Physical examination

See chapter "Clinical methods of examination of pregnant women."

Laboratory research

· When taking a pregnant woman for accounting, a general analysis of blood and urine, determining the group and reserves-affiliation of blood, determining blood glucose levels.

· If there is a history of stillbirth, unbearable, extragnenital diseases follow:

Determine the content of hemolysins in the blood of pregnant;
- establish a group of blood and respess of the blood of a husband, especially when determining the negative res factor or blood group 0 (i) in pregnant women;
- conduct research for the presence of causative agents of urogenital infection by the method of quantitative PCrdiagnosty;

To determine the excretion of hormones, immunoresistance indicators, as well as all necessary studies for judgment on the presence and nature of the flow of extragenital diseases;
- for pregnant women with burdened obstetric, family and gynecological history papenetic consulting.

· In the future, laboratory studies are carried out on the following dates:

Common blood test - 1 time per month, and from 30 nd pregnancy - 1 time in
2 weeks;
- general urine analysis - every time visited;
- blood test on AFP, HCG - in 16-20 weeks;
- blood glucose level - at 22-24 and 36-37 weeks;
- Coagulogram - in 36-37 weeks;
- bacteriological (preferably) and bacterioscopic (required) study of the discharge from the vagina - in 30 weeks

· Screening infections (see Chapter "Infectious Screening"). Most infections are diagnosed during pregnancy, do not deserve special concern, as in most cases do not affect the course pregnancy, risk of intrauterine or intranatal infection. Therefore, those who lead a pregnant woman, it is important not to apply in relation to pregnancy unnecessary restrictions and not spend thoughtlessly available resources.

When taking a pregnant charter, a survey on syphilis (Vasserman reaction), hepatitis B and C, Vicinfection. In addition, microscopic, microbiological and cytological research is needed massels and scraps from the vagina and cervix for the detection of STIs (gonorrhea, trichomonosis, chlamydia).
- repeatedly conduct a survey on syphilis and HIV in 30 weeks and 2-3 weeks before delivery.

Additional research methods

· ECG is carried out by all pregnant women at the first turnout and in 36-37 weeks, if there are special readings - if necessary.

· Ultrasound during pregnancy produce three times: the first, to eliminate the pathology of the development of a fetal egg - on time up to 12 weeks; The second, with the aim of diagnosing an industrial complex - for a period of 18-20 weeks; Third - for a period of 32-34 weeks.

· Studying the clinical significance of additional ultrasound methods in the later period of pregnancy revealed increase in the number of cases of prenatal hospitalization and induced delivery without any improvement Exodues.

The feasibility of ultrasound in special clinical situations is proved:
- when determining the exact signs of vital activity or fetal death;
- when evaluating the development of the fetus with a suspicion of the SIR;
- in determining the localization of the placenta;
- confirmation of multiple pregnancy;
- an estimate of the volume of accommodation at suspicion of a lot or low;
- clarification of the position of the fetus;
- In some invasive interventions.

· KTG. There are no evidence of the feasibility of routine use of KTG in the antenatal period as additional testing of the well-being of the fetus during pregnancy. The use of this method is shown only when a sudden reduction of fetal movements or at prenatal bleeding.

· Evaluation of the fetal movement - a simple diagnostic method that can be used in a comprehensive assessment the state of the fetus in pregnant groups of high risk.

Subjective evaluation of fetal movement. Pregnant women need to offer informal observation fetal motels for self-control. Worsening the fetal movement during the day is an alarming symptom during pregnancy, which is necessary to report to the future mother at one of the first receptions (no later than 20 weeks) so that it can navigate and seek medical help.

Counting the number of fetal movements. Two different techniques are proposed, but there is no data about benefits one before the other.

- Mettodaka Cardiff: Starting from 9 am, a woman, lying or sitting, must concentrate on the movements of the fetus and fix how much time it goes to make the fruit 10 movements. If the fruit did not make 10 movements up to 9 evenings, a woman should contact a specialist to assess the state of the fetus.

- Garden technique: For one hour after receiving food, a woman should, if possible, lying, concentrate on the movements of the fetus. If the patient did not feel 4 moves for an hour, she follows fix them within the second hour. If two hours later, the patient did not feel 4 movements, it should contact a specialist.

The routine crime of fetal movements leads to a more frequent detection of reducing the activity of the fetus, more frequent use of additional methods for assessing the state of the fetus, to more frequent hospitalization pregnant women and to an increase in the number of induced labor. However, there is no data on the effectiveness of the calculation fetal movements to prevent the antenatal fetal death in the later dates.

Genetic analysis during pregnancy allows you to take care of the child's health. Read our article, and you will learn why to conduct a timely genetic analysis of the fetus and from which it can save, which genetic analyzes are recommended to pass during pregnancy and who necessarily need to pass them.

Examination and analyzes during pregnancy

Medical examination during pregnancy is important for mom and child. In the article you will learn about the features of visiting the gynecologist on trimesters, the importance of blood and urine tests, about the deadlines of the ultrasound, the concept of screening research of the fetus, its appointment, as well as cardiotokography.

