Topic 10 PDF

DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY
DEPARTMENT OF SOCIAL MEDICINE, ECONOMICS AND ORGANIZATION OF

HEALTH CARE
METHODICAL RECOMMENDATIONS
FOR PRACTICAL CLASSES ON THE EDUCATIONAL DISCIPLINE
«SOCIAL MEDICINE, PUBLIC HEALTH»
(MODULE 2. PUBLIC HEALTH)
for the preparation of students of the second (master) level of higher education
branch of knowledge 22 «Health care»
specialty 222 «Medicine» (ІV year)
Topic № 10: ORGANIZATION OF OBSTETRIC-

GYNECOLOGICAL CARE
Lviv – 2020
METHODICAL RECOMMENDATIONS FOR PRACTICAL CLASSES for
preparation of students of the second (master) level of higher education branch of knowledge
22 «Health care», specialty 222 «Medicine» (ІV year) elaborated at the Department of Social
Medicine, Economics and Organization of Health Care, Danylo Halytsky Lviv National
Medical University by the Head of the Department, Associate Professor GUTOR Т.H.,
Associate Professor, KOVALSKA О.R., Assistant of the department BALUKH U.Y.,
Assistant of the department LITVINYAK R.I.
Reviewers: FEDORENKO V. I. – Doctor of Medical Sciences, Professor, Head of the

Department of General Hygiene and Ecology of Danylo Halytsky Lviv
National Medical University.
LUBINEC O. V. - Doctor of Medical Sciences, Professor, Head of the

Department of Public Health Faculty of Postgraduate Education of Danylo
Halytsky Lviv National Medical University.
GUTOR Т.H., KOVALSKA О.R., BALUKH U.Y., LITVINYAK R.I.

Organization of obstetric-gynecological care. Methodological recommendations for
practical classes for preparation of students of the second (master) level of higher education
branch of knowledge 22 «Health care», specialty 222 «Medicine» (ІV year) on the
educational discipline «Social medicine, Public health» (module 2 «Public health»). Lviv,
2020. 28 p.
Methodological recommendations discussed, approved and recommended for printing

at the meeting of the Department of Social Medicine, Economics and Organization of Health
Care and at the meeting of Cycle Methodological Commission «Preventive medicine» of
Danylo Halytsky Lviv National Medical University.
Topic of practical lesson: ORGANIZATION OF OBSTETRIC-
GYNECOLOGICAL CARE
I. ACTUALITY OF THE TOPIC: Maternity and child health care is one of the
most important tasks of the state, a priority direction of the state policy in the field of public
health.
WHO experts recommend to include indicators, which are reflecting the health status
of these populations and characterize the organization of medical and social care for mother
and baby, in the system of indicators, which are used to assess the level of public health.
Among them, the most important are maternal and infant mortality as integral indicators of
assessing the health of women and children, as well as the availability and coverage of
pregnant women by qualified medical care.
The acquiring of knowledge about the organization of this type of medical care
enables future doctors from different medical fields to apply the basic knowledge, acquired in
practice; have the ability to assess the volume and quality of preventive measures.
II. GOAL OF PRACICAL LESSON:

Know:
• organization of maternity health care system;
• current legislative documents of Ukraine on maternity health care;
• principles of organizing women's health care.
Be able to:
• characterize the forms of medical records, which have to be filled out in the
maternity welfare centre and maternity hospital;
• calculate and evaluate statistics on work of the maternity welfare centre and
maternity.
III. THEORETICAL PRESENTATION OF THE TOPIC
ORDER OF THE MINISTRY OF HEALTH OF UKRAINE No 417

from 07/15/2011, approved by Directive of MPH of Ukraine (current revision as of
4/13/2016, grounds - v0353282-16)
Guidelines on the organization of outpatient obstetric-gynecological care
1. General provisions
1.1. Outpatient obstetric-gynecological care is provided in general practice/family
medicine outpatient clinics, maternity welfare centre, gynecological offices of central district
hospitals, rural medical ambulatories, family planning centers and observation rooms in
outpatient clinic.
At level I, outpatient obstetric-gynecological care is provided to the village residents
at general practice/family medicine outpatient clinics (without an obstetrician-gynecologist).
Pregnant women with uncomplicated general and obstetric history, as well as uncomplicated
pregnancy can be under the dynamic supervision of a general practitioner (GP)/midwife, with
the obligatory consultation of an obstetrician-gynecologist in the maternity welfare centre of
central district hospitals - 21 and 30 weeks of pregnancy. In case of obstetric complications,
fetal pathology, exacerbation of the extragenital pathology, the pregnant woman is
immediately transferred to the supervision of an obstetrician-gynecologist.
At the II level, outpatient obstetric-gynecological care for pregnant and gynecological
patients is provided by medical staff of the central district hospitals (hereinafter - CDH),
central city hospital (hereinafter - CCH), city hospital (hereinafter - CH), maternity welfare
centre, gynecological offices of central regional hospitals, family planning centers,
observation rooms in outpatient clinics. In medical and preventive facilities (hereinafter –
MPF) of II level take into account pregnant women without complicated type of pregnancy
and obstetric complications, with concomitant severe extragenital pathology, congenital
malformations of the fetus. In the presence of complications, pregnant women are sent to the
III level of medical care. If necessary, pregnant women are referred to hospitals of day
inpatient facility.
At level III, outpatient obstetric-gynecological care is provided by specialists of
regional hospitals. Level III MPF provides in-depth performance of a medical examination,
which cannot be performed at the previous stages of medical care for pregnant and
gynecological patients.
1.2. Outpatient obstetric-gynecological care includes measures to preserve the
reproductive health of the population, observation of pregnant and gynecological patients, the
prevention and treatment of obstetric and gynecological pathology, family planning, sanitary
and educational work.
1.3. Staff positions of medical personnel of the outpatient obstetric care facility shall
be established in accordance with applicable staff standards.
2. Organization of medical observation of pregnant women

The purpose of medical observation of pregnant women is to maintain the health of
the woman and the birth of a healthy child.
2.1. The first visit of a pregnant woman (preferably up to 12 weeks) is the longest in
time and includes: anamnesis questioning, general and obstetric examination, filling of
medical records (Individual card of pregnant woman and woman in labor - form No 111/о
and Exchange card - form No 113/о), determination of the scope and timing of the laboratory
examination, completion of the pregnancy consent form, information consent.
2.2. The Exchange card is issued to the pregnant woman from the moment of
registration.
2.3. After the first visit, a specialist, who observes a pregnant woman, has to receive
information from a GP/district therapist about the health of the pregnant woman. In the case
of the observation of a pregnant by GP, he fills this application himself.
2.4. Pregnant women with extragenital diseases are subject to dynamic observation by
a specialist. The list of extragenital diseases requiring dynamic monitoring is defined in
Annex 5.
2.5. Women at high risk of developing fetal congenital/hereditary disease should be
referred for medical-genetic consultation.
2.6. Pregnant women, who are not at high risk of developing congenital/hereditary
pathology, should be informed by a GP/obstetrician-gynecologist/midwife, who monitors the
pregnancy, about the examinations (later on, during pregnancy) - ultrasound (11 - 13 weeks,
18 - 21 weeks of pregnancy), biochemical screening of pregnant women (chorionic
gonadotropin (hereinafter - HCG), placental PAPP protein (hereinafter - PAPP) and
calculation of chromosomal fetal risk and other congenital pathology.
2.7. In the case of detecting signs of the presence of congenital or hereditary
pathology of a fetus, the pregnant woman is directed to medical-genetic consultation to
decide the tactics of pregnancy and childbirth. In case of confirmed pathology, a prenatal
consultation is performed with the assistance of an obstetrician-gynecologist.
2.8. An ultrasound examination of the fetus may be performed by an appropriately
trained specialist according to an approved protocol.
2.9. At each visit, all physical, laboratory and instrumental examination data are
entered into the "Individual Card for Pregnancy and Maternity" and "Exchange Card" with
indicating the respective appointments, the date of the next visit and certified by the
physician’s signature and informed consent of the pregnant woman by the form –
(“agree/does not agree”).
2.10. In the case of uncomplicated pregnancy, the optimal number of visits to a
specialist during the observation period is an average of seven to nine times (preferably with
a member of the family).
2.11. In case of complications during pregnancy, if the pregnant woman is observed
by a GP/midwife, she is immediately transferred to the observation of an obstetrician-
gynecologist. The frequency of visits is determined by the doctor according to the case. The
indications for an additional visit should be substantiated in the medical records.
2.12. In case of pregnancy complications, which are requiring treatment in the
hospital (or treatment in a day inpatient facility), the pregnant woman is hospitalized for
examination and treatment at the department of a pregnant maternity hospital (department) or
a specialized obstetric hospital or in a gynecological department (up to 22 weeks) or in a day
inpatient facility.
If the treatment of extragenital pathology is necessary, the pregnant woman is
hospitalized up to 22 weeks of pregnancy in the therapeutic department or in the department
on the profile of the disease or in the department of extragenital pathology of pregnant
women.
2.13. While issuing maternity leave because of pregnancy and childbirth, the doctor is
guided by the Ministry of Health of Ukraine of November 13, 2001 No 455 "On Approval of
the Instruction on Procedure issuance of documents proving temporary disability of citizens".
2.14. Pregnant women and their family members are preparing for future paternity at
the School of Responsible Parenthood at General Practice - Family Medicine Clinics /
Maternity welfare centre. Work is carried out by using demonstration materials, equipment
and child care items.
2.15. If the pregnant woman does not appear for the scheduled examination, the
reason is determined by the specified contact phone. In the absence of 2 or more mandatory
visits and / or systematic failure to follow recommendations and appointments, the physician
/ midwife, who is observing the pregnant woman, should inform the Head of the maternity
welfare centre and the supervisor, who is subordinated to the clinic with a mark in the
medical records.
2.16. In the course of physiological pregnancy, if a pregnant woman is observed by a
GP or feldsher/midwife, she should be referred for consultation to obstetrician-gynecologist
at the time of 19 - 21 and 30 weeks of pregnancy.
3. Organization of outpatient obstetric-gynecological care in the rural areas

