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Ministerul Sntii al Republicii Moldova

___________________________________________________
denumirea instituiei

DOCUMENTAIE MEDICAL
Formular
nr. 111/e

Aprobat de MS al RM

nr. 828 din 31.10. 2011

FIA PERSONAL A GRAVIDEI I LUZEI


Numele, prenumele ___________________________________________________________


, ,
_________________________________________________________________________________________

Numrul de identificare ________________________________________________________



Numrul poliei de asigurare ___________________________________________________

Data naterii ________________________________________________________________

Adresa la domiciliu ___________________________________________________________

___________________________________________________________________________
Telefon ____________________________________________________________________

GESTAII I NATERI ANTERIOARE



Anul n care a avut
loc sarcina
,

Sarcina ntrerupt (termenul)


()
artificial
spontan

normal

Natere

complicat (a indica cauza)


( )

vii (starea sntii)


( )

decedai (a indica vrsta i cauza)


( )

Copii

greutatea la natere

alimentaie

natural (luni)
artificial
(.)

DATE ANTECEDENTE DESPRE FAMILIE I PERSONAL DESPRE MAM


O
(n particular, maladii cronice, contracepie, tratament)
( , , , )
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3

Sarcina prezent:

Prima zi a ultimei menstruaii_____________________________________


a __________ la numr

Naterea este ateptat la _________________________________________


Date personale despre mam



Naionalitatea (etnia)____________________________________________________________________
()
Studii:
primare, medii incomplete, medii,
medii speciale,
: , , , ,
superioare incomplete, superioare
(a specifica)
,

()
Starea civil:
cstorit, celibatar, divorat,
vduv
: , , ,
Anul ncheierii prezentei cstorii _________________________________________________________

Adresa la domiciliu (actual):_____________________________________________________________
()
____________________________________________________________________________________
Condiii de trai:
:
Numr odi
WC n locuin
Da
Nu
o

Numr persoane n cas
Sal de baie
Da
Nu

Serviciu n afara casei pe parcursul sarcinii


Da
Nu

Locul de munc________________________________________________________________________

Profesia sau funcia_____________________________________________________________________

Condiii de munc: favorabile
sau nocive,
:
,
a indica factorii nocivi __________________________________________________________________

Observaii ____________________________________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
4

Date despre sntatea tatlui



Vrsta tatlui __________________________________________________________________________

Relaii de rudenie ntre soi_______________________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________
Date antecedente despre familie ___________________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Date antecedente personale_______________________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Grupa de snge ________________________________ Factor Rhesus ___________________________

-
Examen radiologic _____________________________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Not: Se recomand de a prezenta medicului rezultatele ultimelor examene efectuate.


:
.

PROGRAMUL DE EXAMINARE A GRAVIDEI


Pn la 12 sptmni
de sarcin

Investigaii obligatorii:
c:
- Testul la sarcin (n primele 5 sptmni de reinere a menstruaiei)
( 5 )

12

- Masa corpului

- Tensiunea arterial

- Examenul glandei tiroide

- Examenul glandei mamare

- Consultaia obstetricianului-ginecolog atunci cnd gravida este
supravegheat de alt specialist, consultaia medicului de familie cnd
gravida este supravegheat de obstetrician-ginecolog
a-a
,
,
-a
- Pelvimetria

- Examenul vaginal

- Frotiu vaginal la gradul de puritate, inclusiv testul cu KOH de 10%
, 10% KOH
- Analiza general a sngelui

- Grupa de snge i factorul Rhesus
-
- Analiza general a urinei

- Reacia Wassermann (RW)

- Antigen australian (HbsAg) la gravida nevaccinat

- Date despre sntatea soului

- Recomandaii n privina alimentaiei, igienei i comportamentului
sexual, pregtirea psihoprofilactic a gravidei
,
,

Dup indicaie:
:
- Glucoza n snge

- Bilirubina, AsAT, AlAT n snge
, AAT, AAT
- HIV

- Titrul de anticorpi

- Grupa de snge i factorul Rhesus ale soului
-
- ECO grafia, eventual amniocenteza i analiza cromozomic la gravid
dup 35 de ani i la gravid cu anamneza genetic complicat
,
35
- Electrocardiografia (ECG)
()
- Colposcopia

- Frotiu dup Papanicolau



- nsmnare bacteriologic din vagin (gradul III-IV de puritate)
(III-IV )
- Consultaia stomatologului, ORL, oculistului
, ,