Gynecologist

A visit to the gynecologist is necessary in every trimester of pregnancy.

First trimester

Third trimester

Inspection during pregnancy at the attending physician goes now 2 times a month. Coming to the gynecologist every 7 days is necessary from 37 weeks. The load on the body of a pregnant woman becomes quite strong, need more thorough control. A metabolic map is filled and decorated leave.

There were official obstetrics to the eighteenth century on the territory of our country. There were only obstacles and folk remedies. The situation changed the princess Golitsyn. She established the Foundation for the creation of a scientific school, thanks to which a manual for gynecologists appeared.

Visiting specialists

In the first two weeks after the first visit to the gynecologist, it is necessary to go to the therapist, an ophthalmologist, a dentist, a otolaryngologist, an endocrinologist and make an electrocardiogram.

Blood test

The doctor appoints analyzes during pregnancy for weeks, directing the patient for blood delivery. When registering, it is necessary to make a complete blood test. At 30 weeks it will need to repeat.

A complete blood test includes the following:

1. On sugar. During pregnancy, the possibility of the development of diabetes increases, since the pancreas is experiencing an increased load.
2. General analysis. The fence is made of finger. Blood to pass in the morning. Before going to the hospital is not. Shows the dynamics of changes in blood composition. In terms of hemoglobin, you can see how the fruit is provided with oxygen. It is carried out monthly.
3. On coatability. Determines the tendency to bleeding and thrombam.
4. Resh factor, blood type.
5. On HIV, hepatitis, syphilis.
6. Torch infection. It is rubella, herpes, toxoplasmosis, cytomegalovirus. The risk of the intrauterine abnormalities of the fetus due to these diseases increases. With the help of blood test on antibodies, they are excluded.

Blood on sugar is examined in addition to 19 weeks. Syphilis is excluded at 38 weeks again. Fresh result is needed in the maternity hospital.

Analyzes from vagina

Analyzes from the vagina include the following:

1. The smear takes up to 12 weeks, for 30 and 36 weeks. Explore the microbial flora of the vagina. Reveal inflammation.
2. Sowing from the vagina on the STD (chlamydia, mycoplasma).

Analysis of urine

You need to donate urine before every visit to gynecology. This is done in the morning on an empty stomach. It is important to use clean containers to collect. Watching the kidney work, the condition of the bladder.

Cardiotokography

Cardiotokography will help to conduct a fruit survey during pregnancy. Check the heartbeat and the frequency of the child's movements. The doctor also defines the tone of the uterus, its contractile activities.

Allows you to find out the rate of blood flow of the uterus, umbilical cord and placenta to understand whether the baby receives oxygen and nutrition. It is held on the period of 34-35 weeks.

Screening

It is important to conduct screening research during pregnancy for weeks, clearly fulfilling the prescriptions of the doctor. Otherwise there is a possibility of an erroneous result.

The first screening is held at the end of the third month of pregnancy. Make blood test, revealing possible violations in the development of the child. The degree of risk of development in the baby genetic anomalies shows ultrasound.

On July 18-19, the second screening is carried out. Take blood and explore the level of proteins indicating certain diseases: HCG, AFP, free estriol. This triple test makes it possible to eliminate chromosomal disorders and developmental deviations.

The doctor appoints the third screening of 33 weeks. With the help of ultrasound research looks at the development of limbs, internal organs, the fetus size.

Ultrasound

Ultrasound is also held in trimesters:

• First trimester. Ultrasound is carried out within the screening. Also watch the place of attachment of the placenta, the period of pregnancy.
• Second trimester, 22 weeks. The state of the placenta, the development of the kid organs, the number of accumulating water, floor.
• Third trimester. As part of screening at 33 week.

A couple of weeks before the end of the pregnancy, the last ultrasound do. Determine the quality of the placenta, the position of the child and the umbilical cord.

The development of ultrasound in medicine was preceded by the development of metal defectoscopes of metal. With their help, in the thirties, the integrity of military equipment buildings were checked.

Surveys and tests during pregnancy occupy a lot of time. A young and active future mother of his and so little. But the planned examinations of the gynecologist and other medical manipulations are necessary, as they allow you to control the condition of the baby and moms.

Perceive "Camping in Doctors" How care for the future child. This thought will build a minute of expectations conducted in hospital corridors.

Compeced two strips on pregnancy test showed that yes, it happened. You are pregnant. And, the world for you, immediately, has changed dramatically into two steps to pregnancy and after. You started listening to yourself, to identify additional confirmation of pregnancy. But, together with a pleasant and joyful news, it comes to the realization that now you have to do a significant part of your personal time to spend not for your favorite classes and hobbies, but in medical institutions to visit numerous medical rooms there.

Not all visits are pleasant for a woman, but without them it is impossible to do without them. Sometimes it is unwittingly becoming a witness of various conversations in the circle of giving birth and pregnant women. Some rejoice that the procedures during pregnancy were not enough, the other do not make sure that they were tortured to fulfill all the prescriptions of their attending physician. Is there a Golden Middle?

