Day hospital for pregnant women, indications

What are the consequences of refusing hospitalization?

Evenstar, the same bullshit with blood pressure, always normal, for some reason they sent me to a day hospital, I first took a referral, but now I want to go to G. to write a refusal. She refused both hospitalization and treatment with certain drugs that were unsafe for the child. She refused hospitalization due to disgusting conditions in the hospital and then agreed to go to another hospital in another city.

I don’t know. I am also in favor of prenatal hospitalization. We managed to get to the maternity hospital by ambulance, and this despite the fact that we live in the city, not in the village))). Now I’m thinking, should I go to bed and write a refusal? And I gave birth in an exemplary manner, I followed all the instructions, then they set me up as an example for everyone, I didn’t even squeak. Registration of pregnant women: what a doctor should and what a woman should.

It happens that in the antenatal clinic during pregnancy you. The mother also has the right to refuse supplementary feeding and breastfeed. and the place of hospitalization of the patient by ambulance services. If the above documents are available, patients must. choice of doctor and medical organization, refusal of medical intervention c. 28 (“Refusal of medical intervention, hospitalization”), Resolutions. The urine was normal, however, I lived in an embrace with canephron all the time. How they swore at me in the residential complex for not complaining about anything and writing refusals. I laughed for a long time when, after giving birth, on the 5th day, an obstetrician-gynecologist came into the room for an examination and blurted out: “Oh, you have ankles!

Let us dwell in more detail on the possible reasons for hospitalization. Let us immediately make a reservation that this is not a highly specialized article in a medical publication, so we will not delve too deeply into physiological and anatomical issues.

There are no specific symptoms of isthmic-cervical insufficiency. This is explained by the fact that the dilation of the cervix, which occurs in this condition, is painless for the woman and bleeding or any unusual discharge is usually not observed.

I didn't refuse. At least the hospital can provide timely assistance. There is no need to wait for an ambulance and then register...you can lose precious minutes. The life of a child is worth the temporary inconvenience.

I'm being sent to the antenatal hospital tomorrow (37 weeks, they count - 38, twins) I feel fine, only swelling in my legs at the end of the day... yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy….

DAY HOSPITAL

Day hospitals are organized at outpatient clinics (antenatal clinics), maternity hospitals, gynecological departments of multidisciplinary hospitals in order to improve the quality of medical care for pregnant and gynecological patients who do not require round-the-clock monitoring and treatment.

· The hospital maintains continuity in the examination, treatment and rehabilitation of patients with other health care institutions: if the condition of sick women worsens, they are transferred to the appropriate departments of the hospital.

· The recommended capacity of a day hospital is at least 5–10 beds. To ensure a full-fledged treatment and diagnostic process, the duration of a patient’s stay in a day hospital should be at least 6–8 hours per day.

· The management of the day hospital is carried out by the chief physician (head) of the institution on the basis of which this structural unit is organized.

· The number of medical personnel and the operating hours of the antenatal clinic day hospital depend on the volume of assistance provided. For each day hospital patient.

· Indications for the selection of pregnant women for hospitalization in a day hospital:

Vegetative-vascular dystonia and hypertension in the first and second trimesters of pregnancy; - exacerbation of chronic gastritis; — anemia (Hb not lower than 90 g/l); — early toxicosis in the absence or presence of transient ketonuria; - threat of termination of pregnancy in the first and second trimesters in the absence of a history of habitual miscarriages and a preserved cervix; - critical periods of pregnancy with a history of miscarriage without clinical signs of threatened miscarriage; — medical genetic examination, including invasive methods (amniocentesis, chorionic villus biopsy, etc.) in pregnant women at high perinatal risk in the absence of signs of threatened miscarriage; — non-drug therapy (acupuncture, psychotherapy and hypnotherapy, etc.); — rhesus conflict in the first and second trimesters of pregnancy (for examination, nonspecific desensitizing therapy); — suspicion of PN; — suspicion of heart disease, pathology of the urinary system, etc.; — conducting special therapy for alcoholism and drug addiction; — upon discharge from the hospital after suturing the cervix for ICN; - continuation of observation and treatment after a long hospital stay.

