsii) was established for dispensary monitoring, which dramatically reduced morbidity.

After World War II, against the background of declining birth rates, the value of every child's life increased manifold. In 1973, at a congress in Moscow, perinatology was officially approved as the science protecting the health of the fetus and newborn. The modern concept of this discipline views the fetus as an independent patient to whom diagnostic methods (ultrasound, MRI, DNA analysis via maternal blood) and even surgical treatment are applicable.

Structure of the Perinatal Period

The term originates from Latin and Greek roots meaning the study of events "around birth". The perinatal period is divided into three stages:

1. Antenatal (prenatal). Previously counted from 28 weeks, but today the threshold has been shifted to 22–23 weeks (once the fetus reaches a mass of 500 g). The time prior to this gestational age is called the prenatal period.
2. Intranatal (during childbirth). Requires careful objective monitoring to choose the optimal delivery method.
3. Postnatal (early postpartum). Covers the first 7 days (168 hours) of the infant's life.

Modern Care System and Routing

Today, a three-tier inpatient care system operates, based on strict patient routing. Patients are distributed among facilities depending on their obstetric risk level.

The key link for high-risk pregnant women is perinatal centers. They concentrate advanced technologies and must include intensive care units (ICUs) for women and children. The latest prenatal diagnostics methods are applied here: color Doppler mapping (CDM), 3D and 4D ultrasound, and echocardiography. Silhouette scanning is particularly promising, allowing detailed visualization of blood vessels and bone structures for precise verification of developmental malformations.

If an infant is born with extremely low birth weight (less than 1000 g), signs of oxygen deprivation, or trauma, they are transferred to stage II nursing care. These specialized pediatric departments are located outside the maternity hospital building but in close territorial conjunction with it.

Statistics and Birth Criteria

The effectiveness of the obstetric service is evaluated by strict demographic indicators that directly depend on social conditions and living standards.

• Maternal mortality: calculated as the number of deaths of women per 100,000 live births. It accounts for the period of pregnancy, childbirth, and 42 days postpartum.
• Perinatal mortality: the number of dead fetuses and infants per 1,000 births (measured in promille, ‰). Accounting is maintained from 22 weeks until the end of the 7th day after birth.

For accurate statistics, it is critically important to distinguish birth statuses:

• Live birth is recorded if the fetus (from 22 weeks) has at least one sign of life. Cutting the umbilical cord or detaching the placenta is not required to record these signs.
• Stillbirth is stated when all signs of life are completely absent.
• Abortion is the death of a fetus before 22 weeks of gestation. Anything occurring at 22 weeks and later is classified as childbirth.

Class and exam questions

What else to study on this topic

• Methods of prenatal diagnostics: ultrasound, CDM, MRI, and silhouette scanning
• History of the development of obstetrics: from Semmelweis to the present day
• Organization of stage II neonatal nursing care
• Fetal surgery and neonatal intensive care

Other topics in the "Obstetrics" section

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