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The size of the pelvis in pregnant women. What is a narrow pelvis

The definition of the sizes of the pelvis is extremely important, since their decrease or an increase can lead to a significant impairment of the flow of labor. The size of a small pelvis, which are judged by measuring certain sizes of a large pelvis with the help of a special tool - Tazomer, are the greatest importance during childbirth. The definition of the size of a large pelvis is produced by a martine pelvomer (Fig. 6).

Fig. 6. Tazer Martin.

The pelviser has a circulation form equipped with a scale on which centimeter and semi-beacon divisions are applied. At the ends of the branches of the thazzomer there are spherical formations ("buttons"), which are applied to the protruding points of a large pelvis, a somewhat squeezing subcutaneous fatty tissue. To measure the transverse size of the outlet of the pelvis, a tazometer with intersecting branches is constructed.

The examined woman lies on his back on a solid couch with a broken and hipsted joints with their knees. The doctor becomes the right of a pregnant face to her. Tazomer branches are taken in such a way that the I and II fingers kept butt. The scale with divisions is drawn up. The points of the point, the distance between which is to be measured, pressing the branches of the pelvomer to be measured to be measured to them. The scale mark the value of the appropriate size.

Measure the transverse sizes of the pelvis (Distantia Spinarum, Distantia Cristarum, Distantia TroChanterica) and the outer conjugate pelvis - Conjugata Externa. (Fig. 7, 8).

Fig. 7. Measuring the transverse sizes of the pelvis (1 - Distantia Spinarum, 2 - Distantia Cristarum, 3 - Distantia TroChanterica).

1. Distantia Spinarum - the distance between the front axles of the iliac bones on both sides; This size is 25-26 cm.

2. Distantia cristarum - the distance between the most remote areas of the ridges of the iliac bones, this size is 28-29 cm.

3. Distantia TroChanterica. - the distance between big skewers of the femoral bones; This distance is 31-32 cm. (Fig. 9).

In a normally developed pelvis, the difference between the transverse dimensions of the large pelvis is 3 cm. The smaller difference between these sizes will be decreasing to deviate from the normal structure of the pelvis.

4. Conjugata Externa. - The distance between the middle of the ultra-level edge of the symphysis and the articulation of the V lumbar and I sacrive vertebrae. (Fig. 8).

To measure it, the woman should lie on the left side, bending the left foot in the knee and hip joints, and the right to hold stretched. The "button" of one branch of the thasomer is installed in the middle of the ultra-storey edge of the symphysia, the other end is pressed to the surplus fossa, which is under an oste-oestum of V lumbar vertebra, corresponding to the upper corner of the sacroy rhombus. It is possible to determine this point, gliding with your fingers on the masculous process of lumbar vertebrae down. The fossa is easily determined by the protrusion of the spiny process of the last lumbar vertebra. The outer conjugate is normal equal to 20-21 cm.


Fig. 8. Measurement of the outer conjugate.

The outer conjugate is important - according to its magnitude, it is possible to judge the size of the true conjugate (direct size of the entrance to the small pelvis).

To determine the true conjugate from the length of the outer conjugate, 9 cm are subtracted. For example, if the outer conjugate is 20 cm., Then the true one is 11 cm.

The difference between the outer and true conjugate depends on the thickness of the bones (sacrum, symphiz) and soft tissues. To determine the thickness of the bones in a woman, the corticle of the rastic joint (Solovyov index) is measured (Fig. 9).

Fig. 9. Measurement of the Solovyov index.

The average value is 14 - 16 cm. With a Solovyov index less than 14 cm. (Thin bones) The difference between the outer and the true conjugate will be less, therefore 8 cm are torn from the outer conjugate. At the Solovyov index more than 16 cm. (Thick bones) The outer and true conjugate will be larger, therefore it is taken from it 10 cm.

Example: The outer conjugate is 21 cm., Solovyov's index - 16.5 cm. What is the true conjugate? Answer: 21 cm. - 10 cm. \u003d 11 cm. (Norm).

You can also calculate the size of the true conjugate, measuring the diagonal (Fig. 10).

Fig. ten . Measurement of diagonal conjugates.

