Dispensary book of a pregnant woman what to write in the column. When they give out an exchange card to a pregnant woman: what it looks like and what it is for

According to Order No. 50 of the Ministry of Health of the Russian Federation of February 10, 2003 "On the improvement of obstetric and gynecological care in outpatient clinics", which regulates the process of managing pregnancy in antenatal clinics, a pregnant woman's exchange card is a document containing all necessary information about a woman and her child. This information is needed not only to provide medical care during pregnancy and childbirth, postpartum period, but also when observing a child in a children's clinic. An exchange card must be presented upon admission to the maternity hospital for childbirth (or to the pregnancy pathology department). Without an exchange card, a pregnant woman is hospitalized in an observational department, that is, where unexamined pregnant women receive medical care, as well as expectant mothers with infectious diseases.

An exchange card is issued in antenatal clinic or other medical institution, who has the right to conduct pregnancy, for a period of 20–22 weeks and consists of three coupons. Let us consider in more detail which sections are filled out in this document, and explain why this or that information is needed. Indeed, it is often possible to hear statements from expectant mothers that the doctor at the reception asks a huge number of completely unnecessary questions and for some reason prescribes too many tests. But it is important to understand that the doctor does not do this out of idle curiosity, all this data is needed for the proper management of pregnancy and childbirth, and the number of tests and examinations is clearly defined by the relevant orders of the Ministry of Health of the Russian Federation.

Exchange card: first coupon

This part is filled in at the antenatal clinic when registering for pregnancy, and then, at the next visits to the obstetrician-gynecologist. It contains all the necessary information about the expectant mother, including information about the presence of pregnancies, childbirth in the past and their course, about the woman's health before and during real pregnancy. This data will be needed by the doctor who will deliver the baby. At each visit to the antenatal clinic, the woman should always bring exchange card with myself. The doctor enters there the next results of examinations, studies, consultations, tests and other data of the pregnant woman. For some questions of the doctor (this applies mainly to the first visit to the LCD), it makes sense for the expectant mother to prepare in advance so as not to delay the appointment, remembering the necessary information.

1. Full name future mother.

2. Age. Pregnant women under 18 and over 30 require special attention as they are more likely to develop complications during pregnancy and childbirth.

3. Address and phone number of the pregnant woman. This data is necessary to contact the expectant mother or her relatives in case of emergency. For example, when receiving alarming test results, when you need to take urgent action.

4. Information about the father of the child. It is very important to know if the future father has hereditary and infectious diseases(especially hepatitis B and C, HIV). At negative Rh factor blood of a pregnant woman (to predict the risk of developing a Rh conflict in the fetus), information is needed on the Rh factor of the father of the child.

5. Past diseases of a pregnant woman. Availability chronic diseases various systems organism has a significant impact on the course of pregnancy and requires more careful monitoring by an obstetrician-gynecologist, consultations of specialists, addressing the issue of the need for planned hospitalizations, childbirth in a specialized hospital. Important information about childhood diseases, operations, the presence of allergic reactions(especially on drugs), bad habits.

6. Features menstrual cycle, date of the last menstruation, date of the first fetal movement, PDR. If the menstrual cycle is disturbed, it may be necessary additional methods to determine the gestational age. The date of the first day of the last menstrual period and the date of the first fetal movement are also needed to calculate the gestational age and the expected date of delivery (ED).

7. Date of prenatal leave, sick leave number, birth certificate number. These data will be needed at the place of work and in maternity hospital. Continue if necessary sick leave after childbirth, it is this information that will be used (the sick leave itself will be handed over at work when going on maternity leave).

8. What kind of pregnancy is on the bill, the presence of abortions, premature birth are you healthy born children, features of the course of previous pregnancies. During the initial visit, the doctor will ask in detail about how previous pregnancies, childbirth and the postpartum period went, whether there were abortions (year, for how long), in order to timely prevent possible complications during this pregnancy. It is important to know whether surgical interventions in previous births. This may affect the method of delivery this time.

9. Examination at the first visit to the pregnant woman. At the first visit to an obstetrician-gynecologist, the weight and height of the pregnant woman, the size of the pelvis, the results of the examination (general, blood pressure measurement, vaginal examination) must be indicated.

