History of the development of obstetrics. History of the development of obstetrics and obstetrics. Main historical stages of development

Gynecology (from the Greek words: gyne - woman and logos - science) is a science that studies the structural features and physiological processes that occur in a woman’s body from childhood to old age, as well as diseases of the female genital organs that occur outside of pregnancy and childbirth. Modern obstetrics and gynecology are a single clinical discipline.

The history of the development of gynecology is closely connected with the formation of all medical knowledge accumulated during the existence of mankind. In particular, gynecology is sometimes inseparable from obstetrics and is in close connection with related sciences - surgery, therapy, neurology.

According to written sources, gynecology is the oldest field in medical science. The first mentions of solving issues related to gynecology in its modern understanding are found already in the most ancient Indian, Greek, Egyptian, and Slavic written monuments.

Thus, references to female diseases, their treatment, and the menstrual cycle are found in historical sources such as the Talmud and the book of Moses. The great attention paid to gynecology in such ancient times is also explained by the fact that it is directly related to procreation.

Mentions of gynecology are found in the documents of Hippocrates (4-5 centuries BC), doctors of ancient India and Egypt, and among the Slavic peoples. Hippocrates described the diagnosis and clinical picture inflammatory diseases of the female genital organs. After Hippocrates, gynecology, like all medicine, continued to develop, although rather slowly.

In the Middle Ages, although gynecology was revived, it came under the dominant influence of mysticism and scholasticism at that time. Only since the Renaissance did doctors begin to collect material for the construction of a building for scientific gynecology. Gynecology began to actively develop in the 16th century, when the structure of the female body and its features were accurately studied and described in scientific works. Scientists of that time A. Vesalius and T. Bartolin contributed to the development of this branch of medicine by studying the anatomy and physiology of the female reproductive system.

From the 18th century Gynecology emerged as an independent science. The Russian doctor N. M. Maksimovich-Ambodik, in the first Russian original manual, “The Art of Bowing” (1784-86), paid a lot of attention to physiology, pathology, diagnosis and prevention of gynecological diseases. The progress of gynecology was significantly facilitated by the opening of gynecological clinics and higher medical educational institutions in Russia (the first gynecological department was created in 1842 in the obstetric clinic of the St. Petersburg Medical-Surgical Academy) and abroad.

Gynecology received significant development at the beginning of the 20th century thanks to the research of Russian, American and German scientists. In the first half of the 20th century, important steps were made in the diagnosis and treatment of many gynecological diseases. In the middle of the 19th century, the first obstetrics and gynecology centers began to emerge. At the dawn of the 20th century, the surgical direction in gynecology began to develop.

In Russia, gynecology for a very long time was combined with obstetrics and even childhood diseases; in some medical institutes these three departments are still connected together. The development of operative gynecology was facilitated by advances in anesthesiology, the use of antibiotics, blood transfusions, and the development effective fight with shock and terminal conditions and improvement of operative techniques.

In 1903, the founder of gynecology in Russia, Snegirev, spoke out against one-sided hobby surgical interventions. He was the first to express an opinion about the relationship between the local process and the state of the whole organism. Subsequently, this point of view in gynecology became generally accepted.

Study methods radiation therapy made it possible to use it in gynecology in the treatment of malignant neoplasms of the female genital organs. Application of what was proposed in 1925 German doctor H. Hinzelman's colposcope and the method of cytological examination, introduced in 1933 by the American scientist G. Papanicolaou, expanded the diagnostic capabilities of gynecological examinations.

In Russia and abroad the following are being developed: issues of physiology and pathology of the female genital organs, gynecological oncology; problems with menstrual dysfunction, endocrine disorders; mechanisms of development and treatment of inflammatory diseases of the female genital organs; issues of operative gynecology, urogynecology and pediatric gynecology.

A method of radical surgery for uterine cancer was developed and became widespread (the Austrian scientist E. Wertheim and the Russians A. P. Gubarev, I. L. Braude, S. S. Dobrotin, etc.). The development of operative gynecology was facilitated by advances in anesthesiology, the use of antibiotics, blood transfusions, the development of effective control of shock and terminal conditions, and the improvement of surgical techniques.

Techniques that are widely used in world gynecology are widely used in modern medicine and help avoid the most serious complications of many gynecological diseases.

In the 20th century Great strides have been made in theoretical gynecology. In Russia, problems of theoretical and clinical gynecology are covered in general medical literature and special journals - “Obstetrics and Gynecology” (since 1936), “Issues of maternal and child health” (since 1956), etc.

Since the end of the 20th century, the rapid development of cryosurgery, videoendoscopy (sparing “croneless” operations on the pelvic organs for infertility, tumors of the ovary, uterus), fetal therapy (surgeries on intrauterine fetus), assisted reproductive technologies (in vitro fertilization for infertility) have significantly improved the quality of life of women. Improvement medicines, used in gynecology, allows you to successfully solve problems that were impossible in the 50s of the twentieth century. - correction of the menstrual cycle, safe contraception, radical cure for inflammatory diseases, regression of small benign tumors of the ovaries and uterus.

The introduction of evidence-based medicine (medicine based on controlled randomized trials and meta-analysis) made it possible to introduce clinical practice standard diagnostic and treatment protocols, truly proven, reliable, safe.

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Abstract on the topic:

History of the development of obstetrics"

Prepared by: Fokina Anzhelika Alexandrovna

Group student: B31-IIILD

Introduction

Chapter 1. The origins of obstetric practice

1.1 Primitive society

1.2 Ancient Greece

Chapter 2. Middle Ages

2.1 General development obstetrics

2.2 Major achievements

Chapter 3. From XIX to the present day

3.2 Modern obstetrics

List of used literature

Introduction

Obstetrics (French accoucher - to help during childbirth) - area clinical medicine, studying physiological and pathological processes, occurring in a woman’s body associated with conception, pregnancy, childbirth and the postpartum period, as well as developing methods of obstetric care, prevention and treatment of complications of pregnancy and childbirth, diseases of the fetus and newborn.

Assistance during childbirth and care of children (newborns) is one of the most ancient types of medical activities. Even in primitive times, there was instinctive self-help during childbirth, but after many centuries the ability to help a woman in labor almost reached perfection. This all happened due to the fact that over time people have accumulated a huge amount of material necessary for diagnosing childbirth and treating pathologies that may arise due to pregnancy.

I believe that the profession of an obstetrician-gynecologist is very important, since it is these doctors who should be responsible for saving not one life, but two at once, for preserving the health of the mother and her child.

obstetric practice greece birth

Chapter 1.The origins of obstetric practice

1.1 Primitive society

Obstetrics is an ancient field of medicine. Even in the early stages of development, people understood the need to help their fellow tribesmen, especially women and their future offspring.

The first bearers of this medical field were experienced women who accumulated knowledge and passed it on from generation to generation. Of course, treatment in those distant times was very different from how we are used to seeing it today. Women in labor were given a variety of medicinal herbs, and certain rituals were performed with them using amulets and spells. But along with irrational medicine, there were also rational methods. There is reason to assert that already at that time there was a caesarean section (Cesarean section or Caesarean section (lat. sectio caesarea, from sectio - section and caedo - cut), an artificial delivery operation in which the fetus and placenta are removed through an incision in the anterior abdominal walls and bodies of the uterus).

In the book by R. Felkin, published in Marburg in 1885, which describes a caesarean section observed by a traveler in a black family Central Africa: “A 20-year-old woman, a first-born woman, completely naked, lay on a slightly inclined board, the head of which rested against the wall of the hut. Under the influence of banana wine, she was half asleep. She was tied to her bed with three bandages. The operator with a knife in his hands stood on the left side, one of his assistants held his legs at the knees, the other fixed the lower abdomen. Having washed his hands and the lower abdomen of the patient first with banana wine and then with water, the operator, uttering a loud cry, which was echoed by the crowd gathered around the hut, made an incision along the midline of the abdomen from the pubic joint almost to the navel. With this incision he cut both the abdominal walls and the uterus itself; one assistant cauterized the bleeding places with great skill with a hot iron, the other parted the edges of the wound to enable the surgeon to remove the child from the uterine cavity. Having removed the placenta and the resulting blood clots through the incision, the operator, with the assistance of his assistants, moved the patient to the edge of the operating table and turned her on her side so that all the fluid could flow out of the abdominal cavity. Only after all this were the edges of the abdominal coverings connected using seven thin, well-polished nails. The latter were wrapped with strong threads. A paste was applied to the wound, which was prepared by carefully chewing two roots and spitting the resulting pulp into a pot; a heated banana leaf was placed on top of the paste and the whole thing was strengthened with a kind of bandage.”

Today, some African tribes still live in conditions close to primitive society. Therefore, this excerpt from the book is given in order to show how a caesarean section most likely took place in a primitive society.

1.2 Ancient Greece

It's no secret that Ancient Greece was a source of medical knowledge. The collection of Hippocrates was the main basis for any outstanding medical professional for a long time in Europe.

In the Collection of Hippocrates, much attention is paid to obstetrics. An indication of the true continuation of pregnancy, consideration of the diagnosis of pregnancy, a description of the pathology of pregnancy and childbirth, such as prolapse and entanglement of the umbilical cord, hydatidiform mole - these are not all the issues that are mentioned in the book.

Soranus of Ephthea made a huge contribution to the development of obstetrics at the beginning of the 2nd century BC. His main achievement was a work consisting of 4 books, in which he described the complications of the postpartum period. De mulierum morbis is one of the most famous books of Soranus, which was used by many obstetricians until the Middle Ages.

Galen played an equally significant role in the development of obstetrics. He was one of the first to describe the anatomy of the pelvis. Moreover, all his life he was attracted to embryology, in which he also achieved success.

In Ancient Greece, midwives already had a certain foundation of knowledge. They knew the signs by which it could be said that a woman was pregnant: lack of menstruation, nausea, vomiting, the appearance of yellow spots on the face. But they also used rather strange means, for example, they rubbed a red stone in front of a woman’s eyes; if dust got into her eyes, the woman was considered pregnant, otherwise the pregnancy was denied. They tried to determine the sex of the fetus by the inclination of the pregnant woman's nipples; tilting them down indicated pregnancy with a girl, lifting them up indicated a boy.

Chapter 2. Middle Ages

2.1 General development of obstetrics

The Middle Ages were dark times for medicine. The Church fiercely prohibited any development of science. In particular, the ministers spoke about the virgin birth and children from the devil. Moreover, fetal-destroying operations, which could help in the development of obstetrics in the future, caused a lot of discontent and misunderstanding on the part of the church, because many of them ended in death. Obviously, all this hampered the development of this medical area.

Despite the fact that obstetrics was still slowly developing, men did not work in this direction, as it was considered low and indecent. Therefore, as a rule, pregnant women fell into the hands of old women, who treated them with drugs and rituals. It was extremely rare to turn to a male surgeon, only if the birth was difficult, and then this was not available to everyone, but only to rich and noble women.

Hygiene rules in those days were practically not observed, so the mortality rate among pregnant women and newborns was high. Being pregnant was dangerous. Moreover, the church even approved of death during childbirth, believing that everything happens according to God's will.

