History of the development of obstetrics. The main stages of the development of obstetrics and gynecology. Further progress in obstetrics and gynecology is associated with the active use of advances in medical genetics, in particular genetic engineering, immunology, endocrinology, bio

Obstetrics is rightly recognized as the oldest branch of clinical medicine, because the need for emergency care and various benefits during childbirth (“midwifery”) appeared simultaneously with the emergence of humanity. Already ancient Egyptian papyri and Chinese manuscripts (27th century BC) contain information on obstetrics and female diseases, and the Indian sacred books "Ayurveda" (9th - 3rd century BC) report the duration of pregnancy , incorrect positions of the fetus, nutrition of pregnant women, uterine displacements, condylomas.

In ancient Greece and Ancient Rome, Hippocrates, Aristotle, Philumenus, Celsus, Soranus of Ephesus, Galen and others in their works devoted significant attention to female diseases, pathology of pregnant women (bleeding during pregnancy, description of some obstetric operations and instruments for their implementation). One of the chapters of the "Hippocratic Collection", entitled "On Women's Diseases", contains not only a description of inflammatory diseases of the uterus and vagina, tumors of the genital organs, but also recommendations for their treatment (in particular, removal of the tumor from the uterus using forceps, a knife and a hot gland). During the era of feudalism, along with the general decline of science and culture, the development of obstetrics and gynecology stopped. It was argued that all knowledge had already been taught in the “holy scripture”, the idea that it was low and even indecent for male doctors to engage in the art of midwifery. In 1522, Dr. Veit was publicly burned in the central square of Hamburg, who suffered a painful death for heretical practice in gynecology. During the Middle Ages, a special place and merit belongs to the famous Tajik doctor Abu Ali Ibn Sina (Avicenna, 980-1037 AD), who created the encyclopedia of medicine of his time - “The Canon of Medical Science”. Ibn Sina systematized the heritage of ancient doctors and enriched medicine with his clinical experience, describing some diseases of the female genital organs and mammary gland, obstetric operations (reduction of the fetal leg, cranio-embryotomy).

His works have been translated into Hebrew languages, and the “Canon of Medical Science” has been published more than 30 times.

The anatomical and physiological basis of obstetrics and gynecology was laid in the 16th - 17th centuries. V. the works of outstanding anatomists A. Vesalius, K. Bartolin, G. Graaf and others.

V. Harvey, who opposed Aristotle’s doctrine of spontaneous generation, first expressed the position that “everything living comes from an egg,” and his discovery of blood circulation (1628) made physiology, as F. Engels put it, a science and marked the beginning of a scientific approach to the problem of transfusion blood.

France is deservedly considered the cradle of practical obstetrics. The famous French surgeon A. Pare (1509-1590) founded the first school for training midwives in Paris. After a long period of oblivion, he reproduced the operation of turning the fetus by the leg, introduced a breast pump into practice, and suggested speeding up labor in case of bleeding and quickly emptying the uterus. He owns some provisions of a forensic medical nature concerning the establishment of virginity, determining the duration of pregnancy, and the drowning of newborns.

The largest representative of the French obstetric school, F. Morisot (1637-1709), is the author of an original treatise on diseases of pregnant women. Based on his own data and observations, he refuted the erroneous view that there is a significant divergence of the pubic bones during childbirth, as well as the false idea that has prevailed since the time of Hippocrates that seven-month fetuses are more viable than eight-month-old ones. He improved the technique of obstetric operations, proposed a technique for removing the head during childbirth with pelvic presentation and tools for removing the perforated head. F. Morisot introduced bloodletting as a method of treating eclampsia, which for almost two centuries was used as the only life-saving remedy in the treatment of pregnant women with severe forms of toxicosis.

France is also associated with the transition of obstetric care from midwives to doctors. Until the mid-17th century, according to established customs, doctors (surgeons) were invited to women in labor only in advanced and hopeless cases to perform fetal-destroying operations. Only after the French doctor J. Clement successfully performed childbirth at the court of Louis XVI in 1663, noble women began to consider it good form to give birth under the supervision of male doctors, and obstetrics ceased to be the domain of midwives only. From that time on, doctors involved in obstetrics received the honorary title of “obstetricians,” and midwives began to be called “midwives.” However, deep-rooted prejudice has long been an obstacle to the work of male doctors in the field of obstetrics in many countries.

Thus, even in 1829 in Russia, the doctor Bazhenov was put on trial only for a gynecological examination of a woman, which he conducted in the absence of a midwife.

The biggest achievement in obstetrics at the end of the 17th century. and the beginning of the 18th century. was the study of the anatomical structure of the female pelvis (Deventer) and the mechanism of childbirth (Smellie, Levre), which marked the beginning of scientific obstetrics. J.L. Bodelok (1746 - 1810) was the first to propose and apply a technique for measuring the female pelvis (external pelviometry), which has survived to this day, and began to consider obstetrics as a science based on the laws of mechanics. The invention of obstetric forceps should be considered a significant progress, with the introduction of which into practice the number of fetal destruction operations sharply decreased. Although the use of obstetric forceps is associated with the Chamberlain family, the author of this instrument should be considered the Dutch surgeon Palfein (1650-1730), who reported his invention at the Paris Medical Academy in 1723. Palfein's obstetric forceps contributed to the development and subsequent appearance of more advanced models proposed Negele, Simpson, Lazarevich, Fenomenov, etc. Thus, obstetrics as a science was formed and became an independent medical discipline in the 18th century in France, England, Germany, Russia and other countries. This was manifested in the opening of departments of “midwifery art” at the medical faculties of a number of European universities, obstetric clinics in Strasbourg (1764), Göttingen (1751), Berlin (1751), maternity hospitals in Moscow (1728) and St. Petersburg ( 1771).

Of great importance for the development of obstetrics and gynecology was the development of methods for the prevention of postpartum septic diseases (“puerperal fever”), which were accompanied by a huge maternal mortality rate from 10% to 40% and higher. Particular merit in the fight against postpartum sepsis, in the development and promotion of the antiseptic method belongs to the Hungarian obstetrician I.F. Semmelweis (1818-1865). His introduction of mandatory hand washing with soap and 3% bleach solution for medical personnel made it possible to sharply reduce the incidence of “puerperal fever” and the mortality of postpartum women. Called by descendants the “savior of mothers” I.F. Semmelweis himself died of sepsis without being recognized by his contemporaries during his lifetime.

Discoveries of the 19th century in the field of morphology (Vikhrov R.), biology and bacteriology (Baer K., Pasteur L., Mechnikov I.I., Lister D.), physiology (Bernard K., Sechenov I.M., Pavlov I.P.) contributed to the further development of obstetrics and gynecology. The beginning of the 19th century includes the creation of the doctrine of a narrow pelvis and the biomechanism of childbirth, the introduction into practice of external examination of pregnant women to recognize the position of the fetus and listen to the fetal heartbeat, the study of pregnancy complications, and the spread of obstetric operations (forceps, symphysiotomy, cesarean section). It is worth highlighting the contribution of the Viennese obstetrician L. Bouler (1751-1835), who, in contrast to the excessive radicalism of obstetricians of his time, substantiated the advantage of conservative management of childbirth, which remains the most accepted tactic in the world. A significant achievement was the introduction of inhalation anesthesia, first used in obstetrics by D. Simpson in 1847. The first successful use of anesthesia during obstetric operations is associated with the name of N.I. Pirogov, who used general anesthesia in April 1847 during the application of obstetric forceps in the clinic of obstetrics and women's diseases of the Medical-Surgical Academy (St. Petersburg).

The development of the study of female diseases lagged significantly behind obstetrics, although already in the 16th century the first guide to female diseases appeared, written by Mercado (Spain). Gynecological patients were usually admitted for treatment to surgical or therapeutic clinics, and the necessary surgical treatment was carried out by surgeons. The study of women's diseases was usually included in surgery, obstetrics or therapy. Thanks to the successes of natural science, pathomorphology and physiology, gynecology at the end of the 19th century. became an independent scientific discipline. A special medical specialty appeared - a gynecologist, the study of diseases of the female genital organs began, the number of gynecological operations performed increased, although the mortality rate after them, before the introduction of antisepsis and asepsis, reached 50% and higher.

The formation of gynecology was facilitated by the works of M. Sims, S. Wells, J. Pian, K. Schroeder, E. Wertheim, E. Bumm, A. Dederlein and others. A significant contribution to the development of operative gynecology and conservative methods of treating female diseases was made by domestic obstetricians and gynecologists A.A. Keeter, A.Ya. Krasovsky, K.F. Slavyansky, V.F. Snegirev, D.O. Ott et al. Obstetricians and gynecologists have priority in a number of discoveries that have accelerated the progress of medical science. Thus, it was in obstetrics that blood transfusion was first used for massive blood loss (Blundell D., 1818, Wolf A.M., 1832), scientific research on blood transfusion and preservation began (Sutugin V.V., 1865 ), the principles of asepsis and antiseptics were proposed (Holmes O., 1843; Semelweis I.F., 1847), the first successful laparotomies were performed for ovarian tumors (Mc Dowell E., 1843; Krassovsky A.Ya. ., 1862), endoscopic research methods were used for the first time, in particular laparoscopy (Ott D.O., 1914).