3.1. The main directions for the development of obstetric-gynecological care in rural
areas are the creation of a unified system of medical assistance to the population by
maximizing the approximation of medical care to the residents of the village, improving not
only forms, methods of preventive work, dynamic observation, but also medical and social
assistance.
3.2. Outpatient obstetric-gynecological care is provided in maternity welfare centre or
obstetric and gynecological departments, family planning offices of polyclinics of district,
central district hospitals, general practice clinics.
3.3. Advisory assistance to rural female population is provided by city maternity
welfare centres, family planning centers, obstetric and gynecological departments of city,
regional, consultative polyclinics.
3.4. The organization of gynecological assistance to the rural population has a number
of features and general provisions. Preventive gynecological examinations are for girls /
women over the age of 14. Each woman should be examined once a year.
3.5. Outpatient obstetric-gynecological care is performed according to a certain stage:
3.5.1. At the stage I, outpatient obstetric-gynecological care is provided to the village
residents at general practice clinics - family medicine, at the rural medical ambulatories and
the district hospitals (without an obstetrician-gynecologist). Outpatient midwifery work in the
first stage is mainly prophylactic in order to preserve reproductive health, prevent unwanted
pregnancy, complications of pregnancy and gynecological diseases. Practically healthy young
women with uncomplicated general and obstetric history, as well as uncomplicated
pregnancy, can be under the dynamic supervision of midwives, GPs - family medicine,
visiting an obstetrician-gynecologist at a regional hospital.
3.5.2. At stage II, outpatient obstetric-gynecological care for pregnant and
gynecological patients is performed by an obstetrician-gynecologist in RH and CRH, CCH,
CH. Pregnant women without complications of pregnancy can be observed in stage II.
Pregnant women with medium and high obstetric and perinatal risks are constantly observed
by the obstetrician-gynecologist in RH and CRH, CCH, CH.
3.5.3. At stage III, outpatient obstetric-gynecological care is provided by specialists of
regional hospitals. Stage III MPF provides in-depth performance of a medical examination,
which cannot be performed at previous stages of medical care for pregnant and gynecological
patients. If necessary, an advisory examination is carried out by other specialists.
3.6. The rural population is also provided by acomprehensive obstetric-gynecological
care by the outreach teams, which include obstetrician-gynecologist, pediatrician, physician-
therapist and other specialists (if needed).
The outreach teams carry out their activities in accordance with the approved
schedule, which stipulates the date of each departure, its duration, the place of departure, the
composition of the team, which is approved by the Chief doctor of the hospital.
The departure schedule of the health care team is also made known to the GP of
general practice - family medicine, rural medical clinics.
The feldsher and midwife must have a list (register) of women in their district, who
are subject to periodic screening.
3.7. An obstetrician-gynecologist, who is part of the visiting team, is obliged to:
- to carry out examination of pregnant and gynecological patients, to determine the
plan of an observation or treatment;
- to provide consultative assistance to pregnant and gynecological patients;
- provide consultation on family planning;
- to provide medical assistance if necessary;
- provide organizational and methodological assistance on the quality of medical and
preventive work;
- to train staff on current issues identified in the work of RHP staff or general practice
clinics - family medicine;
- to carry out outreach activities (lectures, discussions) on reproductive health among
the population.
3.8. The activity of the outreach team obstetrician-gynecologist must be reflected in
the documentation of the institution, where he works. Identified patients with gynecological
pathology according to the conditions, should be taken into account with the following
measures of recovery. At the second departure, the obstetrician-gynecologist checks the
performance of the obstetrician's FMS appointments and recommendations.
4. Guidelines on the organization of outpatient gynecological care

4.1. The organization of outpatient gynecological care provides measures to preserve
reproductive health, prevent gynecological diseases, identify them early and provide medical
and rehabilitation care.
4.2. Gynecological diseases are detected during the visit of women to a maternity
welfare centre or gynecological departments of a multidisciplinary polyclinic, to a GP -
family medicine, a gynecologist of childhood and adolescence.
4.3. Preventive examinations in the examination rooms are provided for girls from the
age of 14 and all women (with their informed consent). The diagnosis of the disease is made
by the midwife, GP - family medicine, obstetrician-gynecologist or gynecologist of childhood
and adolescence on the basis of complaints, medical history, gynecological examination data
and subsequent examination.
4.4. Carrying out preventive examinations of girls from 18 years (according to
indications from 14 years, they are examined in the presence of parents by the gynecologist
of childhood and adolescence) is entrusted to the midwife, GP - family medicine,
pediatrician, obstetrician-gynecologist and gynaecologist of childhood and adolescence.
Prophylactic examinations are aimed at preserving reproductive health, prevention of
unwanted pregnancy, inflammatory diseases of the genital tract and teenage pregnancy,
infection with human papillomavirus, diagnosis of impaired physical and sexual development
(delay or anticipation), impaired menstruation.
The examination consists of the assessment of the physical and sexual development,
examination and palpation of the mammary glands and examination of the external genitalia.
In case of menstrual dysfunction, suspected gynecological pathology - ultrasonographic
examination of the pelvic organs (ultrasound), recto-abdominal examination of the internal
genital organs, analysis of vaginal discharge. If necessary, hormonal testing, diagnostic tests,
etc. are provided. Sexually active adolescents also undergo: examination of the cervix in
gynecological mirrors, examination for sexually transmitted infections, oncocytology and
colposcopy.
4.5. Preventive examinations of girls/women of 18 years (according to indications
from 14 years, they are examined in the presence of parents by the gynecologist of childhood
and adolescence) are conducted by the FMS midwife, midwife of the examination room of
multidisciplinary polyclinics, GP - family doctor or family planning center, and aimed at
early detection of cancer pathology in women, prevention of sexually transmitted diseases
(STDs) and HIV / AIDS, counseling on family planning and prevention of unwanted
pregnancy, preservation of reproductive health. While carrying out preventive examinations
of women, they carry out examination and palpation of the mammary glands, examination of
the cervix in the mirrors, sampling of vaginal smears for oncocytology (in the absence of
pathology once every 3 years) and bacterioscopic examination, bimanual examination, finger
rectal examination. The ultrasound scan is prescribed according to the case.
APPROXIMATE POSITIONAL INSTRUCTION