2.2 Achievements

Despite the prohibitions, there were people who tried to secretly or openly conduct experiments and operations that would help medicine get back on its feet.

The 15th-16th centuries became a turning point not only for obstetrics, but also for medicine in general. It was in the 16th century that the first atlases and manuals for midwives were published and the first model of obstetric forceps was developed (1569). A huge number of scientists also appeared who made great contributions to the study and development of science.

The surgeon and obstetrician A. Pare, who did not even have a medical education, resumed the practice of cesarean section on stillbirths. Moreover, he was the first to invent a breast pump.

His students also achieved considerable success, especially J. Guillemot and L. Bourgeois.

The main reformer of anatomy was Andreas Vesalius (1514-1564). He excellently described the human skeleton and examined the organs of the body in connection with their function. A follower of Vesalius was G. Fallopius, a brilliant physician, surgeon and obstetrician who studied and described in detail the structure and functions of the paired tubular organ - the fallopian tubes, and was deeply interested in the development of the human embryo and its vascular system.

Fallopius had students who went on to study obstetrics. For example, G. Arantius studied the functions of the placenta and described the embryonic duct, which now bears his name. L. Botallo studied the intrauterine blood circulation of the fetus, described the duct, which now bears his name, connecting pulmonary artery with the aortic arch during the prenatal period. X. Fabricius, clarified the location of the fetus in the uterus during pregnancy.

R. Graaf described in detail the structure and functions of the female genital organs.

Jean Louis Baudelocq, French physician and scientist (1747-1810), studied the female pelvis. He distinguished between the large and small pelvis and was the first to use external pelviometry. The method he proposed for measuring the female pelvis is still used today.

Chapter 3. Since XIXcenturies to the present day

3.1 19th century

The 19th century was the century of outstanding achievements of many natural sciences. The development of obstetrics was greatly influenced by the emergence of anesthesia (pain relief) and methods of asepsis and antisepsis. Also at this time, the modern model of obstetric forceps was formed and the first scientific society of obstetricians and gynecologists was created in England.

For the first time, special schools are beginning to teach obstetrics and midwifery. Thanks to the development of physiology and pathology of the female genital organs, gynecology has become a separate discipline. A specialty such as a gynecologist is emerging.

The 19th century was a century of rapid development of obstetrics in Russia. Vladimir Fedorovich Snegirev became one of the founders of this medical discipline. He introduced the teaching of gynecology as an independent subject. The Obstetrics and Gynecology Clinic of the Moscow Medical Academy named after him was named in his honor. I.M. Sechenov.

In 1889, Vladimir Fedorovich first created a gynecological clinic in Moscow, which he directed until 1900 and with the help of which he increased the prestige of Russian doctors not only within the country, but also abroad. Moreover, Snegirev understood the importance of the work of female doctors in gynecology, despite the fact that many held conservative views and believed that women had no place in medicine.

Vladimir Fedorovich had an extraordinary creative mind, thanks to which he wrote the book “Uterine Bleeding,” which was included in the gold fund medical science.

3.2 Modern obstetrics

Modern obstetrics is faced with a lot of problems, in particular, environmental problems and the irresponsibility of parents for their future children. That is why it is necessary to carefully monitor the pregnancy and, if necessary, promptly intervene in delivery.

Nowadays, the most commonly used procedure is caesarean section. It cannot be said that this delivery is safe, as various infections, bleeding and other complications may occur. In any case, all these problems also occur during childbirth through the birth canal, so for modern obstetrics it is important to assess the desire of the woman in labor.

IN Lately Caesarean section surgery has changed a lot. It is performed in the lower uterine segment, as least traumatic as possible. After the fetus is removed, the wound on the uterus is repaired with a single-row continuous suture using absorbable synthetic threads.

Along with women in labor, attention is also paid to the health of the fetus and newborn. Thanks to modern technologies, maternal and perinatal mortality is reduced. Nowadays, it has become possible to deliver a child born prematurely.

Conclusion

Obstetrics has changed a lot since ancient times, thanks to special work we can trace how this science developed. And if earlier pregnancy was dangerous and scary, today medical workers will certainly help not only save the life of the woman in labor and her unborn child, but also, if possible, maintain the health of the mother and the new person.

An obstetrician-gynecologist is a very important doctor, especially in our time, when we are surrounded by polluted air, GMO (genetically modified) foods and other harmful substances. Few women think about their health before conceiving a child, which is why the proportion of children born with various pathologies. And only an obstetrician-gynecologist can help women who want to have a healthy generation.

I would like to hope that obstetrics will develop in the future and all the achievements of this medical field will save the lives of many thousands of children and their mothers.

List of used literature

Savelyeva G.M., Kulakov V.I., Strizhakov A.N. and others. Obstetrics: Textbook: Publishing house "Medicine". 2000. 816 p.

Great Soviet Encyclopedia

Elena Andreeva, obstetrician-gynecologist, 1st category, medical genetic center, Gomel, http://www.9months.ru/ginekologia/3154

Ailamazyan E.K. Obstetrics: Textbook for medical universities: 4th ed., additional: SpetsLit Publishing House. 2003. 528 p.

Sorokina T.S. History of medicine: Textbook for students. honey. textbook institutions: Publishing house "Academy". 2004. 560 p.

Medical journal, Serov V.N., http://www.medlinks.ru/article.php?sid=21531

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Obstetrics and gynecology. obstetrics and gynecology

Gynecology (from the Greek gyneko- - woman and -ology - study) is a branch of medicine that studies diseases characteristic only of the woman’s body, primarily diseases of the female reproductive system. Most gynecologists on modern stage They are also obstetricians. Gynecology is closely related to obstetrics, which studies phenomena in the female body related to pregnancy and childbirth, from the moment of conception to the end of the postpartum period; It is also close to surgery and other departments of practical medicine - nervous, internal diseases, etc.; outstanding representatives of gynecology were in the vast majority at the same time obstetricians or surgeons; but a woman’s sex life is so complex, it so influences the functioning of all the organs of her body, and pathological changes Its sexual spheres are so numerous and varied that gynecology itself became a separate science. Obstetrics is a branch of gynecology, a science dealing with theoretical and practical issues of pregnancy, childbirth and obstetric care. Previously, obstetrics included the care of the newborn, which is now subdivided into neonatology.

obstetrics and gynecology

Obstetrics (French accoucher - to help during childbirth) - the study of pregnancy, childbirth and the postpartum period and gynecology (from the Greek gyne, gynaik (os) - woman; logos - teaching) - in the broad sense of the word - the study of women, in the narrow sense - the doctrine of women's diseases - are the most ancient branches of medical knowledge. Until the 19th century they were not separated, and the doctrine of female diseases was an integral part of the doctrine of obstetrics.

The first information about obstetrics and female diseases is contained in medical texts of the ancient East: Chinese hieroglyphic manuscripts, Egyptian papyri (“gynecological papyrus” from Kahun, 19th century BC, and the G. Ebers papyrus, 16th century BC). BC), Babylonian and Assyrian cuneiform tablets (II-I millennium BC), Indian Ayurvedic texts. They talk about women's diseases (uterine displacement, tumors, inflammation), diet for pregnant women, normal and complicated childbirth. The samhita of the famous surgeon of ancient India Sushruta mentions the incorrect position of the fetus in the uterus and the operations of turning the fetus on the stem and head, and, in necessary cases, the extraction of the fetus through fetal-destructive operations.

“The Hippocratic Collection” contains a number of special works: “On the Nature of Women”, “On Women’s Diseases”, “On Infertility”, etc., which contain descriptions of the symptoms of uterine diseases and methods of removing tumors using forceps, a knife and a hot iron. The ancient Greeks also knew about caesarean section, but they performed it only on a dead woman in order to extract a living fetus (according to mythology, this is how the god of healing Asclepius was born). Note that the first reliable information about a successful cesarean section on a live woman in labor dates back to 1610, it was performed by the German obstetrician I. Trautmann in the city of Wittenberg. In the final period of the history of ancient Greece - the Hellenistic era, when Alexandrian doctors began to perform anatomical dissections, obstetrics and gynecology began to emerge as an independent profession. Thus, a famous obstetrician of his time was the student of Herophilus Demetria from Apamea (2nd century BC). He studied the development of pregnancy, the causes of pathological childbirth, gave an analysis of various types of bleeding and divided them into groups. Another Alexandrian physician, Cleophantus (2nd century BC), compiled an extensive work on obstetrics and women's diseases.

In the Middle Ages, although gynecology was revived, it came under the influence of mysticism and pseudoscientific ideas. Medicine and, in particular, obstetrics and gynecology during this period developed rather poorly, like all medical science and natural science in Europe, since science was strongly influenced by the church and medieval religion. Religion instilled absolutely fantastic ideas like the dogma of the “immaculate conception,” church fanatics in the Middle Ages instilled the idea that children could be born from the devil, etc. Any critical statements about such wild views from scientists and doctors led to their persecution , expulsion from his native country and torture of the Inquisition. It is quite clear that this situation had a disastrous effect on the development of obstetric science and gynecology.

And yet medicine continued to develop. Thus, in Byzantium in the 9th century, a higher school was first founded, in which scientific disciplines and medicine were studied. History has preserved for us the names of the Byzantine doctors Oribasius, Paul (from Aegina), and others, who continued to develop the legacy of their predecessors. At the same time, obstetrics continued to remain at a very low stage of development. Obstetrics in the Middle Ages was considered low and indecent for male doctors. Childbirth continued to remain in the hands of midwives. Only in the most severe cases of pathological childbirth, when the mother and the fetus were in danger of death, did the “grandmothers” call for help from a surgeon who most often used a fetal-destroying operation. In addition, the surgeon was not invited to every woman in labor, but mainly to women in labor from the wealthy class. The rest, insolvent women in labor, were satisfied with the help of the “grandmother” and, instead of actual obstetric care, received from them spoken water, an amulet, or one or another ignorant aid. It is not surprising that with such assistance, and in the absence of basic hygiene requirements, mortality during childbirth and the postpartum period was very high. Pregnant women lived under constant fear of death. Correction of fetal malposition by rotation, this great achievement of antiquity, was forgotten or not used by most doctors.

History of the development of gynecology. Ancient world

The history of medicine indicates that in ancient times the development of obstetrics, gynecology and surgery went hand in hand; in the books of Moses, the Prophets, the Talmud, etc. there is clear information about midwives, menstruation, female diseases and methods of treating them. Judging by the books of Hippocrates, knowledge of gynecology was quite extensive at that time (400 BC), and in gynecological examinations even then they resorted to palpation and manual diagnosis; Manual examination techniques were considered necessary to determine the displacement, prolapse and inclination of the uterus, the presence of tumors, and the suffering of the uterine cervix and sleeve. In ancient times, gynecological instruments were already used; Thus, during the excavations of Pompeii, a three-leaf sleeve mirror was found, which opened with a screw; Paul of Aegina mentions the sleeve mirror. Methods of treating female diseases were practiced in ancient times - local: smoking, douching, pessaries, cupping, poultices, lotions, etc.; and internal: laxatives, emetics, herbs and roots special for women, etc.