I APPROVED

Head of the Main Department

protection of motherhood and childhood

Ministry of Health of the USSR

I.A.LESHKEVICH

INSTRUCTIONS

ON THE SELECTION OF PREGNANT WOMEN FOR TREATMENT IN A HOSPITAL

(DEPARTMENT, ROOM) DAY STAY IN HOSPITALS

(MATERNITY HOSPITAL), DAY HOSPITAL IN THE POLYCLINIC

(WOMAN'S CONSULTATION) AND IN HOSPITAL AT HOME

This instruction provides for the examination and treatment of pregnant women with obstetric and extragenital pathologies.

The selection of pregnant women into day hospitals at various levels depends on the capacity of the laboratory and diagnostic services of treatment and preventive institutions, the availability of doctors of various specialties, the socio-demographic characteristics of the regions and local conditions.

Pregnant women suffering from extragenital diseases can be hospitalized in day hospitals at hospital departments according to the profile of the disease.

I. Indications for selecting pregnant women for treatment

in hospital at home

Hospital care at home is organized by the pregnancy pathology department of the maternity hospital (department). The indications are:

– early toxicosis in the absence of ketonuria;

– dropsy of pregnancy without pronounced edema;

– miscarriage at a critical time without clinical signs of threatened miscarriage;

– threat of termination of pregnancy in the first and second trimesters in the absence of a history of habitual miscarriages and a preserved cervix;

– carrying out nonspecific desensitizing therapy in the presence of Rhesus incompatibility;

– vegetative – vascular dystonia and stage I hypertension in the I and II trimesters of pregnancy;

– acute respiratory viral infections and tonsillitis;

– exacerbation of chronic gastritis;

– anemia with a decrease in hemoglobin of at least 90 g/l;

– observation upon discharge from the hospital after suturing the uterus for isthmic-cervical insufficiency;

– continuation of observation and treatment after a long hospital stay.

II. Indications for selecting pregnant women for daytime treatment

inpatient clinics (antenatal clinics)

Indications:

– specified in section I;

– with extragenital diseases, in need of

diagnostic examination:

if you suspect a heart defect;

to clarify the nature of the pathology

urinary system;

– with obstetric complications:

for the treatment of early toxicosis with

the presence of transient ketonuria;

for examination and treatment

pregnant women with Rhesus - conflict in I

and II trimesters of pregnancy;

– to assess the condition of the intrauterine fetus;

– for non-drug therapy

(acupuncture, psycho- and hypnotherapy, etc.).

III. Indications for selecting pregnant women for hospitalization

to a day hospital in a hospital, maternity hospital

Pregnant women are subject to hospitalization in a day hospital:

– specified in sections I and II;

– with other extragenital diseases that require examination and treatment;

– for examination and treatment if fetoplacental insufficiency is suspected;

Day hospital for pregnant women: indications

Medical specialists may decide to undergo treatment in a day hospital if the patient has one or more of the following indications:

• high water and low water
• pregnancy period is more than 9 months
• there is a threat of miscarriage due to early or late toxicosis
• The examination revealed serious pathologies of the fetoplacental system (hypoxia and malnutrition of the fetus, fetoplacental insufficiency)

Experienced medical specialists monitor the condition of a pregnant woman around the clock. They help a woman get rid of various pathologies, as well as carefully prepare a woman for the birth of a child. There is also a . Obstetricians-gynecologists will help a woman monitor her medication intake (if necessary) at all stages of treatment, as well as give the necessary recommendations on compliance with the treatment regimen.

