Critical periods of pregnancy

Medical psychologist Fesenko Nadezhda Vasilyevna

Nurse Sultanmutova Zumrud Dzhamalutdinovna

Services provided in female consultation:

Critical periods of pregnancy

1. Treatment of cervical pathology with the Surgitron apparatus;The radiosurgical method of surgitron allows high-frequency energy to concentrate on the tip of the surgical electrode. Surgitron as a radiosurgery method is also preferable in that its technique does not cause painful muscle contraction during the passage of waves through the patient’s body and stimulation of nerve endings. Surgitron allows you to treat many formations, significantly reducing the time for operations. The fabric is easily removed or completely excised. Using this method of radiowave surgery, a wide range of treatment of diseases of the external genital organs, cervix and vagina is performed: in one outpatient procedure, you can cure the cervical deformity zone, perform conization and perform a bloodless biopsy from the cervix surface. Unlike other methods of treating the cervix of the uterus, Surgitron gently removes the thinnest layer of altered skin without causing burns to the surrounding healthy tissue. The procedure is carried out a week after the end of menstruation under local anesthesia (not chipping) or without it on an outpatient basis. After it, women do not need hospitalization and can almost immediately go home.

2. Uterine cervical diathermoecoagulation (DEC) – “cauterization” of erosions of the cervix, dysplasias by electric current – is one of the oldest and proven methods and has been successfully used in treatment. In DEK, an electric-heated knife is used, which not only allows excision of the affected areas of the cervix, but at the same time coagulate the vessels, thereby stopping the bleeding. The efficiency of the method is about 98%. The procedure is carried out in the first half of the menstrual cycle. This method is assigned only by indication. In women who have not given birth, it is used with extreme caution, only if there are clear rationales for the operation and the inability to carry out treatment with the help of a more sparing technique, which also includes laser vaporization used in our clinic. Indications for diathermoelectrocoagulation (DEC) are deep, severe lesions, dysplasia, confirmed by the results of cytology, video-colposcopy, biopsy with a significant risk of malignant transformation. It can also be used for precancerous conditions of the cervix or at its very initial stage. For the purpose of the procedure for the treatment of cervical pathologies (erosions, dysplasias), it is necessary to undergo an examination, to identify the nature of ectopia, the causes of its occurrence. Examination before treatment of the cervix on the apparatus “Surgitron” and DEK:

  • Bacteriological examination – smear on the flora to identify the inflammatory process, infections;
  • Cytological study – the study of the structure of the cells of the cervix;
  • Biopsy – to determine the nature of the pathology;
  • Blood for RW, HIV, Hepatitis B and -C;
  • Video colposcopy – to determine the nature and extent of damage to the neck.

The healing period after applying this method is about 4 weeks.

3. Colposcopy, cervical biopsy – This examination of the cervix under a special microscope. In modern conditions, this procedure allows you to diagnose benign, precancerous and neoplastic processes. During colposcopy, you can perform a biopsy and take pictures of the affected areas. Indications for colposcopy:

  • adverse cellular changes according to a cervical smear;
  • suspected cancer and other diseases, such as genital warts;
  • positive test for human papillomavirus;
  • bleeding after intercourse in women over 40;
  • bleeding outside menstruation;
  • chronic inflammation of the cervix;
  • vaginal discharge and itching;
  • prolonged abdominal pain.

Special preparation for colposcopy is not required. Diet and diet normal. You must adhere to the following restrictions:

  • two days prior to the study, do not douche or wash with intimate hygiene products;
  • use a condom during intercourse;
  • refuse the use of suppositories, vaginal tablets and other drugs for intravaginal use.

It is usually performed on the seventh to tenth day after the onset of menstruation. During this period, cervical mucus is transparent and does not complicate the inspection. The patient should be warned about the possibility of collecting biopsy material during the procedure. Colposcopy is painless and does not cause any unusual discomfort. When taking a biopsy, there may be slight painful sensations.

4. Paypel – endometrial biopsy – or endometrial aspiration biopsy – This is a diagnostic procedure used in gynecology to clarify the diagnosis for infertility and suspicion of various diseases of the uterus. This method got its name from a doctor named Paypel, who invented an instrument for endometrial biopsy. A pipe is a long tube with a hole that is inserted into the uterine cavity. Thanks to the piston at the other end of the tube, the doctor creates negative pressure in it, with the result that Paypel “sucks” the endometrium of different parts of the uterus (almost like a vacuum cleaner). The resulting material is then sent for histological examination under a microscope. Peipel-biopsy is now widely used in reproductive gynecology to diagnose the causes of infertility, as well as before the procedure of in vitro fertilization (IVF). How to prepare for a pipe biopsy? Since the pipe biopsy is contraindicated during pregnancy, you need to make sure that you are not pregnant (you can do a pregnancy test or take a blood test for hCG). Another contraindication for endometrial aspiration biopsy is inflammation of the vagina or cervix. In order to make sure that there are no inflammatory processes, the doctor will smear the flora several days before the procedure. Paypel-biopsy does not require special training. It is enough to follow the basic rules of intimate hygiene, not to douche and not have sex at least 2 days before the biopsy. Examination required before pipe biopsy:

  • general blood analysis;
  • blood on RW;
  • blood for HIV;
  • smear on flora;
  • fluorography;
  • Ultrasound of the pelvic organs;

A pipe biopsy can be performed on different days of the cycle, depending on the preliminary diagnosis and the purpose of the procedure. Check with your doctor on which day of the cycle it is desirable to perform a biopsy in your case. Peipel biopsy is performed in the clinic under local anesthesia. That is, during the procedure, you will be conscious and may experience discomfort. For some women, this procedure seems completely painless, while others report marked pain during a biopsy. Apparently, this is due to the pain threshold, individual for each woman.

