home Auditorium 8 Obstetrics and gynecology of ancient Greece. History of the development of gynecology. Gynecology: history of development - Middle Ages

Obstetrics and gynecology of ancient Greece. History of the development of gynecology. Gynecology: history of development - Middle Ages

Examination of a gynecological patient only with the help of physical methods is insufficient; it must be supplemented by research using various instruments and instruments.

Research with mirrors is mandatory not only in the hospital, but also at outpatient appointments, as well as during mass oncological examinations. Gynecological speculums have been known since ancient times. They were brought to Russia by Peter I; samples of them can be found in the Peter's Gallery of the State Hermitage in Leningrad.

Vaginal specula are cylindrical, folded and spoon-shaped.

Cylindrical or round mirrors have the shape of a cylinder with a bell at one end; They are made from glass, regular or milk glass, metal or plastic. The diameter must be different; you need to have a set of three to six such mirrors. A round mirror is inserted as follows: with the thumb and forefinger of the left hand, open the genital slit and, bringing the mirror grabbed by the right hand to it, insert its narrow end into the vaginal opening, slightly pressing the perineum downwards. If the mirror is beveled at its end, then its longer wall is directed downwards. Using rotational movements, the speculum is moved deep into the vagina until the vaginal part of the cervix is inserted into its lumen.

When inserting a speculum, it is preferable to place the woman in the second position, since this shortens the vagina. Examination of the vaginal walls with cylindrical mirrors is not very convenient; it is possible only when moving the mirror into depth or when removing it. But these speculums are convenient for treatment (vaginal baths, lubrication of cervical erosions, etc.).

Of the folding vaginal speculums, the most commonly used in practice is the double-leaf speculum of the Cusco or Trell system. These models differ from each other in that when the screw acts, both doors of the Cusco mirror move apart more at their end, while the doors of the Trill mirror expand uniformly and are always parallel. The Cusco speculum stretches the vagina well at the fornix, while the Trill speculum promotes uniform stretching of the entire vaginal tube.

The introduction of these mirrors is carried out next step: Having spread the genital slit with your left hand, grab the mirror with your right hand and, pressing the perineum downwards with its beak, insert the closed mirror obliquely in relation to the genital slit. Having advanced the mirror halfway, turn it flat. At the same time, the speculum is moved apart so that the vaginal part of the cervix is between the valves, then the desired degree of dilation of the vagina is fixed with a screw.

These mirrors are convenient because no assistants are required when using them. With the help of these self-supporting mirrors, you can not only examine the vagina and cervix, but also apply some therapeutic procedures. There are also folding mirrors that make it possible to perform some surgical procedures, for example, curettage of the uterine mucosa and suturing of cervical ruptures.

In cases where the vagina needs to be dilated more, as well as for some vaginal operations, spoon-shaped speculums are used, which require a special lift to hold the anterior vaginal wall. Spoon-shaped mirrors come in different shapes and sizes. The Sims dual mirror of different calibers does not have a special handle. Doyen's speculums of different calibers are also convenient for examining the cervix with a long vagina, as well as during operations. Particularly convenient is the set of Simon mirrors with removable handles. Fritsch's mirrors also have a removable handle; they are shortened at the end, which makes it possible to lower the neck well.

For wider exposure of the vaginal walls and vaults, plate mirrors are used - “lifters” and “laterals”, which are inserted into the vagina in the area of the lateral vaults. A method of exposing the vaginal part of the cervix using a spoon-shaped speculum with a lift: first, a spoon-shaped (posterior) speculum is inserted, and then a lift.

When examined using mirrors, the features of the vagina, fornix and cervix are studied. Speculums allow you to determine the color of the vaginal mucosa, the color and nature of the discharge, proliferation of the mucosa, ulceration and tumors of the vagina (if any), as well as the fornix. Using mirrors, the condition of the vaginal part of the cervix is determined - ruptures and scars, ectropion, erosions, tumors, hypertrophy and elongation, various degrees atrophy and destruction by malignant tumors.

Probing of the uterine cavity. Probing of the uterine cavity is undertaken in cases where it is necessary to study the length and patency cervical canal, configuration of the uterine cavity, the presence of tumors in it. Probing is widely used in some vaginal operations: before curettage of the uterine mucosa, before amputation of the cervix, to identify tumors (nodules, polyps) of the uterine cavity, bicornus, etc. To probe the uterine cavity, it is necessary to prepare spoon-shaped speculum, a lift, two pairs of bullet forceps, long anatomical tweezers and uterine probe. The probe is a nickel-plated brass rod with divisions, ending at one end with a small thickening and at the other with a flat handle. At a distance of 7 cm from the buttoned end there is a second thickening or mark indicating the normal length of the uterine cavity.

After sterilizing the instruments, the woman is placed in the gynecological chair in the second position. Urine is released with a catheter, the vagina is douched. After inserting a Sims or Simon speculum with a lift into the vagina, grab the anterior lip of the cervix with bullet forceps; the elevator is removed and the uterus is brought down to the genital slit. Pulling the bullet forceps towards himself, the doctor, carefully holding the probe with two or three fingers, inserts it into the cervical canal, and a slight resistance is felt at the internal pharynx. By inserting the probe into the uterine cavity to its bottom, determine its length using the divisions of the probe, and then, sliding the probe along the anterior, posterior and lateral walls of the uterus, determine the shape of the uterine cavity, the approximate size of the angle between the body and the cervix, the presence of protrusions in the uterine cavity ( tumor), uneven surface (polyps), etc. If the uterus is bicornuate, it may be necessary to insert a second probe.

Probing of the uterus should be carried out under conditions of strict asepsis and antisepsis. Immediately before probing, the vaginal part of the cervix and the cervical canal are wiped with alcohol or a 5% iodine solution, and the mucus plug must first be removed. Probing, due to the risk of infection, can only be used in a hospital setting. There have been cases of other complications of probing - uterine perforation, bleeding, the fight against which is possible only in inpatient conditions. Thus, this type of instrumental research, bordering on operative aid, is a serious manipulation. Probing
The uterine cavity has its contraindications: purulent discharge from the cervical canal (gonorrheal endocervicitis), disintegrating cancerous ulcer of the vaginal part of the cervix, acute and subacute inflammatory processes of the uterine appendages and suspicion of pregnancy.

Puncture through the posterior fornix. The simplest and most convenient access to the pelvic cavity, or more precisely to the pouch of Douglas, where all types of blood and pus accumulations of genital origin are concentrated, is the posterior vaginal vault. In the space below the cervix between the divergent uterine cross ligaments there is a thin wall of the vaginal mucosa, the connective tissue layer and the peritoneum. It is in this exact place that a test puncture of the posterior fornix is performed.

This test puncture is performed for diagnosis ectopic pregnancy and to detect various blood and pus accumulations in the pouch of Douglas (pelvioperitonitis, pyosalpinx, purulent parametritis, piovarium, hematocele, hematosalpinx).

Technique. Puncture of the posterior fornix can be performed in two ways: 1) using a mirror and 2) using the fingers.

1. To puncture the posterior fornix using the first method, a speculum is inserted into the vagina; in this case, the vagina is pulled back, and the posterior lip of the cervix is grabbed with bullet forceps and pulled anteriorly. A thick and long needle, beveled bluntly at its end and put on a syringe, is inserted into the posterior fornix stretched in this way strictly along the midline, between the uterosacral ligaments.

2. When puncturing the posterior fornix using the second method, two fingers (index and middle) of the left hand are inserted into the vagina and placed under the cervix in the area of the uterosacral ligaments, which must first be identified. It is necessary to press the perineum well downwards using the bases of your fingers. Between the fingers inserted into the vagina, with the right hand, a long and rather thick needle is passed to the posterior fornix, placed on a 5-10 gram Record syringe.