Gynecologist in the Middle Ages. Obstetrics and gynecology in the Middle Ages

In the Middle Ages, although gynecology was revived, it came under the influence of mysticism and pseudoscientific ideas. Medicine, and, in particular, obstetrics and gynecology, developed rather poorly due to the fact that science was under the influence of the church and religion. Religion propagated absolutely fantastic ideas like the dogma of the “immaculate conception.” Any dissent was persecuted and sometimes accompanied by expulsion from their native country and the Inquisition.

And yet medicine continued to develop. Thus, in Byzantium in the 9th century, a higher school was first founded, in which various scientific disciplines and medicine were studied. However, obstetrics continued to remain at a very low stage of development. Obstetrics in the Middle Ages was considered low and indecent for male doctors. Childbirth continued to remain in the hands of midwives. Only in the most severe cases, when the mother and the fetus were in danger, did they resort to the help of an experienced surgeon, who most often used fetal-destroying surgery. It is worth noting that mainly women in labor from the wealthy class had the opportunity to use the help of a surgeon. Women in labor of lower origin had to make do with the help of "grandmothers". As is known, the Middle Ages were characterized by a disastrous sanitary and hygienic situation. Thus, one should not be surprised that if basic hygiene requirements were not observed, mortality during childbirth and the postpartum period assumed enormous proportions.

He is considered the founder of obstetrics in Europe in the mid-18th century. Middle Ages

Medicine during this period was strongly influenced by religion, and therefore developed rather poorly. The Church propagated absolutely fantastic ideas like the dogma of the “immaculate conception.” Any critical statements about such views on the part of scientists and doctors led to their persecution, expulsion from their native country and torture by the Inquisition. It is quite clear that such a situation had a disastrous effect on the development of obstetric science. And yet medicine continued to develop. Thus, in Byzantium in the 9th century, a higher school was first founded, in which scientific disciplines were studied, including medicine. History has preserved for us the names of the Byzantine doctors Oribasius, Paul (from Aegina) and others, who continued to develop the legacy of their predecessors.

Centers higher education, including medical, there were universities that began to appear in the 11th century. There were very few university students. The basis of all sciences was theology. The dominant form of ideology at that time was religion, which permeated all teaching, which proceeded from the position that all possible knowledge was already taught in the Holy Scriptures.

However, although in the early and middle periods of feudalism (from the 5th to the 10th centuries and from the 11th to the 15th centuries) religion and scholasticism were a brake on the development of science, among the doctors there were those who not only studied from the books of Hippocrates, Soranus, Celsus, Paul, but also continued to study nature and its phenomena. Yet obstetrics remained at a very low stage of development. Obstetrics in the Middle Ages was considered low and indecent for male doctors. Childbirth was still handled by midwives. Only in the most difficult cases, when the woman in labor and the fetus were in danger of death, did the midwives call for help from a male surgeon, who most often used a fetal-destroying operation. In addition, the surgeon was not invited to every woman in labor, but mainly to wealthy women. The rest were satisfied with the help of the “grandmother” and, instead of actual obstetric care, received from them spoken water or an amulet. It is not surprising that with such assistance and failure to comply with basic hygiene requirements, mortality during childbirth and the postpartum period was very high. Correction of fetal malposition by rotation, a great achievement of antiquity, was forgotten or not used by most doctors.

Founder of gynecology in Russia. Development of domestic obstetrics and gynecology

In Russia, the emergence of obstetrics dates back to the mid-18th century, but this was preceded by a centuries-old pre-scientific period. Assistance during childbirth was usually provided by healers and midwives (to midwife meant to receive a baby), who had only random information and primitive skills. The first laws concerning the activities of midwives were issued by Peter I and were caused by the economic interests of the state (huge infant mortality, declining birth rates). The state of obstetric care worried the leading people of Russia and was reflected in their works. So the great Russian scientist M.V. Lomonosov, in his letter “On the Reproduction and Preservation of the Russian People” (1761), considered it necessary to “compose instructions in the Russian language” on the art of midwifery, and organize “almshouses” for illegitimate children. A significant role in the training of midwives and the teaching of obstetrics belongs to the outstanding organizer of military medicine and healthcare in Russia P.Z. Condoidi (1720 - 1760). At his suggestion, the Senate was issued, according to which in 1757 the first “babichi” schools for training midwives were opened in Moscow and St. Petersburg. Teaching in schools consisted of a three-year theoretical course in midwifery and practical classes, conducted in German and Russian. P.Z. Kondoidi created the country's first public medical library at the Medical Chancellery, and obtained permission to send Russian doctors abroad for improvement and preparation for teaching work. The first obstetric institutions in Russia were opened in Moscow (1764) and St. Petersburg (1771) in the form of midwifery departments with 20 beds. The founder of domestic obstetrics is N.M. Maksimovich - Ambodik (1744-1812). He wrote the first manual on obstetrics in Russian, “The Art of Midwifery, or the Science of Womanhood” (*1764 - 1786). He introduced the teaching of obstetrics in Russian, conducted classes at the bedside of women in labor or on a phantom, and introduced into practice obstetric forceps. In 1782, he was the first Russian doctor to be awarded the title of professor of obstetrics. Being an encyclopedist scientist, he left fundamental works on botany and pharmacognosy, and founded Russian medical terminology.

The formation of obstetrics and gynecology as independent clinical disciplines. Obstetrics and gynecology in the Middle Ages and Modern times

During the classical Middle Ages, scholasticism dominated in Western Europe, and universities were mainly engaged in the compilation and commentary of individual manuscripts of ancient authors. The period of oppression of progressive thought in medicine lasted for about fifteen centuries. Numerous wars of the Middle Ages contributed to the development of surgery; academic scholastic medicine was useless during hostilities; doctors were needed there who were able to accumulate surgical experience, use it and pass it on to others. However, it was during this period that the first universities began to emerge, which trained doctors, and the hospital uniform finally took shape medical care.

The valuable empirical heritage of the ancient world was preserved and enriched by the doctors and philosophers of the medieval East. Little is known about the medicine of the pre-Islamic period of medieval Arab history. Subsequently, it, like the entire culture of the Arab world, developed in accordance with and within the framework of the ideology of Islam, reaching in the 9th-10th centuries. highest bloom. Arab and Central Asian doctors enriched practical medicine with new observations, diagnostic techniques, and therapeutic agents. The literary heritage of Arab and Central Asian doctors contains many completely rational recommendations on the hygiene and nutrition of pregnant women, the care of newborns and infants, and their feeding.

In Russia, not only in villages or towns, but also in the capital, royal and boyar wives gave birth in most cases with the help of midwives, whose level of medical knowledge was low. Foreign doctors invited to Moscow to the royal court also had poor obstetric skills. Many of them went to Muscovy for the purpose of personal gain.

In Rus', women who helped a woman in labor were called grandmothers-midwives, or midwives. In most cases, they were invited during difficult births; in easy cases, they were invited after birth to ligate the umbilical cord and swaddle the newborn. Also, midwives have performed established customs and spells since ancient times.

During the Renaissance, the development of scientific anatomy and physiological knowledge created the prerequisites for the development of scientific obstetrics and gynecology. Both of these directions from ancient times until the 19th century. were not divided, the doctrine of female diseases was an integral part of the doctrine of obstetrics. The first extensive manual in Western Europe, “On Women's Diseases” (“De mulieram affectionibus”), was compiled in 1579 by Luis Mercado. - Professor at the University of Toledo (Spain). Of great importance for the development of obstetrics and gynecology was the activity of Ambroise Paré, who, without receiving a medical education and without a medical title, became a surgeon and obstetrician at the king’s court. The great Frenchman gave new life to the rotation of the fetus after several hundred years of oblivion and resumed the practice of Caesarean section upon the death of a woman in labor. Paré introduced gynecological speculum into widespread practice and organized the first obstetric department and the first midwifery school in Europe at the Hotel-Dieu hospital in Paris. At first only women were accepted into it; The training lasted three months, of which six weeks were devoted to practical training. A. Paré's students were the outstanding French surgeon and obstetrician J. Guillemot (1550-1613) and the very popular midwife L. Bourgeois (1563-1636) - author of the book “On Fertility, Infertility, Childbirth and Diseases of Women and Newborns” (1609).

St. Petersburg State University

Faculty of Medicine

Abstract for the course "History of Medicine" on the topic:

"History of the development of obstetrics in Russia"

Completed by: 1st year student 106 gr. E.E. Veshnyakova

1. Introduction-2;

2. Obstetrics-2;

3. Obstetrics in Ancient Rus'-2;

4. Development of obstetrics in the 18th century-4;

5. Development of obstetrics in the 19th century-8;

6. Development of obstetrics in the 20th century-10;

7. Obstetrics in Soviet times-11;

8. Obstetrics in the 21st century-13;

9. Conclusion-13;

10. List of used literature-14.

Introduction:

The birth of a child is the most wonderful moment in the life of every mother and the most serious, because the further development of the fetus depends on the course of childbirth. I believe that the profession of an obstetrician is one of the most difficult and responsible, because these people help bring a new life into the world. And, it seems to me, it is quite interesting to get acquainted with the history of the development of this medical discipline.

Obstetrics(French accoucher - to help during childbirth) - the study of pregnancy, childbirth and the postpartum period and gynecology (from the Greek gyne, gynaik (os) - woman; logos - teaching) - in the broad sense of the word - the study of women, in the narrow sense - the doctrine of women's diseases - are the most ancient branches of medical knowledge. Until the 19th century they were not separated, and the doctrine of female diseases was an integral part of the doctrine of obstetrics.

The history of obstetrics is closely connected with the history of medicine in general, although until the 18th century it stood at a lower stage of development than other departments of medical science, since it had to endure an even greater struggle against prejudice and ignorance.

In Russia, the science of obstetrics began and developed much later than in other European countries. The first obstetrician mentioned in the chronicles was the Englishman Jacob (under Ivan the Terrible), famous for being “able to very skillfully treat women’s diseases.”

Obstetrics in Ancient Rus':

Obstetrics(from the French “accoucher” - to give birth) is one of the oldest areas of medicine. Pregnant women of Ancient Rus' believed in the help of pagan spells, in sacrifices to the gods, and in the power of herbs.

According to the ancients, the white water lily Odolen, the grass, had special power. Before giving birth, the pregnant woman's belly was smeared with an ointment made from hare bile, wheatgrass juice and goat fat, she was given water in which two eggs had been boiled to drink, and two pieces of white water lily rhizome to eat. There was even a song composed:

If only the woman knew,
What is Odolen - grass,
I would sew it into a belt
And I would wear it on myself...

Traditionally, families had many children, and childbirth, which occurred almost every year, was perceived by everyone as the most natural event. Our ancestors thanked the gods for their favor in the event of the successful birth of a child and met his death with humility. In those days, the elder women in the family provided assistance to the woman in labor. The chronicles have preserved the name of the doctor Eupraxia, an unusually talented and selfless woman who lived in the 12th century. From the period of early Christianity, the prayer of a woman in labor has reached us:

I will stand, blessing myself, and cross myself,

from the hut by the doors, from the yard by the gates,

into an open field, into a blue sea.

