About the implementation of the integrated model of obstetric care for 9 months of 2016 in the Republic of Kazakhstan

The integrated model of delivery of medical assistance of the obstetric service in Kazakhstan is aimed at reducing maternal and perinatal mortality. The main goal of obstetrics service is to increase the effectiveness of obstetric care in emergency situations, to reduce critical conditions for obstetric reasons.

Within the framework of this model, the specialists of the Center conducted an audit of maternal mortality for 9 months of 2016: indicators were calculated; The structure of maternal mortality is compiled for reasons, by the level of regionalization, by pregnancy, by age, causes of death are determined by regions.

According to reports, a high percentage of women of fertile age with extragenital diseases in the South Kazakhstan region (62%, severe extragenital pathology – 42%), including those with absolute contraindications (0.7%), which constitute a high risk of maternal mortality, About unsatisfactory medical examination of women of childbearing age, inadequate contraception, insufficient information and explanatory work, late decision on the possibility of prolonging pregnancy with specialized specialties Alists, underestimation of the severity of the condition and late hospitalization in a hospital in a serious condition. Insufficient integration of obstetric and multidisciplinary hospitals.

Nevertheless, the regionalization of obstetric-gynecologic and perinatal care is fully observed: the planned hospitalization of pregnant women in obstetric medical organizations is carried out by referring a medical worker to primary health care in accordance with the level of necessary medical care through the Portal of the Bureau of Hospitalization.

Pregnant women with a gestation period of up to 30 weeks, postpartum and post-abortion women with extragenital pathology, in the presence of medical indications and absence of obstetric complications, are hospitalized in specialized somatic departments of hospitals. The transfer of pregnant women, parturients, puerperas, newborns to medical organizations of obstetrics and childhood of a higher level (in the absence of contraindications for transportation) is carried out by the sanitary aviation service.
All air ambulance services that provide round-the-clock medical care to pregnant women, women in labor, women in childbirth and children are equipped with modern means of communication: consultations by the department’s specialists via telemedicine, THURAYA, SCYPE satellite communication is used for communication.

For example, in Akmola region, telemedicine equipment operates in 15 districts, the percentage of GPS navigation equipment is 25.9% (Kokshetau and Shchuchinsk). To ensure the transportation of patients in the Aktyubinsk region, there are 5 ambulances, including 3 reanimobiles, 1 helicopter and 1 airplane provide air transportation, Karaganda Oblast emergency medical service provides 20% of GPS, 70% radio communication, 1005 staffed with medical personnel, ADIS, The material and technical equipment is 95.7% equipped with an AN aircraft.

In Kazakhstan, the material and technical equipment of maternity facilities has been strengthened.

The construction of the microbiological laboratory of the Mangistau regional perinatal center has been completed. Due to paid services purchased: 18 portable pulse oximeters for delivery rooms; 7 syringe dispensers; 1 centrifuge for the genetic laboratory; 1 additional chamber for laparoscopic operating room; 1 operating table; 2 electrocardiograph; 2 cardiotocographs; 16 vacuum cleaners; 2 portable fetal stethoscope; 1 hematological analyzer, urinary analyzer, audiometer.

On staffing the need of obstetrician-gynecologists, anesthesiologists-resuscitators, neonatologists was made. Steps are now being taken to reduce the deficit of personnel in Aktobe, Almaty, Atyrau, East Kazakhstan, Zhambyl, WKO, Mangystau, North Kazakhstan oblasts, with the retraining of specialists (mainly neonatologists), and the training of doctors of all specialties in effective perinatal care, Childhood diseases.

The staff of the Center conducted thematic cycles, trained 55 obstetrician-gynecologists, 15 doctors of prenatal diagnostics and 12 doctors on functional diagnostics. Working training programs on the theme “Effective Perinatal Technologies” were developed and approved. The coordinator of the EPU conducted an audit: in the Kazalinsky district of the Kyzylorda region; Mangistau region; Atyrau region; West-Kazakhstan region.

In addition, during the reporting period, agreements were concluded with the supervised areas for the provision of educational services and 186 students attended the training: Kazalinsk-8, Aktau-24, Zhanaozen-18, Atyrau-31, Uralsk – 33, Taraz – 46, Shymkent – 18, the city of Kzyl-Orda – 8.

In order to provide practical assistance, business trips were made to Aktau, Taraz, Zhanaozen, Almaty oblast, Uralsk, SKO, Kyzylorda and planned – 66, sanitary aviation – 8, mentor courses, master classes In the years. Taraz, South-Kazakhstan oblast, consultations on telemedicine – 38, telephone consultations – 20, teleleacies – 10.

The branches of the residency for obstetrician-gynecologists of the Center on the basis of the Regional perinatal centers of Mangistau oblast (5 residents), SKO (19 residents) and Zhambyl oblast (3 residents) are opened and functioning.