The needle is inserted below the cervix along the midline of the posterior fornix, between the uterosacral ligaments, and is directed horizontally or slightly anteriorly.

If blood accumulates in the pouch of Douglas, the blood enters the syringe immediately after puncture of the thin wall of the posterior fornix. If there is a hematocele or if the needle enters the cavity of the hematosalpinx, then it needs to go through some, albeit small, space before blood enters the syringe. In this case, the blood will not be liquid, as with a fresh hemorrhage, but thick, dark, with clots, which is considered characteristic of an ectopic pregnancy with a long-standing hemorrhage.

If the blood does not immediately enter the syringe, then we can recommend slightly moving the end of the needle backwards, followed by slowly removing it and pulling back the piston; This method is good for minor hemorrhages.

When puncturing some long-standing pus accumulations, thick pus can clog the needle hole, as a result of which it does not enter the syringe. In these cases, the needle should be removed and washed, and the puncture should be performed with a thicker needle or repeated with the same needle in another place.

Biopsy. Taking a sample piece of tissue for microscopic examination is called a biopsy. In gynecological practice, most often a test piece of tissue has to be taken from the vaginal part of the cervix. Indications for biopsy are cervical erosions that do not respond to conservative therapy for a long time, papillomatous growths and especially ulcers accompanied by tissue destruction. Only for decubital ulcers of the cervix and vagina, in case of prolapse, do not resort to biopsy. In addition to the cervix, a biopsy is often performed in the area of the vulva, external urethral opening, vaginal walls, etc.

The technique of cervical biopsy was best developed by I. L. Braude. After disinfection of the external genitalia and vagina, a spoon-shaped speculum and a lift are inserted into the latter. The cervix and fornix are disinfected again, the vaginal part of the cervix is grabbed by two pairs of bullet forceps so that the suspicious area of the cervix is located between them. Using a thin scalpel, using an oval incision, radially in relation to the external pharynx, the suspicious tissue is excised in a wedge shape so that healthy tissue also gets into the removed piece. Two or three catgut sutures are applied to the wound. The excised piece is washed with saline (but not treated with alcohol and iodine) and placed in a test tube with a 4% formaldehyde solution. A tampon is inserted into the vagina, the end of which is moistened with a penicillin solution. Instead of excision of tissue, modern authors use a loop of a diathermocoagulation apparatus or a sharp spoon to take material, which is best done in case of significant necrotic changes in the cervix.

Cervical dilation and digital examination of the uterine cavity. In cases where examination with a probe does not give clear results of the condition of the uterine cavity, it is possible to perform a digital examination of it, but in this case it is necessary to first expand the cervical canal.

Technique. This manipulation requires a set of metal dilators, two pairs of bullet forceps and spoon-shaped mirrors with a lift. After preliminary disinfection of the external genitalia and douching of the vagina, a Sims or Simon mirror and a lift are inserted into it; One pair of bullet forceps grabs the front lip, the other - the back. The neck is lowered, the lift is removed, and the spoon-shaped mirror is replaced by a Fritsch mirror. The cervix is now well accessible for expansion. Hegar's metal dilators are inserted sequentially by number from No. 4 to No. 14 or 15, i.e., until the index finger is patent. After cervical dilatation index finger examine the uterine cavity, especially carefully in the uterine angles. If you wish to collect material for microscopic examination, you can insert a curette into the uterus and perform diagnostic curettage its mucous membrane.

Trial diagnostic curettage of the uterine mucosa. Test curettage is a type of biopsy and is often used in gynecological practice. It is indicated for uterine bleeding that raises suspicion of uterine cancer, chorionepithelioma, or the presence of remnants of a fertilized egg in the uterus.

Contraindications to the use of trial curettage are acute and subacute inflammatory processes, submucosal fibroids of the uterus (necrosis of the node may occur after curettage), and gonorrheal endocervicitis.

The test curettage technique resembles curettage during an incomplete or medical abortion. After disinfection of the external genitalia and douching of the vagina, speculums are inserted into it. The cervix is grabbed with bullet forceps, the cervical canal is moderately dilated with Hegar dilators to number 8-10. Using a small sharp curette, scrape out the entire uterine mucosa, especially carefully at the uterine angles. In cases where repeated test curettage is necessary to monitor the menstrual cycle, the so-called “strichabrasio” is performed; in this case, only one movement is made with a small curette from the bottom to internal os uterus. To determine the phase of the menstrual cycle, a small scraping is sufficient. Ash and A.I. Petchenko recommended taking scrapings from the cervical canal for the purpose of diagnosing chronic gonorrhea, treating focal forms of endocervicitis and monitoring cure. Ash suggested using a special spoon for scraping the cervical canal.

Let's move on to the presentation endoscopic research methods in gynecology. These include: colposcopy, hysteroscopy, cystoscopy, urethroscopy and diaphanoscopy.

Colposcopy . Examination of the vagina and cervix using mirrors and a magnifying light is called colposcopy.

The first device for colposcopy was proposed in 1925 by Ginzelman. The original model of the Ginzelman apparatus was a binocular magnifying glass equipped with a lighting device; the increase reached 3.5 times. This colposcope was subsequently improved both by the author himself and by others. L. L. Okinchits proposed a monocular colposcope with a magnification of 10-30 times. Currently, improved binocular-type colposcopes on a tripod are being produced. Modern atlases of colposcopic pictures have been published.

Colposcopic images make it possible to carry out the finest diagnosis of precancerous conditions of the cervix or early stages of cancer. In addition, colposcopy is used in cases of suspected criminal intervention for fetal expulsion. Colposcopic changes in the cervix during a criminal abortion are quite characteristic.

Hysteroscopy . Instruments for examining the uterine cavity, equipped with optical system, are called hysteroscopes. They are designed on the principle of a cystoscope. R. Schroeder, using an improved Gauss hysteroscope, studied the cyclic changes of the endometrium. I. M. Litvak, using the same apparatus, studied pathological changes mucous membrane of the postpartum uterus. Hysteroscopy to a certain extent replaces hysterography, digital examination of the uterine cavity and test curettage.

Cystoscopy . Cystoscopy should be performed not only by a urologist, but also by a gynecologist. Cystoscopy is especially widely used in patients with uterine cancer. One of the cystoscopic images - bullous edema of the bladder mucosa - is a common finding when cervical cancer has already progressed quite far.

Diaphanoscopy , or the method of examining various cavities using transillumination from the inside, began to be used in gynecology by Steckel for prolapse of the anterior vaginal wall. A. M. Mazhbits widely used diaphanoscopy to study the boundaries of the bladder and differential diagnosis pelvic tumors.

The diaphanoscopy technique is that 250-300 ml of a 3% boric acid solution is poured into the bladder and a cystoscope is inserted into it in a darkened room with the beak anteriorly, while the bladder is well illuminated. When the beak is rotated, the lateral sections of the bladder are also illuminated.

Urethroscopy . Examination of the urethra using a special optical instrument called a urethroscope is called urethroscopy. The well-known Valentin urethroscope was modified by Steckel, who shortened it to 4-6 cm. Urethroscopy is indicated for lesions of the urethra by tumors - polyposis, papillomas, cancer, in the presence of foreign bodies and chronic urethritis. At acute urethritis urethroscopy is contraindicated. Medical procedures are performed using a urethroscope.

Rectoscopy , or sigmoidoscopy, is a method of optical examination of the rectum and sigmoid. S.P. Fedorov and D.O. Ott took part in the development of this method. The most modern is the Strauss sigmoidoscope, consisting of a set of tubes 20-30 cm long; The lighting part of the instrument is equipped with an electric light bulb. The study is performed after cleansing the intestines. The woman lies on her back or lies in a knee-elbow position. After lubricating the tube with Vaseline, the obturator is inserted with a rotational movement into the rectum; then the obturator is removed and replaced with a light carrier, after which the light is turned on. Indications for sigmoidoscopy are bloody discharge suspicious for rectal cancer, advanced forms of cervical cancer, perforation of abscesses in the rectum.