10. Summary sheet of dynamic observation. This section reflects the number of times the woman visited the antenatal clinic, as well as blood pressure, weight gain and the presence or absence of protein in the urine. Order of the Ministry of Health of the Russian Federation No. 50 determines how many times the expectant mother should visit an obstetrician-gynecologist. So, up to 28 weeks, the doctor appoints appearances at least once every four weeks. After 28 weeks and until full term, that is, up to 37 full weeks, a woman visits a antenatal clinic doctor once every 2 weeks, and after 37 weeks - every week.

eleven. . During pregnancy, blood is given three times for RW (syphilis), HIV, tests for hepatitis B and C.

• Group and Rh factor of blood. In the absence of a specific protein on the erythrocytes of a woman - Rh, she is considered Rh-negative. If her future child is Rh-positive, with the development of complications such as termination of pregnancy, hemolytic disease and some others. The blood type must be indicated in the exchange card, as it is vital if the mother needs a blood transfusion during pregnancy and childbirth.
• Clinical Analysis blood taken three times during pregnancy. And with a decrease in hemoglobin (anemia) or other deviations in the analysis, it can be carried out more often.
• Biochemical analysis blood and blood clotting tests(coagulogram) is carried out at least 3 times during pregnancy (if there are no deviations). This extremely important information needed to predict possible complications in childbirth (bleeding).
• Biochemical screening carried out at 10-14 weeks and 16-20 weeks and identifies the risk of the fetus having genetic diseases(Down syndrome and others).
• Results are recorded swabs from the vagina and cervix. This study is carried out three times during pregnancy ( last time before childbirth).
• Feces on worm eggs examined once upon registration.
• General analysis urine available for every visit. Normally, the analysis should not contain protein and a large number leukocytes. One indicator is entered into the exchange card - protein in the urine.

12. Data of a pregnant woman obtained as a result of consultations of specialists. During pregnancy, a woman should visit an ENT specialist, an ophthalmologist, a dentist, a therapist (other specialists according to indications).

13. Visits to the doctor, where complaints are covered, arterial pressure, weight, weight gain, abdominal circumference, fundal height, position and , fetal heart rate, presence of edema, diagnosis, recommendations before next appointment, the date of the next appearance.

14. School of mothers and physiotherapy. The date and number of visits are indicated here.

Exchange card: second coupon

The second part of the exchange card is filled out in the maternity hospital and contains information about the course of childbirth, postpartum period, health of the puerperal. This coupon is issued upon discharge from the obstetric hospital and presented at the antenatal clinic for follow-up monitoring of the health of the young mother. In addition to the general data of the pregnancy (full name, address of the puerperal, date of admission to the hospital), the following columns are filled in:

1. The date of birth is needed to issue a birth certificate for a child, to issue an additional certificate of incapacity for work in case of complicated childbirth.

2. Features of the course of childbirth. Includes duration of labor, duration waterless period, complications. These data are important for predicting the course of the postpartum period.

3. Operative benefits in childbirth (for example, whether a caesarean section was performed, indications for surgery are indicated).

4. Methods of anesthesia. Information is needed to recognize possible complications in the postpartum period (for example, pain in the spine after spinal anesthesia).

5. Gender, height and weight of the newborn, its Apgar score (a scoring system that assesses the state of the newborn; the maximum score is 10).

6. Features of the postpartum period. It indicates whether there were complications of an infectious or other nature after childbirth.

In addition to this information, the date of discharge, test results and treatment carried out in the hospital are recorded in the second coupon.

Exchange card: third coupon

The last coupon contains the information necessary for a pediatrician in a children's clinic. In this document, the doctor of the children's department of the obstetric hospital reflects information about the health of the newborn, about all the manipulations and studies carried out with him in the maternity hospital, as well as about those features of childbirth that could affect the health of the baby. It also indicates what type of feeding the baby is on, whether vaccinations were carried out, and the results of the tests are recorded. This coupon is also issued upon discharge from the maternity hospital.

Many expectant mothers are concerned about the question of why an exchange card is needed when it is issued. An exchange card for a pregnant woman is a very important document that reflects basic information about the expectant mother, the course of pregnancy and possible complications that doctors in the maternity hospital may encounter. In order to correctly fill out the form, doctors use a sample approved by the Ministry of Health.

What is an exchange card?

The exchange card of a pregnant woman consists of three parts:

• data from the antenatal clinic;
• information about a woman in labor, childbirth;
• information about the child.