La termenul de sarcin
16-18 sptmni

16-18

Investigaii obligatorii:
:
- Masa corpului

- Tensiunea arterial

- nlimea fundului uterin

- ECO grafia 1(2) - la 18-21 sptmni
1(2) - 18-21
- Hemoglobina

- Analiza general a urinei



Dup indicaie:
:
- La Rhesus negative titrul de anticorpi
-
- Snge la a-fetoprotein
a-

La termenul de sarcin
22-24 sptmni

22-24

Investigaii obligatorii:
:
- Masa corpului

- Tensiunea arterial

- nlimea fundului uterin

- Btile cordului fetal (BCF)

- Hemoglobina

- Analiza general urinei



Dup indicaie:
:
- La Rhesus negative titrul de anticorpi
-

La termenul de sarcin
28-30 sptmni

28-30

Investigaii obligatorii:
:
- Masa corpului

- Tensiunea arterial

- nlimea fundului uterin i circumferina abdominal

- Btile cordului fetal (BCF)

- Hemoglobina

- Reacia Wassermann-2 (RW-2)


-2
- Analiza general urinei

- Frotiu vaginal, inclusiv testul cu KOH de 10%
, 10% KOH
- Pregtirea psihoemoional a gravidei i a membrilor familiei ei

- Oferirea concediului de maternitate

Dup indicaie:
:
- Glucoza n snge

- La Rhesus negative titrul de anticorpi
-
- Investigaii bacteriologice ale coninutului vaginal
(gradul III-IV de puritate)

(III-IV )
- Consultaia stomatologului

La termenul de sarcin
35-36 sptmni

35-36

Investigaii obligatorii:
:
- Masa corpului

- Tensiunea arterial

- nlimea fundului uterin i circumferina abdominal

- Btile cordului fetal (BCF)

- Poziia ftului i partea prezentat

- Analiza general a sngelui

- Frotiu de control, inclusiv testul cu KOH de 10%
, 10% KOH
- Pregtirea psihoemoional a gravidei i a membrilor familiei ei

Dup indicaie:
:
- La Rhesus negative titrul de anticorpi
-
- Protrombina i fibrinogenul n snge

- Consultaia stomatologului

La termenul de sarcin
38-40 sptmni

38-40

Investigaii obligatorii:
c:
- Masa corpului

- Tensiunea arterial

- nlimea fundului uterin i circumferina abdomenului

- Btile cordului fetal (BCF)

- Partea prezentat i atitudinea ei ctre intrarea n bazinul mic

Dup indicaie:
:
- Orientarea gravidei ctre natere i controlul spitalizrii

- ECO grafia 2 (3)
2 (3)

10

EVOLUIA SARCINII

Prima zi a ultimei menstruaii __________________________________ Concediul de maternitate ______________________

Data

Termenul sarcinii (sptmni)


()
Starea general

Perimetrul abdomenului (cm)
()
Poziia ftului (longitudinal, oblic,
transversal)
(,
, )
Partea prezentat

Spitalizare

10

REZULTATELE INVESTIGAIILOR INSTRUMENTALE I DE LABORATOR


Data

Hemoglobina, g/l
(/)
Urina:
:
protein/glucoz
/
bacterii

Titrul de anticorpi Rh
Rh
RW-I
RW-II
Antigen australian HBsAG-1
1
Frotiu vaginal, grad de puritate
,
Bacteriologia coninutului vaginal, inclusiv
testul cu KOH de 10%

, 10%
KOH
ECO grafia

11

Semntura medicului

11

DINAMICA TENSIUNII ARTERIALE I BTILE CORDULUI FETAL


Tensiunea arterial
(mm. Hg)

( . .)

Btile
cordului
fetal (min)

( )

Data, luna, anul


. ,
Termenul sarcinii

180
160
140
120
100
80
240
220
200
180
160
140
130
120
100
80
60
40

EVOLUIA SARCINII N CONFORMITATE CU NLIMEA FUNDULUI UTERIN (n cm)


( )
45

40

35

30

25

20

15
17 18 19

20 21 22

23 24 25

26 27 28

29 30 31

32 33 34

35 36 37

38 39 40

41 42

Sptmni de sarcin

()
_______________________
()
Sptmni
de sarcin

12

20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1

NATEREA

Adaos la greutate (kg)


Greutatea iniial (kg)