of a General Practitioner - family medicine for obstetric and gynecologic care
Medical care of a pregnant woman
Preventive and educative work:
1. Organization and holding of a school of responsible parenthood. Counseling and
education of expectant parents on breastfeeding, umbilical cord and infant skin hygiene, child
safety, sleep and stool patterns, normal physical and mental development of the child,
vaccination schedule, etc.
2. Developing individual recommendations and counseling parents on: malnutrition
and feeding; parent-child relationships, etc.
3. Coordination of solving psychosocial problems that arise in pregnant women and in
their families.
4. Teaching pregnant women a rational diet, nutrition.
5. Counseling and preparation of a pregnant women and their family members for the
birth of a newborn baby.
6. Advice on childbirth preparation.
7. Advising the pregnant woman on the signs of the beginning of labor.
8. Individual and group counseling on family planning, contraceptive methods, incl.
postpartum contraception, prevention of congenital abnormalities, reproductive risks,
endemic diseases; immunoprophylaxis.
Pregnancy diagnosis, observation and organization of the pregnancy route
- Diagnosis and follow-up of pregnant women with physiological pregnancy
according to the current clinical protocol; timely registration of pregnant women (up to 12
weeks);
- Interaction with the second level of medical care delivery (timely referral of the
pregnant woman to the obstetrician-gynecologist and instrumental (ultrasound) and paraclinic
examination;
- Development of an individual plan of action for pregnant women (and adult
members of the family who live with her) at the beginning of labor.
- Planned referral to maternity hospital.
- Identification and management of pregnant women at risk to the highest level of
care: diagnosis of deviations from the physiological course of pregnancy; pointing to the 2nd
level; Level 2 feedback (exchange of information); control over the implementation of
pregnant recommendations of top-level specialists
- Providing care to pregnant women in urgent conditions according to clinical
protocols and guidelines; remote consultation with specialists of the 2nd and 3rd levels and
obtaining from them comprehensive information on the clinical situation; and immediate
referral to a specialist in cases of the prognosis of severe pregnancy complications.
- Oobtaining from the specialists of the 2nd and 3rd levels comprehensive information
on the condition of the woman and the newborn; patronage according to current clinical
protocols and guidelines; postpartum hygiene counseling and breastfeeding support.
- Prevention, early diagnosis and assistance in postpartum complications of mild
course (psychological status, lactostasis, nipple cracks, delayed uterine involution) and
referral (if needed) to the highest level; organization of psychosocial support for other family
members.
Practical and communication skills
Communication skills (including counseling, discussions, lectures, trainings).
Assessment of the status of the pregnant woman, indicators of vital functions, determination
of the degree of urgency of the case; examination in the mirrors, bimanual gynecological
examination, collection of material for cytological and bacterioscopic examination, finger and
rectal examination, examination and palpation of the mammary glands, carrying out and
evaluation of a rapid pregnancy test, measuring the height of standing of the uterine fundus,
examination of the abdomen and date of pregnancy childbirth according to the dates of the
last menstrual period and the first movement of the fetus, determination of the fetal position
in the uterus, assessment of the fetal condition (auscultation of the heartbeat, conducting a
chart), determination of the degree of maturity of the cervix, assessment of the degree of risk
in pregnant women, assessment of paraclinical methods of pregnancy studies.
MODEL PROVISION
on maternity welfare centre
1. Maternity welfare centre is the outpatient-polyclinic facility, created for providing
outpatient obstetric-gynecological medical care for population
2. Maternity welfare centre can be the structural division of maternity hospital or the
territorial medical-prophylactic facility (MPF).
3. The list of rooms offered for maternity welfare centre:
– Chief of the maternity welfare centre room; - senior midwife room; – obstetrician-
gynecologist rooms;
– rooms of specialized receptions: family planning, recurrent pregnancy lost,
gynecologic endocrinology, mammology, uterine cervix pathology, diagnosis and treatment
of the infertility, pediatric and adolescent gynecology, functional and prenatal diagnostics;
– rooms of other specialists: the therapeutist, the stomatologist (dentist), the
phychotherapist (the medical psychologist), the lawyer, etc.;
– physiotherapeutic room; – therapeutic physical training room; room for preparation
pregnant woman for childbirth; – small operating room; – operating room; – room for
temporary postoperative stay; – treatment room; – laboratory; – sterilization room; – a day
inpatient facility; – registry.
4. Planning of activity, financing, staffing, equipping maternity welfare centers by
medical equipment, toolkit and economic stock is spent according to current standards in the
established order.
5. The job management of the maternity welfare centre is carried out by the Chief of
maternity welfare centre.
6. The personnel of maternity welfare centre in the work is guided by the current
legislation, provision about maternity welfare centre, directives, instructions and other current
standards of public health agencies, job descriptions.
7. The settlement area of premises of maternity welfare centre should correspond to
standard requirements shown to medical establishments.
8. The main task of maternity welfare center are:
8.1. The organization and carrying out a complex of preventive measures for
preservation reproductive health of the population including the family planning.
8.2. Carrying out medical-prophylactic measures directed on the prevention of
pregnancy complications, complications of the postpartum period, gynecological diseases on
the basis of modern achievements of a science and a practice.
8.3. Early detection of pregnant women (till 12 weeks of pregnancy) and their regular
medical check-up. Carrying out clinical, functional, ultrasound and laboratory examinations
of the pregnant woman with an application of modern means for definition the degree and the
group of perinatal risk for the purpose of prevention obstetric and perinatal complications.
8.4. Timely detection of diseases in pregnant women and direction on hospitalization
to the department of pregnancy pathology in maternity hospital or to other medical-
prophylactic establishments on a disease profile.
8.5. A referral of pregnant women which require treatment at a day inpatient facility.
8.6. Maintenance of continuity with maternity hospitals, emergency station, polyclinic
and children's polyclinic, specialized MPF (dermato-venereological hospitals, TB dispensary,
etc.).
8.7. Integration to practice of modern diagnostic measures and treatment of the
complications of pregnancy, diseases of lying-in women, gynecological diseases.
8.8. Maintenance in the necessary volume of functional and laboratory examinations
of pregnant women.
8.9. The organization of preparation pregnant women to childbirth - training at
"School of responsible parenthood".
8.10. The organization and carrying out preventive gynecological examinations of
women with use of modern methods of examination (colposcopy, cytology, etc.) for the
purpose of early detecting and treatment gynecological diseases.
8.11. The organization and carrying out consultation of families concerning family
planning.
8.12. Prophylactic medical examination of gynecological patients according to
Standards of medical care for women population on a speciality “Obstetrics and Gynecology”
in outpatient-policlinic conditions.
8.13. Maintenance a legal protection of women according to the current legislation, if
necessary – with participation of the legal adviser.
8.14. Timely granting of maternity leave according to the current legislation, the sick
list in cases of temporary disability of the woman, direction on the treatment-and-consultation
committee (TCC) and medical and social commission of experts (MSCE) according to the
established order.
8.15. The organization of a medical-genetic consultation of spouses and families, in
which there is a high risk of a birth (or having) children with congenital defects or hereditary
diseases.
8.16. Maintenance of drawing up statistical reports on established samples and to
carry out the regular analysis of the activity.
MODEL PROVISION
on the office of cervix pathology of maternity welfare centre
1. The office of cervical pathology is a specialized office in the maternity welfare
centre, which is created in the structure of the maternity hospital, territorial MPF or an
independent medical institution.
2. The position of the doctor of the office of cervical pathology is appointed by the
Chief doctor (maternity hospital, medical-preventive facility or maternity welfare centre)
obstetrician-gynecologist, who has undergone thematic improvement on the issues of cervical
pathology and is constantly improving his qualification.
3. The obstetrician-gynecologist of the Cervical Pathology Office in his work reports
directly to the Head of the maternity welfare centre and to the Head doctor.
4. In the activity the obstetrician-gynecologist of the office of cervical pathology is
guided by this provision, legislative, regulatory documents of health authorities, job
description.
5. Midwife and the junior medical staff is directly subordinate to the obstetrician-
gynecologist of the Cervical Pathology Office.
6. Functional duties of an obstetrician-gynecologist at the Cervical Pathology Office:
6.1. Receive and treat women with pathology of the cervix in the direction of the
midwife examination office, obstetricians-gynecologists.
6.2. Observation of women with pathology of the cervix.
6.3. To establish interaction with the oncogynecologist on timely provision of medical
care to patients with malignant neoplasms of cervical pathology.
6.4. Ensure full and systematic examination of women with cervical pathology.
6.5. To control the timeliness of cytological screening and the accuracy of coverage of
cytological screening of women.
6.6. Conduct sanitary and educational work on prevention of cervical pathology.
6.7. To carry out the analysis on the detection and treatment of pathology of the
cervix.
MODEL PROVISION
on the mammological office of the MPF
1. The mammological office is organized as a part of polyclinics (polyclinic
departments) of city, central, district hospitals, maternity welfare centre for the purpose of
early diagnosis of precancerous and breast cancer and dynamic observation of patients of this
category.
2. A specialist, who has complete higher education (specialist, master's degree) in the
field of "medicine", specialty "medical" in the field "obstetrician-gynecologist", or "surgeon",
who has undergone thematic improvement courses to the post of doctor of the breast
physician and gynecological endocrinologist.
3. The doctor of mammological office reports to the Chief doctor of the polyclinic,
hospital, the structural unit of which is the office, to the Chief doctor of maternity welfae
centre.
4. The Chief physician of the institution on the basis, of which the mammological
office operates, shall be responsible for the state of mammological care to the population of
the district.
5. While organizing mammological office of a polyclinic (a polyclinic department of a
hospital), the Head of this department shall have the function of a district mamologist.
6. Opening and closing of the mammological office is carried out in accordance with
the procedure established by the legislation of Ukraine.
7. The mammological office works according to the plan, which is agreed with the
oncology hospital and approved by the Head of the medical institution, within which the
office is organized.
8. The main tasks of the doctor of the mammological office are:
- reception of patients, who go to the clinic for diseases of the breast;
- providing counseling to patients with breast pathology;
- treatment of patients with precancerous and other diseases of the breast;
- organization of hospitalization in 10-day term in oncological institutes of patients
with suspected or presence of malignant neoplasm for further examination and further
treatment (malignant neoplasms of the breast, pre-invasive forms of breast cancer, malignant
localized diseases and malignant localization breast, nodal forms of breast fibroadenomatosis,
fibroadenomas, cysts, proliferative types of mastopathy);
- screening for breast pathology;
- observation of patients with nodal tumors of the breast should be performed by an
obstetrician-gynecologist, a surgeon, with malignant tumors - an oncologist, by women at
risk - a district doctor, a GP - family doctor;
- consultation and patronage at home of mammological patients, who need it, except
for patients with IV clinical group, who are served by therapists at the precinct;
- conducting an analysis of the reasons for refusals and taking urgent measures for
hospitalization for special or symptomatic treatment of patients with malignant neoplasms;
- keeping records of all patients with benign and malignant neoplasms residing in the
territory of the office's activity, and monitoring the timely sending of reports of each case of
malignant neoplasms to oncology institutes;
- filling in the control charts of terms of examinations of mammological cancer
patients, data on their treatment, life status, and more.
9. The doctor of the breast physician office is involved in organizing anti-cancer
activities in the area of his activity, which include:
-prophylactic examinations of the population by medical staff of medical facilities,
including in the examination rooms;
- medical examination and treatment of persons with pre-neoplastic breast diseases;
- sanitary and educational work among the population;
- organizing a population screening session to detect breast cancer.
10. The doctor of mammological office conducts a systematic analysis of the
diagnostic errors, made by the doctors of the medical establishments, takes personal
responsibility for the quality and completeness of the analysis of the specified cases of
malignant tumors at the cancer commissions. Protocols for the analysis of breast cancer cases
are submitted to the oncology clinics at least once every 2 months.
11. The mammological office should have a separate room for the reception of
patients, storage of medical records and sanitary education,
APPROXIMATE POSITIONAL INSTRUCTION