Day hospital for pregnant women: main areas of activity

Basically, a day hospital for pregnant women performs the following activities to provide assistance to pregnant women:

• breastfeeding consultations
• carrying out psychoprophylactic measures to prepare for childbirth
• carrying out comprehensive treatment for possible complications of pregnancy
• carrying out all necessary measures for prompt resolution of pregnancy
• taking all necessary preventive measures to prevent miscarriage

The provision of all of the above services depends on the initial condition of the pregnant woman.

Day hospital for pregnant women: main advantages

The main advantage of undergoing treatment in a hospital is the ability to carry out some procedures (drips, injections, etc.) right at home. This allows the expectant mother not to experience psychological pressure from the approaching birth, and also to avoid possible danger during transportation or during her hospital stay.

A pregnant woman receives a full range of preventive and therapeutic measures that she could receive during normal treatment. Thus, the woman does not need hospitalization, which contributes to the correct and safe course of pregnancy and the successful birth of the child.

In fact, a day hospital for pregnant women is no different from standard outpatient treatment “conservation”. But in the maternity ward, a woman will be deprived of the support of family and friends, which contributes to additional psychological pressure. The absence of family and friends negatively affects the condition of both the woman herself and the unborn baby.

In addition, there is no need to pay a large amount of financial resources for day hospital services. A woman undergoes preventive or therapeutic measures right at home. The cost of staying in a day hospital includes only standard therapeutic and preventive procedures, which a pregnant woman can easily undergo at home.

Vegetative-vascular dystonia and hypertension in the first and second trimesters of pregnancy;

Exacerbation of chronic gastritis;

Anemia (decrease in hemoglobin not#

below 90 g/l);

Early toxicosis in the absence or presence of transient ketonuria;

Threat of termination of pregnancy in the first and second trimesters in the absence of a history of habitual miscarriages and a preserved cervix.

To conduct a medical genetic examination, including invasive methods (amniocentesis, chorionic villus biopsy, etc.) in pregnant women at high perinatal risk in the absence of signs of a threat of miscarriage;

For non-drug therapy (acupuncture, psycho- and hypnotherapy, etc.);

To carry out nonspecific desensitizing therapy in the presence of Rh-negative blood;

For examination and treatment of pregnant women with Rhesus conflict in the first and second trimesters of pregnancy;

To assess the condition of the fetus;

For examination and treatment of suspected fetoplacental insufficiency;

For examination in cases of suspected heart disease, pathology of the urinary system, etc.

For special therapy for alcoholism and drug addiction (according to indications);

During critical periods of pregnancy with a history of miscarriage without clinical signs of threatened miscarriage;

Upon discharge from the hospital after suturing the cervix for isthmic-cervical insufficiency;

To continue observation and treatment after a long hospital stay.

If the course of the disease worsens and round-the-clock medical supervision is necessary, the pregnant woman is immediately transferred to the appropriate department of the hospital.

Can a pregnant woman refuse hospitalization in a hospital or maternity hospital?

Doctors and a bunch of bad diagnoses piss me off! I'm pregnant, not sick! From the very beginning, B was ascribing some kind of bullshit to me, “run to the hospital.” Yeah, I ran away! If only I could double-check everything and turn on my head...

We don’t know your story, and in any case, the whole responsibility is on YOU, so you have to make decisions, otherwise you’ll hear enough of us... A pregnant woman is no longer responsible only for herself, but also for her baby, who has not yet been born.

I pointed this out to her myself, stupid, she never asked me to give it up, but I played it safe and so I handed it over. At the beginning of pregnancy I was 26, i.e. fine.

Hospitalization during pregnancy

Try a fasting day on one unsalted rice + at least 1 liter of plain water per day. For such a day I removed 1.5 kg, those liters))) And so monitor the pressure, measure at least 2 times a day and test urine for protein. I think. that only swelling at this stage is not a reason for hospitalization.

Very often, the doctor’s decision about the need for urgent hospitalization plunges the expectant mother into shock and into a state of prostration.

It's like going to a store—health care offers you services that you can choose to use or not.