Digo-Nal conjugate - This is the distance between the lower edge of the Symphysia and the outstanding point of the cape. The easy accessibility of the Cape indicates a decrease in true conjugates. If the middle finger reaches a cape, then press the radial edge of the II of the finger to the lower surface of the symphysis, feeling the edge of the arcuate ligament of the pubis. After that, the director of the left hand mark the place of contact with the right hand with the lower edge of the alphabet. With a normally developed Taza, the super-rank of diagonal conjugates is 13 cm. In these cases, the cape is unattainable.

If the cape is achieved, the diagonal conjugate turns out to be 12.5 cm and me. Measuring the magnitude of the diagonal conjugate, the doctor determines the magnitude of the true conjugate. To do this, from the size of the diagonal conjugate, 1,5-2.0 cm are subtracted (this figure is determined taking into account the height of the symphysis, the level of the cape, the angle of inclination of the pelvis). The higher the symphiz, the greater the difference between the conjugates, and vice versa. With an altitude of a 4 cm altitude and more from the size of the diagonal conjugate, 2 cm are subtracted, with a summary height of 3.0-3.5 cm, 1.5 cm are subtracted. At an angle of inclination of the pelvis over 50 °, to determine the true conjugate from the size of the diagonal conjugate, subtract 2 See if the angle of inclination of the pelvis is less than 45 °, then 1.5 cm are subtracted.

There is another dimension of a large pelvis - side Kerner conjugate. This is the distance between the upper front and upper back of the iliac bones. Normally, this size is 14.5-15 cm. Its recommending it to measure inquiry and asymmetric pelvices. A woman with an asymmetric pelvis has an absolute magnitude of the side conju-gas, but a comparison of their sizes on both sides.

If, when examining a woman, a suspicion of the pelvis arises, then determine the size of the output plane.

The size of the output of the pelvis is determined as follows. A woman lies on his back, legs bent in hip and knee joints, diluted and tightened to the stomach.

Direct output plane size Measure the usual pybeomomer (Fig. 11-a). One "button" thazomer is pressed to the middle of the lower edge of the symphysis, the other - to the top of the tailbone. In the normal pelvis, the direct size of the outlet plane is 9.5 cm.

Fig. 11. Measurement of transverse (A) and direct (b) dimensions of the plane of the entrance into a small pelvis.

Transverse size plane outlet(Fig. 11-b) - the distance between the inner surfaces of the seeded bones is to be measured quite difficult. This size is measured by a centimeter or a baser with crossed branches in the position of a woman on the back with the legity given to the belly. 1.5 cm is added to the obtained size. Normally, the transverse pelvis size is 11 cm.

In the same position of a woman to evaluate the features of a small pelvic. With normal sizes and the shape of the pelvis, the angle is more than 90 degrees.

Indirect signs of the right physique and normal pelvis are the forms and size of the sacrum rhombus (Roma Michaelis)(Fig.12).

Fig. 12. Romble Michaelis (A - general view: 1 - deepening between the asset processes of the last lumbar and the first sacrilament vertebrae; 2 - the top of the sacrum; 3 - the ass of the ileal bone; 6 is the form of rhombus Michaelis with a normal pelvis and various bone pelvic anomalies (scheme ): 1 - Normal pelvis; 2 - flat pelvis; 3 - a general-level pelvis; 4 - a cross-like pelvis; 5 - Square Taz).

The sacral rhombus prevents the platform on the back of the sacrum. In women with a normally developed pelvis, the form approaches its square, all sides of which are equal, and the corners are about 90 °. Reducing the vertical or transverse axis of rhombus, the asymmetry of its half (upper and lower, right and left) indicate anomalies of the bone pelvis. The top corner of the rhombus corresponds to an acmost vertebrae v. Side angles correspond to the sudden absenteeic bones, the lower angle is a verbal sacrum (sacring cochochie articulation).

The size of the rhombus is measured by a centimeter ribbon. Normally, the longitudinal size is 11 cm., Transverse - 10 - 11 cm. Dimensions of long rhombus Mikhailis correspond to the size of the true conjugate.