DINAMICA GREUTII PE PARCURSUL SARCINII


-1
-2
-3
4

12

16

20

24

28

32

36

40

Datele examenului ecografic


-
Data

V.G. (cronologic)
. .()
V.G. (biometrie)
.. ()
D.B.P.
( )
L.F.
..
C.A.
..
C.C.
..
B.C.F.
...
Prezentaie C./P./T.
./ ./.
M.A.F.(+/-)
...(+/-)
Inseria placentei

Grosimea i gradul de maturitate a
placentei

Cantitatea LA (N, >, <)


(
) (, >, <)
Masa ftului

Raportul C/P

I vizit ______________________________________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________
II vizit _____________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________

III vizit _____________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
13

Se completeaz de medicul care supravegheaz gravida la fiecare vizit pentru a evalua riscurile i a referi gravida pentru natere

SUPRAVEGHEREA GRUPURILOR DE RISC MATERN LA NIVELURILE I, II I III DE ASISTEN PERINATAL


I, II III

14

Grupul de risc minim (fr risc), supraveghere la nivelul I:


( ), I :
Evoluia fiziologic a sarcinii

Anemia gravidelor, gradul I (depistat pentru prima dat)
, I ( )
Iminena ntreruperii sarcinii n trimestrele I-II n cazul efectului pozitiv de la tratamentul efectuat
I-II

Gestoz precoce, cu excluderea formelor severe
,
Rhesus izosensibilizare fr titru de anticorpi
-
Prezena patologiei extragenitale dup consultarea specialitilor de profil (distonie neurocirculatorie, boala
hipertensiv, gradul I, afeciuni pulmonare nespecifice fr insuficien respiratorie, afeciuni ale tractului
gastrointestinal, afeciuni inflamatorii ale rinichilor i cilor urinare depistate pentru prima dat, fr dereglarea funciei lor)
(
, I- , , ,
, )
Grup de risc moderat, supraveghere la nivelul II:
, II :
Anamnez obstetrical complicat (prematuritate habitual, insuficien cervical, sterilitate, dup
intervenii chirurgicale la uter, polihidramnios)
( , ,
, , )
Iminena ntreruperii sarcinii n trimestrele I-II n cazul tratamentului neefectiv la nivelul I al asistenei
perinatale
I-II I-

Deces fetal, ante- sau neonatal, sau natere prematur n anamnez dup consultarea medicului
genetician
, ,
-
Evoluie medie a gestozelor n cazul efectului pozitiv de la tratamentul efectuat

Maladie genetic n familie (dup consultarea medicului genetician i testele screening care s-au
efectuat la nivelul III)
( - -,
III- )
Adaos la greutate sub 4,5 kg pn la 30 sptmni de gestaie
4,5 30
Rhesus izosensibilizare fr titru de anticorpi
-
Iminena de natere prematur n cazul efectului pozitiv de la tratamentul efectuat

Sarcin multipl

Poziia transversal sau prezentaia pelvian a ftului dup 36 sptmni
36
Placenta praevia

Anemie de gradul II
II-
Boala hipertensiv de gradul I-II
I-II-
Hipertensiune arterial fr gestoz

Vicii cardiace fr decompensare































Grup de risc nalt, supraveghere la nivelul III:


, III :

Gestoze severe, evoluie medie sau tratament neefectiv al gestozelor la nivelul II (lipsa eficacitii
tratamentului n decurs de 5-7 zile)
, II-
( 5-7 )
Natere prematur n cazul ruperii membranelor la termenul de sarcin pn la 32 de sptmni

32
Sarcin cu Rh conflict cu titru nalt de anticorpi
-,
Anemie de gradul III
III-
Anomalii de dezvoltare a ftului

Patologie a sistemului feto-placentar (insuficien placentar, anomalia cantitii lichidului amniotic,
hipoxia ftului, retard de dezvoltare intrauterin a ftului (sub 10 percentile) etc.)
( ,
, , (
10%) ..)
n anamnez malformaii congenitale severe la ft

Afeciuni extragenitale cu decompensare sau n cazul lipsei eficacitii de la tratamentul efectuat

Intervenii chirurgicale la cord, vase, plmni, ficat, rinichi, intervenii plastice ginecologice etc.
, , , , ,
..
Maladii cardiovasculare cu i fr insuficien cardiac
-
Afeciuni ale rinichilor i cilor urinare (glomerulonefrit, pielonefrite cronice recidivante sau alte
maladii) n cazul lipsei eficacitii tratamentului la nivelul II
(,
) II-
Diabet zaharat, indiferent de form
,
Maladii endocrine cu manifestri clinice










