Vaginal study of pregnant and feminine. Vaginal Research of Rozens Vaginal Study in Roers

09.07.2020

1 period : period of disclosure - since the beginning generic activity Before opening the cervix (full discovery - 10-12 cm). Fights must be not only regular, but also effective. Efficiency is determined by the pace of opening of the cervix: at the primary-in the middle of 1 cm / hour, in a repeated 2 cm / hour. The opening order of the cervix: the primary-child first opens the inner zev and the cervix smoothes, the repeated and internal zev are also open at the same time. 1. The period is completed with a complete discovery and influence of oily water Maintaining 1 period : 1) Control over the common Cost of the Genuineers: - I feel, pain, - Imit the hearts of the tones of the female in the man in labor, -pils, blood pressure, "the emptying of the urine of the PUC and direct K-ki, -Asbolization.2) Evaluation will reduce the SPOS: - Palpatorno the uterus tone, with hysterography, riography or radiotelemetry. - Interval Mr. fights (4-4.5 days 10min). 3) Control over the Fetal Cost: CHS Counting with Cardiotockography (CTG) -\u003e The presence of AKKELOTIC-N Fruit Cost. 4) Hardened Research: - Sost m-C TAZwHO DNA, ITAGED, SHAKE OPERATION OF THE CAKE, -PERFLET. Clinic: At the beginning of the birth, the contrall of the scaffold appeared (C / S24min); since the amplification, the transition of h / s each 3-4min; At the height of one and break the fruit of the PUC. Shatting a variety of circle. Mate. C.--\u003e The bottom of the uterus approach. To the pen of BR, the fetus axis and the axis of the genus the channel of the blinds are transmitted to the offender, the head is lower below. Poster Vaginal research : Upon admission (primary inspection). After the expulsion of the accumulating water is the purpose of assessing the effectiveness of generic activities. For the production of amniotomy. For the reason for the causes of the hypoxia of the fetus. In the bleeding from the genital paths. For the detection of conditions for the delivery

. Amniotomy- This is the instrumental opening of the fruit bubble, is carried out strictly according to the testimony. Indications for amniotomy:Multi-way or lowland (flat bubble). Best (programmented birth begin with amniotomy. Property placenta. For the purpose of the rhodesion (but now it is not practiced). Contraindications for amniotomy : Pelvic preview. Frequent and oblique position. A reasonable pelvis.

21.Biomechanism of childbirth at the rear: Biomechanism of childbirth at the background is composed of five points. First moment - flexing the head of the fetus. In the rear of the occipital preclusion, the sweat-shaped seam is installed synclinitically in one of the oblique sizes of the pelvis, in the left (first position) or in the right (second position), and the small springs are facing left and for the post, to the sacrum (first position) or Right and for the post, to the sacrum (second position). The flexion of the head occurs in such a way that it passes through the plane of the entrance and the wide part of the cavity of the small pelvis with its middle oblique size (10.5 cm). The drive point is the point on the sweep seam, located closer to the large springs. Second moment - internal wrong Turning the head. Straw-shaped seams of oblique or transverse sizes makes a rotation of 45 ° or 90 °, so that the small spring is rendered from behind at the sacrum, and the big one is in front of the led. The inner rotation occurs when switching through the plane of a narrow part of the small pelvis and ends in the plane of the output of a small pelvic, when the sweat-shaped seam is installed in direct size. Third moment - Further ( maximum) Head bending. When the head fit the border of the scale of the forehead (point of fixation) under the lower edge of the lane joint, it occurs, it occurs, and the head makes further maximum bending, resulting in its population to the poddle-mock. Fourth moment - Extension of the head. The Point of Support (the front surface of the tailbone) and the fixation point (podental fossa). Under the influence of the generic forces, the head of the fetus makes the extension, and from under the head, forehead appears, and then the face facing LON. In the future, the biomechanism of childbirth is accomplished in the same way as in the leading of the occipital presence. Fifth moment - Outdoor turn of the head, the inner entry of the shores. It is an additional and very difficult moment in the biomechanism of childbirth at the rear view of the occipital presence and very difficult moment is the maximum bending of the head - the expulsion period is delayed. This requires additional work of the muscles of the uterus and the abdominal press. Soft fabrics pelvic bottom and crotch are exposed to strong stretching and are often injured

22. BIOM. Giving birth at the foreform: First moment - Flexing the head.

It is expressed in the fact that the neck of the spine bends, the chin approaches the chest, the head is lowered down, and the forehead is delayed above the entrance to a small pelvis. As the nape is lowered, small spring is set below much, in such a way that the drive point (the lowest point on the head, which is on the wired middle line of the pelvis) becomes the point on the sweep seam closer to the small spring. When the head form of the occipital presence, the head bends to a small oblique size and passes into the entrance to a small pelvis and into a wide part of the cavity of the small pelvis. Consequently, the head of the fruit is inserted into the entrance to a small pelvis in a state of moderate bending, synclinitically, in transversely or in one of its sizes.