Gynecology achieved significant success in the 20th century with the discovery of blood groups, hormones, antibiotics, and the introduction into practice of the achievements of endocrinology and other sciences.

SUBJECT OF OBSTETRICS AND GYNECOLOGY.

OBSTETRIC SCIENCE.

ORGANIZATION OF OBSTETRIC AND GYNECOLOGICAL CARE.

History of the development of obstetrics.

History of the development of obstetrics in Russia.

Organization of obstetric and gynecological care in Russia.

Dear students IV course! This year you are starting your studies at our department, and you will get acquainted with one of the most interesting sections of clinical medicine - obstetrics and gynecology.

In modern thinking, obstetrics and gynecology should be considered as a science about women. Our subject studies the physiology and pathology of the female reproductive system, the condition and activity of the female genital organs under normal and pathological conditions, and the biological functions inherent in women, including childbirth.

Obstetrics (from French accoucher give birth, assist during childbirth) a field of clinical medicine that studies the physiology and pathology of processes associated with conception, childbirth, the postpartum period, developing methods of obstetric care, prevention, treatment of complications of pregnancy, childbirth and assistance with them for women, fetuses and newborns.

Starting this year, you will become familiar with the most important part of the clinical discipline - general gynecology, the task of which is to study the symptomatology, diagnosis, prevention of gynecological diseases and methods of treating gynecological patients.

Gynecology (from Latin gyne woman, logos science) a medical discipline that studies the physiology and diseases of the female reproductive system, develops methods of prevention, diagnosis, treatment and deals with issues of reproductive health and behavior of women.

In addition to the fact that the basics of obstetrics and gynecology that you will receive at our department are necessary as part of your training at a higher medical educational institution, all of you, without exception, will need this knowledge in your personal life. All of you will be faced with issues of contraception for many years to come; every third woman sitting in this room will be diagnosed with uterine fibroids. The incidence of endometriosis, a disease that is now called “the disease of urbanization, the disease of female careerism,” is catastrophically increasing. More than 50% will personally encounter background and precancerous diseases of the cervix. Every fourth person has climacteric syndrome. Therefore, knowledge of our subject is necessary not only for a successful transition to the next year of the institute, but also for personal life.

One can talk at length and at length about the origins of man, but one thing remains obvious - each of us had a mother. THE WOMB IS THE SOURCE OF HUMANITY.

Pregnancy, childbirth this condition is natural and simple, but at the same time unpredictable and complex. These two states, inextricably linked with each other, largely determine the entire future life of not only the person himself, but also the family where he was born, and therefore society as a whole.

Obstetrics includes the following sections: physiology and pathology of pregnancy; childbirth and the postpartum period; operative obstetrics; physiology and pathology of the fetus and newborn (which is now called perinatology).

At the dawn of its development, obstetrics was called the art of midwifery(ars obstetricia).

MAIN HISTORICAL STAGES OF DEVELOPMENT

OBSTETRIC SCIENCE

Ancient world

The history of obstetrics is closely connected with the history of medicine, although before XVIII centuries, it stood at a lower level of development than other departments of medical science, since it still had to fight against prejudice and ignorance.

The beginnings of obstetrics have been known since ancient times. With the advent of the human race, people sought to provide relief to the woman in labor and provide assistance during childbirth. In the days of hoary antiquity: elderly women, wise from personal experience, helped their young and inexperienced fellow tribesmen with advice and action, since it was considered immodest for men to see female genital organs.

The cultural peoples of antiquity - Hindus, Jews, Greeks and Romans - even before our era had midwives, inThe oldest written monuments mention midwives as a special class of specialists. « Obstetrices "("old woman standing nearby") - indicates how this class developed. In ancient China, midwives, when assisting women in labor, often used various amulets, special manipulations, and even special instruments, information about which has not reached us.

The custom of inviting older, experienced women to give birth led over time to the fact that they became midwives by profession, and obstetrics remained in their hands as a craft for many centuries.

However, it happened during complicated childbirths, when the wisdom and experience of midwives was not enough and then they turned to male doctors for help. These were male surgeons who had the difficult and thankless task of removing a child from the mother’s womb in the most difficult, advanced cases. At the same time, the surgeons had no experience in observing normal childbirth and did not have any understanding of the natural course of childbirth. Therefore, most doctors did not want to deal with such art in practice and in most cases limited themselves to speculative conclusions about obstetrics.

Even the best doctors could not escape the influence of many misconceptions."Father of Medicine" the great Hippocrates (460-370 BC), his mother was the famous midwife Phanarega,in his treatises he covered the issues of obstetrics much less than other medical disciplines. Hippocrates wrote many essays on childbirth and obstetrics in general, in which he showed his genius as a great observer, although he established few rules in practical obstetrics. Hippocrates has a clear, briefly formulated principle of a doctor’s activity: “Do no harm!”

According to the views of Hippocrates, the fetus strives to leave the mother’s womb under the influence of hunger; it is born on its own, moves head first, and rests with its legs against the bottom of the uterus. It followed that we should strive to return the fetus to a cephalic position. If this failed, then natural delivery was considered impossible, and then they resorted to instruments to extract the fetus in pieces.

Due to the fact that Hippocrates enjoyed unquestioned authority and respect among all physicians, his obstetric views found wide practical dissemination among his contemporaries. Together with Greek doctors and midwives, they penetrated into Rome, remaining unchanged until the Christian era.

The ancient Greeks knew about caesarean section, but performed it only on a dead woman in order to extract a living baby (according to mythology, this is how the god of healing Asclepius was born).

In the final period of the history of ancient Greece - the Hellenistic era (Alexandrian doctors began to perform anatomical dissections), the practice of obstetrics and gynecology began to emerge as an independent profession. Famous obstetricians of their time wereHerophilus, Demetrius, Cleophantus and Erasistratus(II century BC). Being a surgeon and obstetrician, Herophilusstudied the development of pregnancy, the causes of birth pathology, gave an analysis of various types of bleeding and divided them into groups. Another Alexandrian physician, Cleophant (2nd century BC), compiled an extensive work on obstetrics and women's diseases.

The Romans borrowed from the ancient Greeks and transferred many religious cults with the worship of gods to medicine, including obstetrics. Thus, the Greek god-healer Asclepius in Rome is renamed Aesculapius - the god of medicine. The goddess of menstruation becomes Fluonia, the goddess of the uterus - Uterina, the goddesses of childbirth - Diana, Cybele, Juno and Mena.The goddess Prose patronized the fetus during childbirth in the cephalic presentation, and Prosverta - during the pelvic presentation and transverse position. Children born in a breech position were given the name Agrippa.

Valuable classical works by famous doctors of ancient Rome on obstetrics and women's diseases have survived to this day - A.K. Celsus, Sorana from Ephesus, Galen from Pergamum ( I V). They knew various methods of obstetric and gynecological examination, operations of turning the fetus on its leg, removing it by the pelvic end, embryotomy; they were familiar with genital tumors (fibroids, cancer), uterine displacements and prolapses, and inflammatory diseases. Also the work of the female midwife Aspasia (2nd century), which describes methods of conservative and surgical treatment of female diseases, pregnancy hygiene, and care for newborns.

Middle Ages

At the beginning of our era, Arab statehood, culture and medicine flourished. Arab doctors developed only the false views of Greek authors, leaving without any attention what was sound in the writings of their predecessors. This is explained by the fact that, due to Eastern and Muslim customs, Arab doctors were removed from the bedside of the woman in labor and had no practical experience.

Avicenna (Ibn Sina, 980-1036) - representative of Arab medicine.The "Canon of Medical Science" contains chapters on obstetrics and women's diseases. They mention the operations of turning the fetus onto its head, bringing down the fetal legs, craniotomy and embryotomy. When choosing an operation, Ibn Sina considered it necessary to take into account the woman’s health condition and the possibility of her undergoing the operation.He described a method for removing uterine polyps and described in detail some diseases of the mammary glands.

New time. Revival of science.

After the collapse of the Roman Empire, Hippocratic medicine and the achievements of the Alexandrian school were forgotten. The new philosophical schools did not improve science, but waged a fruitless, fierce struggle against any progressive thought and scientific experiment.

In the Middle Ages obstetrics, like all sciences, was completely neglected. For 15 centuries, the period of medieval stagnation, the Inquisition, prejudices, and superstitions lasted. Midwifery was left to the monks andmidwives.

The first books for midwives were published in Germany, which immediately gained great popularity. In 1513, the doctor Evrakhios Resslin from Frankfurt published a book entitled “The Rose Garden for Pregnant Women and Midwives.” In 1545, a book by a Strasbourg surgeon was published Reiffa “A fun, comforting little book about human pregnancy.” These books mainly expounded Hippocratic, Galenic and Arabic teachings. At the same time, the fact that after many years of oblivion of obstetric teachings, special publications were published was of great importance.

The Renaissance was characterized by the rapid development of sciences, including natural science. Thanks to the great anatomists of that time - Vesalius, Paracelsus, Eustachius, Fallopius, Batallo, Fabricius - medicine received a new anatomical basis, which led to the development of surgery, as well as obstetrics and gynecology. But due to the incompleteness of the scientific observations of doctors, the successes of science were limited only to the operational part, since male doctors were invited to deliver births only in very difficult cases and obstetrics was viewed as a department of surgery.