Se completeaz de medicul care supravegheaz gravida la fiecare vizit pentru a evalua riscurile i a referi gravida pentru natere

Primipar la vrsta peste 35 de ani (dup consultarea medicului genetician i testele screening care s-au
efectuat la nivelul III)
35 ( - -,
III- )
Intervenii obstetricale sau ginecologice pe uter n anamnez

Obezitate la mam (exces n greutate peste 20%)
( 20%)
Abuz de alcool, fumat, consum de droguri i alte medicamente
, , ,
Afeciuni ale sistemului respirator (pneumonie, astm bronic, bronhoectazie, bronite cronice
recidivante, afeciuni nespecifice pulmonare fr insuficien respiratorie)
(, , ,
,
)
Afeciuni ale ficatului n stadiul de compensare

Afeciuni ale rinichilor i cilor urinare (glomerulonefrit, pielonefrite cronice recidivante)
(,
)
Infecii urogenitale specifice (chlamidioz, micoplasmoz, CMV, herpes etc.)
(, , ,
..)








15

Se completeaz de medicul care supravegheaz nou-nscutul pentru a evalua riscurile i a referi copilul la nivelul superior de ngrijire

SUPRAVEGHEREA GRUPURILOR DE RISC NEONATAL


LA NIVELURILE I, II I III DE ASISTEN PERINATAL

I, II III

16

Grup de risc minim (fr risc), supraveghere la nivelul I:


( ), I :
Infecie intrauterin suspectat

Dereglri neurologice de o gravitate medie datorit asfixiei, hipoxiei
,
Hiperbilirubinemie a nou-nscutului cu indicele Bi de peste 170 mol/l n I zi de via
Bi 170 / I-
Dereglri metabolice, n special la nou-nscut cu greutate mic la natere, postasfixie etc.
,
.
Malformaii congenitale

Grup de risc moderat, supraveghere la nivelul II:
, II :
Nscut la termenul de gestaie 32-37 sptmni
32-37
Nscut cu masa corpului 2000-2500 g
2000-2500
Nscut la termenul de gestaie de peste 42 sptmni
42
Nscut de la mam n anamneza deces fetal, antenatal sau neonatal etc.
, .
Rh sau AB0 incompatibilitate ce necesit tratament conservativ
Rh AB0 ,
Nscut de la mam cu infecie intrauterin suspectat sau diagnosticat (polihidramnios, ruptura prematur
a membranelor etc.)

(, .)
Nscut de la mam cu gestoz de grad mediu

Nscut din duplex

Nscut n poziie pelvian

Nscut de primipar n vrst de peste 35 de ani
35
Dereglri metabolice sau ionice nepronunate

Leziuni ale SNC, evoluie medie, grav
, ,
Vicii cardiace compensate

Retard de dezvoltare intrauterin a ftului (25-10 percentile)
(25-10 %)
Hipoxie, asfixie n natere, evoluie medie, grav
, , ,
Extras prin operaie cezarian planic

Nscut de la mam cu alte patologii severe


















































Se completeaz de medicul care supravegheaz nou-nscutul pentru a evalua riscurile i a referi copilul la nivelul superior de ngrijire

Grup de risc nalt, supraveghere la nivelul III:


, III :
Nscut la termenul de gestaie pn la 32 sptmni i cu masa corpului sub 2000 g
32 c 2000
Nscut de la mam cu ruptura prematur a membranelor la termenul pn la 34 sptmni

34
Nscut de la mam cu hipertensiune indus de sarcin, evoluie medie sau grav
, ,

Nscut de la mam cu hemoragie uterin cauzat de patologia inserrii placentei, cu termenul de


gestaie pn la 32-34 sptmni
,
, 32-34
Retard de dezvoltare intrauterin a ftului (sub 10 percentile)
( 10%)
Nscut de la mam cu patologie extragenital i obstetrical grav, cu pericol pentru viaa copilului
,

Nscut de la mam n anamnez malformaii congenitale severe la ft



Nscut de la mam cu diabet zaharat

Nscut de la mam cu patologie hepatic grav

Nscut din sarcina multipl (mai mult de 2 fei)
( )
Izoimunizare grav n sistemul Rh i AB0, ce necesit exsangvinotransfuzie
Rh AB0,
Nscut de la mam cu patologie cardiovascular cu sau fr insuficien cardiac
-