The first part is completed during pregnancy by a gynecologist, the second in the maternity hospital by an obstetrician, and the third by a neonatologist.

You can get an exchange card in the second trimester, or you can take your time and get it in your hands just before the birth, for a period of 34-36 weeks. This is the maximum term for issuing an exchange card, because last month preterm labor can start at any time during pregnancy. The data of the exchange card will certainly be duplicated in the outpatient card at the place of residence, so even if this document is lost, it will not be difficult to restore it.

An exchange card is issued on hand at the request of a pregnant woman: than harder pregnancy and the higher the possibility of early delivery, the earlier the pregnant woman should receive it, regardless of the condition of the pregnant woman. If labor has begun and an exchange card is not available, deny you medical services are not eligible, but most likely you will give birth in the infectious diseases department, since the doctors are not aware of your health status.

The exchange card is basically signed in the selected maternity hospital in advance, then the risk of losing information and admitting you as a patient with an “unknown” pregnancy history is minimized.

How and when is it done?

They draw up an exchange card when registering, with each new visit to the antenatal clinic there is more and more information, and the prognosis of pregnancy, childbirth and the health of the child is becoming more understandable. The main ways to obtain information about a pregnant woman are:

• conversation;
• visual inspection;
• anthropometric measurements (eg height, weight, blood pressure);
• laboratory research;
• ultrasound diagnostics.

At the first appointment, when a pregnant woman only comes for confirmation of her “ interesting position”, the doctor will find out from you:

• your passport details (name, age, home address);
• the presence of chronic diseases, surgical interventions;
• what is the pregnancy number, how many children were born and in what way, were there any abortions, in what year and for how long;
• will set the gestational age at the time of the examination, calculate the approximate date of delivery.

It is important to know your blood type and Rh factor, as well as the data of the father, in order to avoid Rh and immunoconflicts.

When you come to your gynecologist in the future, information about laboratory research(blood, urine, feces), ultrasound, and on recent weeks- marks about attending the school of expectant mothers and psychological preparation to childbirth. A visit mark is very necessary: ​​if you missed inspections or were not registered at all, you may not be issued an exchange card. In addition, it is important not to miss regular consultation visits, since missed examinations can negatively affect delivery: doctors will not know what to watch out for, which means that precious time may be lost in emergency situations.

After the birth has begun, the doctor will definitely record the necessary information in the card (the speed of the course of labor, the presentation of the fetus, the way of delivery, etc.), because these records will help your gynecologist in the future to observe the recovery process after childbirth, they will be in demand if you decide to give birth again.

The last part of the exchange card is completely devoted to the child. It contains data on birth, weight, height, health status on the Apgar scale and other important facts, which will then be carefully studied by your local pediatrician.

Many are interested in what a pregnant woman's exchange card looks like. You can find a photo on the Internet or ask to see a sample at the antenatal clinic. Another way is to ask your pregnant friends who have already received such a card to send you a photo of it or tell you what questions are reflected there, what to be prepared for.

Changes in exchange cards in 2016

In 2016 significant changes in appearance No exchange card has been entered. It looks exactly the same as it did 10 years ago, when its current version was only developed and put into use. Naturally, in each city, region there may be variations (somewhere it is a book, somewhere a form), but the essence of this does not change.

A novelty for women in labor in 2016 was the general receipt of birth certificates. If back in 2006 only a few people knew about such an innovation, and in 2016, according to the Ministry of Health, 99% of pregnant women use this service. birth certificate issued together with an exchange card for a pregnant woman, it consists of 3 coupons for payment various stages medical care for pregnancy and childbirth:

• A coupon with a nominal value of 3 thousand rubles is intended to pay for the services of a women's consultation.
• The second coupon for 6 thousand pays for the services of the maternity hospital.
• The last, third coupon is used to pay for the services of children's clinics.

The total amount of coupons in 2016 is 11 thousand rubles and is obliged to fully cover all expenses of a pregnant woman for medical care for pregnancy and childbirth.

Do not delay receiving an exchange card until the last minute, it is better to issue it in advance and always carry it with you than to be late and risk your health and the health of your child!

Pregnancy exchange card sample

Completed Sample

This important document is issued to every pregnant woman, but not everyone knows what it is for.

Medical document recorded data exchange card
It is important to remember the pregnant phase
pulls how much
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What an exchange card looks like, how to use it, the gynecologist usually tells the pregnant woman when she is issued.