There is Christ on the throne there

The Most Holy Mother of God sits,

holding golden keys

opens meat chests,

releases the baby from the flesh, from the womb;

releases the baby from flesh, from hot blood,

so as not to feel any pinching or aching, amen.

But the Mongol-Tatar yoke, which dominated Rus' for more than two centuries (1237–1480), practically stopped the development of medicine. Only at the end of the 16th century, under Ivan the Terrible, was the first government agency, managing the healthcare system - the so-called Pharmacy Order. Religious dogmas and domostroy that existed in Rus' established the idea that male doctors should not engage in obstetrics, and childbirth was usually attended by “midwives” (“to midwife” - to receive a baby).

“...Village midwives are always elderly women, mostly widows. Sometimes married women also give birth, but only those who have stopped giving birth themselves and who do not have menstrual cleanses. A girl, although elderly, cannot be a midwife, and a childless one is a bad midwife. What kind of grandmother is she if she didn’t torture herself? With her, it is difficult to give birth, and the children will not always survive... The midwife is invited to all difficult births, and always comes at the end to tie the umbilical cord, wash and steam the woman in labor and the newborn, and take care of him for the first days.” (G. Popov. Russian folk medicine. 1903)

Midwives did not have special education, but were famous for their skills, based on the experience of entire generations. They resorted to the help of midwives until the middle of the 20th century. However, in the 20s of our century, for some reason they fell under a wave of persecution and repression. Pregnancy has always been something of an event in the village. As soon as the pregnancy became noticeable, the neighbors began to discuss the “bellied”, wondering who would be born. It was believed that the sex of a child could be accurately predicted by the shape of the mother's abdomen. If the belly is sharp, then the woman is carrying a boy; if it is wide and flat, the woman will have a girl. They also paid attention to the face of the pregnant woman. A ruddy and clean face meant the birth of a boy, and a face covered with age spots meant the birth of a girl. In former times there were many folk signs related to pregnancy. For example, for those going to haymaking or harvest, meeting a pregnant woman was supposed to bring good luck. A woman expecting a child was not allowed to attend the funeral or look at the deformed and blind. They believed that if a pregnant woman committed theft, then birthmark on the child's body it will repeat the stolen item in its shape. The position of a woman during pregnancy has at all times been determined by views on this state of the social environment, her well-being, the number of workers and relationships in the family. However, caring attitude towards a pregnant woman was typical for all layers of Russian society. In the villages, even the most angry husbands stopped “teaching the woman,” and her mother-in-law freed her from heavy housework. They often prepared something tasty and nutritious separately for a pregnant woman, tried to fulfill her whims, treated her sometimes strange desires, disgust, etc. with understanding.

In some villages there was a custom to give birth to the first child in the house of the mother, who, under a plausible pretext, removed the rest of the family members from the hut. Sometimes the cramped conditions of peasant quarters forced a woman in labor from a large family to rush to the midwife and give birth to her. However, most often births took place at home. If there was no separate room, then in the upper room a corner was fenced off with a curtain. In many families, the bathhouse was deliberately not very hot, believing that this would relax and “soften” the body of the woman in labor. It is interesting that the midwife’s visit to the pregnant woman was also surrounded by secrecy. She always passed through backyards, through vegetable gardens. Usually the midwife entered the house with the words: “God help me work! " She dressed the woman in labor in a clean shirt, gave her Epiphany water to drink, and lit a candle in front of the icons. It was believed that the surest means to speed up labor were to unbutton the shirt collar, remove rings, earrings, untie knots, and unravel the braids of the woman in labor. They unlocked all the locks in the house, opened the barriers of the stoves and gates: after all, if everything is open and untied, then the birth will be “untied” more quickly. Throughout the birth, the midwife encouraged the woman in labor, telling her that everything was going well, and stroking her lower back. Almost until the moment the baby erupted through the external genitalia, it was customary to lead the woman in labor around the hut by the arms. The umbilical cord of a newborn was tied with a thread twisted with the mother’s hair so that the connection between them, according to popular belief, would remain for life. The attitude towards the children's place was also special. If Soviet maternity hospitals in the recent past carried out a plan to donate placenta for the production of various medicines (placenta is a strong biological stimulant), then in Russian villages there was a real ritual of burying a child’s place. It was thoroughly washed and, wrapped in a cloth, buried in the ground, while special spells were recited. In most villages, the husband was not present at the birth, but was sure to wait somewhere nearby... It was believed that “it is not the place for men to see how women’s affairs are done. “Only sometimes, during prolonged labor or real threat life of a woman in labor, it was he who was supposed to fervently pray to God and even go around the house with images.

Development of obstetrics in the 18th century:

The opinion about the “non-involvement” of men in childbirth was largely overcome with the help of Peter the Great. During his reign, many Western doctors came to Russia, whose opinions were not recommended to be criticized. A special decree was issued obliging foreign doctors to “improve the qualifications” of Russian doctors. In addition, hundreds of young people were able to receive education abroad. Russia soon raised its own scientists.

Although Peter the Great opened schools “for medical and surgical practice,” but since the needs of the army and navy were exclusively in mind, obstetrics was not taught in them. Only in 1754 were obstetric schools established in St. Petersburg and Moscow, in which professors and assistants were invited to teach, in St. Petersburg Lindeman, in Moscow Erasmus, who owned the first obstetric essay in Russian - “Instruction on how a woman should be treated in pregnancy, childbirth and After giving birth, you have to support yourself.” The said manual was compiled according to Horn, the original of which was published in 1697, so that in the middle of the last century, when Smellie, Levre and Roederer had already transformed obstetrics, Russian doctors drew their knowledge from an extremely outdated book of the late 16th century.

The formation of obstetric education in Russia is associated with the name of P. Z. Kondoidi (1710-1760). In the 50s of the XVIII century. he was appointed to the position of archiatr - senior doctor of the Medical Chancellery, established in place of the Pharmacy Prikaz. 1723 in accordance with the reforms of Peter I. At the suggestion of P. 3. Kondoidi, the Senate in 1754 issued a decree “On the decent establishment of Babich’s business for the benefit of society.” In 1757, “women’s schools” were created in Moscow and St. Petersburg, which trained “sworn attendants” (educated midwives, or midwives). They were taught “Originally by foreigners: one doctor (professor of women’s affairs) and one doctor (obstetrician). In the first years, the training was only theoretical. Then, after” the opening of the first obstetric (maternity) departments in Russia with 20 beds at Moscow (1764) and St. Petersburg (1771) Orphanages, a practical course began to be taught. At first, education in Babich schools was ineffective. There were significant difficulties in recruiting students: for example, in 1757, 11 midwives were registered in St. Petersburg, and 4 midwives in Moscow; they made up a very limited reserve for recruiting students. As a result, in the first 20 years, the Moscow school trained only 35 midwives (of which five were Russians, and the rest were foreigners).

Since the establishment of the Russian Academy of Sciences and the University in the first half of the 18th century, we can talk about the creation in Russia of a system of institutions promoting the development of medical education and science. Nestor Maksimovich Ambodik (1744 –1812), “a doctor of medicine and a professor of midwifery,” is rightly called the father of Russian obstetrics. In 1770, after graduating from the St. Petersburg Hospital School, he was sent on a special scholarship to the Faculty of Medicine at the University of Strasbourg, where in 1775 he defended his doctoral dissertation on the human liver (“De hepate humano”).

Returning to Russia, N. M. Maksimovich-Ambodik organized the teaching of womanhood at a high level for his time: he acquired obstetric instruments, accompanied his lectures with demonstrations on a phantom and at the bedside of women in labor, a phantom of a female pelvis with a wooden child, as well as straight and curved steel forceps (“pincers”) with wooden handles, a silver catheter and other instruments were made according to his own models and drawings.

On his initiative, in 1797, the St. Petersburg Midwifery Institute was created at the “imperial maternity hospital,” which from the very first days of its foundation became the center of obstetric education throughout Russia. Nestor Maksimovich Ambodik was the first to introduce an obstetrics course in Russian. Ambodik’s work “The Art of Midwifery, or the Science of Womanhood” with an atlas of drawings for many years became the main scientific manual for all domestic doctors and midwives.

His “The Art of Midwifery, or the Science of Babishing” was the first original Russian manual on obstetrics and pediatrics. N.M. Ambodik was one of the first in Russia to use obstetric forceps.

In Russia, obstetric forceps began to be used in 1765, when the first professor of the medical faculty of Moscow University, I. F. Erasmus, who began teaching obstetrics at the department of anatomy, surgery and woman's art in 1765, began to use them in childbirth.

Among the numerous modifications of obstetric forceps created in Russia, the most famous are the forceps of Kharkov professor I. P. Lazarevich (1829-1902). They were distinguished by slight pelvic curvature and the absence of decussation of the spoons. Over time, many models of obstetric forceps were created in different countries of the world. Some of them were good only in the hands of their creators, others gained worldwide fame, but one thing is certain - their invention significantly reduced the number of fetal destructive operations and mortality in childbirth.

In the second half of the 18th century, Moscow and St. Petersburg became centers of Russian obstetric science. In 1797, a maternity hospital with 20 beds was founded in St. Petersburg, and with it: - A midwifery school for 22 students (now the Institute of Obstetrics and Gynecology of the Russian Academy of Medical Sciences).

Since 1798, after the establishment of medical-surgical centers in St. Petersburg and Moscow. At the beginning of the 19th century at the Russian academies, the teaching of obstetrics began to be carried out in independent departments of midwifery science. The first professor of obstetrics at the Moscow Medical-Surgical Academy was G. Frese. The first professor. Obstetrics at the St. Petersburg Medical-Surgical Academy became I. Conradi.

In 1790, the department of midwifery at Moscow University was headed by Wilhelm Mikhailovich Richter (1783-1822). After graduating from medical school in Moscow, he received his doctorate in medicine from the University of Erlangen. Returning to Alma Mater, V. M. Richter opened a Midwifery Institute with 3 beds at the Clinical Institute of Moscow University (in 1820 their number increased to 6). Thus, the idea of clinical teaching of obstetrics in Russia was put into practice.

Development of obstetrics in the 19th century:

The further development of domestic obstetric care is associated with the works of D.I. Levitsky “Guide to midwifery science” and G.I. Korableva “Course of obstetric science and women’s diseases.” Valuable contributions to Russian science in the 19th century were made by A.Ya. Krasnovsky, A.M. Makeev, V.F. Snegirev, I.M. Sechenov, K.A. Timiryazev and N.I. Pirogov. In 1893, the director of the Clinical Midwifery Institute, Professor D.O. Ott wrote: “Russian gynecology is not at all behind the West. It is necessary to build an institution that would correspond to all the latest achievements in the field of gynecology, which would guide all gynecological thought. In many ways, Russia is even scientific center in the development and study of obstetrics and women’s diseases.”

The introduction of ether (1846) and chloroform (1847) anesthesia, the beginning of the prevention of puerperal fever (1847), as well as the development of the doctrine of antiseptics and asepsis opened up wide opportunities for obstetric and gynecological practice. All this together with advances in morphology and physiology female body contributed to the successful development of gynecology and its isolation in the middle of the 19th century. into an independent medical discipline.