Second moment - The inner turn of the head (correct). The headband of the fetus, continuing its progressive movement in the pelvis cavity, meets the opposition to further promotion, which is largely due to the form of the generic channel, and begins to turn around its longitudinal axis. The turn of the head begins when it is transition from a wide pelvic in a narrow part. At the same time, the head, gliding along the side wall of the pelvis, approaching the Lonnoye articulation, the front department of the head goes down to the sacrum. The sweat-shaped seams of transverse or one of the oblique sizes in the future passes into the direct size of the exit from the small pelvis, and the podgotilkaya fossa is installed under the Lonny Jim. Third moment - Extension of the head. The head of the fetus continues to move along the generic channel and at the same time starts to be blown up. Extension in physiological childbirth occurs at the outlet of the pelvis. The direction of the fascial muscular part of the generic channel contributes to the deviation of the fetus head to the Lon. Podtotillae pits rests on the lower edge of the LONA joint, the point of fixation, supports. The head rotates with its transverse axis around the point of the support - the lower edge of the Lonnoy articulation - and within a few fence is completely inflicted. The birth of the head through a vulvar ring occurs with a small skeleton size (9.5 cm). Consistently born the head, the topics, forehead, face and chin. Fourth moment - the inner turn of the shoulders and the outer turn of the fetus head. The time of extension of the head of the fruit, the transverse size Included in small pelvis or one of its sizes. As you follow the head on the soft tissues of the outlet of the pelvis, the shoulders are properly moving along the generic channel, i.e. move down and at the same time rotate. At the same time, they are their transverse size (distantia biracromialis) from the transverse size of the cavity of the small pelvis in oblique, and in the plane of the cavity of the small pelvis - in a straight size. This turn occurs when moving the fetal body through the plane of a narrow part of the cavity of the small pelvis and is transmitted to the born head. At the same time, the back of the fetus turns to the left (at the first position) or the right (at the second position) of the mother's thigh. The front shoulder is now under the wagon arc. A second point of fixation, supports formed between the front shoulder at the site of attaching the deltoid muscle and the lower edge of the symphysis. Under the influence of the generic forces, flexing the fetal body in breast Department The spine and the birth of the brachial belt of the fetus. The front shoulder is born first, the rear is keenly delayed with the tailbone, but soon it fits it, protruding the crotch and born over the rear spike with the side bending of the body. After the birth of the shoulders is the rest of the body, thanks to the good preparedness of the generic paths born, is easily released.

23. Called flow and maintenance of 2 periods; . The degeneration of the expulsion (from the full of color sh / m to the fetus) -Unorroy1 and a replay 5-10min-1h: - swelling (Redfish BR Press, diaphrag, M-C TAZ DNA) Loda Protect on the genus - Cutting the head in 1-rod continued 10-20 mni, re-smoothly (Svidov, that internal turn turning, starts a bend); - Front of the head (head does not hiss after stopping) conducting birth during the expulsion period: 1) recruited for the general of the Rozhnica, 2) control for the disclosure of the dija head with Pom Akush Issh, Wellace Issh; M-yes Pischek: fingers, wool gauze, pressed on the TC in the region of Later, the edge of Bol Paul lips to a meeting with the head of the fetus (if the head is in a narrow Taza). In N, the speed is moving the head of the genus in 1 cm. 1cm / h, re-2 cm / h. Pr-Lo: In 2 pen head, it was not in one flat\u003e 2h in 1-genus and 1h at re-. 3) control over the COS. Fetal: CSS - In response to attempts more often, register of deceleration to 80 ° C. / min.