Pertubation . Determining the patency of the fallopian tubes by blowing air through them is called pertubation. Pertubation was proposed by Rubin. According to Rubin, oxygen was passed from a balloon under the control of a pressure gauge through a cannula into the uterine cavity at a pressure of 100 mmHg. Gas entry into the abdominal cavity was determined fluoroscopically or radiographically. Our pertubation method was developed by A.E. Mandelstam, who proposed his own device. Mandelstam's device consists of the following parts: a pear-shaped cylinder that pumps air, a pressure gauge, a glass jar with a rubber stopper through which two glass tubes are passed - induction and outlet, rubber tubes connecting all parts of the device; a special metal cannula with a cone-shaped tip and a hole at the end is attached to the end of the outlet rubber tube. It is advisable to have a set of such cannulas of different diameters. Glass jar is filled with a disinfectant solution and serves to visually monitor the passage of air through the system. Similar to Mandelstam's device, the Zelheim device differs from it in the absence of a jar of liquid, and instead of a pear-shaped balloon, air is pumped into it with a large syringe.

Blowing the tubes should be done in the first week after the end of menstruation. Before blowing, it is necessary to carefully examine the patient bimanually, examine the flora of the vagina and cervical canal and check the erythrocyte sedimentation reaction. The indication for pertubation is the so-called “tubal factor” in case of infertility (to determine the patency of the tubes). Contraindications to blowing include: pregnancy, pathological bleeding, acute and subacute inflammatory processes and tumors of the appendages and uterus.

The technique for blowing pipes is as follows. After disinfection of the external genitalia and vagina, vaginal speculum is inserted, the anterior and posterior lips of the cervix are grabbed with bullet forceps, Simon's speculum is replaced with a Fritsch speculum, the cervix is lubricated with iodine, and the cervical canal only with alcohol after thorough wiping and removal of the mucus plug. The direction of the cervical canal is determined using a probe. A cannula of the appropriate caliber is inserted into the uterine cavity between the bullet forceps. The doctor firmly presses the cannula to the cervix with his right hand, fixing the cervix with bullet forceps with his left hand. For better tightness and narrowing of the external pharynx, you can cross the bullet forceps. An assistant pumps air into the balloon, the pressure of which is monitored using a pressure gauge. In this case, the following positions are possible: 1) the arrow moves forward and backward, but does not rise above 50-80 mm - good pipe passage; 2) the arrow rises by 100-200 mm and slowly falls - one or both pipes are passable; 3) the needle rises to 150-200 mm and stops motionless - the pipes are impassable.

The passage of air into the abdominal cavity is usually listened to 5 areas of the hypogastrium with a stethoscope or phonendoscope through abdominal wall(whistle sound). If air enters the abdominal cavity, patients sometimes develop pain in the shoulder and shoulder blade - a phrenicus symptom. After the examination, the instruments are removed, the vagina is wiped with a tampon, and the patient is put to bed.

Later, S. A. Yagunov proposed a more complex apparatus that made it possible to measure the amount of introduced air and obtain more accurate information about the condition of the pipes. This device also allows you to register and obtain a graphical record of tubal contractions.

Currently, the clinic we run, like some others, uses an improved apparatus for blowing pipes, which is produced by our industry; This device allows you to obtain a kymographic recording of tubal contraction and gives an idea of the nature of tubal pathology (spasms, stenoses, peristalsis disorders).

The qualities of this device were studied in the clinic by I. S. Rozovsky and P. P. Nikulin. The article by these authors indicates the possibility of obtaining six types of kymographic curves characterizing the different states of pipes. With kymographic pertubation, an average of 10-12 tube stillations per minute is detected. With tubal patency, a phrenicus symptom and a feeling of pressure in the pit of the stomach are usually observed.

A negative point when blowing pipes with the apparatus described above is the impossibility of completely eliminating the return of air through the cervical canal.

Blowing pipes from the side abdominal cavity through the ampullary end of the pipe was suggested by Curtis. Initially, Curtis used a five-gram Record syringe, the spout of which was inserted into the funnel of the pipe, and the fimbriae were pressed with his fingers; Later, Curtis suggested using a special cannula. For many years now, we have been using a 5- or 10-gram Record syringe, with a rubber tip from a Tarnavsky syringe attached to the nozzle, to blow out the tubes from the abdominal cavity. A Tarnavsky tip is inserted into the lumen of the tube and the fimbrial part of the tube is fixed to the tip with fingers. Air is slowly pumped into the pipe using a syringe; when the tubes are patent, a bubbling sound is heard due to the movement of air from a narrow opening into the wide cavity of the uterus and vagina. In case of obstruction, the pipe is inflated above the obstruction.

Let's move on to a description of some studies of a woman's genital organs using x-rays: metrosalpingography, injection of air (gas) into the abdominal cavity - pneumoperitoneum - and x-ray diagnostics to detect foreign bodies in bladder and in the pelvic cavity.

Metrosalpingography . Obtaining contrast images of the uterine cavity and tubes using X-rays is called metrosalpingography. The final development of metrosalpingography was achieved after obtaining good contrast agent, which does not irritate tissue, is iodolipol (iodipine). Iodolipol is a colloidal compound of iodine with poppy seed oil.

The metrosalpingography technique is as follows: after cleansing the intestines, emptying the bladder and disinfecting the external genitalia and vagina, the patient is placed on the X-ray room table. The mirrors expose the neck, which is grabbed with bullet forceps and brought down. After removing the mucus plug and disinfecting the cervical canal with alcohol, a metal tip of a Brown syringe or a special tip with a conical thickening is inserted into the cervix. The tip is attached to a 10-gram syringe with a slightly warmed contrast solution, iodolipol is injected very slowly. The first picture is taken immediately after the administration of the contrast material, the next pictures are taken after 3-5 minutes. A sign of tubal patency is the detection of iodolipol in the abdominal cavity in the form of balls and clusters.

Metrosalpingography is widely used for diagnosis and partly for treatment of tubal infertility. Metrography is important for the diagnosis of uterine tumors, especially submucosal fibroids, and its malformations. Pertubation, metro- and salpingography complement each other. Contraindications to metrosalpingography are as follows: inflammatory processes in the acute and subacute stages - endocervicitis, severe colpitis, extensive erosions, adnexitis and especially saccular inflammatory tumors of the tubes; bleeding, both menstrual and pathological; severe general diseases of the heart, lungs, and liver.

To avoid spasm of the interstitial part of the tubes, you should wait 3 minutes after inserting the cannula or use a subcutaneous injection of atropine solution (1 ml of 0.1% solution). During pertubation, if the air passes in a jerky manner, the formation of an aerosalpinx is possible; Cases of shock, even air embolism after pertubation have been described. A common complication after pertubation, much less often after salpingography, is the occurrence of infection. Thus, with unrecognized adnexitis after pertubation, pyosalpinx or even pelvioperitonitis may occur.

Application of pneumoperitoneum . The method of introducing air (gas) into the abdominal cavity by puncturing the abdominal wall is already 50 years old. To apply pneumoperitoneum, a device is used that consists of two graduated glass vessels, one of which is filled with gas (air, carbon dioxide), the other with water, which displaces the gas through a system of rubber tubes. The system ends with a puncture needle. A puncture of the abdominal wall is made below the level of the navel, with the patient in a supine position, at the middle of the left rectus muscle. Having grabbed the skin in the form of a fold, a scalpel is used to make an incision in the skin, through which, without any violence, a needle is inserted in an oblique direction posteriorly and inwardly; After this, air is released from the system in an amount that must be accurately determined. Usually, from 500 ml to 2-3 liters are administered. The needle is removed and an x-ray is taken.