Getting ready for the first inspection

The first pregnancy will take place with the use of a gynecological chair. Little to some of the women like a procedure for the soul, but there is nowhere to go and therefore, to reduce the percentage of unpleasant sensations, you should prepare for him in advance. It is necessary to make calendar marks when you were monthly in case you were not pregnant.

Agree to do it easy, especially with a regular cycle. Therefore, directly these days a visit to the doctor do not plan, as they are considered critical periods, and therefore dangerous, for the development of pregnancy. Also postpone the ultrasound and medical examinations, if, of course, you are not bothering you, until the eighth week, counting from the first day of the last menstruation.

Before visiting the medical institution, take a bath or shower, put on fresh underwear. Especially to be folded, and even more so it is not necessary to drain. The doctor must examine the state of your vagina in the usual condition. The use of perfumes and intimate deodorants is not recommended. They are often the cause of an allergic reaction, regarding the doctor as inflammation.

Most women in front of a visit to the doctor are caught crotch. But, is it necessary to do it? No, optional. The doctor, of course, is not always convenient to make an inspection of a woman with excess on the outer genitals by the hairproof, but if you do not regularly do it, it is not worth it, because this intimate process can lead to severe skin irritation.

Be sure to empty the bladder. During the inspection, the doctor should evaluate the condition of the internal genital organs, and not an excessively filled bladder. In addition, the intestine should also be empty. Sexual contacts should be excluded per day until a visit to the doctor. This is explained by the fact that the vagina after sexual act remains a small span of a seed fluid that distorts the results of the analysis. Of course, a long queue is sometimes for a gynecologist, therefore, it will not be superfluous to visit the toilet.

What you will be dressed also plays an important role. You should be comfortable, but you must and quickly undress or free the chest at the reception at the gynecologist. Socks or slippers will not be superfluous so that you do not go barefoot on the cold floor to the gynecological chair. Take your towel, despite the fact that the gynecologist will offer you a paper.

It will also be desirable and acquiring a disposable gynecological set so that you will not be tormented by the thoughts about the conscientiousness of the sterilization of the medical staff tools for inspection. By the way, they are inexpensive and, as a rule, are sold in most pharmacies. In the set: plastic mirror, intended for inspecting the cervix, sterile gloves, special brushes or wands for the collection of material for analysis, necessarily a disposable film replacing a towel.

Before the inspection itself is preceded by a preliminary conversation of a doctor with a patient, pressure measurement, then inspection on a couch and weighing. Leave some recommendations for women. Leave your shoes in front of a separate viewing room if there is such. Ask the midwife or a doctor, where it is possible to undress to unstable do not put clothes on the battery or sterile table.

Understand slowly, during this time the medical staff will fill the necessary documents.

Bear to slippers or put on the socks, put a towel or film on the chair so that it comes with the edges, but did not breathe with it. Close the chair slowly along the steps and take such a position so that the buttocks are on its very edge. Further, on the stands on the chair on the chair, place your legs, while the slingshots should be fixed in the patented jamb.

If the design of the chair is not familiar with you, ask about it, not embarrassed, in the gynecologist. Try to relax and calm down, while putting your hands on the chest. Consider what the doctor does not follow. It aggravates the unpleasant feeling and makes it difficult to inspect. About everything that interests you, you can ask the doctor after inspection.

What does 1 inspection with pregnancy?

The examination begins, as a rule, from inspection in a woman of outdoor genital organs. At the same time, the doctor professionally estimates the condition of the skin and mucosa, the clitoris, large and small sexual lips, necessarily the outer opening of the urethra.

The doctor also examines the inner surfaces of the thighs, allowing pre-predetermined varicose veins in advance, sections of rash or pigmentation elements. It is observed in obligatory and the area of \u200b\u200bthe rear passage for the presence of cracks and hemorrhoidal nodes, other pathologies.

The second stage is the inspection in the mirrors. Several is directed mainly to identify certain diseases of the vagina or determines the state of the cervix. There are mirrors of two species: fabric and slad. The introduction of the mirror turns out to be the most unpleasant procedure during the inspection.

The nature of the sequel from the cervix is \u200b\u200bgiven for more attention. Blood secretions indicate the risk of abortion. The infection speaks an unusual discharge smell and if they are muddy.

Required analyzes

The smear on the flora turns out to be the first analysis when registering during pregnancy. The doctor, a special spoon, "scursts" from the channel of the cervix, the urethra, vagina - substate and causes it on the glass. The material is subjected to a study in the laboratory under the microscope.

With this analysis, the presence of an inflammatory process is revealed, and some types of infection are identified, namely: gonorrhea, candidiasis, fungal, bacterial vaginosis, trichomoniasis.

The smear on the flora, during the whole of the baby tooling, is repeated 3-4 times, even in the case of its positive results.