Paracelsus (1493-1541) rejected the teaching of the ancients about the four juices of the human body, believing that the processes occurring in the body are chemical processes.

The great anatomist A. Vesalius (1514-1564) corrected Galen’s mistake regarding communications between the left and right parts of the heart and for the first time correctly described the structure of a woman’s uterus.

The Italian anatomist Gabriel Fallopius (1532-1562) described in detail the oviducts that received his name (fallopian tubes).

Eustachius (1510-1574), a Roman professor of anatomy, very accurately described the structure of the female genital organs, based on mass autopsies of corpses in hospitals.

Arantius (1530-1589), a student of Vesalius, dissecting the corpses of pregnant women, described the development of the human fetus and its relationship with the mother. He saw one of the main reasons for difficult childbirth in the pathology of the female pelvis.

Botallo (1530-1600) described the blood supply to the fetus.

The beginning of scientific obstetrics dates back to the 16th and 18th centuries and is associated with general advances in anatomy, embryology, physiology and clinical medicine. The first hospitals appear to provide care to women in labor. These hospital-hospitals become bases for the training and improvement of doctors in the field of obstetrics and “educated” midwives.

Center for the Development of Clinical Obstetrics in XVI century, France was where the foundations of classical operative obstetrics were laid.

At that time, certified doctors adhered to the motto “ Haes ars viros dedecet ” (“Stand proudly aside”), active barbers took it upon themselves to break the dominance of midwives in maternity rooms and soon achieved this. At first, in their hands, obstetrics went almost exclusively in the operational direction.

Ambroise Pare (1510-1590) founder of modern obstetrics, went from a simple barber to a field doctor, then became a member of the prestigious Parisian Surgical Society and the first surgeon of the king. He gave the surgeons a ligation of blood vessels,rediscovered and restored the pedicle rotation operation in obstetric practice, introduced gynecological speculum into widespread practice and organized the first obstetric department and the first obstetric school in Europe at the Hotel-Dieu hospital in Paris.

Midwife Louise Bourgeois (1563-1636), a student of A. Pare, developed a technique for turning the fetus from a transverse position or breech presentation to a cephalic presentation; widely used the relegation of the fetal leg when turning it.

The emergence of obstetrics as an independent clinical discipline began in France at the turn of the 17th-18th centuries. This was greatly facilitated by the organization of obstetric clinics.

Famous French obstetrician XVII century François Morisot (1637-1709), his work "Diseases of pregnant women and postpartum women, etc." (1668), translated into many languages and going through a large number of editions, has become a reference book for many generations of doctors and midwives around the world.F. Morisot considered pregnancy as a physiological process, but full of dangers. Morisot was the first to divide childbirth into natural and unnatural, he proposed his own technique for removing the subsequent head during breech presentation (the name has survived to this day), and successfully used fetal destruction operations.

Obstetric treatises occupied an increasing place in the works of surgeons.Jeremiah Trautmann(I. Trautmann) German obstetrician from Wittenberg (1610), he was responsible for the successful performance of a caesarean section on a live woman in labor.

The country that did a lot for the development of obstetrics in the 17th century was Holland. Works publishedHeinrich van Deventer(1651-1724) ("New World", 1701), a generally uniformly narrowed and flat pelvis was described in detail for the first time. Van Deventer emphasized that assessment of pelvic dimensions should be an integral part of the obstetric examination.

Among the outstanding obstetricians of that time was Juleus Clement (1649-1729). He was a court obstetrician in France, but also traveled to Spain three times for the birth of King Philip’s wife. II.

Obstetricians become prominent and wealthy people, princesses and noble ladies choose their own obstetricians. And even the wives of burghers, artisans and ordinary people preferred to deal not with midwives, but with obstetricians, if they had the means to pay for the latter’s services.

French obstetrician Jean-Louis Baudelocque (1746-1810), developed the doctrine of the female pelvis,proposed external pelvic measurement, which is currently used.He first introduced the concept and term “fetal position” and argued that in the process of labor it is the uterus that is active, and not the fetus, as many obstetricians of that time thought.

English obstetrician Smellie ( 1697-1763) drew attention to the importance of measuring the diagonal conjugate of the pelvis, described the normal mechanism of labor and its deviations with a narrow pelvis, designed a new model of forceps and an “English” lock for them.

Austrian obstetrician Johann Plenk (1728-1807) developed a diagnosis of pregnancy by determining the size of the uterus. He studied and classified ectopic pregnancy in detail.

Harvey discovered two circles of blood circulation (1619) and brought new light to old views on the nutrition of the fetus in the womb. But Harvey was unlucky with the discovery during his lifetime; back in 1694 he was ridiculed by other doctors.

Nils Stensen (Nikolai Stenoy . 1638-1686), a professor from Copenhagen, was the first to unequivocally state that “female testicles” contain eggs and that the uterus in a woman performs a function similar to that of the oviducts in oviparous mammals.

At the same time, data were obtained on the structure of the ovaries. Regner de Graaf discovered ovarian follicles, which later became known as Graafian vesicles in his honor. He described the ovaries and fallopian tubes in detail.

Happy opening Anthony Levengukmicroscope, he was the first to see sperm in semen.

In the 17th century, the concept of the existence of an egg in a woman that matures in the ovary was first clearly formulated.

Obstetrics in England in the 17th centurysignificantly lagged behind French. However, the British played a significant role in the use of obstetric forceps.

Invention of obstetric forceps by Chamberlain (England) (1721)has an interesting history. In its perfect form, obstetric forceps were invented and owned by the English medical family of Chamberlains. They are considered the inventorPeter Chamberlain(senior), a surgeon who practiced in London and died in 1631. The forceps were inherited by his younger brother, and from him - by his son, also Peter Chamberlain - in a secret room of his country house, 4 pairs of modern forceps with two branches were found, crossing branches and fenestrated spoons connectingusing a special lock. The first imperfect forceps, from which all the others came, were also found. These forceps are now in the Medical and Surgical Association Museum in London.

From Peter Chamberlain Jr. the tongs passed to his son Hugo Chamberlain. The famous French doctor Morisot reports about this doctor in his essays that in 1670 he volunteered to give birth to an elderly primigravida woman whose pelvis was severely narrowed, and on whom Morisot himself unsuccessfully applied his art for 8 days. Chamberlain worked for three hours without success, the woman died a day later without giving birth. As the autopsy showed, there were multiple tears on the uterus from the instruments used - forceps.

After this public unsuccessful experience, there could be no talk of selling the secret of the forceps, but Chamberlain asked the king’s French physician for 10,000 thalers for it - a lot of money at that time. Then Hugo Chamberlain went bankrupt and fled to Holland. Here he sold the secret of the forceps to Ronhausen, from whom he moved to the medical-pharmaceutical college in Amsterdam. This company speculated on the instrument and allowed it to be used only by those doctors who bought this secret for a lot of money.

The Dutch surgeon D. Palfin (1650-1730) reinvented obstetric forceps in 1723, but in a less perfect form, and arrived in Paris to offer them to the Academy of Medicine. The merit of D. Palfin is that his forceps quickly entered into widespread practice and gave impetus to the development of more advanced modifications of forceps. Since 1730 Palfin's improved obstetric forceps become an integral part of the obstetric kit.

The French obstetrician Andre Levret (Levret, A., 1703-1780) gave his forceps a pelvic curvature, improved the lock, and established the indications and methods of using his model.

In Russia, obstetric forceps began to be used in 1765: they were first applied by the first professor of the medical faculty of Moscow University, I.F. Erasmus, started in 1765 teaching obstetrics at the department of anatomy, surgery and woman's art.

Among the numerous modifications of obstetric forceps created in Russia, the most famous are the forceps of Kharkov professor I.P. Lazarevich (1829-1902). They were distinguished by slight pelvic curvature and the absence of decussation of the spoons.

Over time, many models of obstetric forceps were created in different countries of the world. Some of them were good only in the hands of their creators, others gained worldwide fame, but one thing is certain - their invention significantly reduced the number of fetal destructive operations and mortality in childbirth.

Modern times

Obstetrics became an independent specialty in the 18th century.Commemoration in the status of obstetrics: there was a combination of two disciplines - obstetrics and medicine. Before this period, obstetrics was entirely in the hands of midwives and surgeons. In all European countries, maternity institutions began to open, connected to schools for midwives. A system of special training of midwifery personnel according to standard programs was initiated.

The rapid development of obstetrics in the 18th centuryalso affected Germany. Became a reformerJohann Georg Roederer(1726-1763) - professor of anatomy, surgery and midwifery at the University of Göttingen, studied the anatomy of the birth canal and the mechanism of childbirth. He proposed dividing the mechanism of labor into five points, and was the first to draw attention to the importance of external obstetric examination.

With the name Roderer associated with the separation of the teaching of obstetrics in European universities into an independent professorial course. According to his textbook " Elementa artis obstetriciae ” (“Elements of the Art of Obstetrics”) has been taught to students in most European countries for about 50 years. The training of medical students in Russia was also initially carried out using this textbook.