Questions for self-control

1. What instrument measure the size of the female pelvis?

2. List the 4 basic pelvis size.

3. How to measure Distantia Spinarum? What is this size equal?

4. What is the Distantia Cristarum?

5. How to measure the interstate size (Distantia TroChanterica)?

6. How to measure the outdoor conjugate? What position should a woman be?

7. For what purpose and how is the Solovyov index measured?

8. What is the side conjugate? What is the purpose of measuring it?

9. How to measure the direct and transverse dimensions of the exit from a small pelvis? What are they equal?

10. What is a rhombus Michaelis? What form does it have?

11. Name 3 methods for calculating true conjugates.

12. How to measure the diagonal conjugate? What is it equal to?

  1. Distantia Spinarum - the distance between the front-upper essays of the iliac bones is 25-26 cm.
  2. Distantia Cristarum - the distance between the remote points of the ridges of the iliac bones is 28-29 cm.
  3. Distantia TroChanterica - the distance between large skewers of the femur bone, normally 30-31 cm.
  4. Conjugata Externa (outer conjugate, direct pelvis size) - distance from the middle of the upper-outer edge of the symphysis to the Nadcrest fellows, which is between an awesome void vertebrae process and the beginning of the middle sacrilate ridge (coincides with the top corner of Mikhaelis Roma), is 20-21 cm.

Sizes of small pelvis

1. The plane of the entrance to the pelvis is limited to the upper edge of the symphysis, the upper-inner edge of the pubic bones (in front), arcuate lines of the iliac bones (from the sacrifice), sacral cape (from behind). This boundary between large and small pelvis is called the border (nameless) line.

  • Conjugata Vera (True conjugate, the direct size of the entrance to the small pelvis) is the distance from the inner surface of the symphima to the Cape of the sacrum; To determine the true conjugates from the size of the outer conjugates, 9 cm are subtracted. A normal conjugate is 11 cm.
  • Anatomical conjugate is the distance from Cape to the middle of the upper inner edge of the symphysis (11.5 cm).
  • The transverse size is the distance between the most distant dots of arcuate lines (13-13.5 cm).
  • Kosy dimensions are 12-12.5 cm. Right oblique size is the distance from the right sacrator to the left ilio-pubic elevation (Eminentia iliopubica). The left braid size is the distance from the left sacrum-iliac connection to the right iliac lobby (Eminentia iliopubica).

2. The plane of a wide part of the pelvis cavity is limited to the middle of the inner surface of the symphysis (front), the middle of the godded depression (from the sides) and the connection site of the II and III of the sacral vertebrae (rear).

  • The straight size is the distance from the compound II and III of the sacral vertebrae to the middle of the inner surface of the symphysis, is 12.5 cm.
  • The transverse size is the distance between the middle of the accumulative depression (12.5 cm).

3. The plane of a narrow part of the pelvis cavity is limited by the lower edge of the symphysis (front), the absenteeic bones (from the sacrifice) and the sacring bones (from the back),

  • The straight size is the distance from the sacratling of the cockerel to the lower edge of the symphysis (11-11.5 cm).
  • The transverse size is the distance between the absenteeic bones (10.5 cm).

4. The plane of the outlet of the pelvis is limited to the lower edge of the symphysis (front), sedanistic shoots (from the sides) and the top of the tailbone (rear).

  • The straight size is from the top of the tailbone to the lower edge of the symphysis (9.5 cm). When the cipper is discharged during the birth - 11.5 cm.
  • The transverse size is the distance between the internal surfaces of the sciatic bugs (11 cm).

Sleep rhombus

During the examination, the pelvis draws attention to the sacral diamond (rhombus of Michaelis) - the platform on the back of the sacrum. Borders: the upper angle is the deepening between the spiny process V of the lumbar vertebra and the beginning of the middle sacrilate crest; Side angles - the ass of the ileal bone; Nizhny - the tip of the sacrum. On the top and outside the rhombus are limited to the protrusions of large spine muscles, from the bottom and outside - the protrusions of the jagged muscles.

When the spine is curvatched to the sides (scoliosis), the distance from the curved area of \u200b\u200bthe spine to the plumb is measured by a ruler (according to S. Ya. Mikladze).

When examining the rear surface of the body, the surveillance of spine processes of vertebrae. The line corresponding to the masculine processes is presented in the form of a furrow walking along the midline along the back. In the sacral region, this groove goes into a deepening, which gradually expands and takes the form of Roma Michaelis (Fig. 10).

Fig. 10. Romble Mikhailis.

The dotted line is the line connecting its stupid angles, the cross is the top corner of the rhombus (the point where the cycling button is placed when measuring the outer conjugates).

Mikhailis rhombus from above and outside the protrusions of Mm. ERECTORES TRUNCI (Seu Longissimi Dorsi). Both lateral stupid angle correspond to the rear top of the iliac bones (Spinae Posterior Superior Ossium Ilei).