24.Thenium and maintenance of the 3rd period:Tactic exit to TCH 30min: -Control for total Sost, hell, PS, Oro Puz Owner; - Thence of bleeding (300-500ml); -After separation of the post of the uterus of Pozop pops, lifting up and right from the navel; -After the birth of the sequence of the uterus sharply cut, the bottom of it in the middle between the Lone and the Pup. Signs of placenta branch: a) Schroeder: the bottom of the uterus will rise up and right from the navel, the shape of the sand clock; b) Chukalov-Kustener: pressing the edge of the brush on a par with a gloom, and more\u003e exit outside; c) Aldfeld: ligature, plugged on the cord with the floor of the gap, dropped to 8-10 cm and below; d) Dovzhenko: When exhaling, after the depth of the inhalation of the umbilical, it is not retreating; e) Klein: After the excavation at the department, the placenta PUP-on remains. In place, not a department - retreating in Vl. 1 )Methods of selection of post.: a) SP-B ABUBLYZE: After the Ocaler Urine, PUB Pen Art captures with both hands in a fold and predict to sleep; b) SP-B Credit-Lazarevich: -Or Man Urine Puz catheter; - the bottom of the uterus in the middle of the position; - Fabulous stroking the uterus from the course of it to reduce it; - Cooking the bottom of the uterus with a brush so that 4 fingers were on the back of the wall, palm at the bottom, B. Finger on the wall in front of the wall; - in front of the uterus fingers in front of the back, palm from top to bottom. c) If after the time the last Obol was delayed in the uterus, then the placenta rotate, spinning the shell into the rope. 2) inspection of the pillar, the set of placenta, then the shells (with a defect of the slices or shell, the manual is removed under anesthesia. 3) oPR Number of blood is lost. 4) osmatic outer floor organs, walls of Vl-sch and sh / m, breaks are sewn. 5) the first 2h Pedargin Wire in the race in the postpartswoman separate.

25. Proceedings of the state of the newborn: Scale apg- heart rate (ABS /<100/>100) - Breathing (ABS /, rare, single movement / loud cry) - mouse tone (lake) (absent) Refl (no R-ii / grimace / cough, sneezing, scream) -ska skin (pallor , cyanosis / pink only on the body / all pink). Each sign is appreciated by 0-2 points.

26. First processing of a newborn: The newborn processing is carried out on the maternity hospital, over-1m in the children's room with an obstetrician in sterile gloves, using sterile tools (pipette, Kohrin clamps, scissors, brackets of the corner) and dressing material. Newborn processing attacks and their goal: th stage - prevention of aspiration with this purpose is to remove mucus from nasal strokes and oral cavity The fetus at the birth of its head with the help of electric cover or sterile rubber pear. The 2nd stage - the prevention of ophthalmoblennogeniores of the newborn is wiped with a dry sterile cotton swab (separate tampon for each eye) in the direction from the outer angle of the eye to the internal (Matveyev method). Then, the lower eyelids are then slightly and 1 drop of a 30% sodium sodium solution is dripped out of the bootets. There are 2 drops of this solution. The 3rd stage - the prevention of umbilical sepsis and bleeding from the umbilical cord. After the termination of the pulsation of the cord of the newborn is separated from the mother. On the umbilical cord impose 2 clamps of Kochler: one - at a distance of 10-15 cm from the umbilical ring, the other - by 2 cm of the dust from it. The plot of cord, which is between the clamps, is treated with 5% alcohol solution iodine, iodonate or 96% alcohol and intersect with sterile scissors. In the case of the presence of newborn dirt (blood, mucus, mingonium), it is washed with a baby soap under warm running water, dried with a warm sterile diaper and put on a changing table on a warm dry sterile diaper under The source of radiant heat. The residue of the cord and the umbilical ring is treated with 96% alcohol. At a distance of 0.3-0.5 cm from the umbilical ring on the umbilical ring, the COCHER clamp is applied, which after 1-2 minutes is replaced with a metal bracket with a special clamp or a special disposable plastic bracket. The umbilical cord is crossed with sterile scissors above the bracket by 1.5-2 cm, blood presses and warrtons of a jelly with a marlevary napkin. The bottom of the umbilical cord and its residue is treated with a 5% potassium permanganate solution, a gauze bandage is applied to the residue of the umbilical bandage or leave it open 4th stage - prophylaxis of pyodermia. The tampon, moistened with sterile vaseline or vegetable oil, from the skin of the child is removed with a raw lubricant. After the specified processing of the newborn, the following activities are carried out.1. Anthropometry: 2. Marking..3. Observation. In the maternity department, the newborn is under the supervision of midwives for 2 hours. 27. Evaluation of the fetal life: . OPR-E Biophysic. Profile fruit .