The merit of the German school is that they called on obstetricians to return to the natural physiological process of childbirth, against supporters of operative obstetrics. Boyer, a famous doctor of that time, said on this occasion: “The passion for operations has become such that nature seemed to abandon the birth act and leave it to the forceps of obstetricians.”

In 1902 The first edition of the fundamental manual of the German obstetrician was published Ernst Bumm - "Guide to study of obstetrics”, presented in 28 lectures and in 1908. it was published in Russian in Russia.

The opening of maternity hospitals in a number of cities (Strasbourg, 1728; Berlin, 1751; Moscow, 1761; Prague, 1770; St. Petersburg, 1771; Paris, 1797) was of great importance for the development of obstetric science. However, soon after their organization, doctors encountered a serious, often fatal complication - “puerperal fever”, i.e. postpartum sepsis. Pandemics of this “fever” were the scourge of maternity hospitals in the first half of the nineteenth century. Mortality from puerperal sepsis fluctuated in certain periods of the eighteenth - first half of the nineteenth century from 10 to 40-80%.

Great discoveries XIX century. The Hungarian obstetrician was the first to prove the infectious nature of childbed fever.Ignaz Philipp Semmelweis(1818-1865). Antiseptics came to obstetrics in Lister's great discoveryand made the devastating epidemics of puerperal fever disappear from maternity hospitals.

Achievement of obstetrics XIX century began the development of methods for pain relief in childbirth. October 17, 1846 surgeon Warren from Boston performed the first operation under ether anesthesia. Simpson recommended using chloroform instead of ether to anesthetize labor. Since then, most obstetric operations began to be performed under anesthesia. Chloroform has also been used to treat eclampsia. This method was proposed by the Russian obstetrician Vasily Stroganov.

Anesthesia and antisepsis made possible the rapid development of gynecology, which, in turn, had a fruitful effect on obstetrics. The advances in surgical techniques and diagnostics achieved in the gynecological field contributed to the development of obstetrics.

Both sciences - obstetrics and gynecology - complement each other and from the middle XIX centuries are studied and taught together. Since that time, women's clinics began to be created in Europe.

The development of obstetrics has followed the path of increasing introduction of surgical principles and methods into practice. This was especially true for caesarean section operations. The danger of its use has decreased many times due to the introduced methods of antisepsis and asepsis and improved surgical technique, as a result of which this operation has become widespread in obstetric practice.

History of obstetrics in Russia

Obstetric care in Ancient Rus' was provided by the oldest women in the family. During the period of feudalism, the development of obstetrics slowed down sharply due to the oppression of the Christian and Islamic religions. In Russia, the science of obstetrics began and developed much later than in other European countries. The first obstetrician mentioned in the chronicles was the Englishman Jacob (at Ivan the Terrible) , famous for being “able to very skillfully treat women’s diseases.”

The first representative of scientific obstetrics in Russia was P.Z. Kandoidi (1710-1760), at his proposal the Senate in 1754. issued a decree“On the decent establishment of Babich’s business for the benefit of society.”Based on the decree, the first school of “women’s business” was founded in Moscow and St. Petersburg; the teaching staff consisted of a professor and his assistant, an obstetrician.

The first teachers in midwifery schools were Germans Johann Ersamus in Moscow and Andrey Lindeman in St. Petersburg, who did not speak Russian and gave lectures with the help of translators. Women - midwives and midwives - were trained in these schools. The basis of the training was only a theoretical course. The training was ineffective, since the majority were women who did not have any medical knowledge. Over 20 years, Erzamus has trained only 35 midwives.

Nestor Maksimovich Maksimovich-Ambodik(1744-1812) - the first Russian professor of midwifery, considered one of the founders of scientific obstetrics. PAfter graduating from the St. Petersburg Hospital School, he was sent to the Faculty of Medicine at the University of Strasbourg and in 1775 defended his doctoral dissertation. N.M. Maksimovich-Ambodik organized the teaching of womanhood in Russian and at a high level for his time: he acquired obstetric instruments, accompanied the lectures with demonstrations on a phantom and at the bedside of women in labor. He wrote the first Russian manual on obstetrics, “The Art of Midwifery or the Science of Womanhood,” and he was one of the first in Russia to use obstetric forceps.

In the second half of the 18th century, Moscow and St. Petersburg became centers of Russian obstetric science.

Wilhelm Mikhailovich Richter(1768-1822) the beginning of teaching obstetrics as a separate discipline at the medical faculty of Moscow University is associated with his activities. In 1786 V.M. Richter was sent abroad (Berlin and Göttingen midwifery institutes) for an internship and defense of his doctoral dissertation with the aim of “preparing himself for the department of obstetrics at Moscow University.”

The weak point of teaching obstetrics was that students were taught only a theoretical course, since there were no clinics, and the training system provided for practical internship only after graduation.

An important event was the discovery in 1846. Faculty clinics of Moscow University. From now on, the clinical teaching method became the basis of the entire educational process. The clinic was intended to have 30 maternity beds. The first director of the clinic was M.V. Richter (junior), and then from 1851.Vladimir Ivanovich Kokh(1820-1884), German by birth, but the first of the professors who began to lecture on obstetrics in Russian. Merit of V.I. Koch is that his teaching method changed and became practical and clinical in nature. Students practiced on phantoms, were allowed to perform basic obstetric techniques in the maternity room, and were required to come to nightduty roster. Under the leadership of V.I. Koch defended 4 doctoral dissertations in Russian (before that they were written in German or Latin).

The introduction of ether (1846) and chloroform (1847) anesthesia, the beginning of the prevention of puerperal fever (1847), as well as the development of the doctrine of antiseptics and asepsis opened up wide opportunities for obstetric and gynecological practice. All this, together with advances in the field of morphology and physiology of the female body, contributed to the successful development of gynecology and its differentiation in the middle of the 19th century. into an independent medical discipline.

In Russia, the first gynecological departments were opened in St. Petersburg (1842) and Moscow (1875). The beginning of the surgical direction in Russian gynecology was laid byAlexander Alexandrovich Kiter(1813-1879) - talented student of N.I. Pirogov. For 10 years (1848-1858) A.A. Keeter headed the department of obstetrics with the teaching of women's and children's diseases at the St. Petersburg Medical-Surgical Academy; he wrote Russia's first textbook on gynecology, "Guide to the Study of Women's Diseases" (1858), and performed the country's first successful vaginal operation to remove a cancerous uterus (1842).

Made a great contribution to the development of operative gynecology and operative obstetricsAnton Yakovlevich Krassovsky(1821-1898). He was the first in Russia to perform successful operations of ovariotomy (oophorectomy) and removal of the uterus and constantly improved the technique of these surgical interventions, proposed an original classification of forms of a narrow pelvis, clearly dividing the concepts of “anatomically narrow pelvis” and “clinically narrow pelvis”, and developed indications for the application of obstetric forceps, limiting their unjustified use with a narrow pelvis.

On the basis of the St. Petersburg Medical-Surgical Academy, he was the first in Russia to organize extensive clinical training for obstetricians and gynecologists and introduced a system of postgraduate improvement in this area. His “Course of Practical Obstetrics” for a long time served as the main guide for domestic obstetricians and gynecologists. A.Ya. Krassovsky organized the first St. Petersburg Obstetrics and Gynecology Scientific Society in Russia (1887) and the first in this area, the Journal of Obstetrics and Women's Diseases (1887).

Vladimir Fedorovich Snegirev(1847-1916) is considered the founder of scientific gynecology in Russia.In 1870 He graduated with honors from the Faculty of Medicine of Moscow University, and in 1873. A public defense of his doctoral dissertation “On the issue of determination and treatment of retrouterine hemorrhage” took place. In this work, the problem of diagnosis and treatment of a disease that was extremely confusing at that time - ectopic pregnancy - was raised for the first time.On Snegirev’s initiative, gynecology began to be taught for the first time as an independent discipline. On his initiative, the first gynecological clinic was opened (1889) and the gynecological institute for advanced training of doctors (1896), the director of which Snegirev remained until the end of his life. Of Snegirev’s numerous works, the main ones are devoted to the issues of uterine bleeding, ovariotomies, fibroid operations, ligation of the uterine arteries, etc. Snegirev was a brilliant surgeon, he proposed a number of new operations and surgical techniques and at the same time paid great attention to conservative methods of treating female diseases. Snegirev and his school are characterized by the study of a woman’s entire organism and its connection with the environment, and not just individual diseases of the genital area.

The life of any operating doctor is full of drama, and there are often tragic moments. It is not for nothing that the famous German gynecologist E. Wertheim wrote: “If an operation does not always prolong the life of the patient, it always shortens the life of the surgeon.” There was such a tragic incident in the life of V.F. Snegireva. In 1887 he lost one of his patients - a young woman of 35 years old - after an extensive and complex gynecological operation. The patient's relatives took a callous and extremely cynical step in revenge on the doctor. On the gravestone of the monument on the territory of the Donskoy Monastery in Moscow, they made the inscription: “... here lies Princess Olga Lvovna Shakhovskaya, who died from the operation of Dr. Snegirev.” However, from this terrible blow V.F. Snegirev did not drop the scalpel from his skillful hands. It is noteworthy that one of the most brilliant Russian surgeons, Sergei Sergeevich Yudin, virtually a self-taught person who did not have any school behind him, called Snegirev his teacher, since he attended his classes at the clinic as a student.