Such periodicity is explained by the fact that during pregnancy "wake up" for a long time forgotten and do not allow themselves to know infections. An example is candidiasis, occurring in women during pregnancy, 2-3 times more often. The woman's body is rebuilt, which leads to an increase in the level of female genital hormones. The vaginal environment becomes more acidic, in which Claim feels excellent.

It should be noted that hormonal changes reduce the cellular immunity and the activity of leukocytes, which leads to reinforced reproduction in the genital paths of the pregnant woman of this fungus. The number of microorganisms is higher than the longer the term of pregnancy. Therefore, candidiasis is stiguously worried about future mothers in the last trimester.

A cytological study is a second mandatory analysis, in which the characteristics of the structure of the surface cells and the cervical cervical channel are investigated. Takes the smear with a special tool - brush or spatula. Analysis is important for detecting oncological diseases in the early stages. During pregnancy, it is extremely necessary, because the pregnancy itself only aggravates the course of such diseases. Cytological smear, directly taken from the vagina arch, is important for analysis.

Allows you to properly evaluate its hormonal status in a woman, determine disorders in the royal and placental blood flow or to predict the risk of abortion.

In many women's consultations, in recent years, pregnant women in infections are examined, which are transmitted by sexual. At the first visit, such an analysis does not take, usually when a survey on the chair is re-examined.

The doctor will also appoint a mandatory and urine. By the way, it gives up during the first visit to the female consultation, and the analysis itself is most frequent due to the fact that the kidneys may not cope with the increased load during pregnancy. Blood from veins are taken to determine the blood type and rhesus. Also, with the help of this analysis, malignant changes are detected.

Determined by blood test and hemoglobin levels. Its low level, in addition to the poor health of a woman, leads to a violation of the course of pregnancy. To increase the level of hemoglobin, iron preparations are shown. But, women in the early stages, these drugs are carried out bad due to toxicosis. Therefore, proper nutrition is recommended as substitution. It is necessary to identify the presence of antibodies to rubella and other infections: herpes, cytomegalovirus.

With the first inspection, the doctor will also ask for the health of your husband. It will find out his age, the presence of hereditary diseases, blood group and. Anamnesis of relatives will also be collected, and on both sides. With hormonal, exchange and hereditary diseases, other additional surveys will naturally be appointed.

Inspection with hands

After inspection with the help of the mirror, a two-handed vaginal study is carried out. In this regard, the doctor determines the situation, the size and state of the uterus, ovaries, uterine pipes. For this, the doctor breeds the big sex lips with his hands and enters the medium and index fingers of the right hand in the vagina. Left hand falls on the belly. In this case, the state of the vagina is estimated: the tensile walls, the width of the lumen, the presence of partitions, tumors, scars and other pathological conditions affecting the course of pregnancy and subsequent birth.

Next, the doctor examines the cervix and establishes its value, form, location, consistency. The neck of the uterus during the normal course of pregnancy is rejected back, its length is over 2 cm, tight to the touch, the channel for the finger is not passing. In case of interrupting pregnancy, the neck softened, shortening, shifts to the center, while the channel is revealed. An experienced gynecologist to assess the state of the neck is enough to touch it.

Further, the doctor is feeling the uterus, the value of which, most often, corresponds to the period of pregnancy. But, if a woman is diagnosed by the Mioma of the uterus, she expects twins, the third or fourth time is pregnant, with some gynecological diseases, then the size of the uterus may be greater. The doctor also draws attention to the form and consistency of the uterus. When pregnancy, the uterus is softer than in the usual state. The softening of the part of the uterus is especially observed, which is closer to the neck.

Various irregularities in the uterus are often a sign of various anomalies for the development of uterus or misa. The uterus is movable on a small time and in a small pelvis occupies the average position. In the event of limiting its mobility or deviation to the side, this indicates an inflammatory disease of the appendages of the uterus or adhesive process. Next to examine the doctor are ovaries and uterine pipes to eliminate ectopic pregnancy, in which the inspection is painful. At the end of the inspection, the doctor feels the inner surface of the symphysis, the sacrum, the side walls of the pelvis.

As you can see, nothing terrible at the first visit is not a doctor, so feel free to go - this is important for your further pregnancy.

All pregnant women should regularly undergo a doctor of an obstetrician gynecologist. This will allow you to detect starting complications in time and prevent their consequences for mom and baby.

To get to the doctor's reception, it is best to register in a female consultation or conclude a contract for pregnancy. We do not recommend that you walk from the case of the case in a private center, because doctors in them usually do not bear any responsibility for you.

The frequency of visits

From the moment of registration or contract conclusion and up to 12 weeks of pregnancy, the doctor's inspection is necessary once a month.
From 13 to 28 weeks - once every three weeks.
From 29 to 36 weeks - once every two weeks.
From 36 weeks to childbirth - a weekly inspection.

Before each visit to the doctor, you must pass urine analysis.

