Obstetrics and Gynecology - A. M. Gromova 2000

Structure and Organization of Obstetric and Gynecological Care in Ukraine
Maternity Hospital Inpatient Department

The inpatient maternity hospital, along with the obstetric and gynecological departments, is designed to provide skilled medical care for women during Pregnancy, childbirth, and the postpartum period, as well as for gynecological patients, while also ensuring expert care and management for newborns.

The maternity hospital (or department) generally admits patients based on a regional territorial policy; however, emergency and primary care are provided to all pregnant women and new mothers regardless of their place of residence or departmental affiliation. Hospitalization is typically arranged through a referral from qualified medical personnel, although women may also seek care directly at the maternity facility.

The maternity hospital inpatient facility comprises the following units: a physiological maternity and postpartum department, an observation maternity department, a pregnancy pathology department, a gynecological department, and a neonatal unit. Whenever possible, the maternity and gynecological departments should be housed in separate buildings. The admission and examination areas for obstetric and gynecological services must also be kept separate. These areas include a filter room and examination rooms where, following standard sanitary Processing, patients are admitted to their respective units.

The delivery department (delivery suite) features an examination room, pre-labor and delivery wards, intensive care units, an operating theater, and postpartum recovery wards.

An obstetric inpatient facility should operate two distinct maternity units: Unit I (physiological) and Unit II (observation).

According to USSR Ministry of Health Order No. 691, the observation department of a maternity hospital admits women in labor and postpartum women presenting with the following conditions:

- fever (body Temperature of 37.6°C or higher without other clinical signs of illness);

- prolonged anhydrous interval (rupture of amniotic membranes 12 hours or more prior to hospital admission);

- thrombophlebitis of any localization (acute or chronic in the acute stage);

- general Disorders of the Kidneys and Urinary Tract (acute conditions or Exacerbation of chronic processes during pregnancy, asymptomatic bacteriuria – 10⁵ CFU/ml of urine or more);

- signs of lower genital tract infections (colpitis, cervicitis, condylomata, chorioamnionitis);

- clinical or laboratory confirmation of an infection carrying a high risk of intrauterine fetal transmission (Toxoplasmosis, Listeriosis, cytomegalovirus, rubella, Sexually Transmitted Diseases);

- intrauterine fetal demise;

- acute respiratory infections (Influenza, tonsillitis, etc.), or manifestations of general extragenital diseases (Pneumonia, otitis media, etc.);

- Skin conditions of both infectious and non-infectious Etiology;

- tuberculosis;

- absence of a complete medical evaluation and required documentation in women;

- cases of Spontaneous Abortion occurring between 22 and 28 weeks of gestation;

- malignant neoplasms;

- fetal developmental anomalies identified during pregnancy;

- women in labor (within 24 hours postpartum) who delivered outside of a clinical medical facility.

Pursuant to Order No. 4 of the Ministry of Health of Ukraine dated January 5, 1996, maternity hospitals introduced joint rooming-in for mothers and newborns, which helps reduce morbidity rates in both postpartum women and neonates, facilitates early breastfeeding initiation, and trains mothers in newborn care. Under the rooming-in model, mothers and newborns are accommodated in rooms designed for one to three beds. Each room is equipped with medical scales, a changing table, and necessary medications for newborn care.

Review Questions

1. What are the constituent components of an obstetric and gynecological healthcare center?

2. What are the MAIN OBJECTIVES OF an antenatal clinic?

3. What healthcare facilities provide obstetrical and gynecological care?

4. What is the stepped approach (phased delivery system) in providing obstetrical and gynecological care to the rural population?

5. What are the defined risk levels for future childbirth?

6. What departments make up the inpatient facility of a maternity hospital?

7. Indications for admission of women to the observation maternity ward.