of an obstetrician-gynecologist of maternity welfare centre
1. The expert with the higher medical education, having primary specialization and
the certificate of a doctor-expert in a speciality of obstetrics and gynecology is appointed to a
post of obstetrician-gynecologist of the maternity welfare centre.
2. Obstetrician-gynecologist of the maternity welfare centre is appointed to a post by
the Head physician of the MPF in accordance to the current legislation.
3. Obstetrician-gynecologist in his work directly subordinate to the Chief of the
maternity welfare centre and the Head doctor.
4. In his activity, the obstetrician-gynecologist shall be guided by this provision,
legislative, regulatory documents of health authorities, job descriptions.
5. The midwife and the junior medical staff is directly subordinated to the
obstetrician-gynecologist.
6. The evaluation of the activity of an obstetrician-gynecologist is carried out on the
basis of the analysis of preventive, diagnostic and treatment measures, indicators of women's
health.
7. Main tasks of obstetrician-gynecologist:
7.1. Сonsult women in maternity welfare centre.
7.2. Visit the sick pregnant women at home on call.
7.3. Perform active obstetric home patronage.
7.4. To carry out active sanitary and educational activity on healthy lifestyle, safe
motherhood, family planning, etc.
7.5. Carry out preventative work to identify complications of pregnancy, as well as
risk factors that threaten the physiological bearing of pregnancy.
7.6. Dynamically monitor the health of pregnant women, ensure, that they are taken to
the observation in early pregnancy (up to 12 weeks).
7.7. Provide a complete and systematic examination of pregnant women by using
clinical, functional, laboratory and ultrasound examination methods for the early detection of
maternal and perinatal pathology, the choice of obstetric tactics depending on the factors of
obstetric and perinatal risk, and the development of a pregnancy management plan.
7.8. To identify in time pregnant women, who are in need of treatment in obstetric and
specialized hospitals, in day inpatient facilities of maternity welfare centre, and to referral
them for treatment to appropriate health care institutions.
7.9. Maintain a permanent contact with maternity hospitals, doctors-specialists of the
polyclinic (therapists, pediatricians and doctors of other specialties), specialized medical
institutions (dermatologists, tuberculosis hospitals and others).
7.10. Conduct classes with pregnant women before giving birth at the School of
Responsible Parenthood.
7.11. To carry out prophylactic gynecological examinations of women by using
modern methods of examination (colposcopy, cytology, etc.) for the early detection and
treatment of gynecological diseases.
7.12. To carry out examination of mammary glands, to teach women methods of self-
examination of mammary glands.
7.13. Advise women on family planning.
7.14. Examination of gynecological patients in accordance with the "Standards of
providing medical assistance to the female population in the specialty "Obstetrics and
gynecology" in the outpatient clinics".
7.15. To promote the legal protection of women, in accordance with current
legislation, with the assistance of legal counsel, if necessary.
7.16. Provide obstetric and gynecological assistance to women working at the
enterprises and institutions of the service area.
7.17. Provide timely maternity leave in accordance with applicable law, issue hospital
letters in cases of temporary disability, and refer them to the medical advisory board and the
MSCE in accordance with the established procedure.
7.18. Direct timely referral to medical-genetic counseling for spouses, young people
going to marriage, families at risk of birth and those with children with birth defects or
hereditary diseases.
7.19. Conduct training for middle and junior medical staff.
7.20. Perform and control occupational safety and fire safety.
8. An obstetrician-gynecologist is entitled to:
8.1. Participate in meetings that discuss issues related to the doctor's work.
8.2. Make suggestions for improving the quality of work.
8.3. To submit to the Head of Maternity welfare centre the proposals on the
imposition of penalties or rewards on people, who are subject to the doctor.
8.4. The doctor has the right, in agreement with the administration, to refuse the
management of the patient, if the latter does not fulfill the medical prescriptions or rules of
the internal schedule of MPF.
INDICATORS
of quality of outpatient obstetric-gynecological care
Quality Indicator Reach Calculation Method A legal

№ Name Criteria document that
No regulates this
quality
indicator
Availability
1 of up-to-date 90% or Number of modern medical Table (list)of
1. medical equipment for more equipment, which have to be Equipment
outpatient obstetric- provided by the list (table) Х approved by
gynecologic care 100 the Order of
the Ministry of
Health of
Ukraine dated
04.11.2010
No 951
Availability of outpatient 95% or Availability of outpatient Legal
obstetric and more obstetric-gynecological documents,
gynecological
2 care assistance in electronic and / or approved by
2. paper formats / number of the Ministry of
approved by the Ministry of Health of
Health of Ukraine Certification Ukraine
Protocol Х 100
Provision of training of 95-98% Number of medical workers Journal of
medical
3 staff to medical- involved in the implementation medical
3. organizational of Certified Protocols and personnel
technologies of Certified received training on medical- training
Protocols organizational technologies of
the existing Certified Protocols
and Local Certified Protocols /
total number of medical workers
involved in the implementation
of Local Certified Protocols)
Х 100
Timeliness of registration 90,0- Number of women registered for Individual card
of
4 pregnant women, % 95,0% up to 12 weeks of pregnancy / of the pregnant
4. total number of women woman and
registered for pregnancy and post-parturient
childbirth X 100 woman, 111/о,
F. 21
Pregnancy ultrasound 98,0 - Number of pregnant women Individual card
coverage
5 99,0% who undergo ultrasound twice of the pregnant
5. during pregnancy up to 21 woman and
weeks / total number of women post-parturient
registered for pregnancy and woman, 111/о,
childbirth X 100 F. 21
Pregnancy coverage for 90,0 - Number of pregnant women Individual card
HIV
6 / AIDS detection 95,0% who have been tested for HIV / of the pregnant
6. AIDS twice during the woman and
pregnancy up to 23 weeks / total post-parturient
number of women registered for woman, 111/о
pregnancy and childbirth X 100 F. 21
Pregnancy coverage on 99,0 - Number of pregnant women Individual card
HBsAg
7 99,5% surveyed for / total number of of the pregnant
7. women who were registered for woman and
pregnancy and childbirth Х 100 post-parturient
woman, 111/о,
F. 21
Frequency of antenatal 5.4 per Number of pregnant women Individual card
fetal
8 death 1000 who had antenatal fetal death at of the pregnant
8. pregnant 22 weeks and above / total woman and
women number of women who were post-parturient
and less registered for pregnancy and woman, 111/о,
childbirth X 1000 F. 21,
data of
Statistical
Office
Cervical cancer screening 70,0 - Number of women 18 years and Outpatient
9 75,0% older screened for cervical medical
9. or more cancer / total number of women card, F. 20
18 years and older X 100
Cancer
1 detection at I-II Number of detected women with F. 35
10 stages: specific cancer in stage I - II /
total number of first registered
- breast cancer 80,0 - patients with specific cancer X
90,0% 100
- cervical cancer 75,0 -
90,0%
- uterine cancer 75,0 -
85,0%
- ovarian cancer 40,0 -
55,0%
Mortality
1 rates up to 1 Number of deaths of women F. 35
11 year: within one year after the
detection of cancer / number of
- breast cancer 8,0% women with cancer first
and less detected in the previous year X
- cervical cancer 12,0% 100
and less
- uterine cancer 8,0%
and less
- ovarian cancer 20,0%
and less
STANDARDS
of providing outpatient medical care to the female population by specialty
"obstetrics and gynecology"
GENERAL MEASURES FOR PREVENTING OBSTETRIC-

