Obstetric referral flow chart
Referral system for high-risk pregnant women I. Referral scope for high-risk pregnant women
What does high-risk pregnant women mean? Who may endanger pregnant women, fetuses and newborns or cause dystocia due to certain factors during pregnancy? . Modern medicine believes that high-risk pregnancy should be extended to social high-risk factors such as society, economy, transportation and culture besides pathological factors. In the prenatal examination, in addition to finding complications and complications of pregnant women, pregnant women living in remote mountainous areas, with inconvenient transportation, long-term absence of husbands, backward concepts and poverty should also be treated as high-risk pregnant women, treated as early as possible, and mobilized to be hospitalized in advance for labor. The specific referral scope is:
1, pregnant women with high-risk pregnancy prenatal score 10 must be referred step by step according to routine requirements, and can be referred if necessary. The scoring standard refers to the prenatal scoring standard of high-risk pregnancy of the Ministry of Health (see Annex 3).
2. Pregnant women have unexplained vaginal bleeding, abdominal pain and shock.
Second, organization and management.
(a) the administrative department of health
1, the Municipal Health Bureau is responsible for the standardized management, quality supervision and departmental coordination of the emergency referral of high-risk pregnant women in the city, and designates the municipal medical and health institutions with strong comprehensive rescue capability as the superior referral institutions for receiving critically ill pregnant women. The establishment of maternal first aid leading group and office, organize relevant experts to set up a municipal maternal first aid expert group.
2, the district (city, county) health bureau should set up a leading group for maternal first aid, and in accordance with the regional health planning, set up a county-level obstetric first aid center, organize the deployment of medical first aid resources within the county, and coordinate all relevant units to participate in critical maternal first aid work; Responsible for the construction of emergency referral network for pregnant women in villages, townships and counties, and promote its normal operation to ensure the smooth referral channels for high-risk pregnant women.
(2) Maternal and child health care institutions
City and county maternal and child health care institutions are professional management institutions for referral of high-risk pregnant women.
1. The Municipal Maternal and Child Health Hospital is responsible for standardizing and guiding the construction and business management of the referral network for high-risk pregnant women at the city and county levels, doing a good job in screening, management, referral and treatment of high-risk pregnant women, and organizing the training of relevant technical personnel at the city and county levels.
2, county maternal and child health care institutions to assist the health administrative departments at the same level, the county obstetric emergency center and village, township, county maternal emergency referral network construction for business guidance and management, standardize the area of critical maternal referral management; Responsible for guiding the screening and management of high-risk pregnant women and organizing technical training for township health personnel.
(3) Responsibility of other medical institutions
Responsible for screening, management, treatment and referral of high-risk pregnant women.
Third, build an emergency referral network for high-risk pregnant women.
High-risk maternal emergency network includes village, township and county-level maternal management network, county-level obstetric emergency center (sub-center), and designated medical and health institutions with maternal emergency ability at or above the municipal level.
(1) village level
Village-level maternal and child health workers or rural doctors master the dynamics of high-risk pregnant women in the village, communicate with township-level maternal and child specialists in time, and urge high-risk pregnant women to choose appropriate medical and health institutions for prenatal examination and hospital delivery. In areas with inconvenient transportation, the village committee should set up a maternity escort team to escort pregnant women to the township (town) hospital or county-level obstetric emergency center for delivery or treatment.
(2) Township level
Township (town) health centers are responsible for the management of high-risk pregnant women in their townships (towns), carry out high-risk screening and early identification of pregnant women in their jurisdictions, do a good job in information reporting and feedback, and guide and urge high-risk pregnant women to choose appropriate medical and health institutions for prenatal examination and hospital delivery. Township health centers that have been approved to carry out midwifery technology must set up primary rescue teams for pregnant women, strictly implement graded treatment and management systems while carrying out primary rescue for intrapartum and postpartum complications, and timely send critically ill pregnant women to? Obstetric emergency center (sub-center)? Recommended. Central hospitals should be divided into departments (designated by county-level health administrative departments) to help general hospitals deal with general dystocia. Dystocia that cannot be handled should be immediately transferred to county-level medical and health institutions without delay. Cesarean section should not be performed in general township hospitals or central hospitals that do not have the conditions for blood transfusion rescue.
(3) county-level obstetric emergency center (including sub-centers)
1. setting: after evaluation by county-level health administrative departments, each county has set up 1 obstetric emergency center (in principle, it should be set up in county-level general hospitals), and regional 1-2 obstetric emergency sub-centers can be set up in relatively remote areas with large county scope according to actual needs, and the health administrative departments should announce the compliance status to the public? Obstetric emergency center (sub-center)? List.
2. Construction standard: See the annex for details.
3. First aid organization: The county-level obstetric first aid center (sub-center) must set up a maternal first aid expert group, which is responsible for guiding and participating in the training of maternal first aid and related first aid techniques. The members of the expert group are composed of local experts in obstetrics and gynecology, pediatrics, internal medicine, surgery, emergency department, anesthesiology and laboratory. The leader of the expert group shall be the person in charge of the medical and health institution where the emergency center is located. Obstetric emergency center implements the working system of division of labor and cooperation among team leaders and 24-hour duty.
4. Responsibilities: Responsible for receiving the referral of high-risk pregnant women within the jurisdiction and undertaking the diagnosis, treatment and rescue of critically ill pregnant women; Be responsible for the diagnosis and treatment of critical obstetric patients, and the requests for consultation and rescue made by lower-level hospitals should be immediately divided into three groups.