BFP includes 6 parameters: 1) Unrespensive test (NST) during cardiotokography. 2) Sleepers. Defrup (DDP) when ultrasound in real time. 3) Motig Act (yes) 4) Fetal Tonus (T) 5) Volume of accumulating waters (OOB) 6) The degree of maturity of the placenta (SZGT). High feelings and specifications are explained by the combination of acute markers (NST, DPP, T, and yes) and XP. (OOP, SPP) Disrupts of the Fetal State. The reactive NST is the indicator of the satisfaction of the fetus, with an ultrasive NST, the ultrasound of the rest of biophysic. Fetal parameters. The amount of points is 12-8 - normal comp. Fetal, 7-6 points - doubt. The state of the fetus + the possibility of sealing complications, 5-4 points - the presence of a pronounced / in hypoxia of the fetus with high. Risk of development of perinatal complications. Definition of the BFP to obtain objective information - from the beginning of the III trimester.

28.Plosrol period: From the moment of birth, the postpartum period begins, the duration of which is approximately 6-8 weeks. Throughout this time in the body of women, all changes that arose in connection with pregnancy and childbirth are undergoing reverse development (involution). Such changes occur in genital organs, endocrine, nervous, cardiovascular and other systems. The exception is the dairy glands, the function of which reaches maximum development in the postpartum period. Postpartum period.

The most significant changes in the postpartum period are noted in the reproductive system, especially in the uterus. In the first hours after childbirth, the walls of the uterus thicken, it acquires a spherical shape, its bottom is located at the navel level, that is, on average 15 cm above the pubis. The transverse size of the uterus immediately after birth is 12-13 cm, the mass of 1000 g. The process of involution of the uterus rapid. Due to muscle cuts, it is reduced. The degree of contraction of the uterus is judged on the height of its bottom. Every day this level decreases by 1.5-2 cm (approximately 1 cross finger). The formation of the cervix and the oz occurs due to the reduction of circular muscles, which surround, the inner hole of the cervical cervix. On the 10th day after childbirth, the channel is completely restored, but the external ZEV closes completely throughout the 3rd week after delivery, acquiring a slightly shape. At the end of the 6-8th week after the birth, the magnitude of the uterus corresponds to its magnitude to the beginning of pregnancy, and the mass equals 50-60 g. After separation of the placenta and the birth of the lane, the uterus is a wound surface. In the process of healing the inner surface of the uterus, postpartum discharges appear - Lochi. Their character over the postpartum period changes. If in the first 3-4 days they are bloody, then on the 4-5 days, the nature of the serous-succinous fluid is acquired, and on the 10th day they become light, liquid, without blood impurities. The number of succeeds, from the 3rd weeks they are scarce, and from the 5-6th week of selection of the uterus, they are generally stopped. On the 6-7th day of the postpartum period disappears swelling of the external genital organs, healing the cervix, vagina, and The perineum is restored by the tone of the muscles and fascia of the pelvic day. Source pipes, ovaries, a binder apparatus are gradually returned to its original position. The ovaries ends with the regression of the yellow body and the ripening of follicles begins. Most women who do not feed the breast, on the 6-8th week after childbirth, menstruation comes. Nursing menstruation has no time for several months or the entire period of breastfeeding. The first menstrual cycle after childbirth often passes without ovulation. In the future, the ovulation process is renewed, and the menstrual function is completely restored. The abdominal wall is gradually strengthened mostly due to the reduction of the muscles and the most stretched fabrics around the navel. The scars of pregnancy on the front abdominal wall after childbirth are pale and remain forever. During pregnancy in the mammary glands, changes occur, which prepare them for the secretion of milk. Already during pregnancy and throughout the first days after birth from the mammary glands, colosure is distinguished, and

For 3-4 days of the postpartum period, dairy glands swell and milk appears

Vaginal research in childbirth is carried out on the gynecological chair after processing the outdoor genital devices. mortar, in sterile gloves. Includes the definition of the following characteristics:

1. Inspection of external genital organs (type of agriculture, signs of hypoplasia, perineal state);

2. The state of the vagina (extensibility, the presence of partitions, strictures);

3. The state of the cervix:

a) preserved (length, shape, consistency, location relative to the wired pelvic axis, cervical canal permeability);

b) smoothed;

4. The degree of disclosure of the outer uterine duty in centimeters, the state of the edges of the oz (thick, thin, soft, dense, easily stretchable, rigid), its shape, deformation and defects.

5. Condition fruit bubble (There is no, no, well poured, flat, tense outside the contamination);

6. Character and location of the prerequisite part relative to the planes of a small pelvis (above the entrance, pressed, a small segment, a large segment, in a wide, in a narrow part, on a pelvic day). Determine the location of seams and spring, signs of the head configuration, the presence of a generic tumor;

7. Characteristics of the bone pore, measuring the diagonal conjugate.

Taking into account the signs identified with the vaginal examination of the cervix, determine the degree of its maturity on the Bishop scale:

When estimating 0-5 points, the cervix is \u200b\u200bconsidered immature if the amount of points is more than 10 - the cervix mature (ready for childbirth) and can be used to be applied.