In Russia, the first gynecological departments were opened in St. Petersburg (1842) and Moscow (1875). The beginning of the surgical direction in Russian gynecology was laid by Alexander Alexandrovich Keeter (1813-1879), a talented student of N. I. Pirogov. For 10 years (1848-1858) A. A. Keeter headed the department of obstetrics with the teaching of women's and children's diseases at the St. Petersburg Medical-Surgical Academy; he wrote Russia’s first textbook on gynecology, “Guide to the Study of Women’s Diseases” (1858), and performed the country’s first successful transvaginal operation to remove a cancerous uterus (1842). A. A. Kiter’s student Anton Yakovlevich Krassovsky (1821-1898) made a great contribution to the development of operative gynecology and operative obstetrics. He was the first in Russia to perform successful operations of ovariotomy (oophorectomy) and removal of the uterus, and constantly improved the technique of these surgical interventions; proposed an original classification of forms of a narrow pelvis, clearly dividing the concepts of “anatomically narrow pelvis” and “clinically narrow pelvis”, and developed indications for the application of obstetric forceps, limiting their unjustified use in a narrow pelvis. In 1858. took over the obstetric department.He can be considered the founder of the entire now extensive family of Russian obstetricians, who brought the teaching of obstetrics to an unprecedented height, created a school and became famous as a wonderful diagnostician and exemplary operator.

On the basis of the Medical-Surgical Academy, he was the first in Russia to organize extensive clinical training for obstetricians and gynecologists and introduced a system of postgraduate improvement in this area. His “Course of Practical Obstetrics” for a long time served as the main guide for domestic obstetricians and gynecologists. A. Ya-Krassovsky organized the first St. Petersburg Obstetrics and Gynecology Scientific Society in Russia (1887) and the first in this area, the Journal of Obstetrics and Women's Diseases (1887). The teaching of gynecology as an independent discipline was introduced in Russia on the initiative of Vladimir Fedorovich Snegirev (1847-1916), one of the founders of Russian gynecology. In 1889, he created the first gynecological clinic in our country at Moscow University, which he directed until 1900.

Development of obstetrics in the 20th century:

Dream Russian doctors really came to life when in 1904 in one of most beautiful places Petersburg, in Birzhevoy Square on Vasilyevsky Island, a hospital complex of the Imperial Clinical Obstetrics and Gynecology Institute, almost perfect in its architectural and functional characteristics, with magnificent interiors and equipment, was erected. The activities of this institute marked the beginning of a new stage in the history of Russian medicine. It is also interesting that it was in this building that Tsarevich Alexei, the heir of the last Russian Emperor Nicholas II, was born. The organization of obstetric care in Tsarist Russia had its own characteristics, directly related to financing, mostly provided by various charitable societies and organizations, as well as individuals. For example, funds for the construction of an obstetric clinic and a clinic for women's diseases in Moscow were donated by landowner E.V. Paskhalova and adviser T.S. Morozov. However, philanthropy could hardly cope with all the pressing problems of this branch of medicine: according to the memoirs of contemporaries, private hospitals and maternity hospitals, even in such major cities, like Moscow and St. Petersburg, were very primitively equipped and had an insufficient number of places for women in labor. So in 1913, throughout the vast country, there were nine children's clinics and only 6,824 beds in maternity hospitals. According to statistics, more than 30,000 women died annually during childbirth - mainly from sepsis and uterine ruptures. The mortality rate among children in the first year of life was also extremely high: an average of 273 children died per 1,000 births. According to official data from the beginning of the 20th century, only 50 percent of Moscow residents had the opportunity to receive professional medical care during childbirth in a hospital, and in the country as a whole this percentage was only 5.2 percent for city residents and 1.2 percent in rural areas . Most women continued to traditionally give birth at home with the help of relatives and neighbors. Moreover, this form of mutual assistance extended not only at the time of childbirth, but also included help around the house, looking after older children, caring for the baby, etc. Only in particularly difficult cases were midwives, midwives or a gynecologist invited to assist in childbirth. It is interesting to note that, with funds from numerous charitable societies, a network of institutions was organized called “A Drop of Milk” - the prototype of modern dairy kitchens, where “neutralized cow’s milk” was sold.

Development of obstetrics in Soviet times:

However, the events of October 1917, which turned the whole life of Russia upside down, also changed the system of providing care to pregnant women and women in labor. Of course, the Soviet government had reason to be critical of the principles of medical care that existed in the country. First of all, the typical for that time psychology of denying any, including positive, past experience worked.

Traditions, even good ones, were deliberately rejected; everything started “from scratch.” A special decree of 1918 created the Department for the Protection of Motherhood and Infancy at the People's Commissariat of State Charity. This department was assigned the main role in solving the grandiose task of constructing “a new building for the social protection of future generations.”

It should be noted that during the years of Soviet power, a whole system of legislative acts was developed aimed at the social protection of motherhood and the organization of medical care for pregnant women. These included: and systematic observation in antenatal clinics, and prenatal care, and early diagnosis pathologies of pregnancy, and prenatal hospitalization of pregnant women, and the active fight against social diseases such as tuberculosis, syphilis, alcoholism, etc. But not all legislative acts aimed at protecting women’s health had an unambiguous positive result. An example of such a double effect can be, for example, the Resolution of the Central Executive Committee and the Council of People's Commissars of the USSR of June 27, 1936. On the one hand, this resolution really greatly strengthened the social protection of women. On the other hand, the sections of the document that prohibited abortion with all the categoricalness inherent in a totalitarian system in the conditions of a complete lack of contraception, deprived many women of the possibility of an alternative and led to an increase in the number of illegal abortions. Since the mid-1930s, most women living in rural areas gave birth in collective farm maternity hospitals, the emergence of which was mainly due to a clear shortage of urban maternity hospitals and poor transport links. In these collective farm maternity hospitals (with 2-3 beds), the midwife attended only normal births. The women in labor felt very calm here: there were only familiar faces around, roommates - childhood friends, and the midwife herself - a frequent guest in the family. Just as typical for the village was the paramedic-midwife station, which operated like an outpatient facility. The midwife of such a point monitored pregnant women, sent them to a hospital for childbirth, and provided patronage to young mothers and children up to one year old. By the beginning of the 60s, our country had accumulated extensive experience in providing care to pregnant women and newborns. A system of specialized obstetric care was created, which included monitoring pregnant women in the antenatal clinic at the place of residence, organizing hospitalization in case of complications, as well as sending pregnant women to the maternity hospital.

Already in the 20s, a real revolution began in the field of medical care for pregnant women and newborns. In 1921, 1,402 nurseries, 135 mother and child homes, 118 milk stations, and 216 children's clinics were opened.

G. Frese, S. A. Gromov, S. F. Khotovitsky, G. P. Popov, I. P. Lazarevich, V. V. Stroganov and others also made a great contribution to the development of obstetrics and gynecology in Russia.

At Moscow University, the department of obstetrics was opened in 1764, and it was occupied by Professor Erasmus. Obstetrics received a solid foundation only with the appointment of Professor Wilhelm Richter in 1790.

At Kharkov University, an obstetric clinic with 4 beds was opened only in 1829, although the teaching of obstetrics began back in 1815. The clinic became especially famous when it was headed by Professor Lazarevich.

In Kazan, an obstetric clinic was opened in 1833, with 6 beds.

In Kyiv, the obstetric department with a clinic has existed since 1847.

Obstetrics in the 21st century:

Currently: Vladimir Nikolaevich Serov, President of the Russian Society of Obstetricians and Gynecologists, Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences, Professor, Honored Scientist of the Russian Federation. Adamyan Leila Vladimirovna, academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences, professor, Honored Scientist of the Russian Federation, chief freelance obstetrician-gynecologist of the Ministry of Health and Social Development of the Russian Federation. Radzinsky Viktor Evseevich, vice-president of the Russian Society of Obstetricians and Gynecologists, Doctor of Medical Sciences, Professor, Honored Scientist of the Russian Federation, Head of the Department of Obstetrics and Gynecology of the People's Friendship University of Russia, chief freelance expert obstetrician-gynecologist of Roszdravnadzor.

Conclusion:

Obstetrics provides invaluable assistance to a woman during childbirth. Unfortunately, the birth process is almost unpredictable. The healthiest woman, with a smooth pregnancy, may develop conditions during childbirth that are dangerous not only to her health, but also to the life of herself and the child. Over the past decade, we have increasingly heard about the benefits of home birth. No one will ever be able to predict what intensity the contractions and attempts of a woman in labor will be, how the child will move along the birth canal, in what condition the child will be born, how the placenta will separate, how intense the bleeding will be in the postpartum period, and so on and so forth. Obstetrics guarantees a woman qualified care during childbirth and the postpartum period. Even with the existing complaints about the organization of healthcare, one cannot diminish the merits of this branch of medicine, because each of us, regardless of gender, has encountered obstetrics at least once in our lives - at the moment of our birth.

Wikipedia. Internet resource. http://ru.wikipedia.org/wiki/

Article from books "Birth and Rebirth"

Article by Natalia Sokolukho. Internet resource http://www.baby.ru/sp/544254/blog/post/3459055/
Sorokina T.S. “History of Medicine”, volume 2, chapter 7, Obstetrics and Gynecology.

St. Petersburg State Medical University named after. acad. I.P. Pavlova

Abstract on the history of medicine on the topic:

"History of the development of obstetrics and gynecology in Russia"

First year student, Faculty of Medicine, group 111,

Ryazantseva Pavel

1. Introduction

Conclusion

Literature

1. Introduction

Reflection general condition population health, the social structure of society and the degree of perfection of the public health system are the results of maternal and child health. The participation of women in production, where they currently make up more than half of workers and office workers, is of enormous national economic importance. Legislation on labor protection and women's health and the organization of obstetric and gynecological care in the country are aimed at ensuring that women can successfully combine motherhood with social work.

The system of obstetric and gynecological care in the Russian Federation is based on the most progressive principles of Russian healthcare - accessibility, free state forms of medical care, preventive focus, organic connection with science.

In order to improve the quality of medical care for women, reduce maternal and perinatal child mortality morbidity, universal medical examination has been introduced, a network of specialized institutions for maternal and child health is being widely developed, the duration of maternity leave and child care leave has been increased, professional level medical workers.

2. Subject and content of obstetrics and gynecology

Gynecology (Greek Gyne - woman, logos - word, doctrine) is a field of clinical medicine that studies the physiology of the female reproductive system, diagnosis, prevention and treatment of diseases associated with the characteristics of the female body.

Obstetrics (French accoucher - to give birth) is a part of gynecology that studies the physiological and pathological processes associated with conception, pregnancy, childbirth and the postpartum period, as well as developing methods of obstetric care, prevention and treatment of complications of pregnancy and childbirth, diseases of the fetus and newborn. Gynecology, in the narrow sense of the term, is the science of diseases of the female reproductive system outside pregnancy (general symptomatology, etiology, pathogenesis, diagnosis, treatment and prevention of individual diseases of the female genital organs). Gynecology and obstetrics are a single clinical discipline, one of the leading branches of medical science and healthcare.