The lower borders correspond to the lower edges of the sacral bone, and the lower sharp angle is its top.

Lower rhombuses are limited to the protrusions of the jagium muscles. On the surface of this rhombus, you can adversely with the most sacral vertebrae vs. There is a bunch between these protrusions, which, when measuring the outdoor direct size, pelvis put one of the circular legs. However, the acute processes are not always determined clearly even with a sharp flexion of the blasting of the shock. In this case, a horizontal line is carried out at the level of the aspric iliac bones, then approximately 3-4 cm (which approximately corresponds to the width of two transverse fingers) above this line adopt the spiny processes of the last lumbar and I sacral vertebrae and in the deepening between them, i.e. . To the top corner of the Mikhaelis rhombus, they put the circular leg (Fig. 14).


Fig. 11. The form of Roma Michaelis is normal and under pathology.
a - with normal basin; b - with a flat basin; in - with the Square Taza.

The definition of rhombus Mikhailis has a large practical value in assessing the shape of the pelvis (Fig. 11). The change in the rhombus in the vertical and horizontal size gives an idea of \u200b\u200ba certain shape of the pelvis. Ideal when estimating the pelvis, a rhombus is considered, in shape approaching a square.

The line horizontally spent between the gangs line shares the rhombus on two triangles folded with its bases. The wider the seasus, the greater the diameter of the rhombus; Normally, it is equal to 11 cm.

The vertical axis of the rhombus (the distance from the surplus pits before the start of the berry fold) is normal equal to 11 cm; It becomes shorter if the cresses are omitted, which is observed with a flat-profound basin.

With a normal Taza, both triangles, constituting a rhombus of Michaelis, are almost the same, the difference in their sizes is noticeable in the narrow tase. At the same time, the sharper changed against a normal pelvis, the higher the upper triangle is reduced.

With a flat stuffed basin, the top point of the rhombus often coincides with the base of the upper triangle. Along with a decrease in the vertical size, the lateral dots of the rhombus can occur towards the line of sausage processes (Robert Taz). In case of storage pelvices, the sideways of the rhombus are shifted accordingly - one is located above, the other is lower.

After determining the Mihaelis rhombus, the hands are applied to the scallops of the iliac bones, the alignment, the location of their and the outlines of scallops determine. Then feel the hellors, paying attention to their position and at the level - whether they are at one level or on different; Significant speech of the healvugs is characterized by Rachitic pelvis.

A pregnant examination plan necessarily includes the measurement of the pelvis. This procedure is often carried out at the first reception of each woman who applied to the Akuster-gynecologist about the desired pregnancy. Bone pelvis and soft fabrics, lining it, are a generic canal, along which the baby appears to be on the light. Doctors and woman is extremely important to know if the generic canal is not enough. This circumstance is determined by the possibility of childbirth through natural labor paths. The results of the study of the pelvis are contributed to medical documents. So that you can understand what is written in your exchanged card, we will tell you in detail about what the doctor does, measuring the pelvis of pregnant.

Measuring the pelvis during pregnancy

The structure and sizes of the pelvis are crucial for the flow and outcome of labor. Deviations in the structure of the pelvis, especially a decrease in its size, make it difficult for labor or represent irresistible obstacles for them.

The study of the pelvis is produced by inspection, feeling and measuring. During the inspection, pay attention to the entire area of \u200b\u200bthe pelvis, but it is of particular importance to the sacrilant rhombus (Mikhaelis Rhombus, Fig. 1), the form of which, in conjunction with other data, allows us to judge the structure of the pelvis (Fig. 2).

Fig. 1. Sleep rhombus,or rhombus Mikhailisa

Fig . 2. Bonespelvis

The most important of all methods of studying the pelvis has its measurement. Knowing the sizes of the pelvis, one can judge about the flow of labor, about possible complications for them, on the admissibility of spontaneous delivery under this form and sizes of the pelvis. Most of the internal sizes of the pelvis are not available for measurement, therefore, the exterior sizes of the pelvis are usually measured and approximately the magnitude and shape of a small pelvis. The measurement of the pelvis is produced by a special tool - a pelvomer. The pelviser has a circulation form equipped with a scale on which centimeter and semi-beacon divisions are applied. At the ends of the branches of the Thazomer there are butchers; They are applied to places, the distance between which is subject to measurement.

The following pelvis sizes are usually measured: (Latin names and abbreviations are indicated in brackets, since in the exchange map dimensions are indicated by this way.)