Of course, being in a hospital is unlikely to bring you joy, but you need to understand that sometimes this is the only way to save your pregnancy. However, of course, not all problems require continuing the pregnancy in the hospital.

Therefore, whether you do, for example, an ultrasound or a recommended paid analysis is your own business. This is not dangerous either for your neighbors or for women in labor in a regular maternity hospital. And the doctor is still obligated to respect you and your choices while maintaining medical confidentiality.

I'm not pregnant with twins, but I was wondering. I sat in the pathology waiting room. I wrote a refusal to be hospitalized. There was a girl with me. She's having twins, 24 weeks. She is put on hold for two weeks without indication. just monitor the progress of pregnancy and inject medications for lung maturation. She is doing well.

I refused once. At first I wanted to go to bed, then I asked what they would do. They said bed rest and pills. And what’s the point of going to bed, lying down and taking pills at home, in familiar conditions.

We provide a list based on practice and describing the most common reasons:

1. Manifestations of early toxicosis. Its main manifestation is debilitating (more than 10 times per day) vomiting and lack of appetite. In the hospital, such a patient will be strengthened and nourished intravenously, through the administration of saline solutions and nutritional fluids. As soon as there is no longer a need for this, no one will forcibly hold the girl.
2. ICI (isthmic-cervical insufficiency) is one of the most dangerous pathologies, often leading to miscarriage in the second trimester of pregnancy. The fact is that there are no external, tangible symptoms. No pain, no tension, no bleeding - nothing. Only a doctor can detect a discrepancy with the normal state of affairs during an examination in a antenatal clinic. In the hospital, the patient will receive several stitches and will be sent home after a few days.
3. Rh conflict and hemolytic disease develop when mother and baby have different Rh blood factors. When mother's cells enter the fetus's bloodstream, they cause a strong reaction from its immune system. Only in a hospital setting is it possible to carry out a blood transfusion, which allows you to carry a pregnancy to a safe term.
4. Gestosis rarely goes unnoticed by the woman herself. Swelling and increased blood pressure cause discomfort and make the expectant mother worry. The danger is that the severity of these symptoms is insignificant, which is why they are not given due attention. Meanwhile, they, together with poor tests, indicate the development of preeclampsia, which is one step away from brain damage as a result of severe convulsions. If this situation develops in the later stages, then the only way out is artificially induced labor.

Damn, how this protein in the urine bothered me, during the entire pregnancy it showed up in tests 2 times, this is the 3rd, blood pressure 100/60, no swelling, over the last 2 weeks minus 400 grams, total gain of 10 kg. Yesterday I wrote a refusal to be hospitalized; I have no one to leave my child with, and I feel fine.

I was also sent to hospitalization, but they didn’t admit me to the RD. They said you still have a long way to go, but I gave birth 2 days later at 37 weeks, although I was 55 cm and 4450 kg. And I have a planned cesarean!!!

Unfortunately, this is happening less and less often, and more expectant mothers need medical supervision within the walls of a specialized medical institution (hospitalization).

Classification

First of all, it should be noted that swelling can be external and internal. External ones are visible to the naked eye: a woman’s legs and arms swell, her face becomes swollen, and her stomach may become enlarged. Internal swelling is not noticeable externally, which makes it very dangerous. Such a disorder can only be detected by uneven weight gain.

In total, there are 4 degrees of external edema in pregnant women:

1. At the very beginning, swelling appears only on the legs.
2. The legs and lower abdomen are affected.
3. Swelling of the face and hands.
4. The whole body swells, dropsy may appear.

Most often, pregnant women experience grade 1-2 edema, which does not harm the fetus if treated in a timely manner. Edema of the 3rd-4th degree is considered a serious condition that requires hospitalization, sometimes emergency delivery has to be performed - it all depends on the cause of this complication.