1900 Russian obstetrician, professor at the Central Research Institute of Obstetrics and Gynecology in Leningrad, Vasily Stroganov, proposed the use of chloroform and subsequently developed a classic method of conservative treatment of eclampsia. The Stroganov method is recognized in many countries around the world, which has reduced the mortality rate from eclampsia by 5 times.

What kind of medical arsenal did the doctors of that time possess and what kind of assistance did they provide to pregnant women and women in labor?Georgy Andreevich Soloviev(author of the famous “Soloviev index”), based on the study of mourning sheets (medical history) of that time, recalled: “Obstetric pathology and assistance in the form of applying forceps, turning on the legs with a transverse position of the fetus, craniotomy were widely practiced and were especially often used placenta department A pathology such as placenta previa, after preliminary vaginal tamponade, usually ended with turning the fetus onto its stem, sometimes with the application of obstetric forceps to the subsequent head. When the umbilical cord fell out, they worked to set it back.” For eclampsia, or “birthing,” as it was called then, wet wraps, dry cupping on the chest, leeches, pedunculation, or obstetric forceps were used to speed up labor. Injuries to the genital tract were treated in a very unique way - even with deep injuries, up to necrosis, they did softening douches, touched with a hellish stone, applied lotions of goulard water or grated carrots. In 1921 Georgy Andreevich Solovyov exclaimed: “It’s a thing of the past, but in suitable cases, when prescribing these simple medicines, I myself saw in the old years an improvement and even a complete recovery, which I could not explain and cannot now.”

Professor occupies an exceptional place in the history of the Moscow Obstetric Clinic and the Russian Obstetric SchoolAlexander Matveevich Makeev(1829-1913). He first introduced the concept of asepsis and antiseptics into the clinic. Being an excellent organizer, he redesigned the obstetric clinic, for the first time dividing it into two departments: physiological (clean) and observational (dirty); strictly monitored the careful observance of asepsis rules by medical personnel, prohibited midwives delivering births and caregivers for women in labor from going to the postpartum ward; introduced individual antiseptics for women in labor (douching cups, bedpans). The premises began to be sanitized using antiseptics. The cases of purulent-septic diseases, the main scourge of that time, sharply decreased. Professor A. M . Makeev improved the obstetric phantom of the French company Schwab, which at that time was considered the best in the world and was used to train students and doctors. The Schwab company exhibited Makeev's phantom at several Russian and international exhibitions.

A prominent representative of the St. Petersburg obstetric school wasMartyn Isaevich Gorvits,founded in 1870 Mariinsky Maternity Hospital, where he himself was the director. M.I. Horwitz lived a short life, but during his life he published 31 fundamental scientific works on the issues of dysmenorrhea, abnormal positions of the uterus, oncogynecology, and inflammatory gynecology. Under his editorship in 1883. A textbook on obstetrics was published in Russia Karl Schroeder, which went through 4 editions.

In 1879 In St. Petersburg, the first Russian Midwifery Institute with a maternity ward began its activities, transformed in 1895. to the Imperial Obstetrics and Gynecology Institute, now the Research Institute of Obstetrics and Gynecology named after. BEFORE. Otta RAMS. The institute is named afterDmitry Oskarovich Ott(1855-1929) is far from accidental; under him, the institute gained European and world fame. Professor D.O. Ott had excellent surgical technology; he developed and introduced new obstetric and gynecological operations, new instruments, lighting mirrors, and operating tables.

Along with the St. Petersburg and Moscow obstetric schools, other strong schools have developed in Russia: Kazan, Kharkov, Vilnius.

Nikolai Nikolaevich Fenomenov(1855-1918) was a professor at Kazan University. He was an outstanding obstetrician-practitioner, he performed more than 2,000 abdominal dissections, and he also proposed a number of modifications of obstetric operations - perforation of the presenting head, fetal decapitation, cleidotomy; invented and improved a number of obstetric instruments and, in particular, Simpson forceps (Simpson-Fenomenov). They issued a manual“Operative Obstetrics” by N.N. Fenomenov is a classic work even today.

The founder of the Kazan school of obstetricians and gynecologists is consideredVictorina Sergeevich Gruzdev(1866-1938), who in January 1890. at the age of 34, he won a competition to head the department against 12 professors (with a secret vote of 18 “for” and 4 “against”) and headed the department for almost 40 years. He published a textbook on obstetrics and gynecology, “Course of Obstetrics and Women’s Diseases” (1919-1922); he stood at the origins of oncogynecology and genetics in Russia. B. C . Gruzdev trained 12 doctors of science, among whom were such outstanding obstetricians asMikhail Sergeevich Malinovsky(1880-1976) and Ivan Pavlovich Lazarevich(1829-1902), who became recognized leaders of domestic obstetrics and gynecology from the first years of Soviet power until the 80s.

I.P. Lazarevich (1829-1902) professor at Kharkov University. He owns original research on the nervous regulation of the uterus, pain relief in childbirth, and the original two-volume “Guide to Obstetrics” (1892). Lazarevich made a great contribution to the development of straight obstetric forceps. Lazarevich's works made his name famous not only in Russia, but also abroad. He was a champion of women's education, founded the Midwifery Institute in Kharkov, which trained many midwives for the South of Russia.

It is impossible in one lecture to talk about all the outstanding representatives of the national school of obstetricians and gynecologists, who made an invaluable contribution to the development of Russian and world science with their works; we will name only a few of them: V.M. Florinsky (1824-1891) - author of “Introduction to Gynecology”; K.F. Slavic - author of “Private pathology and therapy of female diseases”; V.V. Stroganov (1857-1938) - author of a method for treating eclampsia, which has received worldwide recognition; K.K. Skrobansky (1874-1946) - author of fundamental works on the physiology and pathology of the ovaries, surgical treatment of uterine cancer, pain relief for childbirth; G.G. Genter (1881-1937) - author of classic works on obstetrics - “Textbook of Obstetrics” and “Obstetric Seminary” in three volumes; N.I. Pobedinsky (1861-1923) - author of the “Brief Textbook of Obstetrics” and many works on the issues of cesarean section, narrow pelvis, eclampsia, etc.; A.P. Gubarev (1855-1931) - author of the clinical manual “Operative gynecology and fundamentals of abdominal surgery”; L.I. Bublichenko (1875-1958) - author of the three-volume publication “Postpartum Infection”.

Achievements of obstetrics in XIX century.

The twentieth century saw the advent of antibiotics and blood transfusions, which further reduced maternal mortality.

The attention of obstetricians also extended to the “second patient,” that is, to the fetus - to the possibility of reducing perinatal mortality and disability of the child. Adolphe Pinard in Paris and John Ballantyne in Edinburgh established a maternity care program. Ballantyne's book Pathology and Hygiene in Pregnancy: Embryo and Fetus was the first work in the field of perinatal medicine.

In the late 1950s - early 1960s. Equipment for assessing the condition of the fetus began to appear, which also influenced the reduction of perinatal mortality.

Edward Hohn of Yale University developed an electronic heart monitor to monitor the condition of the fetus.

Albert Lilly (New Zealand), came up with the idea of intrauterine treatment of the fetus, he was the first to carry out intrauterine blood transfusionfor hemolytic disease of the fetusdeveloped as a result of incompatibility inantigens of the Rh system.

In 1958, Donald (Glasgow) began to use ultrasound to assess the condition of the fetus, this event made it possible to transfer prenatal care to a fundamentally newlevel. Of all the achievements of modern obstetrics, Donald’s contribution is given the palm. Modern obstetrics is unthinkable without ultrasound, which helps identify defects inthe fetus, monitor its growth, and evaluate the function of the placenta. Under ultrasound guidance, a biopsy is performed for prenataldiagnostics, and also monitor the insertion of the needle when treating the fetus.

Since the mid-1930s, the development of a new type of institution - antenatal clinics - has reached enormous proportions.The twentieth century has witnessed an ever-increasing role of the physician in the process of prenatal care. Currently, births should only take place in maternity hospitals. The arguments in favor of this are simple and convincing - only a hospital can provide adequate monitoring of pregnant women and access to emergency medical care, which was justified by the reduction in maternal and perinatal mortality

ORGANIZATION OF OBSTETRIC AND GYNECOLOGICAL CARE FOR THE FEMALE POPULATION IN MODERN RUSSIA.

The main objectives of modern obstetrics are: providing high-tech and qualified care to women during pregnancy, during childbirth and the postpartum period, monitoring and caring for healthy people and providing qualified obstetric care to sick and premature children.

One of the priority tasks of domestic healthcare is to improve the health of children and mothers. The goal is aimed at creating conditions for the birth of healthy children, preserving and strengthening the health of children and adolescents at all stages of their development, preserving and strengthening the health of women, including pregnant women, reproductive health of the population, reducing maternal, infant and child morbidity and mortality, preventing disabilities in children.

In our country, at the government level, a priority national project in the healthcare sector “Health” has been adopted and is being implemented, aimed primarily at the development of primary medical care (40.6 billion rubles) and providing the population with high-tech medical care (16.7 billion rubles .). The total volume of financial resources allocated to the healthcare system within the framework of the priority national project amounted to 94.2 billion rubles in 2006 alone, the expected volume of costs is 100.1 billion rubles. In the draft federal budget of 2007. 131.3 billion rubles have been pledged; an additional allocation of 69.1 billion rubles has been provided. for events on demography.