The weaver went to the scene to guide and participate in the treatment. According to the principle of piecemeal referral, the unit receiving the ambulance is generally responsible for receiving the rescue notice. If the ambulance in our hospital goes out, we should contact other institutions to implement the ambulance quickly and report to the local health administrative department, and coordinate with the nearby hospitals to solve it, and we must not delay the rescue opportunity. In case of emergency, the health administrative department shall make unified arrangements to solve it. If the condition is critical and the county-level obstetric emergency center is difficult to handle, it should be immediately transferred to an institution with the ability of maternal emergency treatment at or above the municipal level.
(four) municipal referral agencies
The Municipal People's Hospital and the Municipal Maternal and Child Health Hospital are municipal referral institutions for high-risk, acute and severe pregnant women, and are responsible for the municipal reception, first aid and referral of high-risk pregnant women within the city. Municipal referral agencies should ensure the smooth emergency access for pregnant women, simplify admission procedures and processes, and not shirk and delay the treatment of critically ill patients for any reason.
(5) Other medical institutions.
Other maternal and infant health care practice institutions approved to set up obstetrics should set up in-hospital maternal first aid teams to be responsible for in-hospital obstetric first aid, difficult consultation and discussion, and all practice institutions should earnestly perform the functions of diagnosis, treatment and referral of high-risk pregnant women. Who can't get the correct diagnosis and treatment of pregnant women, should be promptly transferred to the county-level obstetric emergency center or above the municipal level with the ability of maternal emergency treatment institutions. We should take a positive attitude towards the handover, and don't delay or prevaricate.
Fourth, the management of high-risk pregnant women.
Screening system for high-risk pregnant women
Health care personnel at all levels should mobilize pregnant women to build cards (books) in township hospitals (community health service centers), use unified maternal health care manuals, and conduct regular prenatal examinations. 4 to carry out all medical insurance for maternal health care services.
Health care institutions should carry out high-risk screening in every pregnancy health examination according to the prenatal scoring standard of high-risk pregnancy.
(b) The first diagnostic system for high-risk pregnant women
Should the medical and health institutions that first discovered the high-risk factors of pregnant women do it on the cover of the Handbook of Maternal Health Care? High risk? Red triangle logo, detailed registration in the register of high-risk pregnant women, correct handling, and regular reporting. At the same time, inform pregnant women of the adverse outcome of high-risk pregnancy, determine the delivery hospital, and implement early intervention measures such as termination of pregnancy or early hospitalization.
Report and feedback system for high-risk pregnant women
Village-level women who find or suspect high-risk pregnant women should report to township health centers in time. Township health centers are responsible for managing high-risk pregnant women in towns and villages, and report those whose scores are above 10 to county-level maternal and child health care institutions every month, and report critical cases in time. Medical institutions at or above the county level shall, in accordance with the principle of territorial management, report to the local county-level maternal and child health care institutions on a monthly basis the high-risk pregnant women who are out-patient or hospitalized.
County-level maternal and child health care institutions will timely feed back the information of mobile high-risk pregnant women to the township (town) where the pregnant women are registered, and township hospitals will feed back the screened high-risk pregnant women to their villages.
(d) tracking system for high-risk pregnant women
Maternal and child health care institutions at the county level should generally visit high-risk pregnant women with a score of 15 twice (designate a special person to be responsible). After receiving the report of high-risk pregnant women with a score of 15 or above, the pregnant women will be interviewed for the first time within 20 working days, and a comprehensive examination will be conducted, and a case card for high-risk pregnant women will be established, and a second interview will be conducted when they enter the expected date of delivery, focusing on guiding hospital delivery and related matters needing attention. Township maternal and child health care personnel should also visit high-risk pregnant women in townships (towns) twice, and the visit time and work content refer to the requirements of county-level visits.
(5) Referral system for high-risk pregnant women.
five
1, implement the village, township, county or county, city and province referral model for high-risk and critical pregnant women. Cross-level referral can be made when necessary.
2, high-risk, critically ill pregnant women in principle to implement cross-hospital referral. Township and county-level medical and health institutions should undertake the referral task of high-risk pregnant women. Medical and health institutions with ambulances must be designated by the county-level health administrative department to transport high-risk pregnant women. The county-level obstetric emergency center (sub-center) is mainly responsible for the first aid of critically ill pregnant women within its jurisdiction. In principle, pregnant women with a prenatal score of 5 for high-risk pregnancy can give birth in a health center as appropriate; Pregnant women with a score of ≦ 15 can give birth in medical and health institutions above the central health center; ≦25 points of pregnant women, should be promptly referred to the county-level obstetric emergency center or municipal referral agencies; High-risk pregnant women with 25 points must be referred to the Municipal People's Hospital for treatment in time. It is forbidden for high-risk pregnant women to deliver babies at village level.
3, county and township medical and health institutions once found high-risk pregnant women, or found labor, dystocia, etc. And beyond their own rescue conditions and capabilities, should be according to the high-risk maternal referral flow chart (see Annex
1), immediately transferred to a county-level emergency obstetric center (sub-center) or a municipal referral institution with rescue capability for treatment. Referral should be accompanied by an informed doctor and medical staff with certain obstetric first aid skills and experience, observe the condition during the referral, do a good job of handover, and use a unified referral notice for high-risk pregnant women (see Annex 2); If the situation is critical and it is not convenient to transfer to hospital at that time, it is necessary to immediately report to the county-level obstetric emergency center to send the backbone to the scene to participate in and guide the rescue.
Verb (short for verb) others
1, all medical and health institutions should consciously carry out screening, management, diagnosis and treatment and referral of high-risk pregnant women in accordance with these measures. Any medical and health institution shall not use any excuse to intercept the critically ill pregnant women beyond the treatment capacity of our hospital, and must call for help or refer them in time to avoid delaying the illness.
2, the district (city, county) health bureau to medical and health institutions to carry out high-risk maternal management, referral work as an important part of its maternal and child health care service license approval and verification, where in high-risk maternal 6.