DistancePlnarumd.sp.)- The distance between the front-upper essays of the iliac bones. This size is usually equal to 25-26 cm (Fig. 3).

Fig. 3. Distance measurement spinname


Distance Crystarum (DistantiacRistarumd. Cr.)- The distance between the most remote points of crests of the ileum. It is on average equal to 28-29 cm (Fig. 4).

Fig. 4. Measurement of the Distance Crystarum


Distance of the Three Parachentericad. TR.)- the distance between the big skewers of the femur bone. This size is 31 -32 cm (Fig. 5).

Fig. 5. Measurement of a three-metering distance


CNNJUGATAEXTERNAX. EXT.) - external conjugate, i.e. Straight pelvis size. To do this, the woman is placed on the side, the underlying leg be flexed in the hip and knee joints, the overly pulling out. The outer conjugate is normal equal to 20-21 cm (Fig. 6).

Fig. 6. Measurement of the outer conjugate


Outdoor conjugate It is important: it can be judged by its size true conjugates- the distance between the sacrilant cape - the most protruding inside the sacrum and the most protruding point on the inner surface of the LONA Symphysia (the location of the junction bones). This is the smallest size inside the pelvic, through which the fetus head passes during childbirth. If the true conjugate turns out to be less than 10.5 cm, then childbirth through natural generics can be difficult or simply impossible; In this case, the cesarean section is often performed. To determine the true conjugate from the length of the outer conjugate, 9 cm are subtracted. For example, if the outer conjugate is 20 cm, then the true conjugate is 11 cm; If the outer conjugate has a length of 18 cm, then the true is 9 cm, etc. The difference between the outer and true conjugates 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. True conju-Gato can be more accurately determined by a diagonal conjugate.

Diagonal conjugonalis (conju-gatadiagonalis) It is called the distance from the lower edge of the Symphysia to the most outstanding point of the Cape of the sacrum. The diagonal conjugate is determined by a vaginal study of a woman (Fig. 7). The diagonal conjugate at a normal tase is equal to an average of 12.5-13 cm. To determine the true conjugates from the size of the diagonal conjugate, 1.5-2 cm are subtracted.

Fig. 7. Diagonal conjugate measurement

The doctor is not always able to measure the diagonal conjugate, because with normal sizes of the pelvis during a vaginal study, the Cape The sacrum is not achieved by the finger of the researcher or it is hard to work. If, with a vaginal study, the doctor does not reach the cape, the volume of this pelvis can be considered normal. The sizes of the pelvis and the outer conjugate are measured by everyone without exception of pregnant women and fencers.

If, when examining a woman, a suspicion is suspicion of a narrowing of the outlet of the pelvis, then the sizes of this cavity are determined. These measurements do not relate to the mandatory, and measure them in a position in which the woman lies on the back, the legs are bent in the hip and knee joints, diluted aside and tightened to the stomach.

The value of the shape of the pubic corner is of value. With normal pelvis sizes, it is 90-100 °. The shape of the pubic angle is determined by the following intake. A woman lies on his back, legs bent and tightened to the stomach. The palm side of the thumbs are applied close to the lower edge of the symphysis. The location of the fingers allows to judge the magnitude of the corner of the pubic arc.

Additional research

If necessary, to obtain additional data on the sizes of the pelvis, according to its magnitude of the fetus head, bone deformations and their compounds conduct x-ray examination of the pelvis - x-rayoeliviometry. Such a study is possible at the end of the third trimester of pregnancy, when all organs and fabrics of the fetus are formed and X-ray examination will not harm the baby. This study is carried out in the position of a woman lying on the back and on the side, which allows you to set the shape of a sacrum, pubic and other bones; Special ruler determine the transverse and direct sizes of the pelvis. The fetus head is also measured, and on this basis, it is judged on the compliance of its size to the sizes of the pelvis.

On the sizes of the pelvis and the correspondence of its magnitude of the head can be judged by the results ultrasound research. This study allows you to measure the size of the fetus head, determine how the fetus head is located, since in cases where the head is dispersed, i.e., the forehead or face will be pretended, then it needs more space than in cases where the backlog is pretended. Fortunately, in most cases, childbirth goes precisely in the occipital preview.