Gestosis in pregnant women can also be divided into 4 degrees:

• The formation of dropsy is a local accumulation of fluid in the tissues.
• Nephropathy is kidney damage.
• Preeclampsia - accompanied by severe edema, high blood pressure, and increased protein in the urine.
• Eclampsia is the most severe form of gestosis, causing extremely serious complications, including pulmonary edema, placental abruption, fetal death, and renal failure in the mother.

In some cases, pathology can develop very quickly, so women with even the slightest swelling should be regularly observed at the antenatal clinic and treated. If the condition worsens, immediate hospitalization is required.

Refusal to hospitalization during pregnancy: is it possible to write and how?

It is used for chronic diseases, the need to adjust nutrition or daily routine. Upon arrival and accommodation of the pregnant woman, a comprehensive examination is prescribed by taking tests and using various devices. A woman can also independently go to the emergency room of a maternity hospital or hospital for pregnant women.

Nothing worried me, they just said during the examination that this was the way it should be, the period at which there could be a miscarriage. I refused, everything was fine. But I repeat, nothing worried me, the pregnancy was going well.

I feel great. The doctor is a terrible reinsurer, and even uncollected: she constantly loses my tests (I always make copies), she prescribed an exchange twice, not once in 25 weeks. There were no complaints about anything - she took me, and then for the first time the blood clotted - straight to the hospital. She said directly that she did not want to answer for me alone.

Treatment of edema in pregnant women

Treatment of edema during pregnancy is carried out strictly under the supervision of a doctor. There is no question of any self-medication; this is indeed a very dangerous condition that can lead to the death of the child and the woman herself.

Treatment is usually medication. Prescribed drugs to lower blood pressure, diuretics, and a diet for edema. If the cause of edema is, for example, inflammatory kidney disease (pyelonephritis), then a course of antibiotics and anti-inflammatory drugs may be prescribed.

The diet for edema will be different, depending on the cause of its development.

For gestosis, a balanced diet with an increased amount of protein is prescribed. If kidney function is impaired, for example due to inflammation, protein is removed from the diet in the first few days of treatment to make it easier for the kidneys to work. Then protein foods are gradually introduced in small quantities.

It is also necessary to maintain a drinking regime. It is very important to drink enough fluid, at least 1.5 liters, but not to overuse it. Lack of water, as well as excess, leads to disruption of the vascular system and the formation of edema.

The same thing happens with salt. Complete exclusion of salt threatens to disrupt the function of the endothelium (the layer in the blood vessels), which is responsible for vascular tone. Impaired contractility leads to increased capillary permeability and edema.

Excessive salt consumption also has a negative effect, because sodium chloride tends to retain fluid in the body. Therefore, salt is not completely eliminated, but its amount is reduced to 3–3.5 grams per day.

As you can see, the diet for edema can be different, so you don’t need to limit yourself too much. It is enough to exclude very salty, spicy, sweet, fatty foods from the diet. It is better to drink simply purified water without gas, and steam, bake and boil food. It is very important that meals are divided, 5-6 times a day in small portions, so that it is easier for the body to cope.

Women's consultation: don't be offended!

Veronika Zavyalova, mother of two children, initiator of the project “Giving birth as a human being in Belarus”, talks about what changes our maternity hospitals need, and what needs to be done so that the voices of women are heard by doctors.

You know the doctor will not hospitalize you without a reason. In the hospital they can help you, but outside the hospital the doctor will not be able to really help you, he will not be able to help you and carry out the tests that you will take in the hospital. The doctor is responsible not only for you but also for the baby. If you are worried about your miracle, then lie down and don't risk it. If everything was fine with you, then it’s unlikely that they would advise you to lie down.

Was you prescribed aminophylline as a diuretic or for blood pressure? He can drop the pressure very hard. As one victim put it: “they prescribed it for weight control, an extremely effective drug, you drank it and you lie down for several hours, you can’t even get up to eat.”