What does the doctor do on inspection

• Growth measurement - It is carried out at the first visit. It is necessary to calculate the body mass index.
• Weighing - It is carried out at each inspection. By weight gain, the doctor determines whether the pregnancy is normally proceeded and there are no hidden edema.
• Measuring blood pressure (Hell) and pulse - at each reception. It makes it possible to detect dehydration with a strong (drop of blood pressure) or the beginning of the late toxicosis (an increase in hell over 140/90 mm Hg)
• Measuring pelvis - It is carried out on the first inspection. Individually shows the width of the pelvis, since the thickness of the bones also affects the width of the gene channel. If doubt, the Solovyov index is used: wrist circumference in centimeters. If it is more than 14, then the thickness of the bones is considered a big, and the generic canal with the same external sizes of the pelvis will already be.
• Palpation (Turning) Belly - It is carried out at each reception. With her, the doctor can find out if the tone of the uterus (threat of miscarriage), as is the fruit, what is his preview.
• Internal inspection - It is carried out in the first reception, in the future, according to the indications (for example, with pain and bloody discharges). The doctor introduces his hand into the vagina and determines the state of the uterus and cervix. In some cases, a small disclosure is already determined by 28 weeks and may cause.
• Vagina smear - It takes at the first visit and in 36-37 weeks. With the help of it, you can identify infectious diseases and determine the "cytotype of the smear" - a sign of the stage of readiness for childbirth.
• Measurement of the circumference of the abdomen - Starting from 14-15 weeks and further with each inspection.
• Measuring the height of the bottom of the uterus - From the climb to the upper edge of the uterus, measured on each inspection after 14-15 weeks.
• Listening to the palpitation of the Future - Usually starting from 14-15 weeks when it is heard to a regular obstetric stethoscope. Doppler stethoscope (electronic) can be heard the heartbeat before. This gives very important information about the state of the child.
• - Make starting from 30-32 weeks and further by testimony. In other words, the doctor can direct you to the CTG at any time as soon as it suspects something with a child.

If you are late

What if you are late or can't come to the reception? We must definitely call the female consultation and report this to the doctor. Cards of patients The doctor puts on the shelves to the corresponding numbers of appearance, while being late or canceled turnout you will be transferred to another number.
If you can't come because of bad well-being, then call ambulance, the doctor will examine you and take the hospital if necessary.

Survey of pregnant and girlfriend

The survey of pregnant and feminine is carried out by a specific plan. The survey consists of a common and special part. All data obtained is in a map of pregnant or in the history of childbirth.

General anamnesis

- Passport details : surname, name, patronymic, age, place of work and profession, place of birth and residence.

- The reasons forcing the woman to seek medical help (complaints).

- Working conditions and life.

- Heredity and transferred diseases. Hereditary diseases (tuberculosis, syphilis, mental and oncological diseases, multiple pregnancies, etc.) are of interest because they can have an adverse effect on the development of the fetus, as well as intoxication, in particular, alcoholism and drug addiction in parents. It is important to obtain information about all infectious and noncommunicable diseases and operations transferred in early childhood during puberty and in adulthood, their flow and methods and treatment time. Allergic. Transferred hemotransphus.

Special anamnesis

- Menstrual function: the occurrence of menarche and the establishment of menstruation, the type and nature of menstruation (3 or 4-week cycles, duration, the amount of lost blood, the presence of pain, etc.); whether menstruation changed after the start of sexual life, childbirth, abortion; Date of the latter, normal menstruation.

- Secretor function : character of the discharge from the vagina, their number, color, smell.

- Sexual function: from what age is the beginning of a sex life, what a marriage in the account, the duration of marriage, the period from the beginning of sexual life before the first pregnancy, the time of the last sexual intercourse.

- Age and health husband.

- Children's (generative) function. In this part of the history collect detailed information about previous pregnancies in the chronological sequence, which is a real pregnancy, the course of previous pregnancies (there was no toxicosis, gestosis, diseases of the cardiovascular system, kidneys, liver and other organs), their complications and an outcome. The presence of these diseases in the past encourages especially carefully to watch the woman in real pregnancy. It is necessary to obtain detailed information on the flow of transferred abortions, each childbirth (duration of childbirth, operational interventions, floor, mass, the growth of the fetus, its condition at birth, the time of stay in the maternity hospital) and postpartum periods, complications, methods and timing of their treatment.

- Transferred gynecological diseases : time of occurrence, duration of the disease, treatment and outcome

- The course of real pregnancy (in trimesters):

- 1Trimetter (up to 12) - common diseases, complications of pregnancy (toxicosis, threat of interrupts, etc.), the date of the first appearance in the female consultation and the period of pregnancy, established at the first appeal.

2 trimester (13-28 weeks) - common diseases and complications during pregnancy, weight gain, arterial pressure numbers, test results, date of the first fetal movement.

3 trimester (29 - 40 weeks) is a total increase in weight for pregnancy, its uniformity, the results of blood pressure measurements and blood and urine tests, diseases and complications of pregnancy. Causes of hospitalization.