5. Ultrasound diagnostics;Screening ultrasound of pregnant women (12-14 weeks, 20-22 weeks, 32-34 weeks) for coupons. Ultrasound “D” – x (planned) gynecological patients on coupons. Emergency patients – on the fact of treatment.

6. Reception of pregnant women, full examination;

7. Gynecological technique: removal or introduction of the IUD (intrauterine contraceptives). Removal or introduction of the IUD is usually carried out during menstruation. Inspection required to remove or inject IUD:

  • general blood analysis;
  • blood chemistry;
  • blood on RW;
  • blood for HIV;
  • smear on flora;
  • fluorography;
  • Ultrasound of the pelvic organs;

For the convenience of patients, there is a viewing room every day.

8. Psychological counseling, psychological training for pregnant women (a crisis pregnancy room is functioning):

  • Psychological readiness for childbirth and admission to the maternity hospital
  • Psychological readiness for childbirth and motherhood
  • Psychological diagnosis of pregnant women
  • Individual counseling psychologist.

9. Mini abortion, or vacuum aspiration is the termination of an unwanted pregnancy in the early stages (up to 5 weeks or up to 20 days of menstruation), by removing the ovum with a special vacuum suction. The whole procedure is performed under local anesthesia. A mini-abortion is performed at the antenatal clinic. A mini-abortion examination can be performed through a viewing room that works daily from

  • general blood analysis;
  • blood on RW;
  • blood for HIV;
  • smear on flora;
  • fluorography;
  • Ultrasound of the pelvic organs;
  • counseling psychologist.

10. Medical abortion – This is the reception of high-speed hormonal drugs that cause spontaneous miscarriage. Medical termination of pregnancy is allowed to perform up to 42 days of amenorrhea (the countdown starts from the first day of the last menstruation to 6 weeks). Medical examination required for medical abortion:

  • general blood analysis;
  • blood chemistry;
  • blood on RW;
  • blood for HIV;
  • smear on flora;
  • fluorography;
  • Ultrasound of the pelvic organs;
  • counseling psychologist.

Medical abortion is performed free of charge on the basis of a day clinic for antenatal clinic. After taking hormonal drugs a woman should be under the supervision of a doctor for at least 2 hours. Two weeks after a medical abortion, you should definitely undergo a pelvic examination and an ultrasound of the pelvic organs. If a continuation of pregnancy is detected, the woman is vacuumed or scraped the fetus (surgical abortion).

Day hospital of female consultationFrom February 3, 2014 on the basis of the antenatal clinic, the day hospital for 5 beds (3 gynecological and 2 obstetric beds) with a three-shift operating mode began to function. The day hospital is intended for carrying out preventive, diagnostic, medical and rehabilitation measures for patients who do not require round-the-clock medical supervision. Day hospital is located in office number 15. obstetrician-gynecologist doctor Shakhmaeva Julia Sergeevna midwife Dmytriv Lyudmila Nikolaevna The order of directions and indications for treatment in the day hospital of antenatal clinicsIn the day hospital, patients come from the clinics of a polyclinic institution, the prevention department, specialized institutions, and also from hospitals. Indications for the treatment of pregnant women in SDP

  • Early toxicosis pregnant.
  • The threat of abortion in 1 and 2 trimesters with a preserved cervix, no bleeding, with a preserved cervix and a history of common miscarriages.
  • Preventive measures at critical periods of pregnancy with miscarriage in history without clinical signs of threatened abortion.
  • Rehabilitation therapy after a long hospital stay.
  • Prevention of rhesus – conflict pregnancy.
  • Prevention of fetal SDR at gestational age 24-25 weeks.

Indications for the treatment of gynecological patients in SDP.

  • Medical rehabilitation of chronic inflammation of the genitals.
  • Rehabilitation treatment after gynecological operations.
  • The implementation of the complex rehabilitation treatment of the complicated abortion.
  • Medical rehabilitation after destructive methods of treatment of benign tumor-like diseases of the cervix uterus (leukoplakia, dysplasia, erosion, eroded ectropion).

The list of small gynecological operations and manipulations to perform in the SDP:

  • Peipel-biopsy of the endometrium and mucous membrane of the cervical canal for cyto-histological examination.
  • Medical abortions
  • Removal and introduction of intrauterine contraceptives (IUD).
  • Pregnant woman hygiene
  • Diet of pregnant women
  • What to take to the hospital
  • Alcohol and pregnancy
  • Fading Pregnancy
  • Psychoprophylactic preparation for childbirth
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