Why is it necessary?

Consider why you need an exchange card.

1. This includes all the data of the expectant mother.
2. At each visit to the gynecologist, he makes a record of the course of pregnancy in the form.
3. Includes the results of all analyzes conducted surveys.
4. Also, here doctors leave their conclusions about the health of a pregnant woman - narrow specialists.
5. An exchange card is required for a pregnant woman when she is issued a birth certificate.
6. It includes information, as well as all the details about the course of childbirth, information about the child.

When a mother-to-be is given a card, she must carry it with her. This is especially important in the later stages, since at this time childbirth can begin unexpectedly.

When is it issued?

As a rule, such a form is entered when a woman is registered, usually on the first day. However, the terms when doctors issue an exchange card to a pregnant woman in her hands depend on the place of residence. In some cities and regions, it is given only in the second half of pregnancy.

A medical document that will indicate the features of the course of pregnancy

To get a card, you must confirm the fact of pregnancy. To do this, a woman must either undergo an examination by a gynecologist, or go for an ultrasound scan, or donate blood for analysis. If the expectant mother refuses all these actions, the doctor will not be able to register her.

In addition, when an exchange card is issued to a patient, she must provide:

• passport;
• compulsory medical insurance policy;
• SNILS (pension insurance card).

To receive this form, the expectant mother must visit a gynecologist at least once, pass necessary tests, otherwise she may have certain difficulties with admission to the hospital. A woman in labor may not end up in the medical institution that she would like, and will most likely end up in the observational department of the maternity hospital.

Some believe that it is much easier to buy a document and if there is a fake exchange card for a pregnant woman, then you can not visit a gynecologist for 9 months. However, it is not.

The data from this form is extremely important for the management of childbirth, so the expectant mother herself should be interested in complete and reliable information. It is not worth risking your health, and even more so the health of your unborn child, for such an insignificant reason.

In case everything necessary procedures passed and certificates provided, the doctor does not have the right to refuse a woman to register and draw up such an important document.

Features and rules for obtaining

There are times when a future mother may have problems regarding the dispensary book. Answers to the most FAQ can be found below.

What information is entered on this form?

The exchange card records data on the course and the results of the examinations passed

Such a form becomes the main medical document throughout the entire period of bearing a child. What it looks like usually depends on the medical institution, but the internal structure always remains the same.

The exchange card of the pregnant sample of 2015 contains the following sections:

1. Information from women's consultations about women's health.
2. Information from the maternity hospital about childbirth and the woman in labor.
3. Information from the maternity hospital about the newborn.

The doctor from the antenatal clinic enters:

• all personal data about a woman carrying a child;
• information about the health of the expectant mother before pregnancy;
• detailed information about the course of pregnancy.

All facts relevant to the course of pregnancy and childbirth are also entered:

• all past illnesses;
• information about the outcome of previous pregnancies;
• test results, ultrasound;
• risk factors.

It is important to remember that your health information is completely confidential.

All the woman's visits to the gynecologist are also noted, indicating the results of the examination, the doctor's recommendations, the current gestational age.

After labor activity obstetrician-gynecologist enters into this form all information about childbirth:

• date;
• flow features;
• complications;
• the use of any medications or surgical aids.

The pediatrician must enter into it information about the height, weight of the child, the Apgar score, data on vaccinations, diseases, and the nature of feeding.

How is this form used?

To receive, you need to pass a series of tests at least once.

Such an important document must be kept throughout pregnancy. It does not replace a medical card in a hospital or antenatal clinic, but it is very important for the woman herself, since only from this document, if necessary, doctors from other medical institutions will be able to find out all the necessary data about the patient's health.

There are rules for using this form:

• must be carried with you at every visit to the gynecologist;
• must be presented when visiting other specialists so that they make a record of the examination;
• only doctors can enter data here, independent entries or entries by unauthorized persons are not allowed;

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Attention!

The information published on the site is for informational purposes only and is intended for informational purposes only. Website visitors should not use them as medical advice! The editors of the site do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor! Remember that only a complete diagnosis and therapy under the supervision of a doctor will help to completely get rid of the disease!

What tests do you need to pass for an exchange card? What is it at all and why is it needed? How long does it take to issue an exchange card?