As part of the implementation of the national project “Health”, from January 1, 2006. In all regions of the Russian Federation, birth certificates have been introduced, it is expected to increase the financial interest of medical institutions in providing quality medical care to women during pregnancy and childbirth. Financing in the amount of 10.5 billion rubles is provided. Funds in the amount of 400.0 million rubles. in 2006 and 500 million rubles. in 2007 are directed towards strengthening and updating the laboratory diagnostic base, providing diagnostic test systems for medical and genetic consultations in the constituent entities of the Russian Federation.

Due to the continuing deterioration of the demographic situation in Russia, high levels of general, maternal and infant mortality, low reproductive health indicators of the population, high levels of morbidity among pregnant women and gynecological morbidity, the problem of maternal and child health has recently become of high concern at the level of the President and the Government RF. The resolution of the Government of the Russian Federation of December 30, 2005 was adopted. No. 252 “On the procedure for financing in 2006.” expenses associated with payment for services to state and municipal healthcare institutions for medical care provided to women during pregnancy and (or) childbirth,” and an order of the Ministry of Health and Social Development of Russia dated January 10, 2006 was prepared. No. 5 “On the procedure and terms of payment for services to state and municipal health care institutions for medical care provided to women during pregnancy and childbirth.”

The most important document that can significantly improve the quality of the obstetric service and improve its financial condition was the order of the Ministry of Health and Social Development of Russia “On the birth certificate” dated November 28, 2005. No. 701. The structure of the cash costs of the birth certificate provides for the financing of antenatal clinics in the amount of 3 billion rubles. (salaries of at least 60% - 1.8 billion rubles; equipment 40% - 1.2 billion rubles) and financing of maternity hospitals in the amount of 7.5 billion rubles. (salaries at least 40% - 3.0 billion rubles; equipment and purchase of medicines 60% - 4.4 billion rubles).

With the introduction of birth certificates, each expectant mother will receive additional assistance from the state in the amount of 10 thousand rubles. Birth certificate coupons are transferred to the branches of the Social Insurance Fund. Medical institutions will receive additional funds to the usual budget funding for each patient, provided that the birth is completed safely.

Health care institutions providing medical care to women during pregnancy (antenatal clinics, obstetric and gynecological offices and children's clinics). Women's clinics receive 3,000 rubles. Health care institutions providing medical care during childbirth (maternity hospitals, maternity wards, perinatal centers) receive 6,000 rubles. for each woman, and 2,000 rubles. will receive a children's medical and preventive institution in which dispensary observation of a child of the first year of life will be carried out.

Institutions can spend the funds received on salaries and equipment, and in maternity hospitals - on additional drug provision. By introducing the system of birth certificates, the Government of the Russian Federation hopes, first of all, that this will help increase the birth rate in the country.

Currently there are obstetric hospitals(maternity hospitals), which can be independent structures or part of multidisciplinary hospitals. Until the 60-70s. in our country there was a certain hierarchy of maternity hospitals: a collective farm maternity hospital at first aid stations; maternity hospitals in the central district hospital; city maternity hospitals; regional and regional; Republican and research institutes for the protection of motherhood and childhood (now exist in Moscow, St. Petersburg, Yekaterinburg, Ivanovo, Tomsk). Due to unsatisfactory maternal and infant mortality rates, maternity hospitals are currently at high risk ( IV level) were abolished.

Physiological childbirth or childbirth with minor complications can take place in maternity hospitals in the central district hospital or in simple city houses. It is advisable to carry out births of increased obstetric or perinatal risk in large specialized maternity hospitals, where highly qualified personnel are concentrated, there is high-tech equipment, departments of obstetrics and gynecology, that is, there are all the possibilities for providing the most modern care, both for a pregnant woman and for caring for newborns. In the city of Abakan there is a maternity hospital, which serves as a republican one, and two inter-district maternity hospitals (Chernogorsk and Sayanogorsk) where women with obstetric and extragenital pathologies are sent. The technical and diagnostic equipment of maternity hospitals in modern conditions, their laboratory services should allow for the full scope of treatment and diagnosis of pregnant women, women in labor, postpartum women and newborns.

Obstetric hospital

The number of obstetric beds is based on 8.8 beds per 10,000 population. It is advisable to repurpose beds in maternity hospitals by reducing beds in the physiological and observation departments and adding them in the pathology department and day hospital.

The obstetric hospital has the following structure and divisions:

physiological department, including a sanitary checkpoint, prenatal and delivery departments, an operating department, a postpartum department and a newborn department;
observation department (all the same departments and an additional isolation department or boxed wards);
department of pathology of pregnant women (in most hospitals it is customary to distinguish between small and late periods - after 22 weeks);
diagnostic and treatment department or rooms (laboratory, functional diagnostics, physical therapy, etc.);
intensive care anesthesiology department;
administrative and economic services.

All pregnant women and women in labor who pose a risk of infection to healthy pregnant women and newborns should be placed in an observation unit. The total bed capacity of the observation department should be at least 25-30% of the bed capacity of the maternity hospital.

Based on the instructions on the indications for admission of pregnant women, women in labor and postpartum to the observation department of the maternity hospital, the following are subject to hospitalization:

acute respiratory infections, flu, sore throat, etc.;
long anhydrous period - rupture of amniotic fluid 12 hours or more before admission to the hospital;
intrauterine fetal death;
fungal diseases of hair and skin;
febrile conditions ( t - 37.6° C and higher without other clinical symptoms);
purulent lesions of the skin, subcutaneous fat;
acute or subacute thrombophlebitis;
pyelonephritis, pyelitis, cystitis or other infectious kidney diseases;
manifestation of infection of the birth canal - colpitis, cervicitis, chorioamnionitis, bartholinitis, etc.;
toxoplasmosis; listeriosis - not necessary now;
venereal diseases;
tuberculosis;
diarrhea.

Women who have the following complications are subject to transfer from the physiological to the observational department:

increase t during childbirth up to 38°C and above with 3-fold thermometry after 1 hour;
increase t after childbirth, a single dose up to 37.6°C and above of unknown etiology;
subfebrile t unknown etiology, lasting more than 2-3 days;
purulent discharge, suture dehiscence, “plaques” on the sutures, regardless of temperature;
manifestations of extragenital inflammatory diseases;
diarrhea (in the presence of intestinal infectious diseases - subject to transfer to infectious diseases hospitals);
postpartum women in the early postpartum period (the first 24 hours after birth) - in cases of home or street births.

In the presence of purulent mastitis, purulent endometritis, peritonitis and the manifestation of other purulent-septic diseases, women in labor and postpartum are subject to immediate removal from the maternity hospital and hospitalization in the gynecological or surgical department.

The qualitative main indicators of the obstetric hospital are: maternal and perinatal mortality; morbidity of newborns; surgical activity (% of caesarean sections); % postpartum hemorrhage; % purulent-septic complications; birth trauma of mothers and newborns.

Women's consultation

The main task of the antenatal clinic is medical examination of pregnant women, prevention of maternal and perinatal mortality, timely detection and treatment of abnormalities during pregnancy, timely hospitalization of high-risk pregnant women in an obstetric hospital for delivery or in the event of a pathological course of pregnancy. Also, the antenatal clinic carries out work on family planning, contraception, prevention of gynecological cancer, and sanitary education. The activities of obstetricians and gynecologists are based on the local principle; the doctor serves approximately 5,000 female population, of which 3,000 are women of fertile age.

Medical examination of pregnant women begins with their registration at the antenatal clinic. A very important indicator in the work is the time of the first appearance for pregnancy registration, preferably up to 12 weeks (risk groups, prenatal screening, timely detection of somatic pathology, for example, the latent course of acute rubella). If the percentage of early turnout at a site is low (below 60%), this indicates poor preventive and sanitary education work at the site. The doctor is obliged to carefully collect a life history, obstetric and gynecological history, living conditions, work, the presence of hereditary factors and much more. A thorough, complete objective examination is performed, including a gynecological examination. The gestational age and the date of the upcoming birth are established (based on menstruation, ovulation, conception, size of the uterus, according to ultrasound data). The midwife measures blood pressure, height, and weight. The patient is prescribed a full range of studies and consultations with related specialists. In cases where a pregnant woman has a serious extragenital disease (diabetes mellitus, complex heart disease, glomerulonephritis, etc.), observation is carried out together with a specialist in the appropriate field.

At the first visit, the pregnant woman receives a pregnant woman’s card, where all the data in the dynamics of observation are subsequently entered. If the pregnancy proceeds without complications, then the frequency of visits to the doctor should be once every 4 weeks up to 28 weeks; Once every 2 weeks until 36 weeks and once every 7 days until birth. In cases of complicated pregnancy, the frequency of visits increases.

In order to prevent obstetric and perinatal complications, the timeliness of adequate treatment and the completeness of diagnostic measures in antenatal clinics, it is customary to identify high-risk pregnant women. It is most important to identify the following risk groups:

for miscarriage;
on the development of late gestosis;
on the development of chronic FPN and IUGR syndrome;
on the development of intrauterine infection;
on the development of weakness of labor;
on bleeding during childbirth and the postpartum period;
on the development of perinatal pathology.