Classification of the maturity of the cervix in G.G. Hoechyshashvili:

but. Immature cervix - softening noticeably only on the periphery. The neck of the uterus is random in the course of the cervical canal, and in some cases - in all departments. The vaginal part is preserved or slightly shortened, is sacred. The outer zev is closed or passes the fingertips, is determined at the level corresponding to the middle between the upper and the lower edge of the LONA joint.

b. The ripening neck of the uterus - not completely softened, the area of \u200b\u200bthe dense fabric is still noticeable along the gear channel, especially in the area of \u200b\u200bthe inner mouth. The vaginal part of the cervix is \u200b\u200bslightly shortened, at the foregorous, the outer zev skips the fingertips. Less often, the cable channel is passing for a finger to the inner throat or difficult for the inner zev. Between the length of the vaginal part of the cervix and the length of the gear channel there is a difference of more than 1 cm. Notice a sharp transition of the cervical canal to the lower segment in the area of \u200b\u200bthe internal zea. The predatory part is palpable through the archs is not clearly clearly. The wall of the vaginal part of the cervix is \u200b\u200bstill quite wide (up to 1.5 cm), the vaginal part of the neck is located away from the hollow axis of the pelvis. The outer zev is defined at the level of the lower edge of the symphysis or somewhat higher.

in. Not fully matched neck of the uterus - almost completely softened, only in the region of the inner zois is still determined by the area of \u200b\u200bthe dense fabric. The channel in all cases is passing for one finger for the inner zev, from the primordin - with difficulty. There is no smooth transition of the cervical channel to the lower segment. The preeble part is palpable through the vaults is pretty clearly. The wall of the vaginal part of the cervix is \u200b\u200bnoticeably fried (up to 1 cm), and the vaginal part itself is closer to the wired pelvic axis. The outer zev is defined at the level of the lower edge of the symphysis, sometimes below, but not reaching the level of sedlicate arms.

d) Mature cervix - completely softened, shortened or sharply shortened, the cervical canal freely skips one finger and more, not bent, smoothly moves to the lower segment of the uterus in the area of \u200b\u200bthe internal zea. Through the vaults, the prevailing part of the fetus is quite clear. The wall of the vaginal part of the cervical cervix is \u200b\u200bsignificantly fried (up to 4-5 mm), the vaginal part is located strictly via a wired axis of the pelvis, the outer zev is defined at the level of sedlicate arrangements.

Vaginal research in childbirth is made to keep part patterns, orientation in the insertion and promotion of the head, assessing the location of seams and spring, that is, to clarify the obstetric situation. When monitoring the generic process, there is a need for a vaginal study that needs to be carried out in a small operating room with strict compliance with the rules of aseptics (to conduct purely washed hands, in sterile gloves using disinfecting solutions, sterile liquid vaseline oil). Studies must be carried out negro, carefully and painlessly. With normal generic activity, the edge of the cervix is \u200b\u200bthin, soft, easily tensile. In the fighting of the edge of the neck are not strained, which indicates a good relaxation of fabrics; Frucent bubble is well pronounced. A pause between the fights, the fetus bubble voltage is weakening, and through the fetal shells it is possible to determine the identification items on the head: the sagittal seam, the rear (small) spring, the wired point.

According to the existing position, the vaginal study must be carried out twice: upon receipt of the fever and immediately after the octopedic waters. In other cases, this manipulation should be justified in writing in the history of childbirth.

Mandatory vaginal studies are shown in the following situations:

Upon receipt of a woman in the maternity hospital;

With the disheve of the accumulative water;

With the beginning of the generic activity (assessment of the state and disclosure of the cervix);

Under anomalies of generic activity (weakening or excessively strong, painful contractions, as well as early sweeps);

Before carrying out anesthesia (find out the cause of the soreness of the bouts);

When there are bleeding outlets from the generic paths.

1. Inspection of external genital organs (type of agriculture, signs of hypoplasia, perineal state);

2. The state of the vagina (extensibility, the presence of partitions, strictures);

3. The state of the cervix:

a) preserved (length, shape, consistency, location relative to the wired pelvic axis, cervical canal permeability);

b) smoothed;

4. The degree of disclosure of the outer uterine duty in centimeters, the state of the edges of the oz (thick, thin, soft, dense, easily stretchable, rigid), its shape, deformation and defects.