These questions bothered me twice in my life - in my first pregnancy, when I was registered with the LCD and visited her with the exemplary behavior of an excellent student (with a two-hour wait in line), and in the second, when there was no time and energy to sit in queues , and the eldest son was not yet ready for such feats (and there was no one to leave him with). Looking ahead, I will say that, having studied the laws of the Russian Federation on the procedure for providing medical care, I found a very interesting and reasoned answer to all my experiences, that I would be left without an exchange office. The exchange can be obtained easily, moreover, for this you do not need to sit in queues for three hours - can be contacted paid clinic, to do everything necessary tests- and bring them to the residential complex to enter them into the exchange card. However, in this case, you must have a specialist whom you trust and who can assess your health status. The following is an excerpt from the article. lawyer Arina Pokrovskaya:

“The exchange card is a medical document where information about the examinations you have passed is entered. The doctors of the antenatal clinic have instructions on the number of visits at which they should examine you:

In accordance with the Procedure for the provision of medical care in the field of "obstetrics and gynecology (with the exception of the use of assisted reproductive technologies)" (approved by order of the Ministry of Health of Russia dated November 01, 2012 N 572n), "during the physiological course of pregnancy, examinations of pregnant women are carried out:

obstetrician-gynecologist - at least seven times;

physician-therapist - at least two times;

a dentist - at least two times;

an otorhinolaryngologist, an ophthalmologist - at least once (no later than 7-10 days after the initial visit to the antenatal clinic);

Other medical specialists - according to indications, taking into account concomitant pathology.

With a complicated course of pregnancy and concomitant pathology, the frequency, frequency of visits to an obstetrician-gynecologist and specialist doctors increases and is determined individually.

However, if you feel well, and visits to the antenatal clinic do not bring harmony to your life, you have the right to refuse regular visits to the gynecologist . If you have made such a decision, the doctor must respect it and politely explain to you possible consequences for Your health.

Intimidation, raising your voice, insults and threats to refuse to issue an exchange card are unacceptable for a doctor. If something like this happens, you can immediately go to a conversation with the head of the antenatal clinic. If you didn’t find understanding there either, you can find out the contacts of the higher health authorities in your city in the consultation itself, where you can report the incident.

At the same time, in order to receive an exchange card, you need at least pass a series of tests once and visit a doctor at least twice - for an initial examination and obtaining referrals for tests and for the results of the tests to be entered by the doctor into the exchange card and issued to you.

Order of the USSR Ministry of Health of June 12, 1986 N 848 (as amended on December 4, 1992) “On the approval of methodological documents for defining concepts related to the perinatal period and for maintaining primary medical records in obstetric institutions” tells us that

"... An exchange card is issued by a women's consultation to the hands of every pregnant woman with a gestational age of 28 weeks."

A number of more modern documents (decrees of the constituent entities of the Russian Federation) contain provisions similar to the following:

“When registering, an obstetrician-gynecologist fills out an individual card for a pregnant woman and a woman in labor, as well as an exchange card, which is issued to a pregnant woman from the first visit. An exchange card is a document of a pregnant woman that must always be carried with her.”

I would like to note that not a single document contains conditions under which you may be denied a card. Thus, if you want to get an exchange card, you need to have time to pass a series of tests by the specified date or a little later - the main thing is to be in time before the birth.

In the antenatal clinic, as a rule, the pregnant woman is offered to undergo standard set surveys. The opportunity to do all the necessary tests and procedures to obtain an exchange card and the right to give birth in a regular maternity hospital is provided to you for FREE. Everything additional is the reinsurance of the doctor and the possibility of receiving material rewards from paid laboratories, where he advises to apply.

Usually (in accordance with the Procedure for the provision of medical care in the field of obstetrics and gynecology, approved by order of the Ministry of Health of Russia dated 01.11.2012 N 572n) this is:
regular examinations by a gynecologist, 3-fold ultrasound examination at the terms of 11-14, 18-21, and 30-34 weeks, examinations by a general practitioner, ophthalmologist, otolaryngologist and dentist, and a number of tests, a list of which can be found in the consultation itself .

If you want to get by with a minimum of obstetric supervision during pregnancy and are practically healthy, then the main tests with which the doctor can determine the absence of infectious diseases are:

clinical blood count, urinalysis, smear, HIV tests, RW, hepatitis B and C tests. A health certificate from a general practitioner is also required. And all this should be timed to around 23 (earliest) or 35 (latest) weeks of pregnancy.

