6 курс / Неонатология / Научное_обоснование_механизмов_управления_младенческой
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APPENDIX
Questionnaire
For puerperas of the perinatal center (the answer must be underlined)
1.Enter your age: - 15-19 years old - 20-24 years old - 25-29 years old - 30-34 years old - 35-39 years old - 40-44 years old - 45-49 years old
2.Please indicate your marital status: - Married
- Single
3.Do you live:
-Separately
-With parents (other relatives) 4. Do you live:
-in an urban area
-in the countryside
5.What is the pregnancy on the account: - 1st
- 2nd - 3rd - 4th
- 5th and more
6.What kind of childbirth on the account: - 1st
- 2nd
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-3rd
-4th
-5th and more
7.This pregnancy proceeded: - Without complications
- With complications
8.The current birth proceeded: - Without complications
- With complications
9.Current delivery:
-By caesarean section
-Physiological childbirth
10.On which day you are discharged from the perinatal center: - 4th
- 5th - 6th - 7th - 8th - 9th
- 10th and >
11.Your newborn:
-Has a congenital disorder
-Does not have a congenital pathology 12. Your newborn:
-Healthy
-Is ill
13. The child receives:
-Breast-feeding
-Artificial feeding
-mixed feeding
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14.Do you have bad habits: - Yes
- No
15.Do you have bad habits father of the child: - Yes
- No
16.Did you get adequate nutrition during pregnancy: - Yes
- No
17.Did you have increased physical activity during pregnancy: - Yes
- No
18.Are there any genetic diseases in the family:
-Yes
-No
19.Are there any infectious diseases in the family (tuberculosis, etc.): - Yes
- No
20.Have you been diagnosed with a sexually transmitted disease:
-Yes
-No
21.Have you received treatment for a sexually transmitted disease: - Yes
- No
22.Did recovery occur after treatment:
-Yes
-No
23. Do you have diseases of the female genital area: - Yes
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No
24.The first menses came: - At 10
- At 11 years old - At 12 years old - At the age of 13 - At the age of 14
25.Menstruation is profuse: - Yes
- No
26.Menstruation occurs regularly: - Yes
- No
27.The duration of the menstrual cycle is: - Up to 25 days
- 25-28 days
- Over 28 days
28.Do you have somatic diseases:
-Yes
-No
29. What somatic diseases do you suffer from:
-Of cardio-vascular system
-Respiratory system
-Gastrointestinal tract
-Musculoskeletal system
-nervous system
-Skin and subcutaneous fat
-Kidney and bladder
-Ear, throat, nose
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30. How long have you suffered from somatic diseases:
-Up to 1 year
-From 1 year to 3 years
-From 3 years to 5 years
-Over 5 years
31.Your somatic diseases are related to: - With work (industrial hazards)
- Wrong way of life
- With environmental factors
- With economic factors (low income)
- With medical factors (lack of professionalism of medical personnel) - With your lack of awareness about disease prevention and treatment
32.Have you attended classes to prepare for childbirth and care for a newborn: - Yes
- No
33.Have you undergone genetic counseling to identify the risks of a child developing a hereditary pathology when planning a pregnancy:
- Yes - No
34.Have you undergone genetic counseling to identify the risks of a child developing a hereditary pathology during pregnancy:
- Yes - No
35.What is the risk of genetic diseases revealed:
-high
-moderate -Short
How do you rate the organization of the work of the perinatal center:
-by 5 points
-by 4 points
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-by 3 points
-by 2 points
37.How do you rate the work of doctors: - by 5 points
- by 4 points - by 3 points - by 2 points
38.How do you rate the work of nurses: - by 5 points
- by 4 points - by 3 points - by 2 points
39.How do you assess the sanitary and hygienic condition of the wards and other premises of the perinatal center:
- by 5 points - by 4 points - by 3 points - by 2 points
40.How do you rate the quality of food in the perinatal center:
-by 5 points
-by 4 points
-by 3 points
-by 2 points
41.How would you rate drug provision in the perinatal center: - by 5 points
- by 4 points - by 3 points - by 2 points
42.How would you rate the level of medical care in the perinatal center: - by 5 points
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-by 4 points
-by 3 points
-by 2 points
43.How do you rate the care of newborns in the perinatal center: - by 5 points
- by 4 points - by 3 points - by 2 points
44.How do you rate the level of comfort in the perinatal center: - by 5 points
- by 4 points - by 3 points - by 2 points
45.Do you think that partner births provide support for the mother in labor and have a positive effect on the health of the newborn:
- Yes - No
46.At what gestational age did these births occur:
-up to 37 weeks
-from 37 weeks to 41 weeks
-from 41 weeks to 42 weeks
-after 42 weeks
47. Does the actual term of these births correspond to the expected:
-Yes
-No
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