With the help of pneumoperitoneum, it is possible to get an idea of the location of the genital organs, the condition ligamentous apparatus, about the presence of tumors and their relationship to neighboring organs, as well as about the adhesions and adhesions present in the abdominal cavity.

Pneumoperitoneum is also used for medicinal purposes, mainly for the treatment of tuberculosis of the female genital organs. This method was first proposed in our country in 1892-1893. D. M. Kishensky. This method has been widely used recently by M. A. Turdakova.

Gynecological X-ray diagnostics . X-ray diagnostics has quite wide application in gynecology to find foreign bodies, to diagnose calcified tumors, to determine metastases in the bones. Using this method, we have repeatedly been able to find foreign bodies (needles, pins, a piece of a glass catheter) in the bladder, probes, sticks, pins, etc. in the walls of the uterus and parameters during a criminal abortion.

Often, radiography can be used to diagnose a dermoid cyst of the ovary in the presence of teeth, jaw rudiments, etc. We diagnosed a twisted dermoid cyst in a 6-month pregnant woman who suffered from attacks of abdominal pain: the teeth and the rudiment of the lower jaw clearly protruded on the x-ray. X-rays give very good results for fractures of the pelvic bones.

Exploratory laparotomy and laparoscopy . Test laparotomy is used in gynecology for diagnostic purposes, as well as for advanced malignant formations genitals and tuberculosis of the female genital organs. It was widely used by V.F. Snegirev.

Laparoscopy is a method of examining the abdominal cavity with a special device with an optical system inserted through the abdominal wall.

The laparoscope for examining the abdominal cavity through the vagina was first proposed by D. O. Ott. The device consists of spoon-shaped and flat mirrors equipped with a small light bulb, which is inserted through the anterior or posterior colpotomy opening; the woman is in the Trendelenburg position, the abdominal wall is grasped in the navel area with bullet forceps and lifted upward.

Previously, the Jacobeus laparoscope became famous. In recent years, new laparoscopes have been released abroad.

Laparoscopy is still a little common method.

The art of obstetrics, or obstetrics, has ancient origins. We invite the reader to take a short excursion into history. Perhaps much of the obstetrics of the past will seem hopelessly outdated. But we should not forget that the new is often the well-forgotten old...

The modern birthing position (lying down) was first used in France in the 17th century. It is believed that it all started with Louis XIV, who wanted to hide behind a curtain to see the birth of a child from one of his mistresses, for which purpose the woman was placed on her back during childbirth.

And if you remember the entire history of mankind, then until the 19th century, women in Holland, for example, gave birth on special obstetric chairs. Their prototype was delivery on the knees, which was often practiced in Europe in the 16th-17th centuries. In Holland, women who gave birth on their knees were called “living obstetric chairs.” In America, the position of the woman in labor on her side during the second stage of labor was practiced. In many countries (for example, in Central Asia), legends about women giving birth in a squatting position are still alive. And among the Aztecs, the goddess of childbirth is depicted as a woman squatting, with the head of a baby born and located between her legs.

Primitive communal system

It can be assumed that during the period of matriarchy, all possible assistance to a woman in labor was provided by the woman, the eldest in the family. It is possible that in that distant time a woman gave birth without any help, biting the umbilical cord herself, as animals do. This can be confirmed by the life and customs of some native tribes of Brazil, where to this day women give birth this way. The domestication of wild animals and the transition to shepherding led to a dominant position in the family of men - matriarchy was replaced by patriarchy. With constant communication with animals, the shepherd had to provide assistance to animals in case of difficult childbirth. The experience of treating animals was eventually transferred to people.

It is believed that primitive healers even knew how to perform operations. This is how one of the travelers describes a caesarean section, which he observed in a family of aborigines of Central Africa (some of the tribes there still live according to the laws of the primitive communal system): “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 in his knees, the other fixed bottom part belly. After washing 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 wall and the uterus itself; one assistant, with great skill, cauterized the bleeding places with a hot iron, another 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 wound 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.”

Slave system

Currently known monuments medical literature from that era are various Egyptian papyri, including the “gynecological papyrus” from Kahun (XXX century BC), Chinese hieroglyphic manuscripts (XXVII century BC), Babylonian cuneiform records (XXII century BC) , Indian book “Ayur-Veda” (“Knowledge of Life”) in several editions (IX-III centuries BC).

On the background general development human society, in connection with the development of sciences and general medicine, obstetrics is also being further developed. For the first time, questions arise about the cause of difficult childbirth, and rational methods of delivery appear.

Among different peoples ancient world knowledge in obstetrics was different. Thus, among the Egyptians, Jews and Chinese, obstetric care was entirely in the hands of women (midwives). Since ancient times, the Chinese have maintained the tradition of childbirth in a sitting position. The ancient Egyptians had a special class of women who helped women in labor. To find out if a woman was pregnant, she was given a drink made from a special herb (boo-doo-doo-ka) and the milk of the woman who gave birth to a boy. If the drink caused vomiting, pregnancy was assumed, otherwise pregnancy was not present. The sex of the unborn child was also determined using a unique method. To do this, they took grains of barley and wheat, moistened them with the urine of a pregnant woman and monitored their germination. If wheat sprouted first, it was predicted that there would be a girl, if barley - a boy. Egyptian doctors were aware of some women's diseases: irregular menstruation, prolapse of the vaginal walls, and uterine prolapse.

In China, when assisting a woman in labor, midwives often used amulets and special manipulations, but some also used obstetric instruments, the exact information about which has not reached us.

The obstetric knowledge of the ancient Jews was not much different from the knowledge of the Egyptians and Chinese. It is known that to determine pregnancy, they forced a woman to walk on soft soil: if a deep mark remained, then pregnancy existed.

In Ancient India there was no special class of midwives - any woman experienced in this matter could provide assistance to a woman in labor; in cases of difficult labor, the midwife sought help from a male doctor. Whether because of this, or for some other reasons, the obstetric knowledge of Indian doctors was greater than that of the Egyptians, Chinese and Jews. Judging by the literary sources that have reached us, Indian doctors initiated the study of obstetrics and were the first to propose rational methods of assistance during childbirth. Thus, Sushruta for the first time mentions incorrect positions of the fetus, in which he recommends turning it onto the stem and onto the head.

Ancient Greece

Greek doctors practiced in all specialties; they provided obstetric care only in cases of difficult childbirth. They knew some surgical methods of delivery, they knew about caesarean section, which was not performed on the living at that time. The ancient Greek myth about the birth of the god of medicine Asclepius himself, who was extracted from the mother’s corpse by his father Apollo, also tells about this operation on a dead woman in order to extract a living child.

The activities of Greek midwives were quite diverse: they not only provided assistance during childbirth and the postpartum period, but also carried out abortions. In ancient Greece, termination of pregnancy early stages was not pursued. This operation was allowed by the famous ancient Greek philosopher and naturalist Aristotle, believing that in early period During the development of pregnancy, the fetus does not yet have consciousness. It is unknown by what means the abortion was performed.

If for some reason the birth had to be secret, midwives performed the delivery at home (naturally, this was very expensive). In childbirth at home with a midwife, one can see a prototype of a maternity hospital. Midwives of that time already had significant knowledge. Thus, they determined pregnancy by a number of objective signs: absence of menstruation, lack of appetite, drooling, nausea, vomiting, and the appearance of yellow spots on the face. But along with this, they also resorted to rather ridiculous means: they rubbed a red stone in front of the woman’s eyes; if dust got into her eyes, the woman was considered pregnant, otherwise pregnancy was denied. They tried to determine the sex of the fetus by the inclination of the pregnant woman's nipples: inclination downward indicated pregnancy with a girl, upward inclination indicated pregnancy with a boy.