Determination of childbirth or pregnancy terms

General objective examination

A general objective study is carried out in order to identify diseases of the most important organs and systems that may complicate the course of pregnancy and childbirth. In turn, pregnancy may cause aggravation of existing diseases, decompensation, etc. An objective study is carried out according to the generally accepted rules, starting with the assessment of the overall state, temperature measurements, inspection of the skin and visible mucous membranes. Then they examine the blood circulation, respiration, digestion, urinary, nervous and endocrine systems.

Special obstetric examination

Special obstetric examination includes three main sections: outdoor obstetric study, internal obstetric study and additional research methods .

Outdoor obstetric study

Outdoor obstetric research is produced by inspection, measurement, palpation and auscultation.

Inspection Allows you to identify the correspondence of the type of pregnant age. At the same time, pay attention to the growth of women, the physique, the condition of the skin, subcutaneous tissue, the mammary glands and nipples. Special attention is paid to the magnitude and shape of the abdomen, the presence of abortion scars (Striae Gravidarum), the elasticity of the skin.

Study Taza It is important in obstetrics because its structure and dimensions have a decisive effect on the course of generation of labor. Normal pelvis is one of the main conditions for the right flow of childbirth. Deviations in the structure of the pelvis, especially the decrease in its size, make it difficult for labor or represent irresistible obstacles for them. The study of the pelvis is produced by inspection, palpation and measuring its size. In case of inspection, pay attention to the entire pelvis area, but the lumbar rhombus is made of particular importance (Romble Mikhailisa). Mikhailisa Romby call the outline in the field of the sacrum, which have contours of a diamond area. The upper corner of the rhombus corresponds to an accelerable process of V lumbar vertebra, the lower - the tip of the sacrum (the place of the fatal of large butorous muscles), the side angles - the upper-back essays of the iliac bones. Based on the shape and size of Rhomb, the structure of the bone poles can be estimated, detecting its narrowing or deformation, which is of great importance in conducting birth. With a normal basin, the rhombus corresponds to the form of a square. Its dimensions: horizontal diagonal Roma is equal to 10-11 cm, vertical - 11 cm. With different thase narrowes, the horizontal and vertical diagonal will be of different sizes, as a result of which the rhombus shape will be changed.

In the outdoor obstetric measurement study, the measurement is made by a centimeter ribbon (the circumference of the ray-tank joint, the dimensions of the Mihaelis rhombus, the circumference of the abdomen and the height of the bottom of the uterus above the Lone) and the obstetric circulation (pyaseomer) in order to determine the size of the pelvis and its shape.

Santimeter tape measure the greatest circumference of the abdomen at the navel level (at the end of the pregnancy it is 90-100 cm) and the height of the uterine bottom is the distance between the upper edge of the Lonnoye and the bottom of the uterus. At the end of the pregnancy, the standing height of the uterus is 32-34 cm. Measuring the abdomen and standing height of the bottom of the uterus over Lone allows Akuster to determine the term of pregnancy, alleged weight of the fetus, identify violations of fat metabolism, multiplodes.

According to the outer sizes of a large pelvis, one can judge the magnitude and shape of a small pelvis. Measuring the pelvis is produced by a pazer. Only some sizes (pelvis output and additional measurements) can be made of centimeter tape. Typically measure four pelvis size - three transverse and one straight. The surveyed is in the position on the back, the obster sits on the side of her and face to her.

Distantia Spinarum - The distance between the most remote points of the front axles of the iliac bones (Spina Iliaca Anterior Superior) is 25-26 cm.

Distantia cristarum - The distance between the most remote spheres of iliac bones (Crista Ossis Ilei) is equal to 28-29 cm.

Distantia TroChanterica. - The distance between large skewers of the femoral bones (TroChanter Major) is equal to - 31-32 cm.

Conjugata Externa. (Outdoor conjugate) - The distance between the oestic process V of the lumbar vertebra and the upper edge of the LONA joint is 20-21 cm. To measure the outer conjugate, the examined turns on the side, the underlying leg bends in the hip and knee joints, and the overlying pulls. The thazomer button is put between an awesome thoroughfone V of the lumbar and I sacrive vertebra (surplus yam) and in the middle of the top edge of the Lonnoy Jimmer in front. The exterior conjugate can be judged by the size of true conjugates. The difference between the outer and true conjugate depends on the thickness of the sacrum, symphiz and soft tissues. The thickness of the bones and soft tissues in women is different, so the difference between the size of the outer and true conjugate does not always exactly correspond to 9 cm. To characterize the thickness of the bones, measure the circle of the ray-tank joint and the Soloves index (1/10 from the circle of the ray-tank joint). Thin are considered to be bones if the cooling joint is up to 14 cm and thick if the cooling joint is more than 14 cm. Depending on the thickness of the bones with the same outer sizes of the pelvis, its internal dimensions can be different. For example, with an outer conjugate, 20 cm and the Solovyov circle 12 cm (Solovyov - 1,2 index) should be obtained from 20 cm. Subscribe 8 cm and we obtain the value of the true conjugate - 12 cm. At the Solovyov circle 14 cm, it is necessary to subtract 9 cm from 20 cm, and At 16 cm, subtract 10 cm, the true conjugate will be equal to 9 and 10 cm, respectively.