GYNECOLOGICAL PATHOLOGY.
1. Recommendations on forming a healthy lifestyle.
2. Recommendations on family planning.
3. Recommendations for STD prevention.
4. Training in the method of breast self-examination.
5. Carrying out an oncocytological examination of the cervix.
6. Determination of IgG levels to CMV, HSV, toxoplasma, serum chlamydia before
planned pregnancy.
GENERAL MEASURES TO PREVENT COMPLICATIONS OF
PREGNANCY.
1. Recommendations on nutrition during pregnancy.
2. Recommendations on prevention the effects of harmful factors on the body of a
pregnant woman.
3. Informing about the dangers of self-medication during pregnancy.
4. Recommendations on employment during pregnancy.
STANDARD EXAMINATION OF WOMEN DURING PREGNANCY.
1. Anamnesis (general, including mental illness, obstetric, gynecological, health status
of the father of the child).
2. General examination; palpation of the thyroid gland; auscultation of the heart and
lungs; breast examination and palpation; palpation of lymph nodes, measurement of height,
body weight.
3. Breast examination and palpation; measurement of the height of standing of the
uterine bottom; measurement of blood pressure, heart rate (frequency, rhythm), body
temperature; measurement of body weight; examination of the lower extremities for varicose
veins; auscultation of fetal heart rate (all pregnant women from 25 - 26 weeks of pregnancy).
4. Gynecological examination (in mirrors and bimanual examination) (at registration).
5. Laboratory tests:
- general urine analysis, including a protein test (at registration and at each visit);
- urine culture to detect asymptomatic bacteriuria (at registration);
- determination of blood group and rhesus-affiliation (at registration);
- blood test for antibodies with Rh negative blood count (at 28 weeks of age).
- general blood test with platelet count and hematocrit (at 29 weeks of pregnancy, as
indicated);
- serological examination for syphilis (first at registration, second - at 29 weeks of
pregnancy);
- test for the presence of HbsAg (at registration);
- a two-hour glucose tolerance test (all pregnant women at 25-26 weeks).
6. HIV test (the first at registration, the second at 22 - 23 weeks of pregnancy). If the
test is positive, no re-examination is scheduled. In the case of the first treatment of a pregnant
woman within 23 weeks - she is immediately assigned to a blood test for HIV and in case of a
negative result, a re-examination is carried out no later than 32 weeks of pregnancy. In the
case of the first pregnancy of the pregnant woman after 30 weeks of pregnancy - she is
immediately assigned to a blood test for HIV and in case of negative result, a second
examination is performed by express method in childbirth
7. Ultrasound examination: First - at the age of 11 weeks. + 1 day - 13 weeks + 6 days
of pregnancy; The second - in the period of pregnancy 18 - 21 weeks. The third planned
ultrasound is determined individually (high risk of congenital heart defect, etc.).
GENERAL EXAMINATION OF PATIENTS WITH GYNECOLOGICAL
PATHOLOGY
1. Anamnesis.
2. General physical examination.
3. Clinical examination of the mammary glands.
4. Examination of the cervix and vagina in the mirrors.
5. Colposcopy.
6. Bimanual gynecologic examination.
7. Ultrasound of pelvic organs.
8. Oncocytological examination for the cervix.
9. Blood tests for syphilis; HIV (with informed consent).
STANDARD EXAMINATION OF PATIENTS WITH GYNECOLOGICAL
PATHOLOGY OF CHILD AND ADOLESCENT
1. Anamnesis.
2. General physical examination.
3. Clinical examination of the mammary glands.
4. Bimanual recto-abdominal examination.
5. Ultrasound of pelvic organs.
6. Feces analysis on worm eggs.
INDICATIONS
to the referral of the pregnant woman to medical-genetic counseling
1. Age of pregnant 35 years and older. Age of man 40 years and older.
2. The presence of one of the spouses hereditary pathology, chromosomal
rearrangement or congenital defect.
3. Presence in pregnant phenylketonuria, cystic fibrosis and other hereditary diseases
4. The presence in the family of living or dead children with:
- hereditary or chromosomal pathology;
- congenital malformations - isolated or multiple;
- mental retardation;
- stillbirth.
5. The presence of the above-mentioned pathology among relatives.
6. The usual miscarriage of pregnancy of unspecified genesis in the first trimester of
pregnancy.
7. The complicated course of pregnancy (the threat of termination from an early term,
which is not amenable to therapy, hydramnious and oligoamnios).
10. Pregnant women after IVF.
11. Fetal pathology revealed during prenatal screening (ultrasound, biochemical
markers, high individual genetic risk of chromosomal and some congenital pathology).
12. The presence in the spouse of harmful factors associated with the profession.
LEVELS OF PROVIDING
inpatient obstetric-gynecological care to the population
1st level - district, central district and city hospitals, which have no anesthesiology
department and resuscitation departments. Round-the-clock watch of the anesthesiologist is
provided.
Medical facilities of this level provide deliveries of pregnant women with a low
degree of obstetric and perinatal risk of developing complications, and also provide medical
care to gynecological patients. At the same time they have:
- a well-established system for identifying patients at high risk for the development of
perinatal complications and for referral such patients to an establishment of higher level;
- the ability to diagnose and provide supportive treatment for unforeseen maternal and
fetal problems which occurred during childbirth;
- ability to start Cesarean section surgery within 30 min. after determining its necessity;
- a constant supply of blood products, blood substitutes and medicines to provide urgent
obstetric, gynecological and neonatal care;
- the possibility of providing anesthesiology care, and also conducting an initial
(urgent) laboratory examination around-the-clock;
- opportunities to provide medical care for healthy full-term newborns;
- ability to provide full primary resuscitation care, carry out oxygen therapy and
stabilize the vital functions of all newborns born at the establishment until their transfer to a
higher-level medical establishment.
2nd level - district hospitals, central district hospitals and obstetric departments of city
hospitals, city maternity hospitals, which have anesthesiology and resuscitation departments,
and also there’s neonatologist on duty around-the-clock.
Medical facilities of this level provide deliveries of pregnant women with low and
high (according to the combination of factors) degree of obstetrics and perinatal risk, and also
perform all the functions of 1st level establishments, including providing of qualified care to
gynecological patients, except the specialized gynecological care.
Medical establishments of 2nd level must provide medical care for newborns with
weight
> 1800g (gestational term >= 34 weeks) with diseases without significant deviations
of vital functions.
3rd level - city, regional maternity hospitals, perinatal centers and centers of
reproductive health which are clinical bases of departments of obstetrics and gynecology with
III-IV accreditation level, and also labor departments of regional hospitals, which have
department of obstetrical and newborn resuscitation; the Institute of Obstetric and
Gynecologic Pathology AMS of Ukraine.
Medical facilities of this level provide deliveries of pregnant women with extremely
high and high degree of obstetrics and perinatal risk, with severe extragenital pathology,
provide specialized care for gynecologic patients, and perform all the functions of 1st and 2nd
level establishments.
Medical facilities of 3rd level must provide medical care for newborns with weight
<=1800g and gestational term < 33 weeks regardless of existing pathology, and also for all
newborns with severe illnesses or any deviations of vital functions.
REQUIREMENTS
to ethics and deontology in modern obstetric and gynecological practice
1. The issue of psychological support for women
during childbirth, the role and task of medical
workers who provide medical care
At all stages of obstetric care, a woman is guaranteed the right to receive prompt
information from health care providers about her health and the fetus (newborn), all medical
interventions and examinations, their necessity or expediency, possible consequences in
accordance with the current legislation. Such information is provided by a physician,
obstetrician or nurse in a calm ambience, taking into account the psychological state of the
woman (at her request - confidential). After receiving the information, the woman is asked to
consent to the necessary medical interventions for her or her child.
In order to avoid conflict situations, complications during childbirth and the
postpartum period, it is advisable to carry out the process of providing medical care to
pregnant women, parturient women and newborns of maternity hospitals on the basis of
understanding with patients, respect for them, and their involvement in taking care. The
normal psycho-emotional state of a pregnant woman and parturient woman contributes to the
physiological course of labor and the postpartum period.
The principles of confidentiality must be observed during childbirth: the delivery
room provides for the stay of one parturient woman and her (at her will) family members,
whose task is to provide psychological support for the parturient woman, and medical staff
directly responsible for the delivery. The woman is also guaranteed the right to choose a
person for psychological support during childbirth and the respect of medical staff to her
choice.
2. Psychological aspects of medical staff activity
when solving issues about termination
of pregnancy on indications
2.1. In the presence of indications for pregnancy termination, the obstetrician-
gynecologist has to consult a pregnant woman and provide her for the information about the
validity of the termination, the volume of medical interventions and rehabilitation in the
postoperative period, provide psychological support.
2.2. Pregnancy is terminated by informed consent in accordance with the current
legislation.
2.3. The information about possible negative effects of pregnancy prolongation should
not be represented as threatening statements in such cases, according to the psychological
state of pregnant woman and her relatives.
2.4. Women who want to terminate their pregnancy due to the medical indications,
are provided with detailed information on the possible consequences for their health.
RECOMMENDATIONS
on postpartum and post-abortion counseling
Postpartum counseling is performed in the postpartum department by a midwife,
obstetrician-gynecologist, neonatologist.
The purpose of postpartum counseling is to familiarize the mother and her relatives
with the changes in the body of women occurring in the postpartum period; provide
information on postpartum hygiene, current methods of preventing untimely and unwanted
pregnancy, including contraception; nutrition, the benefits of breastfeeding a newborn and
caring for a newborn.
Post-abortion counseling is performed by a gynecologist who performed an abortion.
The purpose is to inform women about possible complications of the post-abortion
period and methods of their prevention, on issues of sexual relations hygiene, modern
methods of contraception, healthy lifestyle, prevention of sexually transmitted infections.
The timeliness of contraception in preventing unwanted pregnancy has a great value.
Individual contraceptive selection is performed by a trained family planning specialist in
accordance with current methods and principles of use.
MODEL PROVISION
about maternity hospital
1. Maternity hospital is an independent MPF providing inpatient obstetric-
gynecological and neonatal care.
2. The maternity hospital is subordinate to the territorial health authority.
3. The maternity hospital may be the clinical base of the obstetrics and gynecology,
neonatology departments of higher medical educational establishments.
4. The management of the maternity hospital is performed by the Chief physician,
who is appointed to the position and dismissed by the property owner.
5. Planning of activities, financing, staffing, equipping maternity hospitals with
medical equipment, tools, household implements and equipment should be carried out
according to current standards in the established order.
6. Maternity hospital structure:
– admission examination department;
– department of pregnancy pathology;
– department of physiological labor with independent labor wards and pre-labor
rooms (independent labor wards without pre-labor rooms in the presence of conditions);
– postnatal physiological department with beds of stay of mother and the child; (with
mutual stay of mother and the child);
– department of neonatology care and treatment;
– observation department with independent labor wards and pre-labor rooms;
– anesthesiology department with emergency wards; department of newborn
emergency; blood transfusion department; department of operative gynecology; department
of conservative gynecology; maternity welfare centre; department of diagnostics with
ultrasound diagnostics room, radiology department (room); laboratory; day inpatient facility;
– organizational and methodological department with accounting and medical
statistics office, equipped with modern means of reception and transmission of the
information; – pharmacy;
– central sterilization department with a disinfection department;
– economic department; medical archive.
7. The main tasks of maternity hospital are:
7.1. Providing for qualified inpatient medical-diagnostic care to pregnant women,
parturient women, newborns and gynecological patients in accordance with the "Standards of
inpatient obstetric-gynecological and neonatal care".
7.2. Providing patients with urgent obstetric-gynecological and neonatal care.
7.3. Providing patients with qualified anesthesiological and resuscitation care.
7.4. Implementation into practice modern means of diagnostics and treatment of
pregnancy complications, parturient women diseases, gynecological diseases.
7.5. Timely referral of patients to the medical facilities of a higher level in accordance
with the determined levels of obstetric and gynecological care organization in Ukraine.
7.6. Implementation of measures for the prevention of nosocomial infections.
7.7. Organization of medical and diagnostic assistance in the field of reproductive
health for spouses, young people, people who are married at the inpatient stage.
7.8. Organization and providing for specialized counseling to the patients of the
maternity hospital.
7.9. Carrying out cytological screening for cervical pathology of all patients who
asked for medical care for the first time in the reporting year.
7.10. Organization of joint stay of mother and newborn in accordance with the
requirements of current regulations.
7.11. Improvement of organizational forms of medical care for pregnant women,
parturient women, newborns and patients with gynecological pathology.
7.12. Analysis of indicators of women’s and children’s health, indicators of the
quality of providing obstetric-gynecological and neonatological care to the population,
development of measures for their improvement.
7.13. Maintaining appropriate forms of accounting, reporting and statistical
documentation, providing information about the activity of the establishment to the territorial
health authorities timely.
MODEL PROVISION
about obstetrician-gynecologist of obstetrics
(gynecological) department
1. The post of obstetrician-gynecologist of the obstetric (gynecological) department is
assigned by a specialist with higher medical education who has passed primary specialization
and holds a certificate of a specialist in the specialty of obstetrics and gynecology.
2. The obstetrician-gynecologist is appointed to the post and dismissed by the Chief
physician of the MPF in agreement with the Head of the department.
3. The obstetrician-gynecologist reports to the Head of the department and carries out
the work under his direction.
4. The obstetrician-gynecologist in his work is guided by this provision, current
legislation, orders and instructions of health authorities, job descriptions.
5. The main tasks of the obstetrician-gynecologist are:
5.1. Providing for qualified scheduled and emergency inpatient obstetric-
gynecological care according to the qualification category.
5.2. Compliance with the rules of medical ethics and deontology.
5.3. Control for the performance of medical prescriptions, manipulations by
specialists.
5.4. Carrying out analysis of indicators of the work, efficiency and long-term results
of treatment of patients.
5.5. Secure timely filling in and giving out documents concerning maternity leave,
sick list in cases of TD, directing to TCC or MSCE examination.
5.6. Carrying out of sanitary and educational work on questions of preservation and
promotion of reproductive health; prevention of complications of pregnancy and childbirth;
prevention of STDs, HIV, AIDS; birth defects, cancer, etc.
5.7. Implementation of the "Standards of the providing for inpatient obstetric-
gynecological and neonatal care".
5.8. Upgrading the level of his qualification.
5.9. Holding of modern methods of examination, diagnosis and treatment of obstetric,
gynecological pathology.
5.10. Maintaining primary medical records in accordance with the requirements of
industry regulations.
5.11. Participation in detours with the Head of the department.
5.12. Timely informing the Head of department about the condition of severe patients.
5.13. Duties according to the approved schedule.
5.14. Providing information to relatives about the health of patients in accordance
with the principles of medical ethics and deontology.
5.15. Compliance with the rules of personal protection when working with blood.
5.16. Providing measures to prevent social orphanage.
Accounting records:
-Individual card of pregnant woman and post-parturient woman(f. No 111 / o);
-Record of pregnant woman of maternity hospital, maternity department of hospital (f.
No 113/o);
-History of pregnancy and childbirth (f. No 096 / o)
-Report on medical care for pregnant women and post-parturient women in 20__ year
(f. No 21).
IV. CONTROL QUESTIONS