Ancient Rome

The Romans had religious cults with the worship of gods borrowed from the ancient Greeks. Thus, the Greek god-healer Asclepius is transferred to Rome under the name of Aesculapius - the god of medicine; the goddess of fever appears, the goddess of menstruation Fluonia, the goddess of the uterus - Uterina and the goddesses of childbirth - Diana, Ki-bela, Juno and Mena. Moreover, the specialization of “divine” obstetric care among the Romans it reached special development. Thus, each position of the fetus in the uterus had its own goddess: Prose was in charge of the birth of the fetus forward with the head, and Postvert was in charge of childbirth during foot and breech presentation (when the legs or buttocks are born first), as well as in transverse positions. Children born with their legs forward received the name Agrippa. In all cases of childbirth, the midwife was required to make various offerings to the appropriate goddess.

Of the doctors of Ancient Rome, particularly famous names have been preserved in the history of medicine: the Roman Celsus and the Greeks Philumenus, Soranus and Galen. Providing assistance during childbirth in Rome, as in Greece, was carried out primarily by female midwives (midwives). The doctor was invited only in cases pathological childbirth when the midwife saw that she could not cope on her own. Among the women midwives there were also outstanding ones who left a mark on history with their activities. These included Aspasia (2nd century AD), who held the title of doctor. She outlined her theoretical and practical knowledge in a book that has survived to this day. In it, Aspasia covered a number of issues, in particular about pregnancy hygiene, caring for a patient during a miscarriage, correcting a displaced uterus, dilating the veins of the external genitalia, candilomas, and hernias. The book outlines indications and methods for examining the uterus and vagina by palpation and using a vaginal speculum.

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.

The centers of higher education, including medical education, were universities, which 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 severe cases When the woman in labor and the fetus were in danger of death, the midwives called 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 incorrect position fetus by turning - this great achievement of antiquity - was forgotten or not used by most doctors.

Renaissance

While Catholic Church the feudal period was the greatest obstacle to progress, the bourgeoisie of the period of the birth of capitalism was especially interested in the development of sciences, in particular natural science. A new direction in medicine appeared in the works of Paracelsus, Vesalius and others. Innovators progressive course sought to develop medical science based on experience and observation. Thus, one of the greatest physician-reformers of the Renaissance, Paracelsus (1493-1541), rejected the teaching of the ancients about the four humors human body, believing that the processes occurring in the body are chemical processes. The great anatomist Vesalius (1514-1564) was the first to correctly describe the structure of a woman’s uterus. Another famous anatomist, the Italian Gabriel Fallopius (1532-1562), described in detail the fallopian tubes, which received his name (fallopian tubes).

During this period, anatomy began to develop rapidly. This led to a large number of discoveries also in the field of gynecology. It is necessary to list the scientists who made significant contributions to the development of gynecology and obstetrics. The Roman professor of anatomy Eustachius (1510-1574) very accurately described the structure of the female genital organs, based on the massive dissection of corpses in hospitals. Arantius (1530-1589), a student of Vesalius, dissecting the corpses of pregnant women, described the development of the human fetus and its relationship with the mother. He saw one of the main reasons for difficult childbirth in the pathology of the female pelvis. Botallo (1530-1600) described the blood supply to the fetus. Ambroise Paré (1517-1590) - famous French surgeon and obstetrician - restored and improved forgotten way rotation of the fetus onto its leg, used in the transverse position of the fetus. He recommended using rapid release of the uterus from contents to stop uterine bleeding, he was the first to invent a breast pump. The German surgeon Trautmann was one of the first to successfully perform a caesarean section on a live woman in labor in 1610.

In the 16th century, the first atlases and manuals for midwives appeared. The rapidly developing science and medicine of this period made it possible to carry out quite complex abdominal and gynecological operations. Original methods for removing abscesses from the pelvic cavity were proposed, reconstructive surgery produced by uterine prolapse. Obstetrics also came under this influence. For the first time, Chamberlain (Chamberlain), and later Geister, proposed the use of obstetric forceps during difficult childbirth. Anatomical concepts such as the size of the pelvis were studied, which made it possible to subsequently more or less accurately predict the course of labor and, accordingly, be prepared for possible complications. Leeuwenhoek's invention of the microscope made it possible to study in more detail the microstructure of the female genital organs, on the basis of which initial ideas about the function of various parts of the reproductive tract began to emerge.

Development of obstetrics in Russia

Obstetrics in Rus' originated during the period of the clan system among the ancient Slavs, about whose life there is very little information. If medical care at that time was provided by a healer, who was called a “baliy” or “witch,” then in the field of obstetric care such a figure should be considered a midwife. The experience of midwives passed from generation to generation. Each locality and even each midwife had its own obstetric technology. In addition, the midwife not only took birth, but was also a necessary assistant in the peasant household, a protector and guardian of mother and child. The life of the mother and child was directly dependent on her talent, intuition and experience. The state did not take any part in the organization of obstetric care.

Over the course of hundreds of years, the practice of Russian folk obstetrics has accumulated a number of useful techniques and manipulations, which were partly included in scientific obstetrics; at the same time, useless and often dangerous techniques were used, with which scientific obstetrics subsequently waged an intensified struggle.

During childbirth, the woman in labor was surrounded only by women: the midwife, mother, and sister. Men never interfered in the birth process. The tasks of midwives, in addition to the first care of the baby, were to fulfill established customs, beliefs, and conspiracies from ancient times. So that the birth would be “untied,” the midwife would unravel the woman’s braids, untie all the knots on her clothes, walk with the woman in labor until she was completely exhausted, hang her up by her arms, shake her, and knead her stomach. Moreover, the more the midwife knew of similar techniques that supposedly speed up childbirth, the more experienced and knowledgeable she was considered.

Only Peter I issued laws concerning the activities of midwives, who had not previously been subject to any control. In 1704, a decree was issued prohibiting, on pain of death, the killing of born monsters, which was practiced by midwives and did not contradict the views established among the people.

To increase the population, a little later, Peter I organized the first shelters for newborns, from whom mothers various reasons wanted to get rid of it. These shelters were the prototype of future educational homes.

In 1771, a maternity hospital for poor women in labor with 20 beds was founded at the orphanage in St. Petersburg. The breeder Porfiry Demidov donated money for the construction of this first large maternity hospital. The maternity hospital and the Midwifery School were combined into a single obstetric institution, in which there were departments for poor women in labor, for those giving birth illegally, as well as a “secret department” for people under investigation, syphilitic women, etc.

Among Russian obstetricians and gynecologists there were many prominent scientists who headed numerous scientific schools that were recognized both here and abroad. However, in Russia there were only 12 obstetric departments. A huge territory of the country, with the exception of large cities, remained without qualified obstetric and gynecological care; the vast majority of births occurred outside of medical facilities and even without medical supervision, and the need for such care was met only to a negligible extent.

So, in 1903, 98% of women in Russia gave birth without any obstetric care. But even in such large cities as St. Petersburg, despite the fact that by the end of the 19th century the city already had a sufficient number of maternity hospitals and doctors, wealthy women preferred to give birth at home, albeit under the supervision of midwives. City and district maternity hospitals were intended mainly for the poor. Only after the 1917 revolution did maternity hospitals become the main place of birth. Of course, the fact that the general public gained access to medical care saved the lives of many women.