With external pelvic, it is difficult to take into account the thickness of the pelvic bones. The known value is measured by a centimeter ribbon of the circumference of the ray-exclusive joint of the pregnant (Solovyov's index). The average value of this circle is 14 cm. If the index is greater, it can be assumed that the pelvic bones are massive and the size of its cavity is less than it could be expected according to the measurement of a large pelvis. If the index is less than 14 cm, then we can say that the bones are thin, and this means that even with small external dimensions, the size of the inner cavities is sufficient for passing the baby.

A long time ago, it took the past when a narrow pelvis was for the feminine of a kind of sentence. Modern medicine makes it possible to ensure the successful outcome of birth, regardless of the characteristics of a woman's pelvic. But for this, doctors must make the necessary measurements in a timely manner. And every woman must be aware of the significance of this procedure.

Every woman wants to know the joy of motherhood. This is a natural impulse associated with the very essence of human nature. However, many turn out to be not ready for the fact that they will have to regularly visit the doctor and tolerate some not particularly pleasant manipulations. But in order for pregnancy to go smoothly and calmly, it is better to follow the instructions of specialists than to rely on good luck.

Preparation for the examination

Before you come to women's advice to become registered on pregnancy or simply on a planned inspection, a fair floor representative needs to be put into order. No special efforts required, but still it is recommended to take a shower. In no case should you paint or something in such a kind, because so the overall picture of the disease (if it is), there will be a lubricant and the doctor will not detect anything. It will not be superfluous and freshly clean linen and hygienic gasket (if necessary).

Common and special history

As with any other doctor, the gynecologist has a standard form to familiarize themselves with the patient's history. It includes passport details, complaints, recordings about the place of residence and work, indicate the presence of hereditary diseases and transferred infections.

Special history is focused on the doctor to understand the essence of the problem with which a woman applied. It includes questions about menstruation, sex life, pregnancies and abortions. In addition, brief data is needed about the wife or partner of the patient, as well as it and its childbearing function.

Then begin the survey on the current pregnancy. The period of gestation is set, the sizes of the pelvis and the position of the child in the uterus are determined.

Determination of the term of gestation

There are several ways to calculate the gestational age and the date of the occurrence of labor. The first one is calendar. He is the easiest. It is necessary to recall the number of the first day of the last menstruation and add 280 +/- 7 days or 10 months or 10 months to it. So you can find out the approximate day of a happy event. If a woman can remember the date of conception, then you need to add all the same 40 weeks again and get an answer to the exciting question.

Another method is based on ultrasound examination. The Diagnostic Diagnostic Diagnostic Signs can determine the gestational age of the fetus and express an approximate date of delivery. With an obstetric study at the height of the duration of the uterus, the term of pregnancy is also calculated. From 12 to 38 week, the height of the uterus in centimeters corresponds to the week of pregnancy. You can also focus on the first fetal movement. At the foregorous, it is felt from the eighteenth week, and in repeatedly - with sixteenth.

Sizes of large pelvis

For a doctor, knowledge about the size of the pelvis woman is important, and the data is important both during the development of the fetus and in the process of childbirth. The size includes an outer conjugate and three distances corresponding to the protruding parts of the pelvic and femur bones.

1. Distantia Spinarum is the gap between the most sublime points of the iliac bones. It is equal to about twenty six centimeters.

2. Distantia cristarum is the space between the ridges and is approximately twenty-eight centimeters.

3. Distantia TroChanterica is the distance that is located between large spit, located on the thigh bone, is 31-32 centimeters, respectively.

The outer conjugate has a slightly different size. If the three previous ones were located at that this is in the sagittal. The outer conjugate is the distance between the protruding process of the fifth lumbar vertebra and the upper ustye for its measurement requires some preparations. The definition of the outer conjugate begins with the fact that the patient is put on the side. The foot that lies on the couch, the woman leads to the stomach, and the overlying - pulls out. Branches of the thasomer are bred and installed above the pubic joint and the surplus yamme so that they are almost parallel. This is an external conjugate. The measurement depends on the constitution of the woman and the thickness of its bones. What they are thicker, the greater the error in the calculation. The size of the outer conjugate is about twenty centimeters. Its computation is necessary to determine the average difference between them corresponds to 9 centimeters. For example, if the outer conjugate is equal to twenty centimeters, then the true will be 11 cm.

Sizes of small pelvis

There is such a concept as a narrowed pelvis. It can be suered clinically or anatomically. In order to figure out the anatomical parameters of the bone rings, the small pelvis is measured.