Among other clinical disciplines, obstetrics and gynecology have the following features:

.Social and demographic problems are directly related to such issues of gynecology as birth control, contraception, infertility in the family, etc. The level of medical care for mothers and children largely determines the fate and health of future generations of human society.

2.Obstetrics, unlike other clinical disciplines, is primarily concerned with the study and provision of specialized medical care for physiological processes such as pregnancy and childbirth. The subject of constant care of the obstetrician-gynecologist is the fetus - the “intrauterine patient”. Correctly and timely obstetric care in the vast majority of cases allows you to maintain a pregnancy, ensure the full development of the fetus, and preserve the health and life of the mother and her child.

.Obstetric care during childbirth is usually an emergency. During both pregnancy and childbirth, physiological processes quite often and suddenly can take on a pathological character, accompanied by massive blood loss, fetal hypoxia, which necessitates operative delivery and emergency operations in the interests of the mother and fetus, requiring constant readiness for resuscitation measures.

.Gynecology and obstetrics, constantly enriched by the achievements of experimental and clinical research, widely use hormonal, cytological, endoscopic, electrophysiological, radiological, ultrasound and other methods for diagnosing diseases, conservative and surgical methods of treatment. At the same time, gynecology and obstetrics, being surgical specialties, continue to be an art and are based on high professionalism. Obstetrics and gynecology are most closely related to surgery, internal medicine and pediatrics, as well as endocrinology, genetics, microbiology, transfusiology, urology, oncology and other sciences.

Modern obstetrics and gynecology include the following main sections:

) physiology and pathology of pregnancy, childbirth and the postpartum period;

) surgical obstetrics;

) physiology and pathology of the fetus and newborn;

) general gynecology (symptomatology and diagnosis of gynecological diseases, methods of their treatment and prevention);

) private gynecology ( individual species diseases of the female reproductive system, features of diagnosis, treatment and prevention).

3. Main stages in the development of obstetrics and gynecology

Obstetrics is rightly recognized as the oldest branch of clinical medicine, because the need for emergency care and various benefits during childbirth (“midwifery”) appeared simultaneously with the emergence of humanity. Already ancient Egyptian papyri and Chinese manuscripts (27th century BC) contain information on obstetrics and female diseases, and the Indian sacred books "Ayurveda" (9th - 3rd century BC) report the duration of pregnancy , incorrect positions of the fetus, nutrition of pregnant women, uterine displacements, condylomas.

In ancient Greece and Ancient Rome Hippocrates, Aristotle, Philumenus, Celsus, Soranus of Ephesus, Galen and others in their works devoted significant space to female diseases and the pathology of pregnant women (bleeding during pregnancy, a description of some obstetric operations and instruments for their implementation). One of the chapters of the "Hippocratic Collection", entitled "On Women's Diseases", contains not only a description of inflammatory diseases of the uterus and vagina, tumors of the genital organs, but also recommendations for their treatment (in particular, removal of the tumor from the uterus using forceps, a knife and a hot gland). During the era of feudalism, along with the general decline of science and culture, the development of obstetrics and gynecology stopped. It was argued that all knowledge had already been taught in the “holy scripture”, the idea that it was low and even indecent for male doctors to engage in the art of midwifery. In 1522, Dr. Veit was publicly burned in the central square of Hamburg, who suffered a painful death for heretical practice in gynecology. During the Middle Ages, a special place and merit belongs to the famous Tajik doctor Abu Ali Ibn Sina (Avicenna, 980-1037 AD), who created the encyclopedia of medicine of his time - “The Canon of Medical Science”. Ibn Sina systematized the heritage of ancient doctors and enriched medicine with his clinical experience, describing some diseases of the female genital organs and mammary gland, obstetric operations (reduction of the fetal leg, cranio-embryotomy).

His works have been translated into Hebrew languages, and the “Canon of Medical Science” has been published more than 30 times.

The anatomical and physiological basis of obstetrics and gynecology was laid in the 16th - 17th centuries. V. the works of outstanding anatomists A. Vesalius, K. Bartolin, G. Graaf and others.

V. Harvey, who opposed Aristotle’s doctrine of spontaneous generation, first expressed the position that “everything living comes from an egg,” and his discovery of blood circulation (1628) made physiology, as F. Engels put it, a science and marked the beginning of a scientific approach to the problem of transfusion blood.

France is deservedly considered the cradle of practical obstetrics. The famous French surgeon A. Paré (1509-1590) founded the first school for training midwives in Paris. He, after a long period of oblivion, reproduced the operation of turning the fetus by the leg, introduced a breast pump into practice, and suggested speeding up labor in case of bleeding and quickly emptying the uterus. He owns some provisions of a forensic medical nature concerning the establishment of virginity, determining the duration of pregnancy, and the drowning of newborns.

The largest representative of the French obstetric school, F. Morisot (1637-1709), is the author of an original treatise on diseases of pregnant women. Based on his own data and observations, he refuted the erroneous view that there is a significant divergence of the pubic bones during childbirth, as well as the false idea that has prevailed since the time of Hippocrates that seven-month fetuses are more viable than eight-month-old ones. He improved the technique of obstetric operations, proposed a technique for removing the head during childbirth with pelvic presentation and tools for removing the perforated head. F. Morisot introduced bloodletting as a method of treating eclampsia, which for almost two centuries was used as the only life-saving remedy in the treatment of pregnant women with severe forms of toxicosis.

Thus, even in 1829 in Russia, the doctor Bazhenov was put on trial only for a gynecological examination of a woman, which he conducted in the absence of a midwife.

The biggest achievement in obstetrics at the end of the 17th century. and the beginning of the 18th century. was the study of the anatomical structure of the female pelvis (Deventer) and the mechanism of childbirth (Smelley, Levre), which marked the beginning of scientific obstetrics. J.L. Bodelok (1746 - 1810) was the first to propose and apply a technique for measuring the female pelvis (external pelviometry), which has survived to this day, and began to consider obstetrics as a science based on the laws of mechanics. The invention of obstetric forceps should be considered a significant progress, with the introduction of which into practice the number of fetal destruction operations sharply decreased. Although the use of obstetric forceps is associated with the Chamberlain family, the author of this instrument should be considered the Dutch surgeon Palfein (1650-1730), who reported his invention at the Paris Medical Academy in 1723. Palfein's obstetric forceps contributed to the development and subsequent appearance of more advanced models proposed Negele, Simpson, Lazarevich, Fenomenov, etc. Thus, obstetrics as a science was formed and became an independent medical discipline in the 18th century in France, England, Germany, Russia and other countries. This was manifested in the opening of departments of “midwifery art” at the medical faculties of a number of European universities, obstetric clinics in Strasbourg (1764), Göttingen (1751), Berlin (1751), maternity shelters in Moscow (1728) and St. Petersburg ( 1771).

Of great importance for the development of obstetrics and gynecology was the development of methods for the prevention of postpartum septic diseases (“puerperal fever”), which were accompanied by a huge maternal mortality rate from 10% to 40% and higher. Particular merit in the fight against postpartum sepsis, in the development and promotion of the antiseptic method belongs to the Hungarian obstetrician I.F. Semmelweis (1818-1865). His introduction of mandatory hand washing with soap and 3% bleach solution for medical personnel made it possible to sharply reduce the incidence of “puerperal fever” and the mortality of postpartum women. Called by descendants the “savior of mothers” I.F. Semmelweis himself died of sepsis without being recognized by his contemporaries during his lifetime.

Discoveries of the 19th century in the field of morphology (Vikhrov R.), biology and bacteriology (Baer K., Pasteur L., Mechnikov I.I., Lister D.), physiology (Bernard K., Sechenov I.M., Pavlov I.P.) contributed to the further development of obstetrics and gynecology. The beginning of the 19th century includes the creation of the doctrine of a narrow pelvis and the biomechanism of childbirth, the introduction into practice of external examination of pregnant women to recognize the position of the fetus and listen to the fetal heartbeat, the study of pregnancy complications, and the spread of obstetric operations (forceps, symphysiotomy, cesarean section). It is worth highlighting the contribution of the Viennese obstetrician L. Bouler (1751-1835), who, in contrast to the excessive radicalism of obstetricians of his time, substantiated the advantage of conservative management of childbirth, which remains the most accepted tactic in the world. A significant achievement was the introduction of inhalation anesthesia, first used in obstetrics by D. Simpson in 1847. The first successful use of anesthesia during obstetric operations is associated with the name of N.I. Pirogov, who used general anesthesia in April 1847 during the application of obstetric forceps in the clinic of obstetrics and women's diseases of the Medical-Surgical Academy (St. Petersburg).

The development of the study of female diseases lagged significantly behind obstetrics, although already in the 16th century the first guide to female diseases appeared, written by Mercado (Spain). Gynecological patients were usually admitted for treatment to surgical or therapeutic clinics, and the necessary surgical treatment was carried out by surgeons. The study of women's diseases was usually included in surgery, obstetrics or therapy. Thanks to the successes of natural science, pathomorphology and physiology, gynecology at the end of the 19th century. became an independent scientific discipline. A special medical specialty appeared - a gynecologist, the study of diseases of the female genital organs began, the number of gynecological operations performed increased, although the mortality rate after them, before the introduction of antisepsis and asepsis, reached 50% and higher.

The formation of gynecology was facilitated by the works of M. Sims, S. Wells, J. Pian, K. Schroeder, E. Wertheim, E. Bumm, A. Dederlein and others. A significant contribution to the development of operative gynecology and conservative methods of treating female diseases was made by domestic obstetricians and gynecologists A.A. Keeter, A.Ya. Krasovsky, K.F. Slavyansky, V.F. Snegirev, D.O. Ott et al. Obstetricians and gynecologists have priority in a number of discoveries that have accelerated the progress of medical science. Thus, it was in obstetrics that blood transfusion was first used for massive blood loss (Blundell D., 1818, Wolf A.M., 1832), and scientific research on blood transfusion and preservation began (Sutugin V.V., 1865 ), the principles of asepsis and antiseptics were proposed (Holmes O., 1843; Semelweis I.F., 1847), the first successful laparotomies were performed for ovarian tumors (Mc Dowell E., 1843; Krassovsky A.Ya. ., 1862), endoscopic research methods were used for the first time, in particular laparoscopy (Ott D.O., 1914).

Gynecology achieved significant success in the 20th century with the discovery of blood groups, hormones, antibiotics, and the introduction into practice of the achievements of endocrinology and other sciences.