In the issue of organizing obstetric education in Russia, a particularly important role should be given to P. Z. Kondoidi (1710-1760). He was the first to organize the teaching of obstetrics in Russia and correctly assessed the importance of organizing obstetric care for the population, gave detailed and precise instructions for theoretical and practical teaching, and established exact deadlines for training and examinations. The entire course of study took 6 years. After the first 3 years of training, independent practice was allowed, but under the supervision of an experienced grandmother. It was assumed that the schools would provide midwives not only to large cities, but also to the entire country.

Due to a lack of funds, “babichi” schools in St. Petersburg and Moscow were opened only in 1757, when the government found it possible to allocate 3,000 rubles annually to each of these schools for the “babi’s business”. Great difficulties were encountered in recruiting students to schools. When, on the basis of a decree approved by the Senate, the registration of grandmothers living in St. Petersburg and Moscow was carried out, there were 11 of them in St. Petersburg, and 4 in Moscow. In addition, there were 3 in St. Petersburg and 1 grandmother in Moscow, who could only practice under the supervision of more experienced. Thus, for two large capital cities of the Russian Empire there were only 19 women with one or another obstetric qualification. But nevertheless, schools began their work. Many of the maternity women among whom the students practiced were so poor that they were unable to pay for the most necessary medicines. P.Z. Kondoidi found a solution to this question as well. According to his proposal, in 1759 the Senate decided that, based on prescriptions from obstetricians, the capital's pharmacies would dispense necessary medicines and things free of charge to poor mothers and newborn babies at the expense of the residual amounts determined by the Senate for the “woman's business.”

The most outstanding representative of Russian obstetrics is N. M. Ambodik-Maksimovich (1744-1812), deservedly called the “father of Russian obstetrics.” N. M. Ambodik was an encyclopedist scientist. He is credited with creating Russian medical terminology. He was the author of several dictionaries (surgical, anatomical-physiological and botanical). He wrote the first original Russian manual on obstetrics in six parts with an excellent atlas “The Art of Midwifery, or the Science of Womanhood.” This was the best guide until the middle of the 19th century. In it, N.M. Ambodik covered in detail all the issues of obstetrics at his current level of knowledge, and also touched on some elements of gynecology (anatomy, physiology, pathology of the female body and female hygiene).

Delivery room in... bathhouse

The Russian bath was integral integral part everyday life They often gave birth there. Traditional healers highly valued the healing power of the bath, its beneficial effect on humans associated with profuse sweating, which facilitates the removal of various harmful substances. In addition, the bathhouse was a sterile space from a bacteriological point of view. In addition, it was a separate room, unlike the other overcrowded ones in which they lived large families. It was also important that there was a sufficient amount of warm water in the bathhouse. All this created good conditions not only for the mother in labor, but also for the newborn.

Consultant: Elena Andreeva. Obstetrician-gynecologist, 1st category, medical genetic center, Gomel

Gynecology includes a complex of tests and diagnostic methods that every woman will have to undergo more than once. An examination by a gynecologist is especially important for that category of women who suspect they have a gynecological disease, are planning motherhood, or are preparing to become a mother. Let's look at exactly what mandatory tests and studies are included in an examination by a gynecologist, how they are carried out and what they can show.

THE COST OF AN APPOINTMENT WITH A GYNECOLOGIST IN OUR CLINIC IS 1000 rubles.

External gynecological examination

External examination is a simple but very important gynecological examination, which is carried out both as a preventative measure and for direct diagnosis of pathology (in the presence of characteristic complaints or symptoms). During this examination, the doctor draws Special attention on all organs located in the anogenital area - the pubis, external and internal labia, anus. After this, the internal condition of the vagina is assessed (examination of the cervix).

During a superficial examination of the genital organs, the doctor, first of all, focuses on such points as:

skin condition (dry, oily, greasy, etc.);
the nature of the hairline (sparse or thick hair, condition of the hair roots, presence of power lines, etc.);
the presence of bulges or any tumors on the surface of the genital organs;
redness, swelling of areas of the skin or the entire organ.

During a more detailed examination, the doctor spreads the external labia and conducts a visual analysis of the state of the genital anatomical structures, assessing:

clitoris;
inner labia;
opening of the urinary canal;
vagina (outside);
hymen (in teenagers).

During such an examination, the doctor may notice pathological discharge, which will indicate some kind of disorder in the woman’s body. In such a situation, an additional bacterial culture test or smear microscopy is necessarily prescribed. This will allow you to accurately determine the presence of the disease and find out its causative agent.

Gynecological examinations for women and girls are different!

Gynecological examination with colposcopy

During this procedure, a gynecologist examines the woman's internal organs - the cervix, vagina and vulva. The examination is carried out using a special device - a colposcope. A gynecological examination with a colposcope is an accessible and informative procedure. The process is absolutely painless.

When colposcopy is prescribed, contraindications

As a rule, examination with a colposcope is recommended every six months, but it is not mandatory for healthy women. Colposcopy is required if significant abnormalities are detected as a result of the analysis of the LBC smear or PAP test.

Colposcopy is also prescribed if:

warts in the genital area;
cervical erosion;
inflammation of the cervix at any stage;
suspicion of presence cancer in the vagina;
uterine cancer;
significant changes in the shape and size of the vulva;
cancerous tumor on the vulva;
precancer, vaginal cancer.

There are no contraindications for this study, but the doctor will not do the examination on critical days and during pregnancy unless there are serious indications for this.

The gynecologist will prescribe an examination with a colposcope during pregnancy, if the procedure cannot be postponed until the baby is born, due to a serious health threat expectant mother. Naturally, the examination by a gynecologist will be carried out with special care so as not to provoke a miscarriage.

Preparation for colposcopic examination

Before performing a colposcopy, the gynecologist will give the following recommendations:

Abstinence from sexual activity, even with a regular partner, for at least three days before the study;
If there are any diseases or inflammatory processes on the genitals, the woman is strictly recommended to refrain from treating them with suppositories and other vaginal remedies. Treatment can be continued after gynecological examination.
If you are hypersensitive to pain, you can take it before the examination. painkiller tablet. Your doctor will prescribe pain medication.

As for the date of appointment for colposcopy, it is determined solely by the gynecologist.

How is a gynecologist examined with a colposcope?

Colposcopy is a routine gynecological examination with enhanced imaging. It is carried out in a completely non-contact way, using modern apparatus, having a built-in microscope and static lighting, with lenses. An examination by a gynecologist in a modern clinic using a colposcope is the norm in Europe!

The device is installed on a special tripod in front of the woman’s vaginal opening. Next, the gynecologist, using a built-in microscope, examines the vaginal tissues under very high magnification, which makes it possible to note even the smallest changes in them. Lighting also helps the gynecologist. The gynecologist, by changing the angle of the light source, can examine scars or folds on the vaginal lining from all angles.

Typically, colcoscopy is performed with a detailed examination of the cervix and vulva. To better examine the surfaces, the gynecologist first removes the discharge using a tampon. Then, to prevent subsequent discharge, the surface of the cervix is lubricated with a 3% solution of acetic acid. If such preparation is not carried out, then, unfortunately, it will not be possible to obtain accurate results. There is no need to be afraid of this moment - the most a woman feels during a gynecological examination is a slight burning sensation in the vagina.

What will an examination with a gynecologist with a colposcope show?

As mentioned earlier, a colposcope allows the doctor to examine even the smallest changes in the structure and color of the epithelial cells of the vagina, which means he is able to identify any ailments on the early stage development.