Nscut de la mam cu patologie renal grav n faza de sub- sau decompensare


-
Infecii intrauterine grave, inclusiv septicemie
,
Traumatism obstetrical i n natere

Leziuni grave ale SNC datorit hipoxiei/asfixiei severe
, /
Insuficien respiratorie grav (schimb insuficient de gaze, necesitate de ventilaie artificial de lung
durat, hipertensiune pulmonar persistent)
( ,
, )
Apnee i/sau bradicardie severe recurente
/
Dereglri metabolice grave

Alimentaie parenteral complet

Aflat n regim de ventilaie artificial dirijat

Dereglri hematologice severe (trombocitopenie, dereglri hemolitice severe), inclusiv cele ce necesit
efectuarea exsangvinotransfuziei
(, ),
,
Malformaii congenitale care necesit corecie chirurgical ndat ce a fost confirmat diagnosticul
,

Malformaii congenitale cardiace simptomatice

Alte stri critice ce necesit terapie intensiv sau complex (hemoragie intracranian etc.)

( .)





17

PRIMUL EXAMEN MEDICAL (pn la 12 sptmni)


( 12 )
Acuze _______________________________________________________________________________________________

q Examen general

Starea general ____________________________________
Greutatea ___________________________ (curba pag. 12)

( .12)
Pulsul ___________________________________________
Talia___________________________________________

TA: stng________________ dreapt _________________


Varice _________________________________________
: a
a

Examinarea glandelor mamare____________________________________________________________________________

q Examinare obstetrical

Dimensiunile bazinului:
DSp ____________________________________ , DCr ________________________________
:
DTr ____________________________________ , CE _________________________________
Examen vaginal _______________________________________________________________________________________

Eliminri vaginale ____________________________________ Hemoragie _______________________________________

q Investigaii instrumentale i de laborator *



Grupa de snge
Factorul Rhesus

-
Alte examinri ________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
Diagnostic________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
Tratament i recomandaii**
__________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
A monitoriza n special__________________________________________________________________________________

q Pregtirea psihoemoional I edin
I
q Observaii suplimentare i concluzie __________________________________________________________________
e
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Data_____________________

Examinri suplimentrare

dreapta

Semntura i tampila _________________________


8
8

7
7

6
6

5
5

4
4

DANTURA

3 2 1 1 2 3
3 2 1 1 2 3

Vezi programul de examinare a gravidei (pag. 6)


(. 6)
** Se recomand administrarea acidului folic i preparatelor ce conin fier
()

18

4
4

5
5

6
6

7
7

8
8

stnga

AL DOILEA EXAMEN MEDICAL


(16-18 sptmni)

(16-18 )
Evoluia sarcinii de la examenul precedent __________________________________________________________________

Acuze _______________________________________________________________________________________________

q Examen general

Starea general ____________________________________
Greutatea ___________________________ (curba pag. 12)

( .12)
Pulsul ___________________________________________
Talia___________________________________________

TA: stng________________ dreapt _________________


Varice _________________________________________
: a
a

Edeme ______________________________________________________________________________________________

q Examinare obstetrical

nlimea fundului uterului (pag. 12) _______________________________________________________________________
(. 12)
Eliminri vaginale ________________________________________ Hemoragie ___________________________________

q Investigaii instrumentale i de laborator



ECO grafia nr. 1 Diametrul parieto-coccigian _______________________________________________________________
1

Diametrul corpului vitelin (luteum) ___________________________ Grosimea corionului ___________________________
()
x
Diametrul sacului fetal _________________________________________________________________________________
o
____________________________________________________________________________________________________
Titrul de anticorpi dac factorul Rhesus este negativ (-) _____________________________________________________
, (-)
Alte examene _________________________________________________________________________________________

____________________________________________________________________________________________________
Diagnostic _______________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
Tratament i recomandaii __________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Observaii suplimentare i concluzie _________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Data_____________________

Semntura i tampila _________________________



19

AL TREILEA EXAMEN MEDICAL


(22-24 sptmni)

(22-24 )
Evoluia sarcinii de la examenul precedent __________________________________________________________________

Acuze _______________________________________________________________________________________________

q Examen general

Starea general ____________________________________
Greutatea ___________________________ (curba pag. 12)

( .12)
Pulsul ___________________________________________
Talia___________________________________________