It also happens that for various reasons you do not want to accept some information regarding your health from medical personnel. So, if you want to remain in the dark about the possible adverse consequences, in the doctor’s opinion, of your refusal to be sent to the maternity hospital for safekeeping, for example, or to receive vaccinations and take vitamins, you can simply inform the doctor about this.

Refusal from hospitalization during pregnancy

However, there is unlikely to be a desire to reject it if you feel unwell and are concerned about the health of the unborn child.

If you are 100% sure that everything is fine and it’s just weight and not swelling, then it’s better not to go to the hospital.

What kind is it? If a woman feels good, why should she lie down all day? It seems to me that this will not contribute to the improvement of labor. I also consider myself a responsible person, but for me, doctors’ recommendations will always remain only recommendations, and I will decide for myself. I refused in both pregnancies. During my first pregnancy I gained 15 kg, and during my second pregnancy 25. I am a doctor myself, but it was difficult for me to find contact with a doctor during my second pregnancy. Indeed, the concern of gynecologists about the excess weight of pregnant women sometimes goes beyond common sense. My child was lying across her stomach, it didn’t bother her, but the 500 grams gained in a week made her grab a pen and write directions.

What hospitalization? I ran for the bus, walked a lot, visited my favorite concerts with my husband, attended his ballet premiere, and traveled alone to the Tver region.

I had a special story with hospitalization. And there was no physical opportunity to refuse. There were sharp pains in the lumbar region, I was two weeks away from giving birth. They brought me to the gynecology department to see the women in labor. They twisted and turned me, they thought I was having contractions. And for me, because... During pregnancy, an exacerbation of illness suddenly caused kidney disease. So they put me in pathology for preservation.

She refused twice. The first time - at 6 weeks a little brown came out. At the residential complex, the doctor, without even examining her, sent me to the hospital; She said that they would do tests there and an ultrasound. As a result, the doctor looked at me only once, without taking a test for progesterone, she prescribed an injection - and that’s all. They didn't do any ultrasound. Yes, they also refused to transfer to daytime.

If the decision to hospitalize is made before 22 weeks, the expectant mother will be admitted to the gynecological department or hospital. Referral to the hospital at a later date means being in a maternity hospital.

Medical error / Complaint against a doctor

They also want to put me in the hospital, it’s just disgusting to lie there in such heat, it’s hot at home, and there’s also nothing to breathe there, you can’t open the windows.

Girls, for information, suddenly someone, like me, was bothered and worried. I arrived at the hospital in the morning, they did a CTG, ultrasound, and removed the pessary on the chair. they said everything was fine. They sent me home on waiver of hospitalization with the parting words that I could give birth at any moment. We are talking about planned hospitalization of a pregnant woman when treatment is ineffective, during exacerbation of existing chronic diseases and some other diseases that require constant medical supervision.

Risk factors

Doctors identify a risk group whose women more often suffer from edema and other manifestations of gestosis during pregnancy:

• Too early birth. If a girl becomes pregnant at 15–17 years old, the likelihood of developing gestosis increases greatly. Despite established menstruation, puberty has not yet ended at this age. Unstable hormonal levels often lead to the development of complications during pregnancy.
• Late birth. If a woman becomes pregnant after 35 years, the likelihood of edema also increases. With age, the body wears out, organs function worse than at 20–25 years old, and a history of various diseases does not have the best effect.
• Preeclampsia in a previous pregnancy. If a woman has a tendency to develop edema, then most likely the situation will repeat in subsequent pregnancies. Such women should be under strict medical supervision.
• Severe toxicosis with incessant vomiting in the first half of pregnancy. It may be a consequence of pathology in the body, as well as a cause of impaired renal function.
• Women who have worked or continue to work in hazardous work.
• Unfavorable living conditions, poor nutrition, smoking, alcohol consumption, tendency to inflammatory and infectious diseases.
• Multiple births. When carrying two or more children, the load on the body increases even more; the kidneys and heart may not be able to cope with it.