One of the most common diseases detected by a gynecologist with a colposcope is cervical erosion. Characteristic symptoms of erosion are uneven coloring, disruption of the epithelial layer, bleeding, etc.
Another disease that can be detected with a colposcope is ectopia. With ectopia, the doctor observes significant changes in the shape and color of the epithelium. This is a precancerous condition.
A pathology that is easily detected during examination with a colposcope is polyps. These are outgrowths that have different sizes and shape. Polyps are dangerous and can quickly increase in size, so they are removed.
No less dangerous are papillomas that populate the walls of the vagina. These formations can develop into cancer. Papillomas easily reveal themselves when a 3% acetic acid solution is applied to them - they turn pale.
During colposcopy, the doctor may see thickening of the inner lining of the vagina, which indicates the presence of leukoplakia. If treatment for this pathology is not started in time, tumors may form on the cervix.

The most dangerous disease, revealed by colposcopic examination during examination by a gynecologist - cervical cancer. If this disease is detected, a biopsy is performed immediately without fail.

Complications, consequences after a gynecological examination with colposcopy

Colposcopy usually does not cause any complications. The normal condition of a woman after a colposcopy procedure is light bleeding.

In rare cases, one of the bleeding options may occur. In this case, you need to urgently contact a gynecologist. Another unpleasant symptom beginning inflammation - severe cutting pain in the lower abdomen.

Examination by a gynecologist with biopsy

The most important test prescribed for girls and women in gynecology is a biopsy. A biopsy is not considered a mandatory test during a gynecological examination, and is carried out on an individual doctor’s prescription. Its task is to confirm or refute the diagnosis of cancer. If the gynecologist recommends a biopsy, there is no need to panic - often the examination shows that the tumor is associated with inflammation or other processes.

Preparing and performing a biopsy

Diagnostics does not require additional preparation and involves taking biomaterials from the woman’s internal genital organs. A gynecological examination with biopsy is painless and lasts no more than 20 minutes. The tissues are examined under a microscope in the laboratory. The gynecologist will be able to announce the results of the study only after 2 weeks.

In total, there are about 13 different types of biopsies, only 4 of them are used in gynecology. These techniques are the most effective and informative when examining the female reproductive system:

Incision type - made by scalpel incision of internal tissues;
Targeted type - carried out by colposcopy or hysteroscopy;
Aspiration type - extraction of the material necessary for research by aspiration - vacuum suction;
Laparoscopic type - taking material for research using special equipment. This analysis is taken from the ovaries.

Before the biopsy, you will need to donate blood and urine to exclude complications after the procedure.

Contraindications and complications after a gynecological examination with biopsy

Biopsy performed good gynecologist in sterile conditions, safe. But it also has contraindications. A biopsy cannot be done if it is diagnosed:

blood clotting disorder;
internal bleeding;
allergies to the drugs used - anesthesia, aseptic treatment, etc.

After a biopsy, a woman may feel tolerable pain in the vaginal area or lower abdomen. However, the nature of the pain should be strictly pulling. In case of cutting pain, usually accompanied by bleeding, the patient should immediately contact a gynecologist for a re-examination.

You will need to refrain from strenuous physical activity and intimate contact for several days. If no abnormalities are observed in a woman’s body after this procedure, this does not mean that you can violate the gynecologist’s instructions and not come for a re-examination by the gynecologist.

As you can see, an examination by a gynecologist, even in its minimal form, provides extensive information about women’s health!

The first information about obstetrics and the treatment of 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, as well as the extraction of the fetus, if necessary, through fetal-destroying operations.

IN Ancient Egypt all advances in medicine were associated with the name of the god Imhotep. Temples were built in his honor, in which priests healed those suffering from various ailments, guided by the instructions of Imhotep. Imhotep was supposed to send dreams to those who were suffering or in pain. He was a doctor for both deities and people. The protector of women in labor and babies was the goddess Tauert, depicted as a monster with the head of a hypopotamus, the body of a horse and the paws of a lion.

Medical practice in Ancient Egypt was subject to strict moral standards. By observing them, the doctor did not risk anything, even if the treatment failed. However, violation of the rules was severely punished, including the death penalty. Each Egyptian doctor belonged to a certain college of priests. Doctors specialize in certain species diseases (“uterine” doctors, eye, dental), special clinics appear in gynecology, surgery and eye diseases. Manuscripts of the 2nd millennium BC also contained detailed instructions on how to treat wounds, fractures, etc. Information about various diseases and their treatment is found in the “Gynecological Papyrus” from Kahun, the “Veterinary Papyrus,” the papyri of Erus, Brugsch, etc.

Currently, there are 10 main papyri known, wholly or partially devoted to healing. In the Ebers papyrus, the gynecological section contains information about recognizing the timing of pregnancy, the sex of the unborn child, as well as “a woman who can and cannot give birth.” The Berlin and Kahun papyri describe a simple way to determine the sex of an unborn child. It is suggested to moisten barley and wheat grains with the urine of a pregnant woman. If the wheat germinates first, a girl will be born, if barley, a boy will be born. American researchers from Georgetown University conducted such tests and received statistically significant confirmation of their effectiveness. However, this fact does not yet have a rational explanation. If the born child was very noisy (the reasons were not sought), then to calm him down they were given a mixture of poppy seeds and mouse droppings.

Egyptian doctors were aware of some women's diseases: irregular menstruation, prolapse of the vaginal walls, and uterine prolapse. What treatment Egyptian doctors used for these diseases is unknown.

Egyptian healers knew several hundred medicinal plants, many of which are Castor oil, flax-seed, wormwood and opium - are used in medicine, including gynecology, even today. Egyptian doctors prepared decoctions, pills, ointments from them, healing candles. The bases for preparing medicines were milk, honey, beer, water from sacred springs, and vegetable oils.

Greek doctors practiced in all specialties. They provided obstetric care only in cases of difficult childbirth. They knew some surgical methods of delivery, in particular, they knew about caesarean section, which was not performed on the living at that time. The ancient Greek myth about the birth of the god of medicine Asclepius himself, who was extracted from the corpse of his mother by his father Apollo, also tells about this operation on a dead woman in order to extract a living child.

Assisting in childbirth in Ancient Greece was carried out exclusively by women, whom the Greeks called “umbilical cord cutters” (“omphalotomoi”). If the birth was difficult and the midwife saw that she could not provide assistance on her own, she turned, as was the case in India, to a male doctor. The activities of Greek midwives were quite diverse: they not only provided assistance during childbirth and the postpartum period, but also engaged in termination of pregnancy. In Ancient Greece, termination of pregnancy in the early stages was not pursued. This operation was allowed by the famous ancient Greek philosopher and naturalist Aristotle, believing that in the early period of pregnancy the fetus does not yet have consciousness. It is unknown by what means the abortion was performed.

Ancient Greek medicine preached the empirical direction of medicine in collaboration with philosophy. A student of the Kos Medical School, Hippocrates (460-377 BC) in his writings mentions palpation and internal gynecological examination, methods for diagnosing pelvic tumors, methods for determining location disorders (prolapse and prolapse) of the female genital organs. It is known that in Pompeii they used a vaginal speculum for internal examination, which could be opened using a screw.

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. “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 knew about caesarean section, but performed it only on a dead woman in order to extract a living baby (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 Wittenberg.

In the final period of the history of ancient Greece - the Hellenistic era (when Alexandrian doctors began to perform anatomical dissections), the practice of obstetrics and gynecology began to emerge as an independent profession. Thus, a famous obstetrician of his time was the student of Herophilus Demetrich from Apamea (2nd century BC). He studied the development of pregnancy, the causes of birth pathology, gave an analysis of various types of bleeding and divided them into groups. Another Alexandrian physician, Cleophant (2nd century BC), compiled an extensive work on obstetrics and women's diseases.

Among the Romans Along with individual outstanding researchers (Galen, Soranus, Archogenes, etc.), religious cults continued to exist with the worship of gods borrowed from the ancient Greeks. Thus, the Greek god-healer Asclepius was transferred to Rome under the name of Aesculapius - the god of medicine; the goddess of fever appears, the goddess of menstruation Fluonia, the goddess of the uterus - Uterina and the goddesses of childbirth - Diana, Cybele, Juno and Mena.