5. The state of the fruit bubble (there is no, is well poured, flat, tense outside the contamination);

7. Characteristics of the bone pore, measuring the diagonal conjugate.

Taking into account the signs identified with the vaginal examination of the cervix, determine the degree of its maturity on the Bishop scale:

When estimating 0-5 points, the cervix is \u200b\u200bconsidered immature if the amount of points is more than 10 - the cervix mature (ready for childbirth) and can be used to be applied.

Classification of the maturity of the cervix in G.G. Hoechyshashvili:

Mandatory vaginal studies are shown in the following situations:

Upon receipt of a woman in the maternity hospital;

With the disheve of the accumulative water;

With the beginning of the generic activity (assessment of the state and disclosure of the cervix);

Under anomalies of generic activity (weakening or excessively strong, painful contractions, as well as early sweeps);

Before carrying out anesthesia (find out the cause of the soreness of the bouts);

When there are bleeding outlets from the generic paths.

Run to the phantom finger study of the rectum.

Indications:

Suspections for the diseases of the rectum surrounding it organs and tissues. Finger study of the rectum in patients with diseases of organs abdominal cavity and small pelvis must be preceded by any kind instrumental research Direct and colon (for example, RectorOnoscopy).

The finger study of the rectum allows you to identify the diseases of the rear pass and the rectum (anal cracks, fistula, hemorrhoids, benign and malignant tumors, scar narrowing of the gossip, foreign body etc.), inflammatory infiltrates and neoplasms of the paragreotal fiber, the sacrum and the tailbone, changes in the prostate gland (adenoma, cancer), accumulation of fluid in the pelvis cavity, etc.

In gynecology according to the indications, a straightworm-bubblythrointestinal and straight-turn and vaginal study are used.

This study, in addition, makes it possible to resolve the possibility of instrumental rectal research.

Patient position:

The finger study of the rectum is carried out in different positions of the patient: lying on the left side or on the back with bent in the knees and the legs given to the stomach, in the knee-elbow position and squatting on a stress. With suspected peritonitis or abscess Douglas Space, the study must be carried out in the position of the patient lying on the back, since only in this position it is possible to determine the sickness and soreness of the front semicircle of the wall of the rectum.

Technics:

Previously examine the area of \u200b\u200bthe rear pass.

2. The rubber glove is put on the right hand, the index finger is abundantly lubricated with vaseline and are gently injected into the rear pass, while the remaining fingers in the pulp-phalange joints are maximally bent and removed thumb.

Consistently feel the walls of the anal channel, evaluate the elasticity, tone, sphincter tensile, the condition of the mucous membrane, the presence and degree of pain in the study.

Then the finger is carried out in the ampoule of the rectum, determine the state of its lumen (gaping, narrowing). Consistently examine the intestine wall throughout the circumference throughout the accessible trace, pay attention to the state of the prostate gland (in men), a straight-turn-vaginal partition and uterine (in women), paralegant tissue, the inner surface of the sacrum and the tailbone.

5. After removing the finger from the rectum, the nature of the separated mucous membrane (mucous membrane, bloody, purulent) is determined.

297. Diagnosis of later pregnancy terms (obstetric terminology, leopold techniques).

1. Obstetric terminology:

but. The position of the fetus (SITUS) is the ratio of the fetus axis to the uterus axis. The axis of the fetus is called a line passing through the head and buttocks. If the fetal axis and the axis of the uterus coincide, the position of the fetus is called longitudinal. If the axis of the fetus crosses the axis of the uterus at right angles and large parts of the fetus (head and buttocks) are at the level or above the ridge of the iliac bone, they say the transverse fetus (Situs Transversus). If the axis of the fetus crosses the axis of the uterus under an acute angle and large parts of the fetus are located in one of the wings of the ileum bones - about the oblique position of the fetus (Situs Obliquus).

b. Position of the Fetal (Positio) - the ratio of the backrest of the fetus to the side walls of the uterus. If the back of the fetus is addressed to the left side of the uterus - this is the first position of the fetus. If the back is addressed to the right side of the uterus - this is the second position of the fetus. With the transverse and oblique positions of the fetus, the position is determined by the fetus head: if the head is on the left - the first position, when the head of the right is the second position. The longitudinal position of the fetus is the most favorable for its promotion by the generic channel and is found in 99.5% of cases. Therefore, it is called physiological, correct. The transverse and oblique positions of the fetus are found in 0.5% of cases. They create an insurmountable obstacle to the birth of the fetus. They are called pathological, incorrect.