4. Development of domestic obstetrics and gynecology

In Russia, the emergence of obstetrics dates back to the mid-18th century, but this was preceded by a centuries-old pre-scientific period. Assistance during childbirth was usually provided by healers and midwives (to midwife meant to receive a baby), who had only random information and primitive skills. The first laws concerning the activities of midwives were issued by Peter I and were caused by the economic interests of the state (huge infant mortality, declining birth rates). The state of obstetric care worried the leading people of Russia and was reflected in their works. So the great Russian scientist M.V. Lomonosov, in his letter “On the Reproduction and Preservation of the Russian People” (1761), considered it necessary to “compose instructions in the Russian language” on the art of midwifery, and organize “almshouses” for illegitimate children. A significant role in the training of midwives and the teaching of obstetrics belongs to the outstanding organizer of military medicine and healthcare in Russia P.Z. Condoidi (1720 - 1760). At his suggestion, the Senate was issued, according to which in 1757 the first “babichi” schools for training midwives were opened in Moscow and St. Petersburg. Teaching in schools consisted of a three-year theoretical course in midwifery and practical classes, conducted in German and Russian. P.Z. Kondoidi created the country's first public medical library at the Medical Chancellery, and obtained permission to send Russian doctors abroad for improvement and preparation for teaching work. The first obstetric institutions in Russia were opened in Moscow (1764) and St. Petersburg (1771) in the form of midwifery departments with 20 beds. The founder of domestic obstetrics is N.M. Maksimovich - Ambodik (1744-1812). He wrote the first manual on obstetrics in Russian, “The Art of Midwifery, or the Science of Womanhood” (*1764 - 1786). He introduced the teaching of obstetrics in Russian, conducted classes at the bedside of women in labor or on a phantom, and introduced obstetric forceps into practice. In 1782, he was the first Russian doctor to be awarded the title of professor of obstetrics. Being an encyclopedist scientist, he left fundamental works on botany and pharmacognosy, and founded Russian medical terminology.

It is known that at the end of the 16th - beginning of the 17th centuries, the Russian government obliged foreign doctors to teach Russians medicine with all care and without hiding anything . At the end of the 16th century, Ivan IV, by his decree, established the Pharmacy Order, which soon became a kind of Ministry of Health in the Russian state.

One of the first large-scale steps in the field of medicine and healthcare was the organization of medical and topographical descriptions of individual territories of the Russian Empire. At the origins of this enormous work, together with V.N. Tatishchev and M.V. Lomonosov was P.Z. Kondoidi (1710 - 1760), domestic military doctor, president of the Medical Chancellery, organizer and reformer of medical education in Russia, founder (in 1756) of the first medical library in Russia. Thanks to his initiative and care, systematic training of midwives was undertaken. He succeeded in sending 10 of the best graduates of a Russian medical school to the best universities in Europe. Returning to Russia, they became teachers for new generations of domestic doctors.

In this period slow increase in population was a subject of state interest and concern. The reasons for the low population growth rates were not only wars and widespread epidemics, but also high stillbirth rates, maternal and child mortality. A very important figure in scientific and practical obstetrics was the teacher, doctor and encyclopedist N.M. Maksimovich-Ambodik (1744-1812). He actually became the founder of Russian obstetrics and pediatrics, the first of the Russian doctors. In 1782 he received the title of professor of obstetrics. His major and highly original work The art of weaving, or the science of womanizing (1781-1786) with an atlas drawing for many decades became the best and most complete manual intended for the training of educated midwives. He was the first to teach obstetrics in Russian and conduct practical classes with midwives on a phantom of his own model and in the maternity ward. Ambodik was an excellent obstetrician practitioner, one of the first to perform complex operations and procedures, including the application of obstetric forceps. At the same time, he remained a supporter of the conservative liberation of the baby before the most urgent need for surgical intervention" showed exceptional measures in choosing the management of labor.

In 1798, the first military medical educational institutions with a training period of 4 years were created in St. Petersburg and Moscow - medical-surgical academies, which grew out of medical-surgical schools. The Moscow Academy did not exist for long; the St. Petersburg Academy became an exemplary educational institution and a center of scientific medical thought (now the Military Medical Academy). In the first years, teaching obstetrics at the St. Petersburg Medical-Surgical Academy was carried out at the department of midwifery and medical-forensic science; an independent department of obstetrics was created only in 1832. It was headed by an excellent obstetrician and pediatrician S.F. Khotovitsky, and since 1848 - one of the best students of N.I. Pirogova A.A. Kitler, who in 1846 performed vaginal hysterectomy for the first time in Russia, 25 years after the world's first operation of this kind. In 1858, this department was occupied by the outstanding Russian obstetrician A.Ya. Krassovsky (1823 - 1898), also passed school N.I. Pirogov. He highly raised the position and technique of operative obstetrics and gynecology. Being a brilliant surgeon and a creative person, he not only performed the first ovariotomy in Russia, but also developed original way performing this operation, and in 1868, summing up all the achievements in this area, he published a monograph About ovariotomy . One of the first A.Ya. Krassovsky performed a hysterectomy. His three-volume course is remarkable Practical obstetrics course (1865 - 1879) and , which went through three editions. AND I. Krassovsky became the organizer of the first St. Petersburg Obstetrics and Gynecology Society in Russia and the creator , who contributed greatly to the creation of the St. Petersburg and Russian school of obstetricians and gynecologists.

One of his closest collaborators was a student of I.F. Balandina is an excellent doctor and scientist V.V. Stroganov (1857 - 1938), who paid a lot of attention to the problem of uterine rupture and placenta previa. World fame V.V. Stroganov benefited from the system he developed for the treatment of eclampsia. His Collection of obstetric problems" and works on the most important complications of pregnancy and childbirth. Already in adulthood, the director of the same institute became the Ukrainian obstetrician-gynecologist A.P. Nikolaev (1896-1972) - author triads of Nikolaev , proposed by him as a method of preventing asphyxia of the fetus and newborn.

A very representative and strong school of obstetricians and gynecologists was emerging in Kazan. Its founder was V.S. Gruzdev (1866-1938), a graduate of the St. Petersburg Military Medical Academy, who headed the department at Kazan University for 30 years. He became one of the first gynecological oncologists in Russia. In obstetrics, his name is associated with fundamental research on the development and morphology of the uterine muscles, and with the authorship of one of the best manuals on obstetrics and women's diseases in the country.

Outstanding students V.S. Gruzdev were M.S. Malinovsky (1880 - 1976) and L.S. Persianinov (1908 - 1978), who became recognized leaders of the Moscow school of obstetrics and gynecology, the largest scientists in our country and organizers of the domestic obstetrics system. M.S. Malinovsky focused his main interests on surgical obstetrics, pain management in obstetrics and gynecology, studying the pathogenesis, prevention and treatment of late toxicosis in pregnant women and postpartum diseases. He was the first, at the beginning of the century, to study the effect of pituitrin on the contractile activity of the uterus during childbirth. His manual on operative obstetrics remains a reference book for a practicing obstetrician. L.S. Persianinov made an invaluable contribution to the doctrine of obstetric traumatism, to the improvement of resuscitation and anesthesia in obstetrics. His work on the physiology and pathology of contractile activity of the uterus during childbirth with the development of methods for correcting its disorders was of a fundamental nature. L.S. Persianinov became a pioneer in the use of computers in obstetrics and gynecology in our country. His services were especially great in the development of perinatology and perinatal medicine: many of his works were devoted to the study of the condition of the intrauterine fetus, early detection of its pathology, complex therapy asphyxia of the newborn.

The Department of Obstetrics and Gynecology of the Women's Medical Institute (the first Leningrad Medical Institute, now the St. Petersburg State Medical University named after Academician I.P. Pavlov), created in 1897, has great merit to the national obstetric science and practice. Over the years, the department was headed by outstanding teachers, organizers of medical education, excellent practicing obstetricians and prominent scientists: N.N. Fenomenov, N.I. Rachinsky, P.T. Sadovsky, D.I. Shirshov, K.K. Skrobansky, L.L. Okinchits, I.I. Yakovlev, I.F. began his career here. Zhordania.

N.N. Fenomenov (1855-1918) was educated in St. Petersburg, then headed the department of obstetrics at Kazan University; after the death of A.Ya. Krassovsky was invited to the capital and replaced him as director of the Nadezhdinsky obstetric institution and at the same time accepted the department at the Women's Medical Institute, to D.O. Otta performed the duties of an obstetrician. He was an outstanding obstetrician-practitioner, personally performed more than 2000 abdominal operations, proposed a number of modifications of obstetric operations - the method of perforation of the presenting head of the fetus, fetal decapitation, cleidotomy, improved several obstetric instruments that now bear his name, consistently and persistently introduced methods of asepsis and antisepsis

I.I. belonged to the Otto school. Yakovlev (1896 - 1968), who created a new methodological approach to the study of the physiology and pathology of pregnancy and childbirth. Supporter of the ideas of N.E. Vvedensky and A.A. Ukhtomsky, he was one of the first in world science to study the functions of the brain during pregnancy and childbirth, proposed physiological methods of pain relief in the biomechanism labor activity. He enriched the understanding of the biomechanism of childbirth, the role of the amniotic sac and amniotic fluid, and created an original classification of labor anomalies.

The formation and development of obstetrics and gynecology in Russia are closely connected with the Medical-Surgical, now Military Medical Order of Lenin Krasnoznamensky Academy named after S.M. Kirov, organized in 1798. Among the first seven departments of the academy was the department of midwifery art and forensic medical science (forensic medicine), and the position of professor of midwifery science was established. In 1835, a separate department of obstetrics was created with the doctrine of women's and children's diseases, headed by S.F. Khotovitsky. The work he wrote Pediatrics" was the first guide to childhood diseases. The Obstetrics and Gynecology Clinic of the Medical-Surgical Academy, opened on October 1, 1842, had a special gynecology department (the first in Russia). On the role of the Department and Clinic of Obstetrics and Gynecology of the Moscow Art Academy, the famous obstetrician-gynecologist V.S. Gruzdev wrote in 1906: ... In first place, we will have to put in the first place, in terms of its significance in the history of Russian obstetrics and gynecology, the obstetrics and gynecology clinic of the St. Petersburg Medical and Surgical Academy, because from here the dawn of Russian obstetrics and gynecology science begins, the Russian obstetrics and gynecology school arose here, the representatives of which became the head of most modern obstetric and gynecological institutions in our country .

The largest representative Russian scientific obstetrics and gynecology is A.Ya. Krassovsky (1821-1898), student of N.I. Kythera. He headed the department of obstetrics, women's and children's diseases at the Moscow Art Academy (1858-1876) and the St. Petersburg obstetric institution. AND I. Krassovsky developed the doctrine of the mechanism of childbirth and the narrow pelvis, introduced antisepsis and asepsis into obstetric practice, and in 1862, with a successful outcome, performed an ovariotomy, which was considered murderous" operation. His development of the operation technique, publication of the atlas About ovariotomy" in Russian and French languages marked new stage in the development of abdominal surgery and operative gynecology. AND I. Krassovsky owns fundamental works: Practical obstetrics course , Operative obstetrics with the inclusion of the doctrine of abnormalities of the female pelvis . Founder of the first St. Petersburg Obstetrics and Gynecology Society in Russia (1886) and Journal of Obstetrics and Women's Diseases (1887). His students were famous obstetricians and gynecologists K.F. Slavyansky, V.M. Florinsky, V.V. Sutugin, G.E. Rein and others.