Very valuable special works by Roman doctors on obstetrics and women's diseases have survived to this day. Among them is the work of the female midwife Aspasia (2nd century), who held the title of doctor. She outlined her theoretical and practical knowledge in a book that has come down to your time. In it, Aspasia covered a number of issues, in particular about pregnancy hygiene, caring for a patient during a natural and artificial miscarriage, correcting a displaced uterus, and dilating the veins of the external genitalia. The indications and methods for examining the uterus by palpation and, for the first time, by using a vaginal speculum are outlined. The book contains information about condylomas, as well as hernias. Aspasia knew surgical methods for treating some female diseases. She promptly removed hypertrophied labia minora and clitoris, removed polyps of the cervical canal of the uterus, etc.

Classic works by famous doctors are also known ancient Rome- A.K. Celsus, Sorana from Ephesus, Galena from Pergamum. They knew various methods of obstetric and gynecological examination, operations of turning the fetus on its leg, removing it by the pelvic end, embryotomy; they were familiar with genital tumors (fibroids, cancer), uterine displacements and prolapses, and inflammatory diseases.

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. In the I-II centuries. AD In Rome, the surgeon and obstetrician Archiven worked, who was the first to use a mirror when examining the vagina and cervix, which he called dioptra (Greek dioptra; from diopleuo - to see everywhere). Gynecological speculums and more surgical instruments discovered during excavations of the ancient Roman cities of Pompeii and Herculaneum, buried under the ashes of the Vesuvius volcano in 79 AD.

After Hippocrates, gynecology, like all medicine, continued to develop, although rather slowly; but from the middle of the 7th century there was almost complete stagnation in its development: among the Arabs and Mongols who dominated at that time, religion did not allow a male doctor to see a sick woman. In Islamic countries, as is known, male doctors could not touch a sick woman, it was also forbidden to use human corpses to study anatomy, so gynecology was at a descriptive level, however, it was the Arab Abu al-Qasim (936-1013) who first described the clinic of ectopic (ectopic) pregnancy, and Ibn-Zohr (1092-1162) published recipes for contraceptives.

Methods of treating female diseases that were practiced in ancient times are local: smoking, douching, pessaries, cupping, poultices, lotions, etc.; and internal: laxatives, emetics, herbs and roots special for women, etc.

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.

During the period of the classical Middle Ages, when scholasticism dominated Western Europe and universities were mainly engaged in the compilation and commentary of individual manuscripts of ancient authors, the valuable empirical heritage of the ancient world was preserved and enriched by doctors and philosophers of the medieval East (Abu Bakr ar-razi, ibn Sina, ibn Rushd and others.

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. Delivery continued to remain in the hands of the 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 - 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 “Grandma” and, instead of actual obstetric care, received from them spoken water, an amulet, or one or another ignorant benefit. It is not surprising that with such help, and with the failure to comply with basic hygiene requirements, the anatomy rate during childbirth and the postpartum period was very high. Pregnant women under constant fear lived in death. Correction of fetal malposition by rotation, this great achievement of antiquity, was forgotten or not used by most doctors.

Only the Renaissance era gave a new round in the deepening and systematization of all sciences and the building of scientific gynecology. A new direction in medicine appeared in the works of Paracelsus, Vesalius, and others. The innovators of the progressive movement sought to develop medical science on the basis of experience and observation. Thus, one of the greatest physician reformers of the Renaissance, Paracelsus (1493-1541), rejected the teaching of the ancients about the four juices of the human body, believing that the processes occurring in the body are chemical processes. The great anatomist a. Vesalius (1514-1564) corrected Galen's error regarding communications between the left and right parts of the heart and for the first time correctly described the structure of the woman's uterus. Another famous anatomist, the Italian Gabriel Fallopius (1532-1562), described in detail the oviducts that received his name (fallopian tubes.

During this period, anatomy began to develop rapidly. This led to a large number of discoveries also in the field of gynecology. In the 16th century, the first atlases appeared - manuals for midwives. It is necessary to list the scientists who made significant contributions to the development of gynecology and obstetrics.

Eustachius (1510-1574), a Roman professor of anatomy, very accurately described the structure of the female genital organs, based on mass autopsies of corpses in hospitals.
Arantius (1530 - 1589), a student of Visalia, dissecting the corpses of pregnant women, he described the development of the human fetus, its relationship with the mother. He saw one of the main reasons for difficult childbirth in the pathology of the female pelvis.
Botallo (1530-1600) described the blood supply to the fetus.
Ambroise Paré (1517-1590) - the famous French surgeon and obstetrician, restored and improved the forgotten method of turning the fetus on its leg. He recommended using rapid release of uterine contents to stop uterine bleeding. He was the first to invent a breast pump.
Trautman is credited with reliably successfully performing a caesarean section on a live woman in labor.

Gynecological surgery was revived somewhat earlier: as a department of pure surgery, it separated from obstetrics back in the Middle Ages. The works of European anatomists of the 16th and 17th centuries (T. Bartolina, R. Graaf, etc.) contain a description of the physiological structure of women. Already in the next century, gynecology as an independent science took shape.

During the Renaissance, the development of scientific anatomy (A. Vesalius, G. Fabricius, G. Fallopius, B. Eustachius) and physiological knowledge created the prerequisites for the development of scientific obstetrics and gynecology. The first extensive manual in Western Europe, “On Women's Diseases” (“De Mulierum Iiffeclionibus”), was compiled in 1579 by Luis Mercado (Mercado, Luis, 1525-1606) - a professor at the University of Toledo (Spain.

Of great importance for the development of obstetrics and gynecology was the work of Ambroise Paré, who returned to obstetrics the forgotten operation of turning the fetus on its leg, introduced gynecological speculum into widespread practice and organized the first obstetric department and the first obstetric school in Europe at the Hotel - Dieu hospital in Paris. Only women were accepted into it; the training lasted 3 months, of which 6 weeks were devoted to practical lessons.

The rapidly developing science and medicine of this period made it possible to carry out quite complex abdominal and gynecological operations. Original methods for removing abscesses from the pelvic cavity and plastic surgery of the female genital organs were proposed. Obstetrics also came under this influence. For the first time, Chamberlain (Chamberlain), and later L. Geister, proposed the use of obstetric forceps for difficult childbirth.

New diagnostic methods were developed that made it possible to determine the correctness and timing of labor, as well as the condition of the fetus. Anatomical concepts such as the size of the pelvis were studied, which subsequently made it possible to more or less accurately predict the course of labor and, accordingly, be prepared for all troubles. Leeuwenhoek's invention of the microscope made it possible to study in more detail the structure of the female genital organs, on the basis of which initial ideas about the function of various parts of the reproductive tract began to emerge. Abortion operations began to improve, although the church greatly interfered with this.

In the 19th century, training in obstetrics and midwifery was introduced into the system in special schools. However, along with this, ideas about the character of pathological processes, arising in the female genital organs, as well as their physiological directions. The field of physiology and pathology of female genital organs has expanded so much that it has become a separate medical discipline - gynecology. In accordance with this, a new specialty is emerging - gynecologists. It also goes to them surgery women's diseases; surgical gynecology arises. Gynecological clinics are opening, and gynecological departments are opening in hospitals.

Obstetrics and gynecology. obstetrics and gynecology

Gynecology (from the Greek gyneco- - woman and -ology - study) is a branch of medicine that studies diseases characteristic only of the woman’s body, primarily diseases of women reproductive system. Most gynecologists today 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 medicine 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 organs of her body, and the pathological changes in her genital area 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 a fetal-destroying operation. 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

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 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.

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 form of medical care finally took shape.

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, 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).