About the magnitude of true conjugates can be judged the vertical size of the sacrum rhombus and frank size. True conjugate can more accurately determine in diagonal conjugate .

Diagonal conjugate (Conjugata Diagonalis) Call the distance from the lower edge of the Symphysia to the most outstanding point of the Cape of the sacrum (13 cm). The diagonal conjugate is determined with a vaginal study of a woman who produce with one hand.

Straight output size pelvis - It is the distance between the middle of the lower edge of the Lonnoye and the top of the tailbone. During the examination, pregnant lies on the back with divorced and semi-bent in the hip and knee joints. Measurement is carried out with a pazer. This size equal to 11 cm, more than a true 1.5 cm due to the thickness of soft tissues. Therefore, it is necessary to subtract 1.5 cm from the figures obtained 11 cm, we obtain the direct size of the exit from the cavity of a small pelvic, which is 9.5 cm.

Transverse pelvis exit - It is the distance between the inner surfaces of the stacked bumps. The measurement is carried out by a special pazer or a centimeter tape, which are applied not directly to the collapsed grouse, but to the tissues covering them; Therefore, it is necessary to add 1.5-2 cm to the resulting dimensions of 9-9.5 cm (thickness of soft tissues). Normally, the transverse size is equal to 11 cm. It is determined in the pregnant position on his back, her legs as much as possible to the stomach.

Oblique sizes of the pelvis it is necessary to measure inquosic pelvis. To detect asymmetry, the pelvis is measured by the following oblique dimensions: the distance from the front axle side of one side to the rear axes of the other side (21 cm); From the middle of the top edge of the Symphysia to the right and left-fledged ostera (17.5 cm) and from the surplus fossa to the right and left reserved ostery (18 cm). The sizes of one side are compared with the corresponding sizes of the other. With the normal structure of the pelvis, the magnitude of the paired sizes is the same. The difference exceeding 1 cm indicates the asymmetry of the pelvis.

Side sizes of the pelvis - The distance between the reserved and the asses of the iliac bones of the same side (14 cm) is measured by its pazer. Side sizes should be symmetrical and at least 14 cm. With a lateral conjugate 12.5 cm, childbirth is impossible.

Taste angle - It is the angle between the entrance plane in the pelvis and the plane of the horizon. In the pregnant position, it is equal to 45-50° . Determine with the help of a special instrument - a pelvic.

In the second half of pregnancy and in childbirth, the head, the back and small parts (limbs) of the fetus are determined during palpation. The larger the term of pregnancy, the more clear palpation of the parts of the fetus. Tests of outdoor obstetric study (Leopold-Levitsky) is a consistently conductive uterine palpation, consisting of a number of certain techniques. The survey is in the back position. The doctor sits to the right of her face to her.

First reception of outdoor obstetric studies. The first taking determine the height of the bottom of the uterus, its shape and part of the fetus, located in the bottom of the uterus. For this, the obster palm surfaces of both hands has in the uterus in such a way that they cover its bottom.

The second reception of the outdoor obstetric study. The second reception is determined by the position of the fetus in the uterus, position and type of fetus. The obstever gradually lowers his hands from the bottom of the uterus on the right and left side of her and, gently pressed the palms and fingers of the hands on the side surfaces of the uterus, determines the back of the fetus on one side along its wide surface, on the other - small pieces of the fetus (knobs, legs). This technique allows you to determine the tone of the uterus and its excitability, forgive the round bundles of the uterus, their thickness, soreness and location.

The third reception of the outdoor obstetric study. The third reception is used to determine the prerequisite part of the fetus. Third reception you can determine the mobility of the head. For this, one hand covers the predatory part and determine the head is or a pelvic end, the symptom of running the fetus head.

The fourth reception of the outdoor obstetric study. This technique, which is a supplement and continuation of the third, allows you to determine not only the nature of the predatory part, but also the location of the head in relation to the entrance to the small pelvis. To perform this reception, the obstever becomes face to the legs of the surveyed, puts hands on both sides of the lower part of the uterus in such a way that the fingers of both hands seems to be with each other over the plane of the entrance to the small pelvis, and palprates the predatory part. When studying at the end of pregnancy and during childbirth, this technique determine the ratio of the preplaying part to the planes of the pelvis. During childbirth, it is important to find out in which plane the head pelvis is its largest circumference or a large segment. The big segment of the head is the greatest a part that passes through the entrance to the pelvis with this preview. When the head of the largest segment, the border of its large segment will be held along the line of small oblique size, with the front-head preview - along the line of its right size, with a frontal presence - along the line of a large sized size, with a facial preview - along the vertical size line. A small head segment is called any part of the head below the large segment.

The degree of head insertion is a large or small segment judged by Palpation. With the fourth outer taking, the fingers are promoted deep into and slide on the head up. If the hands of the hands converge, the head is worth a large segment in the entrance to the pelvis or sank deeper if the fingers diverge - the head is in the inlet of a small segment. If the head in the pelvis cavity, it is not defined by outer techniques.