One of the founders of Russian gynecology is V.F. Snigirev (1847-1916) - an outstanding scientist, surgeon, teacher, founder of the gynecological clinic of Moscow University and the gynecological institute for advanced training of doctors, author of a classic work Uterine bleeding . They were offered some new gynecological operations and conservative treatment methods, including the use of radiation therapy. He is the initiator of studying functional disorders of the female reproductive system and conducting mass preventive examinations to identify oncogynecological diseases.

Large schools with original directions scientific research formed not only in St. Petersburg and Moscow, but also in Kharkov, Kazan, Kyiv. The development of obstetrics and gynecology was facilitated by the works of such outstanding obstetricians and gynecologists of Russia as I.P. Lazarevich, K.F. Slavyansky, D.O. Ott, A.I. Lebedev, N.N. Phenomenov and others. I.P. Lazarevich is known for his research on the innervation of the uterus and the development of direct obstetric forceps. K.F. Slavyansky owns fundamental works on the histology of the pathological anatomy of female genital organs. BEFORE. Ott, the creator of the original school of operative gynecology, proposed new operations, diagnostic methods and instruments, and founder of the Midwifery (Obstetrics and Gynecology) Institute in St. Petersburg. A.I. Lebedev developed indications for caesarean section, developed and introduced physiotherapeutic and resort (mud) methods of treating gynecological diseases. N.N. Fenomenov - author Operative obstetrics , improved obstetric forceps. Thus, domestic obstetricians and gynecologists have made a significant contribution to the development of obstetric and gynecological science, proposing new operations and diagnostic methods, developing conservative surgical directions in the treatment of gynecological diseases and obstetric pathology.

Despite the major achievements of the domestic obstetrics and gynecology school, obstetrics and gynecological care in Tsarist Russia were at a low level. On the eve of the Great October Social Revolution, outpatient obstetric and gynecological care practically did not exist, and inpatient care was represented by a small number of hospitals supported by charitable funds. In the entire Russian Empire, there were only about 7.5 thousand maternity beds, which could satisfy the need for obstetric care by less than 4%. The separate maternity shelters that existed in St. Petersburg, Moscow, and Warsaw were in poor condition; in most provinces there were no maternity beds at all. In maternity shelters, medical care was provided only by midwives, since medical care was available only to wealthy segments of the population. Every year, more than 30 thousand women died due to complications of pregnancy and childbirth, and newborn mortality reached more than 2 million per year.

The organization of the state obstetric care system is associated with the Great October Socialist Revolution and the grandiose socio-economic transformations in our country. The organizers of maternal and infant health care were V.P. Lebedeva, G.L. Grauerman, A.N. Rakhmanov, G.N. Speransky and others. The main direction was the creation of a system of obstetric and gynecological care and the development of the material and technical base (opening antenatal clinics and maternity hospitals, providing patronage for pregnant women), training, adoption of laws aimed at protecting the interests of mother and child. Even during the Great Patriotic War, the Presidium of the Supreme Soviet of the USSR approved the Decree On increasing state assistance to pregnant women, large and single mothers, strengthening the protection of motherhood and childhood, and establishing an honorary title Mother heroine , approval of the order Mother's glory" and medals Medal of Motherhood" (1944). To date, over 200 thousand women have been awarded the title Mother heroine , about 4 million were awarded the order Mother's glory .

Soviet scientists have great merit in the development and implementation of methods of psychoprophylactic preparation for childbirth, pain relief and regulation of labor (Lurye A.Yu., Malinovsky M.S., Zhmakin K.N., Yakovlev I.I., Petchenko A. Yu.), therapy of toxicosis in pregnant women (Stroganov V.V., Petrov-Maslakov M.A.), method of manual assistance for breech presentations (Tsovyanov N.A.), prevention of maternal mortality and treatment terminal states(Bublichenko L.I., Zhordania I.F., Baksheev N.S.), conservative therapy and surgical treatment of gynecological (Grudev V.S., Genter G.G., Skrobansky K.K., Figurnov K.M. , Bodyazhina V.I.) and oncological (Gubarev A.P., Serbrov A.I.) diseases.

5. State and development of modern obstetrics and gynecology

The pride of Russian science is the creation of perinatal medicine and its theoretical branch - perinatology. This term entered the specialized literature in the late 60s of the 20th century. For the development of perinatology, the works of P.K. were of exceptional importance. Anokhin and his students, who substantiated the doctrine of functional systems and who created the theory of systemogenesis on this basis. The problems of antenatal and early postnatal development of animals and humans were studied by students and employees of I.A. Arshavsky, who introduced the concept dominant pregnancy . In the 60s, the doctrine of critical periods of embryogenesis and the damaging effects of various pathological conditions maternal organism on early embryogenesis (P.G. Svetlov, V.I. Bodyazhina). A major role in the establishment of perinatology as an independent scientific discipline belongs to Leningrad scientists N.L. Garmasheva, N.N. Konstantinova, Moscow scientist L.S. Persianinov, I.V. Ilyin, G.M. Savelyeva, V.A. Tabolin, Yu.E. Veltishev, M.A. Studenkin.

Of extreme importance for the development of perinatology and perinatal medicine was the introduction of hardware methods for studying the condition of the fetus: electrocardiography, phonocardiography, ultrasound scanning. Nowadays, intensive methods of treatment and resuscitation of the fetus and newborn are successfully used, invasive methods diagnosis of congenital and acquired fetal disorders (chorionic villus biopsy, placentobiopsy, cardocentesis) with the use of instrumental, biochemical, immunological, microbiological, molecular biological methods to confirm the diagnosis in the fetus; methods of treatment of identified fetal pathology are being introduced (intrauterine, intravascular administration of drugs, transfusion blood in hemolytic disease of the fetus), fetosurgery is developing. In the world and in Russia (D.O. Ott Scientific Research Institute of Obstetrics and Gynecology, Russian Academy of Medical Sciences), the first operations on the intrauterine fetus were performed in order to correct its developmental defects. The fetus in the full sense of the word has become a patient receiving the necessary medical care at the level of modern achievements of science and practice.

One of the greatest achievements of theoretical and practical obstetrics of the 20th century was the creation and implementation of the method of in vitro fertilization (IVF) with embryo transfer into the uterus. The first successful IVF operation was performed in England by R. Edwards and P. Steptoe. In Russia, the first children after in vitro fertilization were born in Moscow (1986) and St. Petersburg (1986). IVF centers are also open in Russian cities Sochi, Krasnodar, Krasnoyarsk, Tyumen, Samara.

A brief outline of the development of obstetrics and gynecology as a science allows us to consider from a dialectical position current state and prospects for the development of obstetric and gynecological care. The need for a historical approach to science was emphasized by V.I. Lenin: ...the most important thing to approach this issue from a scientific point of view is not to forget the basic historical connection, to look at each question from the point of view of how a well-known phenomenon in history arose, what main stages this phenomenon passed through in its development, and with from the point of view of this development, to look at what this thing has now become . In recent years, many countries have achieved success in the field of maternal and child health, which reflects the overall high level of science and technology, the organization of care for women during pregnancy, childbirth and the postpartum period. The path for further development of obstetrics and gynecology, as well as other sciences, on the one hand, is in the differentiation and separation of new disciplines from it, and on the other, in integration and close contact with various sciences, at the intersection with which new specialties appear. It is the needs of the steady development of science and practice that have already led to the establishment of such disciplines as oncogynecology, gynecological endocrinology, gynecology of children and adolescents, urogynecology, female sexopathology, perinatology.

A significant expansion of knowledge in matters of embryology and genetics, physiology and pathology of the reproductive function of women has made it possible to highlight the doctrine of the periods of intrauterine development of the fetus and various damaging factors, the role of the fetoplacental system in the development, functional formation of the fetus and newborn. The fetus is recognized as a full-fledged patient, to whom applicable special methods and diagnosis, treatment and prevention.

The most important achievements of the last decade in obstetrics are the determination of pregnancy and its timing using ultrasound, amniocentesis, and dynamic monitoring of the state of the fetoplacental system. Biochemical and cytological methods make it possible to identify metabolic, congenital and genetic disorders of the fetus and newborn during prenatal and postnatal studies. Research in the field of population reproduction, problems of fertility and sterility (production, transport and implantation of eggs, the role of prostaglandins, hormones and antihormones in activating the functions of the gonads, the development of reconstructive surgery and embryo implantation, etc.) laid the scientific foundations of reproductive physiology.

The knowledge accumulated in recent decades determines the need to create a rational system for the protection of motherhood and childhood, the scientific validity of its main principles, which is the basis for reducing maternal infant mortality. Thus, in countries with a developed medical care system, the maternal mortality rate is 5-30 per 100,000 live births and is constantly declining, while in developing countries this figure reaches 500 or higher. The lack of basic medical care and obstetric care system leads to the fact that in some areas of the world, in 50% of cases, births are still attended by midwives or relatives. This is one of the main reasons that in regions with the highest maternal mortality, i.e. In most countries in Africa and West, South and East Asia, about half a million women die annually from causes related to pregnancy and childbirth, leaving at least a million children without mothers" (WHO, 1982). As an integral component of the maternal and child health system Family planning and the prevention of unwanted pregnancies are becoming more and more firmly established.

Over 30% of married couples of reproductive age use modern contraceptives in one form or another (oral contraceptives, intrauterine devices, and other devices), which has a beneficial effect on the health of the mother and the well-being of the family, and prevents abortions and criminal interventions.

It is well known that the foundation of an adult’s health is laid in the first forty weeks of life, counting from conception. Main principle, which underlies the protection of motherhood and childhood, is that for the survival and development of a healthy child, it is necessary to provide specific biological and psychosocial needs inherent in the growth process of the human body. The mother and fetus are classified as vulnerable groups due to the potential for them to develop serious diseases and complications (in the fetus, in addition, developmental anomalies), which pose a danger both directly to the life of the mother and child, and to the health of an adult. This requires the organization of maternal and child health care on a preventive basis, continuity of observation, an individual approach, and the possibility of receiving qualified and specialized medical care for all pregnant women, women in labor and postpartum women who need it.

obstetrics gynecology medical Russian

Conclusion

Further progress in obstetrics and gynecology is associated with the active use of achievements in medical genetics, in particular genetic engineering, immunology, endocrinology, biophysics, pharmacology, and the introduction of endoscopic, ultrasound, radioimmune, laser and other methods of research and treatment.

Literature

) Bodyazhina V.I., Zhmakin K.N. Obstetrics. - M: medicine, 1978.

) Great Russian Encyclopedia, M.: BRE, 2004.

) Gribanov E.D. Medicine in symbols and emblems., Moscow Medicine , 1990

) Newsletter Life-Medic" No. 14. History of the development of obstetrics, St. Petersburg 2012.

) Multanovsky M.P. History of medicine, Moscow, 1961

) Mashkovsky M.D. Medicines, volume I, Moscow Medicine . 1993

) Marchukova S.M. Medicine in the mirror of history, St. Petersburg, 2003.

) Koney S.P. and others. Obstetrics and gynecology., M.,: GEOTAR Medicine" 1997.

) Sorokina T.S. History of medicine, Moscow, 1988.

) Tsvelev Yu.V. and others. Obstetrics and gynecology., St. Petersburg. 1992