TA: stng________________ dreapt _________________


Varice _________________________________________
: a
a

Edeme ______________________________________________________________________________________________

q Examinare obstetrical

nlimea fundului uterului (pag. 12) _______________________________________________________________________
(. 12)
Perimetrul abdomenului ________________________________ Btile cordului fetal _____________________________


Micarea ftului _______________________________________________________________________________________

Eliminri vaginale ________________________________________ Hemoragie ___________________________________

q Investigaii instrumentale i de laborator



ECO grafia nr. 2 (dup indicaii) Diametrul biparietal _______________________________________________________
2 ( )

Diametrul fronto-occipital _____________________________Circumferina craniului ftului _________________________
-

Circumferina abdomenului ____________________________Lungimea femurului _________________________________


Grosimea placentei___________________________________Volumul lichidului amniotic ___________________________


Titrul de anticorpi dac factorul Rhesus este negativ (-) ________________________________________________________
, (-)
Alte examene _________________________________________________________________________________________

____________________________________________________________________________________________________
Diagnostic _______________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
Tratament i recomandaii _________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Observaii suplimentare i concluzie __________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Data_____________________

20

Semntura i tampila _________________________


AL PATRULEA EXAMEN MEDICAL


(28-30 sptmni)

(28-30 )
Evoluia sarcinii de la examenul precedent __________________________________________________________________

Acuze _______________________________________________________________________________________________

q Examen general

Starea general ____________________________________
Greutatea ___________________________ (curba pag. 12)

( .12)
Pulsul ___________________________________________
Talia___________________________________________

TA: stng________________ dreapt _________________


Varice _________________________________________
: a
a

Edeme ______________________________________________________________________________________________

Examenul glandelor mamare _____________________________________________________________________________



q Examinare obstetrical

nlimea fundului uterului (pag. 12) _______________________________________________________________________
(. 12)
Perimetrul abdomenului ________________________________ Btile cordului fetal _____________________________


Micarea ftului _______________________________________________________________________________________

Eliminri vaginale ________________________________________ Hemoragie ___________________________________

q Investigaii instrumentale i de laborator



Titrul de anticorpi dac factorul Rhesus este negativ (-) ________________________________________________________
, (-)
Alte examene _________________________________________________________________________________________

____________________________________________________________________________________________________
Diagnostic ________________________________________________________________________________________

____________________________________________________________________________________________________
q

____________________________________________________________________________________________________
Tratament i recomandaii __________________________________________________________________________

____________________________________________________________________________________________________
q

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Acordarea concediului de maternitate

de la _______________ pn la _______________

q Pregtirea psihoemoional a II i a III edin


II III
q Observaii suplimentare i concluzie __________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Data_____________________

Semntura i tampila _________________________



21

AL CINCILEA EXAMEN MEDICAL


(35-36 sptmni)

(35-36 )
Evoluia sarcinii de la examenul precedent __________________________________________________________________

Acuze _______________________________________________________________________________________________

q Examen general

Starea general ____________________________________
Greutatea ___________________________ (curba pag. 12)

( .12)
Pulsul ___________________________________________
Talia___________________________________________

TA: stng________________ dreapt _________________


Varice _________________________________________
: a
a

Edeme ______________________________________________________________________________________________

q Examinare obstetrical

nlimea fundului uterului (pag. 12) _______________________________________________________________________
(. 12)
Perimetrul abdomenului ________________________________ Btile cordului fetal _____________________________


Partea prezentat ______________________________________________________________________________________

Micarea ftului _______________________________________________________________________________________

Eliminri vaginale ________________________________________ Hemoragie ___________________________________

q Investigaii instrumentale i de laborator



Titrul de anticorpi dac factorul Rhesus este negativ (-) ________________________________________________________
, (-)
Alte examene _________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
Diagnostic________________________________________________________________________________________

____________________________________________________________________________________________________

Tratament i recomandaii __________________________________________________________________________



____________________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Vizitarea maternitii de ctre familie ______________________________________________________________________

____________________________________________________________________________________________________
Pregtirea psihoemoional a IV edin
IV
q Observaii suplimentare i concluzie __________________________________________________________________

____________________________________________________________________________________________________
q

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Data_____________________

22

Semntura i tampila _________________________



AL ASELEA EXAMEN MEDICAL

(38 sptmni)

(38 )
Evoluia sarcinii de la examenul precedent __________________________________________________________________