in. The type of fetus (Visus) is the ratio of the backrest of the fetus to the front or rear wall of the uterus. If the back is addressed to the front wall of the uterus - the front view; If the back is addressed to the rear wall of the uterus - the rear view.

the city position (Habitus) is called the ratio of the limbs and the fetus head to its body. Normal members position is this, in which the head is bent and pressed against the body, the handles are bent in the elbow joints, they are crossed together and pressed to the breast, the legs bent into the knee and hip joints, are crossed together and pressed to the fetus tummy.

the presence of the fetus (PraesenTatio) is evaluated with respect to one of the large parts of the fetus (head, pelvic end) to the plane of the entrance in a small pelvis. If the head is drawn to the plane of the entrance to a small pelvis, they say head preview. If there is a pelvic end over the entrance plane in a small pelvis, then they speak about the pelvic prevention of the fetus.

2. Receptions Leopold-Levitsky:

To determine the location of the fetus in the uterus, four receptions of the outdoor obstetric study on Leopold-Levitsky are used. The doctor stands to the right of pregnant or female face to face a woman.

1) First reception determines the height of the bottom of the uterus and a part of the fetus that is in the bottom. The palms of both hands are located on the bottom of the uterus, the ends of the fingers are directed to each other, but do not come into contact. Having setting the height of the bottom of the uterus in relation to mesia-shaped process Or the navel, determine the part of the fetus located in the bottom of the uterus. The pelvic end is defined as a large, mild and non-drawing part. The head of the fetus is defined as a large, dense and running part. With the transverse and oblique positions of the fetal, the bottom of the uterus turns out to be empty, and large parts of the fetus (head, pelvic end) are determined to the right or on the left at the level of the navel (with the transverse position of the fetus) or in the iliac regions (with the oblique position of the fetus).

2) With the help of the second reception, Leopold-Levitsky determine the position, position and type of fetus. Hand brushes are shifted from the bottom of the uterus on the side surfaces of the uterus (about the level of the navel). The palpation of the sideways of the uterus is produced by the palpation of the brushes of the hands. Having received an idea of \u200b\u200bthe location of the back and small parts of the fetus, make a conclusion about the position of the fetus. If small pieces of the fetus are palpable and on the right and left, you can think about twins. The back of the fetus is defined as smooth, smooth, without protrusions surface. With the back, reversed by the back (rear view), small pieces are palpable more distinctly. To establish a type of fetus with this reception in some cases is difficult, and sometimes impossible.

3) Using the third reception, determine the prerequisite part and its attitude towards the entrance in a small pelvis. Reception is carried out by one right hand. At the same time, the thumb is as much as possible from the other four. The prerequisite part is captured between large and middle fingers. This technique can be determined by a symptom of ballooning head. If the federated part is the pelvic end of the fetus, there is no symptom of running. The third reception to a certain extent can be obtained an idea of \u200b\u200bthe magnitude of the fetus head.

4) the fourth reception of Leopold-Levitsky determine the nature of the predatory part and its location in relation to the planes of a small pelvis. To fulfill this reception, the doctor turns face to the feet of the examined woman. Hand brushes have lateral from the midline over the horizontal branches of the pubic bones. Gradually, promoting the arms between the preserving part and the entrance plane in the small pelvis, determine the nature of the predatory part (which will be offered) and its location. The head can be movable, pressed to the entrance to a small pelvis or a fixed small or large segment. Under the segment should be understood as part of the fetus head located below the plane conditionally spent through this head. In the case when part of the head is fixed in the plane of the entrance to a small pelvis, the part of its maximum insertion is fixed, they say the head fixation with a small segment. If the largest diameter of the head and, therefore, the plane conditionally spent through it dropped below the plane of the entrance to a small pelvis, it is believed that the head is fixed with a large segment, since its larger volume is below the I plane.

Purpose:internal vaginal research.

Equipment:

· Gynecological chair.

· Individual pellery.

· Sterile gloves.

· Vaginal mirrors.

1. Ask the patient, whether she emptied the bladder.

2. Tell the patient that it will be examined on the gynecological chair.

3. Sterile rag, moistened with 0.5% calcium hypochlorite solution,
treat gynecological chair.

4. Located on the chair a clean diaper.

5. Place the patient on the gynecological chair: legs bent in the knee and tazobed Sustava and divorced on the parties.

6. Put on both hands new one-time or sterile (GD) reusable gloves (a woman should see that you have sterile gloves).

7. Provide sufficient lighting.

8. Inspect the external genital organs (see 2.1).

9. Inspect the vagina and the cervix on the mirrors (see 2 2).

10. Spend a vaginal study: the 2nd and 3rd finger of the right hand, enter in the vagina sequentially (first the 3rd, then the 2nd), pre-fingers of the left hand spreading the sex lips.