    The diagonal conjugate is length from the lower edge to the most protruding part of the sacrum. It equals 13 centimeters. It can only be determined when calculating the true conjugates from the outer and diagonal is that 9 cm are taken from the outer, and from diagonal - 2 cm. As a rule, the true conjugate is equal to at least 11 centimeters. It is in order to calculate this parameter, and the outer conjugate is needed. Its norm can change, depending on the thickness of the bone of a woman, so doctors are reinsured and carried out internal research. The thickness of the bones does not affect the diagonal conjugate.

    The direct size of the exit from the pelvis is defined as the gap between the lower ridge of the pubic juice and the tip of the tailbone. The measurement is carried out with a pazer, and equal to 11 cm.

    The transverse size of the outlet of the pelvis is the gap between the collaborations. It can be carried out both a pazer and a centimeter ribbon. Normally, it is equal to nine centimeters, but if you add the thickness of soft tissues, we get 11 cm.

    The side sizes of the pelvis are needed to determine the symmetry of the location of the bones. They should be at least 14 cm, otherwise the childbirth will be difficult or impossible.

Romble Mikhailisa

The outer conjugate has a certain attitude towards Mikhailis's rhombus, as it also shows the sizes of the pelvis. This is a platform formed by the rear surface of the sacrum. Borders of her:
- fifth lumbar vertebra;
- paired sustained ileal bones;
- The top of the sacrum.

The size is normal amounts to 11 by 11 centimeters. The outer conjugate has a common top point with a rhombus.

Manual techniques in obstetrics

After the twentieth week, an obstetrician gynecologist can determine the head, back and finiteness of the child in the mother's womb. For this, techniques are used for outdoor obstetric studies.

First reception: the doctor determines the height of the bottom of the uterus and part of the bodies of the fetus that goes to it. For this, the doctor puts his palm on the top of the abdomen and feel him.

The second reception determines the position and type of child. For this, the obster slowly lowers his hands from the top of the abdomen, spreading them to the sides. Pressing on the side surfaces of the uterus, fingers and palm, the doctor feels a back or small pieces of the fetus body, thus determining the findings of the child.

The third reception is necessary to determine the subject to be part, that is, that part of the body, which is located above the Lonatic Jim. You can also determine the mobility of the head.

The fourth reception complements the third one. It allows not only to identify the subject to part, but also to understand how it is located in relation to the entrance to a small pelvis. For this, the doctor becomes back to the patient and has hands in such a way that the fingers converge above the pubic symphysome.

View and Make

Position is the positions of the child's back to the side of the uterus. There are first position when the back is on the left side, and the second - when the child turn his back to the right. The first position occurs more often than the second.

Position view - the ratio of the back to the front or rear wall of the uterus. Accordingly, if the child leaned against the front of the uterus, they talk about the front position, and vice versa.

With an outdoor obstetric study, Leopold-Levitsky's techniques give a doctor the opportunity to determine the location of the fetus and predict the flow of labor.

Internal study

An internal obstetric study can be carried out in two or four fingers or with the other hand. To the touch, the doctor can determine the degree of revelation of the cervix, reveal the prerequisite part, the integrity of the fruit bubble, the state of the generic paths. In addition, this method records the dynamics of the child's promotion by the generic canal.

However, this is quite serious interference, and it is necessary to make a procedure strictly for the regulations: when entering the hospital, and then not more than once every two hours. The less often the better.

The study starts with inspection of external genital organs and perineum. Then the fingers are introduced into the vagina and determine its length, width, elasticity of the wall, the presence of scars, adhesions or strictures, which may prevent the normal flow of labor. After that, we are moving to the cervix. It is investigated on maturity, shape, magnitude and consistency, shortening and softening. If a woman comes in childbirth, the opening of the neck is measured in the paths of the fingers. In addition, the doctor is trying to find the prerequisite part and determine the position of the head to prepare for possible complications.

Definition of the position of the child's head

There are three degrees of extension of the head when passing it through the generic paths.

The first degree (front-wheel insertion) means that the head will pass through the pelvis with its direct size. It is equal to 12 cm. This means that the cervix and the vagina should stretch to this value.

The second degree (frontal insert) corresponds to a large oblique size (13-13.5 cm). It will be the largest part that must pass through the birthway.

The third degree (facial insertion) says Akuster that the child moves through a small pelvis with a face forward, and therefore, the largest size of the head will correspond to 9.5 cm.