1 ФГБНУ «НИИ акушерства, гинекологии и репродуктологии им. Д.О. Отта», Санкт-Петербург; 2 СПб ГБУЗ «Родильный дом № 9», Россия, Санкт-Петербург Поступила в редакцию: 10.06.2016 Принята к печати: 04.08.2016 ■ В статье представлен материал о критических состояниях в акушерской и гинекологической практике (near miss), полученный на основании собственных исследований, а также данных отечественных и зарубежных авторов. Показано, что основным фактором, определяющим исход беременности и родов, является качество медицинской помощи, предоставляемой женщине. Дана характеристика состоянию near miss, указаны факторы риска его возникновения. Предложен показатель, характеризующий медицинскую помощь до получения тяжелых осложнений беременности и родов, а также возможные пути снижения частоты их развития. ■ Ключевые слова: качество медицинской помощи; материнская смертность; критические состояния в акушерстве; факторы риска; дефекты медицинской помощи.■ The article presents material about critical states in obstetric and gynecologic practice ("near miss"), obtained on the basis of their own research, as well as the data of domestic and foreign authors. It is shown that the main factor determining the outcome of the pregnancy and birth, is the quality of medical care provided to the woman. The characteristics of "near miss", indicated the risk factors for its occurrence. A measure of the health care until serious complications of pregnancy and childbirth, as well as possible ways to reduce the frequency of their development.
The article considers the issues of managing quality of medical care in obstetrics, the aim of which is to consider different management models, their advantages and disadvantages. Described the system of total quality management based on the needs of the patient. The presented method models outputs and its use in obstetric institution for integrated assessment activities and ensure continuous improvement and improve the quality of care. The calculation of the performance of the obstetric hospital and dynamic analysis of their effectiveness.
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