Acuze _______________________________________________________________________________________________

q Examen general

Starea general ____________________________________
Greutatea ___________________________ (curba pag. 12)

( .12)
Pulsul ___________________________________________
Talia___________________________________________

TA: stng________________ dreapt _________________


Varice _________________________________________
: a
a

Edeme ______________________________________________________________________________________________

q Examinare obstetrical

nlimea fundului uterului (pag. 12) _______________________________________________________________________
(. 12)
Perimetrul abdomenului ________________________________ Btile cordului fetal _____________________________


Partea prezentat ______________________________________________________________________________________

Micarea ftului _______________________________________________________________________________________

Eliminri vaginale ________________________________________ Hemoragie ___________________________________

q Investigaii instrumentale i de laborator



ECO grafia nr. 3 (dup indicaii) Diametrul biparietal _______________________________________________________
3 ( )

Diametrul fronto-occipital _____________________________Circumferina craniului ftului _________________________
-

Circumferina abdomenului ____________________________Lungimea femurului _________________________________


Grosimea placentei___________________________________Volumul lichidului amniotic ___________________________


Titrul de anticorpi dac factorul Rhesus este negativ (-) ________________________________________________________
, (-)
Alte examene _________________________________________________________________________________________

____________________________________________________________________________________________________
Diagnostic________________________________________________________________________________________

____________________________________________________________________________________________________

Tratament i recomandaii __________________________________________________________________________



____________________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Naterea va avea loc n maternitatea _______________________________________________________________________

q Observaii suplimentare i concluzie __________________________________________________________________
e
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Data_____________________

Semntura i tampila _________________________



23

EXAMINRI SUPLIMENTARE

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24

EXAMINRI SUPLIMENTARE

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25

EXAMINRI SUPLIMENTARE

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26

EXAMINRI SUPLIMENTARE

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27

EXAMINRI SUPLIMENTARE

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28

PROGRAMUL DE INSTRUIRE A GRAVIDELOR I A MEMBRILOR FAMILIILOR LOR



Pregtirea ctre natere va ncepe n perioada sarcinii, n form de edine n grupuri i individuale
cu gravida i membrii familiei ei (so, sor, mam, prieten etc.). Forma de organizare a instruirii: edine
n grupuri i individuale. Numrul de edine 4, durata fiecarei edine 1,5-2 ore. Cursul de instruire
este destinat ntregii familii. Tematica treningurilor va corespunde termenului de sarcin.
(, , , . .).
: . 4,
1,5-2 . .
.
Prima edin (dup luarea n eviden)
( )
1. Noiuni generale de anatomie i fiziologie.
.
2. Noiuni generale despre sarcin.
.
3. Modificrile fizice i psihoemoionale n timpul sarcinii.
.
4. Igiena, alimentarea gravidei, regimul de lucru i odihn, comportamentul sexual i deprinderi
nocive n timpul sarcinii.
, , ,
.
5. Problemele posibile i strile de urgen n timpul sarcinii.
.
6. Drepturile i responsabilitatea gravidei de propria sntate i sntatea copilului.
.
7. Metode de relaxare n timpul sarcinii.
.
8. Carnetul medical perinatal.
.
A doua edin (28-30 sptmni de sarcin)
(28-30 )
1. Noiuni generale despre naterea normal, termenele naterii.
, .
2. Semnele nceputului naterii.
.
3. Perioadele naterii.
.
4. Metodele de relaxare n natere.
.
5. Metode medicamentoase i nemedicamentoase de analgezie.
.
6. Problemele posibile i strile de urgen n timpul naterii.
.
7. Instruirea persoanei de suport.
.

29

A treia edin (32-33 sptmni de sarcin)


(32-33 )
1. Parteneriatul la natere.
.
2. Conduita n timpul naterii. Poziiile n natere i importana comportamentului activ.
. .
3. Exerciiile respiratorii i de relaxare n timpul naterii.
.
4. Suportul partenerului.
.
5. Contactul piele la piele.
.
6. Iniierea precoce a alimentaiei naturale.
.
A patra edin (35-36 sptmni de sarcin)
(35-36 )
1. Igiena luzei, sexualitatea i contracepia.
, .
2. Strile de urgen n perioada de luzie. Coordonatele personalului de contact.
.
.
3. ngrijirea nou-nscutului i vaccinarea.
.
4. Alimentaia natural i problemele legate de ea. Grupurile i persoanele de suport al alimentaiei
naturale.
, . ,
.

30

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