Клинпротоколы РФ, обсуждение

[JamesJames]

DrTatyana любезно предоставила ссылку на клинпротоколы по специальности.

Какие у вас есть соображения?

Мои выводы -

1) отстали от цив. мира годов на 10. не на 30, но на десять.
2) кусками переведенные тексты из зарубежных источников без осмысления. Что уже неплохо.
3) пока будут в коллективах Прилепские и иже с ними хорошего ничего не будет. и интерфероны ждут влагалищ русских дам.

[Torren]

Данные протоколы где-то опубликованы? В частности:
Антибиотикопрофилактика при абдоминальном родоразрешении

[DrTatyana]

пройдите по указанной в посте ссылке и - о чудо! все указанные протоколы выложены на сайте

[Torren]

Меня интересуют печатные издания. Предоставленную ссылку видел, спасибо.

[DrTatyana]

Печатных изданий не встречала - только по эндомериозу и миоме матки

[JamesJames]

думаю будет уместно расширить тему следующим пассажем -
new joint guidelines from the American College of Obstetricians and Gynecologists (ACOG) and SMFM

[JamesJames]

Specific Recommendations to Safely Reduce Primary Cesarean Deliveries
Permit prolonged latent (early)-phase labor.
Consider the start of active-phase labor to be defined as cervical dilation of 6 cm (instead of 4 cm).
Permit more time for labor to progress in the active phase.
Permit multiparous women to push for 2 or more hours and primiparous women to push for 3 or more hours. In some situations, for example, when epidural anesthesia is used, pushing may be allowed to continue even longer.
Use techniques, such as use of forceps, to facilitate vaginal delivery, which is the preferred method when possible.
Encourage patients to avoid excessive weight gain during pregnancy.
Increase access to nonmedical interventions during labor, such as continuous labor and delivery support, which has been shown to decrease cesarean birth rates.
Perform external cephalic version for breech presentation.
Permit a trial of labor for women with twin gestations when the first twin is in cephalic presentation.

[JamesJames]

Cesarean delivery is not indicated for prolonged latent phase (> 20 hours in nulliparous women and > 14 hours in multiparous women) in the first stage of labor.
Cesarean delivery is not indicated for slow but progressive labor in the first stage of labor.
The threshold for the active phase of most women in labor should be considered to be a cervical dilation of 6 cm.
Standards of active-phase progress should not be applied before 6 cm of dilation is achieved.
Only women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change, should undergo cesarean delivery for active-phase arrest in the first stage of labor.
Experts have not yet identified a specific absolute maximal length of time spent in the second stage of labor beyond which all women should undergo cesarean delivery.
Labor arrest in the second stage of labor should not be diagnosed without pushing for at least 2 hours in multiparous women, or for at least 3 hours in nulliparous women, if maternal and fetal conditions permit.
As long as progress continues, longer durations of labor may be appropriate on an individualized basis (eg, with the use of epidural analgesia or with fetal malposition).
In the second stage of labor, a safe, acceptable alternative to cesarean delivery is operative vaginal delivery by experienced and well-trained clinicians who maintain their practical skills in this procedure.
Before moving to operative vaginal delivery or cesarean delivery in the setting of fetal malposition in the second stage of labor, manual rotation of the fetal occiput may be a reasonable alternative.
The fetal position in the second stage of labor should be evaluated, particularly in the setting of abnormal fetal descent, to safely prevent cesarean deliveries when malposition is present.
For repetitive variable fetal heart rate decelerations, amnioinfusion may safely decrease the rate of cesarean delivery.
When abnormal or indeterminate fetal heart patterns are present, scalp stimulation can be used to evaluate fetal acid–base status.
Labor should be induced before 41-0/7 weeks of gestation only if needed based on maternal and fetal medical indications.
At 41-0/7 weeks of gestation and beyond, labor should be induced to reduce the risks for cesarean delivery and perinatal morbidity and mortality.
Cervical ripening methods are recommended when labor is induced in women with an unfavorable cervix.
If the maternal and fetal status permit, cesarean deliveries for failed induction of labor in the latent phase can be reduced by permitting longer durations of the latent phase (≥ 24 hours) and requiring that oxytocin be administered for at least 12 to 18 hours after membrane rupture before the induction is considered to be a failure

[howk]

Коллеги, в помощь "вновь россиянам" из Крыма, могли бы вы подсказать, на какие протоколы нужно ориентироваться в работе? Несколько непривычно, после украинских приказов-протоколов по всем нозологиям (ну почти). Как то понял, что основной документ - это Порядок, приказ 572, видел стандарты - но это больше финансы, а протоколы?

[FilippovaYulia]

Согласно федеральному закону №323-ФЗ "Об охране здоровья..." - Россия работает не по протоколам, а по стандартам. И никак иначе.

[KalinichenkoEV]

Посмотрела проект рекомендаций по железодефициту у беременных - это что-то странное и несуразное (я терапевт, но занимаюсь беременными, для меня вопрос ЖДС очень актуален).
Надеялась, что нормы гемоглобина хотя бы во втором триместре снизят до 105 г/л, но нет. Зато вместо ЖДА - МЖД, по-модному.
Надеюсь, документ как-то доведут до ума, работать по нему не хотелось бы...