An important section of the activities of antenatal clinics is patronage of pregnant women at home.

One of the most important sections is the psychoprophylactic preparation of pregnant women for childbirth, which consists of conducting preparatory prenatal courses in the form of classes.

The widespread popularity of prenatal courses reflects the desire of expectant parents (not just mothers) for such education and to receive all the information that interests them. If information about the dangers and benefits of alternative methods to conventional delivery is the main focus of most prenatal courses, then the number of informed women who consciously choose their behavior during childbirth and the method of delivery is increasing. However, if the ideology of the courses is turned towards unconditional recognition of generally accepted obstetric practice, most future parents may be confused, and the benefit from such courses will be small.

Lifestyle during pregnancy.An obstetrician is obliged to give every pregnant woman registered at the antenatal clinic recommendations and advice on proper nutrition, lifestyle, sexual behavior, work, smoking, drinking alcohol and many other issues.

The most important advice is to use folic acid supplements to prevent the development of CNS defects in the fetus for 2-3 months before pregnancy and 3 months after conception. The advice on a balanced diet is correct, however, this diet cannot prevent the birth of a child with low body weight and IUGR. Every pregnant woman should, first of all, receive meat (200 g), fish, and vitamins daily. The role of nutritional supplements, trace elements, minerals or vitamins other than folic acid has not been proven to the extent of current knowledge.

There are still conflicting opinions about the importance of physical activity, work, long and long-distance travel. All these recommendations must be carefully weighed and purely individual.

The main qualitative indicators of the work of the antenatal clinic are: the level of perinatal and maternalmortality; medical examination of pregnant and gynecological patients; timeliness (up to 12 weeks) of pregnancy registration; complete examination of pregnant women in antenatal clinics. In addition, N.P. Kirpasova (2005) identifies the following criteria for assessing the effectiveness of the work of an obstetrician-gynecologist in a antenatal clinic: % of regular observation of pregnant women - at least 10 times (80%); % of timely examination of pregnant women by other specialists (90-95%); coverage of prenatal examinations in I, II, III trimesters of pregnancy (90-95%); coverage of pregnant women with physical and preventive training (100%); coverage of postpartum contraception (80%); early detection of obstetric and extragenital pathology (80%); timely hospitalization of pregnant women with pathology (80%), the frequency of premature births (3 - 5%) and the frequency of eclampsia and preeclampsia (3 - 5%).

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In obstetrics and gynecology at the beginning of the 20th century, surgical methods occupied a dominant position. Classic obstetric interventions (forceps, fetal rotation, embryotomy, etc.) in some cases were replaced by cesarean section and pelvic dilation operations. New methods of surgical treatment of lesions of the female genital organs have emerged. E. Wertheim (1864-1920, Austria) proposed a radical method of surgery for cervical cancer. T. Watkins (1863-1925, USA) developed a method of surgery for uterine prolapse; D. Webster (1863-1950, Canada) proposed in 1901 an operation to create an anteverted position of the uterus when it is bent and deviated posteriorly (Webster-Baldi-Dartigue operation ).

Domestic scientists made a major contribution to the development of the surgical field in obstetrics and gynecology. D. O. Ott (1855-1929) invented special instruments and lighting devices for vaginal operations. V. S. Gruzdev (1866-1938) developed the issue of primary and metastatic cancer of the female genital organs. A.P. Gubarev (1855-1931) was one of the first in the world to propose radical surgery for uterine cancer, developed an extraperitoneal approach to pelvic abscesses, introduced into practice the method of surgery without preliminary ligation of blood vessels, etc., introduced a new concept into medicine - clinical anatomy .

At the end of the 20s, the surgical direction in its extreme manifestations came into conflict with the ideas of prevention. Some radical interventions were replaced by gentle ones. In 1928, N.A. Tsovyanov proposed a widely used method of manual assistance for breech presentation of the fetus. With minor changes, this method was described in 1936 by the German obstetrician Bracht and under his name became famous abroad. A. A. Ivanov in 1932 initiated the use of skin-head forceps for weak labor.

Methods for treating and preventing eclampsia have improved. The method of expectant, conservative treatment of eclampsia developed by V.V. Stroganov (1923) gained a strong position in the USSR, as well as among German, Scandinavian, American and other obstetricians.

Significant successes have been achieved in the fight against postpartum sepsis (L. I. Bublichenko and V. Ya. Ilkevich). Thanks to well-organized prevention and the use of antibiotics, postpartum diseases have lost their former formidable nature.

In recent decades, interest in the physiology of childbirth has increased (M. S. Malinovsky, A. P. Nikolaev, K. K. Skrobansky, etc.) and a movement has emerged that has become known as “childbirth management.” The conquest of Soviet medicine was the method of psychoprophylaxis of pain during childbirth (I. Z. Velvovsky, V. A. Ploticher, Z. A. Shugam), which also became widespread abroad, especially in France and Italy.

In the struggle for the health of women and children in the USSR, social and organizational measures played a decisive role, resulting in a coherent system of maternal and child health care (see). The policy of the Communist Party and the Soviet government towards working women put Soviet obstetrics and gynecology on the path of preventive care, including medical care for women and children, monitoring pregnant women, childbirth, the postpartum period and the feeding period. One of the most striking indicators of the success of Soviet obstetrics is the sharp decrease in the mortality rate of women in obstetric institutions, which has decreased by more than 15 times compared to pre-revolutionary times.

3. Main stages in the development of obstetrics and gynecology

His works have been translated into Hebrew languages, and the “Canon of Medical Science” has been published more than 30 times.

The anatomical and physiological basis of obstetrics and gynecology was laid in the 16th - 17th centuries. V. the works of outstanding anatomists A. Vesalius, K. Bartolin, G. Graaf and others.

Thus, even in 1829 in Russia, the doctor Bazhenov was put on trial only for a gynecological examination of a woman, which he conducted in the absence of a midwife.

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Obstetric care in Ancient Rus' was provided by the oldest women in the family. During the period of feudalism, the development of obstetrics slowed down sharply due to the oppression of the Christian and Islamic religions. In Russia, the science of obstetrics began and developed much later than in other European countries. The first obstetrician mentioned in the chronicles was the Englishman Jacob (under Ivan the Terrible), famous for being “able to very skillfully treat women’s diseases.”

The first representative of scientific obstetrics in Russia was P.Z. Kandoidi(1710-1760), at his proposal the Senate in 1754. issued a decree “On the decent establishment of Babich’s business for the benefit of society.” Based on the decree, the first school of “women’s business” was founded in Moscow and St. Petersburg; the teaching staff consisted of a professor and his assistant, an obstetrician.

The first teachers in midwifery schools were Germans And aboutGunn Erzamus in Moscow and Andrey Lindeman in St. Petersburg, who did not speak Russian and gave lectures with the help of translators. Women - midwives and midwives - were trained in these schools. The basis of the training was only a theoretical course. The training was ineffective, since the majority were women who did not have any medical knowledge. Over 20 years, Erzamus has trained only 35 midwives.

Nestor MaxiMovich Maksimovich-Ambodik(1744-1812) - the first Russian professor of midwifery, considered one of the founders of scientific obstetrics. After graduating from the St. Petersburg Hospital School, he was sent to the medical faculty of the University of Strasbourg and in 1775 defended his doctoral dissertation. N.M. Maksimovich-Ambodik organized the teaching of womanhood in Russian and at a high level for his time: he acquired obstetric instruments, accompanied the lectures with demonstrations on a phantom and at the bedside of women in labor. He wrote the first Russian manual on obstetrics, “The Art of Midwifery or the Science of Womanhood,” and he was one of the first in Russia to use obstetric forceps.

In the second half of the 18th century, Moscow and St. Petersburg became centers of Russian obstetric science.

Wilhelm Mikhailovich Richter(1768-1822) the beginning of teaching obstetrics as a separate discipline at the medical faculty of Moscow University is associated with his activities. In 1786 V.M. Richter was sent abroad (Berlin and Göttingen midwifery institutes) for an internship and defense of his doctoral dissertation with the aim of “preparing himself for the department of obstetrics at Moscow University.”

An important event was the discovery in 1846. Faculty clinics of Moscow University. From now on, the clinical teaching method became the basis of the entire educational process. The clinic was intended to have 30 maternity beds. The first director of the clinic was M.V. Richter (junior), and then from 1851. Vladimir Ivanovich Kokh(1820-1884), German by birth, but the first of the professors who began to lecture on obstetrics in Russian. Merit of V.I. Koch is that his teaching method changed and became practical and clinical in nature. Students practiced on phantoms, were allowed to perform basic obstetric techniques in the maternity room, and were required to come on night shifts. Under the leadership of V.I. Koch defended 4 doctoral dissertations in Russian (before that they were written in German or Latin).