11. In the study, pay attention to:

· The condition of large vestibular glands.

· The condition of the urethra (with a 2nd palm tree through the front wall of the vagina).

· Muscle state of the pelvic bottom (pressed on the back spike)

· From the vagina, pay attention to the volume, folding, vagina package, the state of the vaginal arch;

12. Explore the vaginal part of the cervix, determine the shape of the cervix;

· Consistency;

· Mobility;

· Sensitivity by offset;

· Patency of the cervical canal;

· Presence of pathological formations (tumors)

13. Remove disposable gloves, throw them away, according to the indications, reusable gloves, turning inside out, and immerse 0.5% calcium hypochlorite solution

14. Wash your hands with water with soap

15. Check in medical records.

Table of contents of the topic "Choosing a place of delivery. Preparation for childbirth during admission. Non-drug methods of kindergartery.":
1. Choosing a place of delivery. Choosing a place of birth. Birth at home.
2. Birth in our country. Birth in the hospital. Birth in the perinatal center. Birth in the maternity hospital.
3. Preparation for childbirth when admission. Feeding in childbirth. Food female in childbirth.
4. Choosing a family method. Tactics for childbirth. Intensive observation during childbirth.
5. Maintaining the first period of childbirth. Signs of the beginning of childbirth. False childbirth. Primary period. Harbingers of childbirth.
6. The position of the woman and its behavior in the first period of childbirth. The active behavior of the feminine.

8. Monitoring the heart rate frequency of the fetus. Intermittent auscultation. Permanent electronic control (CTG). Cardiography.
9. Determination of acidic - the main state of the blood of the fetus. Opening of the fruit bubble. Amniotomy. Active management of childbirth.
10. Delvestigation of childbirth. Methods of painting of labor. Non-drug methods of kindness of childbirth.

Vaginal research is one of the important diagnostic methods detection of start and tracking for the process of childbirth, in determining the state and degree of cutting of the cervix, the state of the fetal bubble, insertion and promotion of the preemptive part of the fetus, the determination of the pelvis capacity, etc. The number of vaginal research should be strictly limited: in the first period of generations it is produced every 4 hours to maintain a partograph (WHO 1993 G.). Ideally, the first study is to have to establish the beginning of the birth (whether there is an opening of the cervix); The second study is carried out according to indications, for example, with an infringement of octoped waters, a decrease in the intensity and frequency of the uterus, with a premature appearance of the desire to be stirred, before conducting analgesia, etc., to clarify the obstetric situation, it is better to produce an additional vaginal research than to behave "in the blind".

Currently, around the world abandoned rectal research in childbirthSo it was found that the frequency of postpartum diseases was about the same as in a vaginal study (Crovvlher S. El Al, 1989)

Monitoring the flow of labor.

Observation of the course of childbirth based on observation external species Hoeers, its behavior, contractile activity of the uterus (fights), promotion of the pretepair of the fetus, the state of the fetus. The most accurate indicator of the progress of childbirth is the speed of the cervix. To track the dynamics of the opening of the cervix in the history of genera, it is necessary to have a sample of a partographic part-child and repeated. Analyzing the partial woman of the Giving Women, one can judge about the flow of childbirth (Friedman E.A., 1982; beazleyj.m., 1996). If the cutting speed of the cervix lags behind the control partogram, then you should try to find out the reason to compile a plan for further delivery. Most frequent reasons The slowing down of the cervix are the abnormalities of the generic activity (weakness, discord support), the clinical inconsistency between the size of the fetus head and the mother's pelvis. If a clinical inconsistency is suspected, X-ray detectivity is shown.

Some authors (Cardozo L.D. et al., 1982) for tracking the opening of the cervix spend cervicometry. Instrumental tracking of the cervix; This technique was not widely disseminated in practice.

Porto.

The pace of revelation of the cervix Depends on the contractile ability of MPETERIA, the resistance of the cervix and combination of these factors.

To evaluate the contractile activity of the uterus Tokography (hysterography) should be carried out, which allows with greater accuracy to estimate the intensity of bruses, their duration, the interval between the fights, the frequency of contractions.

Vaginal study of pregnant and feminine. Vaginal Research of Rozens Vaginal Study in Roers

Monitoring the flow of labor.

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