FOR ESTIMATION OF THEORETICAL KNOWLEDGE
1. Briefly explain the organization of outpatient obstetric-gynecological care.
2. Briefly explain the organization of medical care for pregnant women.
3. Explain the organization of outpatient obstetric and gynecological care in the
countryside.
4. The primary dutyes of the family physician for the providing of obstetric and
gynecological care.
5. Briefly explain “Model provision on maternity welfare centre”.
6. Briefly explain “Model provision on the women's examination room”.
7. Briefly explain “Model provision on the office of the cervix pathology of maternity
welfare centre”.
8. Briefly explain “Model provision of mammological office”.
9. Basic principles of the activity of an obstetrician-gynecologist in maternity welfare
centre.
10. Briefly explain “Model provision on the maternity hospital”.
11. Describe recommendations for postpartum and post-abortion counseling.
12. Describe the requirements for ethics and deontology in modern obstetric and
gynecological practice.
13. Describe the content of “Individual card of pregnant woman and post-parturient
woman” (f. No 111 / o).
14. Describe the purpose of “Record of pregnant woman of maternity hospital,
maternity department of hospital” (f. No 113 / o).
15. Describe the content of “History of pregnancy and childbirth” (f. No 096 / o).
V. SITUATIONAL TASKS FOR PRACTICALL SKILLS FORMATION
Situational task No 1
According to the situational task you need to:
I. Determine source of statistical information in the situational task.
II. Calculate: – morbidity rate among all women in Lviv region and Ukraine;
– morbidity rate among all women in age group 15 years and older in Lviv region and
Ukraine.
Disease level among all women and women in age group 15 and older (abs. data)
Total Women in age group 15 years and older

Women in age
Territory Total number of General
group 15 and older General morbidity
women morbidity
Lviv region 1,363,393 2,248,238 1,137,660 1,833,905

Ukraine 25,693,782 45,114,027 22,022,692 38,511,052
II. Analyze received data using rate of visibility and graphically represent achieved
statistical rates.
Results of pregnancy examination and supervision in maternity welfare centre (%)
Therapeutist
Examination
examination
Twice
Early
Wasserman HIV Ultrasound
Territory pregnancy Alpha-
Before test before test examination
supervision Total fetoprotein
12 weeks 30 weeks before before 28
30 weeks
weeks
Lviv region 85,15 96,97 84,32 30,30 96,74 91,77 94,20
Ukraine 86,03 98,30 85,56 14,98 98,06 97,51 95,73
II. Analyze organization of medical-prophylactic care for pregnant women in
Pregnant woman, 35 years old, at 10 weeks of gestation (2nd pregnancy), worked at a
chemical plant. In anamnesis there were spontaneous abortions. Maternity welfare centre has
given conclusion about woman transferring to work without hazards.
Pregnant woman was examined by therapeutist (in 15 weeks), dentist (in 10 weeks),
carried out laboratory examinations, Wasserman test, defined Rh-factor.
Pregnant visited the maternity welfare centre once per month till childbirth. There
were 8 visits to doctor. Pregnant also visited the Motherhood School and trainings on psycho-
prophylaxis of childbirth.
The outcome of childbirth: two full-term newborns. Childbirth complications:
perinatal bleeding. Parturient woman visited the maternity welfare centre after 30 days from
discharge from the maternity hospital.
II. Calculate:
– rate of surgical interventions during childbirth in Lviv region and Ukraine;
– rate of structure of all kinds of surgical interventions during childbirth in Lviv
region and Ukraine.
Surgical intervention during childbirth in Lviv region and Ukraine
Lviv region Ukraine

Type of surgical care during
childbirth Total (abs.data) Total (abs.data)
Application of obstetrical forceps 59 1,472