In Russia, the first gynecological departments were opened in St. Petersburg (1842) and Moscow (1875). The beginning of the surgical direction in Russian gynecology was laid by Alexander Alexandrovich Kiter(1813-1879) - talented student of N.I. Pirogov. For 10 years (1848-1858) A.A. Keeter headed the department of obstetrics with the teaching of women's and children's diseases at the St. Petersburg Medical-Surgical Academy; he wrote Russia's first textbook on gynecology, "Guide to the Study of Women's Diseases" (1858), and performed the country's first successful vaginal operation to remove a cancerous uterus (1842).

Made a great contribution to the development of operative gynecology and operative obstetrics Anton Yakovlevich Krassovsky(1821-1898). He was the first in Russia to perform successful operations of ovariotomy (oophorectomy) and removal of the uterus and constantly improved the technique of these surgical interventions, proposed an original classification of forms of a narrow pelvis, clearly dividing the concepts of “anatomically narrow pelvis” and “clinically narrow pelvis”, and developed indications for the application of obstetric forceps, limiting their unjustified use with a narrow pelvis.

Vladimir Fedorovich Snegirev(1847-1916) is considered the founder of scientific gynecology in Russia. In 1870 He graduated with honors from the Faculty of Medicine of Moscow University, and in 1873. A public defense of his doctoral dissertation “On the issue of determination and treatment of retrouterine hemorrhage” took place. In this work, the problem of diagnosis and treatment of a disease that was extremely confusing at that time - ectopic pregnancy - was raised for the first time. On Snegirev’s initiative, gynecology began to be taught for the first time as an independent discipline. On his initiative, the first gynecological clinic was opened (1889) and the gynecological institute for advanced training of doctors (1896), the director of which Snegirev remained until the end of his life. Of Snegirev’s numerous works, the main ones are devoted to the issues of uterine bleeding, ovariotomies, fibroid operations, ligation of the uterine arteries, etc. Snegirev was a brilliant surgeon, he proposed a number of new operations and surgical techniques and at the same time paid great attention to conservative methods of treating female diseases. Snegirev and his school are characterized by the study of a woman’s entire organism and its connection with the environment, and not just individual diseases of the genital area.

1900 – Russian obstetrician, professor at the Central Research Institute of Obstetrics and Gynecology in Leningrad, Vasily Stroganov, proposed the use of chloroform and subsequently developed a classic method of conservative treatment of eclampsia. The Stroganov method is recognized in many countries around the world, which has reduced the mortality rate from eclampsia by 5 times.

What kind of medical arsenal did the doctors of that time possess and what kind of assistance did they provide to pregnant women and women in labor? Georgy Andreevich Soloviev(author of the famous “Soloviev index”), based on the study of mourning sheets (medical history) of that time, recalled: “Obstetric pathology and assistance in the form of applying forceps, turning on the legs with a transverse position of the fetus, craniotomy were widely practiced and were especially often used placenta department A pathology such as placenta previa, after preliminary vaginal tamponade, usually ended with turning the fetus onto its stem, sometimes with the application of obstetric forceps to the subsequent head. When the umbilical cord fell out, they worked to set it back.” For eclampsia, or “birthing,” as it was called then, wet wraps, dry cupping on the chest, leeches, pedunculation, or obstetric forceps were used to speed up labor. Injuries to the genital tract were treated in a very unique way - even with deep injuries, up to necrosis, they did softening douches, touched with a hellish stone, applied lotions of goulard water or grated carrots. In 1921 Georgy Andreevich Solovyov exclaimed: “It’s a thing of the past, but in suitable cases, when prescribing these simple medicines, I myself saw in the old years an improvement and even a complete recovery, which I could not explain and cannot now.”

Professor occupies an exceptional place in the history of the Moscow Obstetric Clinic and the Russian Obstetric School Alexander Matveevich Makeev(1829-1913). He first introduced the concept of asepsis and antiseptics into the clinic. Being an excellent organizer, he redesigned the obstetric clinic, for the first time dividing it into two departments: physiological (clean) and observational (dirty); strictly monitored the careful observance of asepsis rules by medical personnel, prohibited midwives delivering births and caregivers for women in labor from going to the postpartum ward; introduced individual antiseptics for women in labor (douching cups, bedpans). The premises began to be sanitized using antiseptics. The cases of purulent-septic diseases, the main scourge of that time, sharply decreased. Professor A.M. Makeev improved the obstetric phantom of the French company Schwab, which at that time was considered the best in the world and was used to train students and doctors. The Schwab company exhibited Makeev's phantom at several Russian and international exhibitions.

A prominent representative of the St. Petersburg obstetric school was Martyn Isaevich Gorvits, founded in 1870 Mariinsky Maternity Hospital, where he himself was the director. M.I. Horwitz lived a short life, but during his life he published 31 fundamental scientific works on the issues of dysmenorrhea, abnormal positions of the uterus, oncogynecology, and inflammatory gynecology. Under his editorship in 1883. A textbook on obstetrics was published in Russia Karl Schroeder, which went through 4 editions.

In 1879 In St. Petersburg, the first Russian Midwifery Institute with a maternity ward began its activities, transformed in 1895. to the Imperial Obstetrics and Gynecology Institute, now the Research Institute of Obstetrics and Gynecology named after. BEFORE. Otta RAMS. The institute is named after Dmitry Oskarovich Ott(1855-1929) is far from accidental; under him, the institute gained European and world fame. Professor D.O. Ott had excellent surgical technology; he developed and introduced new obstetric and gynecological operations, new instruments, lighting mirrors, and operating tables.

Along with the St. Petersburg and Moscow obstetric schools, other strong schools have developed in Russia: Kazan, Kharkov, Vilnius.

Nikolai Nikolaevich Fenomenov(1855-1918) was a professor at Kazan University. He was an outstanding obstetrician-practitioner, he performed more than 2,000 abdominal dissections, and he also proposed a number of modifications of obstetric operations - perforation of the presenting head, fetal decapitation, cleidotomy; invented and improved a number of obstetric instruments and, in particular, Simpson forceps (Simpson-Fenomenov). He published the manual “Operative Obstetrics” by N.N. Fenomenov, which is still a classic work today.

The founder of the Kazan school of obstetricians and gynecologists is considered Victorina Sergeevich Gruzdev(1866-1938), who in January 1890. at the age of 34, he won a competition to head the department against 12 professors (with a secret vote of 18 “for” and 4 “against”) and headed the department for almost 40 years. He published a textbook on obstetrics and gynecology, “Course of Obstetrics and Women’s Diseases” (1919-1922); he stood at the origins of oncogynecology and genetics in Russia. B.C. Gruzdev trained 12 doctors of science, among whom were such outstanding obstetricians as Mikhail Sergeevich Malinovsky(1880-1976) and Ivan Pavlovich Lazarevich(1829-1902), who became recognized leaders of domestic obstetrics and gynecology from the first years of Soviet power until the 80s.

It is impossible in one lecture to talk about all the outstanding representatives of the national school of obstetricians and gynecologists, who made an invaluable contribution to the development of Russian and world science with their works; we will name only a few of them: V.M. Florinsky(1824-1891) - author of “Introduction to Gynecology”; K.F. Slavic - author of “Private pathology and therapy of female diseases”; V.V. Stroganov(1857-1938) - author of a method for treating eclampsia, which has received worldwide recognition; K.K. Skrobansky(1874-1946) - author of fundamental works on the physiology and pathology of the ovaries, surgical treatment of uterine cancer, pain relief for childbirth; G.G. Genter(1881-1937) - author of classic works on obstetrics - “Textbook of Obstetrics” and “Obstetric Seminary” in three volumes; N.I. Pobedinsky (1861-1923) - author of the “Brief Textbook of Obstetrics” and many works on the issues of cesarean section, narrow pelvis, eclampsia, etc.; A.P. Gubarev(1855-1931) - author of the clinical manual “Operative gynecology and fundamentals of abdominal surgery”; L.I. BubliChenko(1875-1958) - author of the three-volume publication “Postpartum Infection”.

Achievements of obstetrics inXIXcentury.

The twentieth century saw the advent of antibiotics and blood transfusions, which further reduced maternal mortality.

In the late 1950s - early 1960s. Equipment for assessing the condition of the fetus began to appear, which also influenced the reduction of perinatal mortality.

Edward Hohn of Yale University developed an electronic heart monitor to monitor the condition of the fetus.

Albert Lilly (New Zealand) came up with the idea of intrauterine treatment of the fetus; he was the first to perform intrauterine blood transfusion for hemolytic disease of the fetus that developed as a result of incompatibility of Rh system antigens.

In 1958, Donald (Glasgow) began to use ultrasound to assess the condition of the fetus; this event allowed prenatal care to be taken to a fundamentally new level. Of all the achievements of modern obstetrics, Donald’s contribution is given the palm. Modern obstetrics is unthinkable without ultrasound, which is used to identify defects in the fetus, monitor its growth, and evaluate the function of the placenta. Under ultrasound guidance, a biopsy is performed for the purpose of prenatal diagnosis, and also control over the insertion of a needle when treating the fetus.

Since the mid-1930s, the development of a new type of institution - antenatal clinics - has reached enormous proportions. The twentieth century has witnessed an ever-increasing role of the physician in the process of prenatal care. Currently, births should only take place in maternity hospitals. The arguments in favor of this are simple and convincing - only a hospital can provide adequate monitoring of pregnant women and access to emergency medical care, which was justified by the reduction in maternal and perinatal mortality