So, based on the above, the doctor in the consultation will be able to conclude that your state of health does not pose a threat to others, after which he will be obliged to issue you an exchange card that allows you to give birth in any maternity hospital in your locality.

I “carried out” the second pregnancy myself, consulting with Russian and Western midwives, I did not apply to the LCD for registration, however, I had a daddy with tests that I myself did in a private clinic:

– Blood type and Rh factor;

– Hepatitis C and B;

- General analysis of blood, urine (3 times - on different terms);

- blood clotting;

- Blood chemistry;

- Blood for sugar - separately;

– Ultrasound at 34 weeks;

– Table of pressure (first trimester, second and third) and weight changes;

– A certificate from the dentist (I had to cure several teeth during pregnancy) and an ophthalmologist.

It was important for me to determine my indicators, to have them on hand in case the doctors or me needed this information. By the way, the midwives at the Bumi Sehat birth center in Bali were very grateful to me for this stack of papers! According to them, it was very easy to navigate the changes that occurred during my pregnancy with pressure, weight, hemoglobin, and it was clear what wonderful births await us 🙂

Be healthy, approach your pregnancy and emotional state consciously!

So, yesterday we discussed the need to maintain an exchange card and the nuances of filling it out, and today we will discuss with you point by point what and how to fill in an exchange card so that you yourself can evaluate and tell the doctor certain features of filling out your pregnancy documents. Accurate and detailed filling out of the exchange card is important so that the doctor can, after reading your card, get a complete picture of you - how is your health, what difficulties can you expect during pregnancy and how the birth will be planned - natural or by surgery caesarean section. All this can be understood with the correct filling of documents and communication with the patient.

Filling out an exchange card with a women's consultation.

In the antenatal clinic, the first part of the exchange card is filled out, which indicates information about the woman and the course of her pregnancy, in special order. Let's see how doctors fill out the card, what needs to be indicated and why.

First of all, the doctor fills in your passport data - first name, patronymic and last name, it is important to indicate the exact age, since very young women under 18 years of age and older women after 35 years of age more often than usual may have problems during pregnancy. The exact address will also be indicated both by registration and by actual residence - this is necessary for emergency cases, if a woman in labor (or her relatives) needs to be quickly found, but she does not answer the phone. Usually, the woman’s phone number is also indicated - home and cell, as well as close relatives - usually her husband, for emergency communication if necessary.

Further, data on the woman's diseases, both general (pyelonephritis, bronchitis, sinusitis), and gynecological operations, are entered into the card. It is especially important to identify hereditary and chronic pathologies, since it is they who can provide the most adverse effect on the course of pregnancy, the correct development of the fetus and the course of childbirth. It is even important what diseases a woman suffered in childhood, because with rickets the pelvic bones can be deformed, which will significantly complicate childbirth, in the absence of indications of childhood infections, separation from patients will be necessary. If there are problems in a feminine way, during pregnancy and childbirth they can become aggravated, which leads to complications in pregnancy and childbirth.

Then you must complete the section on the course of previous pregnancies or childbirth, if this is not the first pregnancy. If any complications arose in previous pregnancies and childbirth, then in the postpartum period the doctor will have more careful observation behind the current pregnancy to exclude the influence of negative factors and the tendency to various pathologies during early or late dates pregnancy. So, have the specificity of repeating late or early toxicosis pregnant women, threats of abortion, development of anemia during pregnancy. If the past birth was pathological, it is necessary to carry out the prevention of complications of pregnancy and childbirth this time. You will need special supervision in the postpartum period.

It is indicated in the card what kind of pregnancy is on the account, and what kind of childbirth will be, how many children a woman has. Since it is important for predicting the course of pregnancy that not all pregnancies ended in childbirth, it is indicated whether there were abortions, in what year at what time, since after abortions there is a high risk inflammatory processes in the area of ​​​​the appendages or uterus, which may increase the risk of an unfavorable course of pregnancy this time and may lead to pathologies in childbirth. If earlier there were episodes of premature birth - then when and in what period it happened, what was the reason for their occurrence. This is necessary to prevent preterm birth at the same time.