Vacuum extractions 0 280
Cesarean section (except small vaginal) 2,640 52,131
Fetus-destroying operation 47 180
Total number of childbirth in Ukraine – 400,909, in Lviv region – 24,287.
Pregnant woman, 32 years old, at 15 weeks of gestation (2nd pregnancy), worked as
accountant. In anamnesis there were spontaneous abortions of unknown etiology. Passed
examinations: UA, CBC, Wasserman test, HIV test. Positive Rh-factor was determined. Same
examinations were repeated and treatment were hold. Pregnant woman was examined by
therapeutist, dentist, ophthalmologist. No extragenital diseases were defined.
There were 10 visits to the maternity welfare centre. Pregnant woman visited the
Motherhood School after 20 weeks of gestation. Hospitalized to childbirth department for
preventive measures after 28 weeks. Preterm childbirth after 36 weeks. Newborn (weight
2100 g) was directed to the neonatology department. Parturient woman discharged from the
maternity hospital after 4 weeks under the maternity welfare centre supervision. Parturient
woman visited the maternity welfare centre after 28 days from discharge from maternity
hospital.
II. Calculate: – rate of structure of diseases appeared during pregnancy and
complicated pregnancy, childbirth, postnatal period among women in Lviv region and
Ukraine;
Diseases appeared during pregnancy, complicate pregnancy, childbirth, postnatal
period among women in Lviv region and Ukraine
Lviv region Ukraine

Nosology
Total Total
Edema, proteinuria, hypertension 2,370 46,780
Genito-urinary diseases 2,392 66,898
Cardiovascular diseases 616 26,878
Diabetes 17 322
Diseases of thyroid gland 3,875 40,400
Anemia 8,224 153,936
Total
Total number of childbirth in Ukraine – 400,909, in Lviv region – 24,287.
Pregnant woman, 30 years old, at 11 weeks of gestation (1st pregnancy), worked as
cook. Pregnant woman was examined by therapeutist (twice), dentist. Therapeutist found
wheeze in lungs, focuses of sclerosis. Treatment and additional examination (X-ray imaging
of lungs) were hold. Passed examinations (at 15 weeks): Wasserman test, HIV test,
ultrasound examination.
Blood on Rh-factor was not examined. In second part of the pregnancy there was no
therapeutist consultation. Pregnant was examined 12 times by the obstetrician-gynecologist
before childbirth; visited the Motherhood School after 23 weeks.
At hospitalization to the maternity hospital there was found a rush on forearm.
Childbirth was in the physiological department on February, 2nd. There were no
complications of childbirth. Parturient woman visited the maternity welfare centre after 32
days from discharge from maternity hospital.
II. Calculate: – morbidity rate among all women in Lviv region and Ukraine; –
morbidity rate among girls in age group 0-17 years in Lviv region and Ukraine;
General morbidity among all women and girls in age group 0-17 years (abs.data)
Total Girls in age group 0-17 years
Total number of
Territory Total number of
Morbidity girls in age Morbidity
women
group 0-17 years
Lviv region 1,363,393 2,248,238 225,733 414,333
Ukraine 25,693,782 45,114,027 3,671,090 6,602,975
IІ. Calculate:
– perinatal mortality rate in obstetric department;
– newborns morbidity rate;
– morbidity rate of pregnant women, women in childbirth, post-parturient women in
obstetric department.
Data about activity in obstetric department of the maternity hospital (abs. data)
Department Total
number of dead
Total
pregnant women
Total number of Total number
Total number (after 28 weeks),
Obstetric number of children, of alive
of children women in
department of alive died at newborns and
with diseases childbirth,
maternity hospital newborns first 168 stillbirth
obstetric post-
hour
parturient women
in department
№1 673 8 678 43 3
№2 481 3 489 29 2
II. Calculate:
– childbirth rate per 100 thousand women in age group 15-49 years in Lviv region
and Ukraine;
– structure (%) of complications in childbirth in Lviv region and Ukraine.
Childbirth care and total number of complications in childbirth in MPF in Lviv

region and Ukraine (abs. data)
Total number of
Complications in
Territory Women in fertile age (15-
Childbirth childbirth
49 years)
Lviv region 673,892 24,287 15,230
Ukraine 12,516,747 400,909 270,143
II. Analyze organization of medical-prophylactic care for pregnant woman in
Pregnant woman, 23 years old, worked as officer. At 11 weeks of gestation (2nd
pregnancy). Passed examinations: UA, blood test with determining platelets number,
Wasserman test, HIV test. Pregnant was examined by therapeutist, dentist. Ultrasound
examination: at 24 weeks of gestation. No extragenital diseases were defined. Pregnant
woman visited the maternity welfare centre once per 2 months till childbirth.
At 18 weeks after a business trip addressed to doctor with the complication on pain in
lower abdomen; follow hospitalization for 2 weeks. She visited the Motherhood school. After
22 weeks the exercise therapy was administered.
In the second half of a pregnancy there was mild edema on legs. She hasn’t finished
psychoprophylactic training because of preterm childbirth in 33 weeks, which end by
delivery of preterm newborn. The newborn was redirected to the newborn’s pathology
department.
The newborn was discharged with weight 2700 g, in good general condition.
Parturient woman visited the maternity welfare centre after 2 months from discharge from the
maternity hospital with complaints on pain in lower abdomen.
II. Calculate:
– rate of early and late registration of pregnant women in maternity welfare
centre;
– ratу of pregnant women examined by dentist, by therapeutist, and rate
pregnant women with Rh-factor detection
Results of maternity welfare centre work in N-city (abs. data)
Registered in
Total number of examined
Total number maternity welfare centre at
pregnant women
of registered gestation term
Maternity
pregnant By
welfare
women in therapeutist
centre Before 12 After 12
maternity By dentist in first 3 Rh-factor
weeks weeks
welfare centre month of
pregnancy
№1 1,121 902 131 1,107 679 1,119
№2 685 667 54 660 502 681
Pregnant woman, 24 years old, at 7 weeks of gestation (2nd pregnancy), worked as a
record keeper on a knitted goods factory. In anamnesis there were miscarriages of unknown
etiology. Pregnant woman was examined by therapeutist, dentist. Laboratory examinations
were carried out 3 times during pregnancy. Wasserman test was made one time.
Systematically visited the maternity welfare centre.
Woman were hospitalized in the maternity hospital, where gave birth to the full-term
newborn. There was a manual placental separation during childbirth.
II. Calculate:
– rate of early and late registration of pregnant women in maternity welfare
centre;
III. Analyze received data and graphically represent achieved statistical rates.
During G-year in B-city in maternity welfare center were registered 3,126 pregnant
women, among them: before 12 weeks of gestation – 1,831, 12-28 weeks – 1,075, after 28
weeks of gestation – 220 pregnant women.
VI. RECOMMENDED REFERENCES