The cordial tones of the fetus are listened to the stethoscope, starting with the second half of pregnancy, in the form of rhythmic, clear blows, repeated 120-160 times per minute. With headsets, the heartbeat is best listened below the navel. With pelvic previews - above the navel.

M.S. Malinovsky proposed the following rules for listening to the fetal heartbeat:

With a tight preview - near the head below the navel on the side where the back is turned, with rear species - the abdomen from the front axillary line,

With a facial preview - below the navel from the other side where the breast is located (at the first position - to the right, with the second - left),

With cross position - near the navel, closer to the head,

When prepaying the puzzle end is the above navel, near the head, on the side where the back of the fetus is turned.

The study of the fetal heartbeat in the dynamics is carried out using monitoring and ultrasound.

Internal (vaginal) study

An internal obstetric study is performed by one hand (two fingers, index and middle, four-semi-head, with the whole hand). Internal study allows you to determine the predatory part, the state of the generic pathways, observe the dynamics of the cervical disclosure during childbirth, the mechanism of inserting and promoting the predatory part, etc. In the manufacture of a vaginal study is produced upon admission to a rowing room, and after influencing the accumulative waters. In the future, the vaginal research is carried out only by testimony. Such an order allows you to promptly identify the complications of childbirth and assist. Vaginal research of pregnant and feminine is a serious intervention, which must be carried out in compliance with all the rules of asepsis and antiseptics.

Internal research is beginning with an inspection of external genital organs (exhaust, development, edema of the vulva, varicose veins), perineum (its height, rigidity, the presence of scars) and the defects of the vagina. The vagina is introduced phalanxes of medium and index fingers and produce its survey (width of the lumen and length, folding and extensibility of the walls of the vagina, the presence of scars, tumors, partitions and other pathological conditions). The uterine must then find and determine its shape, value, consistency, the degree of maturity, shortening, softening, the location along the longitudinal axis of the pelvis, the patency of the throat for a finger. In the study in childbirth, the degree of smoothness of the neck (maintained, shortened, smoothed), the degree of disclosure of the oz in centimeters, the state of the edges of the oz (soft or dense, thick or thin). In the guinea in the vaginal study, the state of the fetal bubble (integrity, integrity disorders, the degree of voltage, the amount of the water) is found out. Determine the predatory part (buttocks, head, legs), where they are located (above the entrance to a small pelvis, in the entrance of a small or large segment, in the cavity, at the output of the pelvis). Summary points on the head are the seams, spring, on the pelvic end - the crushes and the tailbone. Palpation of the inner surface of the pelvis walls allows you to identify the deformation of its bones, exotic and judge the pelvic capacity. At the end of the study, if the predatory part is high, measure the diagonal conjugate (Conjugata Diagonalis), the distance between the cape (Promontorium) and the lower edge of the symphysis (normally 13cm). For this, the fingers entered into the vagina are trying to reach the cape and the end of the middle finger relate to it, the index finger of the free hand is supplied under the lower edge of the symphima and mark on the hand, which is directly contacts with the lower edge of the lane arc. Then remove the fingers from the vagina, wash them. The assistant measures the marked distance with a centimeter ribbon or a pazer. In terms of diagonal conjugates, you can judge the sizes of true conjugates. If a solovyov's index (0.1 from the Solovyov circle) to 1.4 cm, then 1.5 cm is subtracted from the size of the diagonal conjugate, and if more than 1.4 cm, then 2 cm are subtracted.

Determination of the position of the fetus head during childbirth

For first degree of extension of the head (front-head inlet) circle, which head will pass through the cavity of the small pelvis, corresponds to its direct size. This circle is a large segment with an optional insertion.

For second degree of extending (The frontal insert) of the greatest circle of the head corresponds to a large scythe size. This circle is a large head segment with its frontal insertion.

For third degree of extension of the head (Facial insert) is the greatest circumference corresponding to the "vertical" size. This circle corresponds to the large segment of the head in the face of its insertion.

Determining the degree of insertion of the fetus head during childbirth

The basis of determining the height of the head of the head during a vaginal study is the ability to determine the ratio of the lower pole of the head to Linea Interspinalis.

Head over the entrance to a small pelvis: With careful pressed finger, the head moves and returns to the original position. Palpation is available all the front surface of the sacrum and the rear surface of the pubic alphabet.

Head with a small segment in the entrance to a small pelvis: The lower pole of the head is determined by 3-4 cm above the Linea Interspinalis or at its level, the sacral collar is free on 2/3. The rear surface of the pubic symphiz is palpable in the lower and middle departments.

Head in the cavity of a small pelvis: The lower pole of the head is 4-6 cm below Linea Interspinalis, sedanistic astes are not determined, almost the entire sacrats of the catch is made by the head. The rear surface of the pubic symphima of palpation is not available.

Head on a pelvic day: The head performs all the sacrilate depression, including the area of \u200b\u200bthe tailbone, only soft fabrics are tested; The inner surfaces of bone identification points are difficult to access.