Next, you need to indicate the period of the last menstruation, and indicate the first day of normal menstruation. This makes it possible to calculate the duration of pregnancy and the expected date of your birth. Next, the terms of pregnancy for the first visit to the doctor are indicated, this also helps to clarify the date of delivery and gives the doctor an idea of ​​\u200b\u200bhow to plan the pregnancy. The card also indicates the total number of visits to the doctor, since according to special medical orders there is a special plan for doctor visits and observations of a pregnant woman. According to it, a woman with an uncomplicated or complicated pregnancy visits the doctor a strictly regulated number of times so that her examination and observation is complete.

If the pregnancy is proceeding normally, this will be ten visits to the doctor:

The first visit, then ten days later with the results of tests and examination by specialists, then the woman goes to the doctor once a month until 28 weeks, twice a month until 36 weeks, and then every seven to ten days until delivery.
- if pathologies or any threatening factors are detected, the terms for visiting a doctor are set for each woman individually. If necessary, the doctor prescribes additional tests.

It is necessary to indicate the timing of the first movement of the fetus, which is important to clarify the timing of childbirth, while the timing of the first movement in a woman with a first pregnancy differs from the timing of the one who gives birth again.

It is important to indicate all the features during this pregnancy, which could somehow affect further childbirth and will give useful information maternity doctor. Many complications during pregnancy can significantly affect the process of childbirth, the method of delivery, and further, the postpartum period.

First of all, you need to measure and accurately indicate all the dimensions of the pelvis, there are several of them. The pelvis can be narrow in one or more sizes if the numbers differ by 1.5-2 cm or more. With a narrowing of the size of the pelvis, there is a possibility that the fetus, when it grows up to the due date, may not pass through the birth canal. But there may also be birth canals of quite normal size, while the size of the fetus is high and creates a state of relative narrow pelvis- that is, regarding the child. The dimensions of the pelvis are specified several times during pregnancy, and they are also correlated with the dimensions of the head and body of the fetus, its weight.

Also, a woman's weight and body proportions are measured, since with low stature there may be anatomical features of the spine and pelvis, which can cause a clinically narrow pelvis and cause difficulties in bearing a child. It is important to measure the weight and fix it initially, since the final weight gain of the woman’s body will be calculated from this weight, add on average future mommy maybe from 10 to 15 kg, depending on the physique and initial weight at the first appearance. If a woman has a weight deficit for height, she can add up to 15-17 kg, if the excess is no more than 9-10 kg.

As the baby grows and develops, it is important to note the position that he occupies in the uterus. This factor is crucial during childbirth, since the most optimal for childbirth is cephalic presentation baby in a special position. With other presentations, the issue of delivery will be decided based on the specific position of the child in the uterus and the possibility natural childbirth towards the end of the term. The fetus takes its final position in the uterus after 32-34 weeks, before this rock it can turn over several times. Pathological presentations are oblique position fetus, transverse, facial, pelvic and others. But in 95% of women, by the time of birth, babies take correct position in the uterus. If the fetus does not unfold by 32 weeks, this gives the doctor a reason to prescribe special methods of gymnastics for the woman so that the fetus turns over in the uterus into the desired position.

Next, the doctor determines the presenting part of the fetus - this is the part that stands in the pelvic area and will be the first to pass through the birth canal. With the head location of the fetus, the presenting part should be the occipital part, so the head will enter the pelvis smallest size. But it can also be the presenting face, forehead, crown. This is worse for childbirth and increases the risk of injury - the size of the head becomes not the smallest size in the pelvis. At breech presentation it can be an ass, legs with buttocks, or just legs. All these data are important for deciding on the management of childbirth - whether it will be a natural delivery or childbirth is best done through a caesarean section.

It is also important to note in the exchange card such indicators as the heart rate per minute in the fetus, determined by an obstetric stethoscope, which is applied to the abdomen and listened to. By the number of heartbeats per minute, the condition of the fetus is determined when it is comfortable in the mother's stomach: if the heart rate reaches 140 beats per minute and the rhythm is clear and precise. If the rhythm is disturbed, one can think of hypoxia, problems with the placenta, or any other complications. In the place where the heartbeat is heard more clearly, one can judge how the baby lies in the uterus - legs or head down. The heartbeat of the fetus in the exchange card begins to be recorded from 32 weeks, at each visit to the doctor, and the data is noted in the card.

Tomorrow we will fill out analyzes and observation diaries, as well as the second and third parts of the map.

Why an exchange card for a pregnant woman?