1. Public health: a textbook for students of higher medical education institutions/
[B.F.Moskalenko, O.P.Gulchii, T.S.Gruzieva]; ed. by V.F.Moskalenko – 3rd reissue: Nova
knyha, 2013.-560p
2. Social Medicine and Organization of Health Care: Teach manual for higher
medical education institutions/ [Yu.V. Voronenko, V.F. Moskalenko, O.G. Protsek, and
others]; for ed. Yu.V.Voronenko, V.F.Moskalenko – Ternopil: Ukrmedkniga, 2000. – 680p.
3. Bases of the legislation of Ukraine on health care. Law of Ukraine. No 2801-
XII November 19, 1992 (as amended on 20-12-2019). URL:
https://zakon.rada.gov.ua/laws/show/2801-12.
4. Order of MOH No 417 from 13.04.2016 «On improvement outpatient obstetric-
gynecological care in Ukraine». URL: https://zakon.rada.gov.ua/rada/show/v0417282-1
5. Order of MOH No 620 from 29.12.2003 «On organization inpatient obstetric-
gynecological and neonatal care». URL: https://zakon.rada.gov.ua/rada/show/v0620282-03.
6. Individual card of the pregnant woman and post-parturient woman (f. No 111/о).
URL: mozdocs.kiev.ua/forms/f111_0.doc
7. Pregnant record of maternity hospital, maternity department of hospital (f. №113/о).
URL: https://zakon.rada.gov.ua/go/z0224-06
8. History of pregnancy and childbirth (f. №096/о). URL:
www.medconsulting.com.ua/f/formu/29/f096_.doc
9. Report on medical care for pregnant women, women in childbirth, lying-in women
for 20 __ year (f. № 21). URL: https://zakon.rada.gov.ua/go/z1019-07
10. Legislation of Ukraine. E-source: zakon.rada.gov.ua/
11. Medical Legislation of Ukraine. E-source: http://mozdocs.kiev.ua/
12. Statistics data of Ukraine. E-source: https://www.lv.ukrstat.gov.ua/
13. Statistics data of Lviv region. E-source: http://www.ukrstat.gov.ua/
14. Lecture materials.
APPROVED BY
Order of MOH of Ukraine
No 258 from 03.07.2001
THE INSTRUCTION
on filling of an “Individual card of the pregnant woman
and post-parturient woman” (form No 111/o)
"Individual card of the pregnant woman and post-parturient woman” (form No 111) is
filled on each pregnant woman who has addressed to the maternity welfare centre.
Passport data, anamnesis (especially detailed about a course and outcome of previous
pregnancies), data about woman’s health condition before addressing to the maternity welfare
centre, results of the general and special obstetric examination, the conclusion of the
therapeutist and other specialists about woman’s health condition are filled into "Individual
card of the pregnant woman and post-parturient woman” (form No 111/o).
At repeated visiting – complaints, data of objective examination and prescriptions are
registered in the special part of "Individual card of the pregnant woman and post-parturient
woman” (form No 111/o). These data allow to see dynamics of some objective indicators of a
condition of the pregnant woman and a fetus, and to take measures in case of their deviation
from norm.
Last page of “Individual card of the pregnant woman and post-parturient woman”
(form No 111) is intended for record of data on a course and outcome of childbirth, and also
during the postnatal period after discharge of the parturient woman from a maternity hospital.
After putting off the woman from regular medical check-up "Individual card of the
pregnant woman and post-parturient woman” (form No 111/o) signed by the attending
physician and the Chief of maternity welfare centre arrives in archive of maternity welfare
centre/maternity hospital.
On the pregnant women who have addressed to maternity welfare centre for an
abortion, "Outpatient's medical card" (form No 025/o) is filled.
Shelf life of “Individual card of the pregnant woman and post-parturient woman”
(form No 111/o) is 5 years.
Approved by
No 67 from 13.02.2006
THE INSTRUCTION
on filling in the “Record of pregnant woman maternity hospital, maternity
department of hospital”
(Information about pregnant woman from maternity welfare centre)
(form No 113/o)
“Record of pregnant woman of maternity hospital, maternity department of hospital”
(Information about pregnant woman from the maternity welfare centre) (form No 113)
consists of three detachable coupons: “Information about pregnant woman from maternity
welfare centre”, “Information about parturient woman from maternity hospital, maternity
department of hospital”, “Information about newborn from maternity hospital, maternity
department of hospital” and assigned for carrying out supervision of the woman and child in
the maternity welfare centre, the obstetric department and the children polyclinic. “Record of
pregnant woman of maternity hospital, maternity department of hospital” (Information about
pregnant woman from maternity welfare centre) (form No 113) is given out by the maternity
welfare centre for each pregnant woman in 32 weeks of gestation.
The doctor of maternity welfare centre at filling in the first coupon “Information about
pregnant woman from maternity welfare centre” of the “Record of pregnant woman of
maternity hospital, maternity department of hospital” (Information about pregnant woman
from maternity welfare centre) (form No 113) in detail writes down features of a course of
previous pregnancies, childbirths, postnatal periods and those features of a course of the
current pregnancy and condition of the pregnant woman, having great value for the doctor
who will manage childbirth.
At visiting of the maternity welfare centre the pregnant woman after 32 weeks of
gestation brings “Record of pregnant woman of maternity hospital, maternity department of
hospital” (Information about pregnant woman from maternity welfare centre) (form №113)
for record in it subsequent observations and examinations.
At hospitalization to an obstetric hospital (on childbirth or in department of pregnancy
pathology) the pregnant woman should show “Record of pregnant woman of maternity
hospital, maternity department of hospital” (Information about pregnant woman from
maternity welfare centre) (form No 113). The first coupon “Information about pregnant
woman from maternity welfare centre” of the “Record of pregnant woman of maternity
hospital, maternity department of hospital” (Information about pregnant woman from
maternity welfare centre) (form No 113) is stored in the Childbirth history (form №096).
The second coupon “Information about parturient woman from maternity hospital,
maternity department of hospital” of the “Record of pregnant woman of maternity hospital,
maternity department of hospital” (Information about pregnant woman from maternity
welfare centre) (form No 113) is filled in the obstetric department before discharge and is
given to parturient woman for transfer to maternity welfare centre. In special cases the second
coupon “Information about parturient woman from maternity hospital, maternity department
of hospital” of the “Record of pregnant woman of maternity hospital, maternity department of
hospital” (Information about pregnant woman from maternity welfare centre) (form No 113)
is transferred to the maternity welfare centre by mail or the courier.
The doctor of the obstetric department at filling in the second coupon “Information
about parturient woman from maternity hospital, maternity department of hospital” of the
“Pregnant record of maternity hospital, maternity department of hospital” (Information about
pregnant woman from maternity welfare centre) (form No 113) in detail write down features
of a course of the current pregnancy, childbirth and postnatal period, having great value for
the following special supervision.
The third coupon – “Information about newborn from maternity hospital, maternity
department of hospital” is filled in before discharge of the newborn and is given out to the
mother for transfer to the pediatric clinic/polyclinic. However, it does not release an obstetric
hospital from necessity of the report for discharge day of the newborn in the children
clinic/polyclinic about its discharge. Doctors of an obstetric hospital (obstetrician and
neonatologist) at filling in the third coupon “Information about newborn from maternity
hospital, maternity department of hospital" of the “Pregnant record of maternity hospital,
maternity department of hospital” (Information about pregnant woman from maternity
welfare centre) (form No 113) in detail write down features of the childbirth and condition of
newborn’s health, demanding special medical supervision after discharge from a hospital.
Shelf life of the “Record of pregnant woman of maternity hospital, maternity
department of hospital” (Information about pregnant woman from maternity welfare centre)
(form No 113) is 5 years.
APPROVED BY
No 29 from 13.01.2016
THE INSTRUCTION
on filling in the “History of pregnancy and childbirth No___” (form No 096)
1. This Instruction specifies the order of filling in the primary accounting records
form No 096/о « History of pregnancy and childbirth No ____» (further - form No 096/о).
2. Form No 096/о is the primary accounting record, which is filled for every pregnant
woman, parturient woman hospitalized after 22 weeks of gestation or more.
3. Form No 096/o contains all the data on the course of childbirth during the
hospitalization, the organization of medical treatment, the data of objective examinations and
appointments.
4. Form No 096/o is conducted to control the correctness of the organization of the
medical-diagnostic process and is used to provide materials on request (law enforcement
agencies, courts, etc.)
5. Paragraphs 1-18 of the first page of the form shall indicate the first name, last name
of the pregnant woman, age, place of residence according to the passport data (in case of
hospitalization of the minor the place of residence of her parents or other legal representatives
is indicated), place of work, specialty or post (for students - place of study), notes about
insurance.
6. Paragraphs 19-21 shall indicate the name of the maternity welfare centre and the
number of visits, diagnosis at hospitalization, method of delivery.
7. Paragraphs 22-27 indicate the date of receipt, discharge/transfer to another health
care institution/death, number of days spent, number and date of disability certificate issued.
8. In paragraphs 28, 29, other information, including the number of previous
pregnancies and how they ended (including anamnesis (paragraph 30)), shall be completed
with the words of pregnant woman/parturient woman.
9. Paragraphs 31-39 provide information on the expected date of delivery, antenatal
care, conditions/illnesses during pregnancy, hospitalization, screenings for research,
hospitalization status, including general medical examination and obstetric examination.
10. Paragraph 40 indicates the results of the analyzes.
11. Paragraph 41 "Discharge epicrisis of the Pregnancy pathology department"
specifies laboratory parameters, treatment methods, specialist consultations and conclusions,
transferring, discharge, diagnosis at discharge/death, to be coded according to the
International Statistical Classification of Diseases of Tenth Review (further - ICD-10).
12. Shelf life of the form No 096/о is 25 years.

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DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY

DEPARTMENT OF SOCIAL MEDICINE, ECONOMICS AND ORGANIZATION OF

Topic № 10: ORGANIZATION OF OBSTETRIC-

Reviewers: FEDORENKO V. I. – Doctor of Medical Sciences, Professor, Head of the

LUBINEC O. V. - Doctor of Medical Sciences, Professor, Head of the

GUTOR Т.H., KOVALSKA О.R., BALUKH U.Y., LITVINYAK R.I.

Methodological recommendations discussed, approved and recommended for printing

II. GOAL OF PRACICAL LESSON:

III. THEORETICAL PRESENTATION OF THE TOPIC

ORDER OF THE MINISTRY OF HEALTH OF UKRAINE No 417

2. Organization of medical observation of pregnant women

3. Organization of outpatient obstetric-gynecological care in the rural areas

4. Guidelines on the organization of outpatient gynecological care

APPROXIMATE POSITIONAL INSTRUCTION

APPROXIMATE POSITIONAL INSTRUCTION

Quality Indicator Reach Calculation Method A legal

GENERAL MEASURES FOR PREVENTING OBSTETRIC-

IV. CONTROL QUESTIONS

V. SITUATIONAL TASKS FOR PRACTICALL SKILLS FORMATION

Total Women in age group 15 years and older

Lviv region 1,363,393 2,248,238 1,137,660 1,833,905

Surgical intervention during childbirth in Lviv region and Ukraine

Lviv region Ukraine

Application of obstetrical forceps 59 1,472

Lviv region Ukraine

Childbirth care and total number of complications in childbirth in MPF in Lviv

VI. RECOMMENDED REFERENCES

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