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.

A pregnant woman's research has the opportunity to predict the course of pregnancy and childbirth, possible complications and, consequently, to take a timely correction aimed at reducing the risk of developing diseases in her and the fetus. This complex will include: a survey, an objective study of the functions of all organs, outdoor and internally obstetric studies, clinical laboratory studies.

Survey pregnant

Anamnese harvest is carried out according to the following plan.

1. Passport details.

2. Diseases transferred in childhood, adulthood, their current and treatment.

3. Heredity.

4. Working conditions and life.

5. Epidemiological history.

6. Allergological anamnesis.

7. Obstetric and gynecological history:

Menstrual function (menarche and the establishment of the menstrual cycle, duration, soreness and regularity of menstruation, the amount of blood lost during menstruation, the date of the last menstruation);

sex life (from what age is married or not);

Gynecological diseases (which, when, duration and nature of their flow, carried out therapy, treatment results);

The generative function is the number of previous pregnancies with a detailed clarification of their flow and outcome (artificial and spontaneous abortions, childbirth);

The course of real pregnancy (the first and second half of pregnancy, transferred diseases and on what date, treatment outpatient, stationary).

Objective research

The examination of the pregnant woman includes: inspection of a pregnant woman, a special obstetric study (external and internal), clinical laboratory studies.

Inspection of pregnantincludes:

Anthropometric studies (assessment of physique, gait, abdomen, measurement of growth and body weight);

Study of organ functions.

Special obstetric studyit is intended to appreciate the obstetric factors in a timely manner and resolve the possibility of conducting birth through natural generic paths.

Outdoor obstetric studyincludes the following.

1. Measurement of the abdomen and standing height of the bottom of the uterus, starting with 16 weeks of pregnancy for each appearance in the female consultation, which allows you to clarify the correspondence of the standing height of the uterus. Lifetime and timely diagnose multiplodes, multiplodes, large fruit, fetal hypotrophy. In the horizontal position of the pregnant, the abdominal circle at the navel level and the height of the uterus bottom of the uterus from the top edge of the Lonnoy Articulation are measured.

2. Measuring the outer sizes of a large pelvis (allows you to approximately judge the value and shape of a small pelvis) carry out a pazer in such a sequence:

Distantia Spinarum - the distance between the front essays of the iliac bones (normally 25-26 cm);

Distantia cristarum - the distance between the most remote points of the ridges "of the iliac bones (on average it is 28-29 cm);

Distantia TroChanterica - the distance between large slices of femur bones (usually equal to 31-32 cm);

Conjugata Externa is the distance between the upper edge of the Lonic articulation and the sausage of the lumbar vertebrae, measured in the pregnant position on the side (normally 20-21 cm);

The straight size of the outlet of the pelvis (normally 9.5 cm) is the distance between the middle of the lower edge of the Lonic articulation and the top of the tailbone, measured in the pregnant position on the back with diluted and semi-bent in the hip and knee joints;

The transverse size of the output of the pelvis (normal is 11 cm) - the distance between the inner surfaces of the sedlicated bugrov (the position of the pregnant woman is the same as when measuring the direct size of the outlet of the pelvis);

Romble Michaelis - an assessment of the shape of the rhombus, measuring the vertical (normal 11 cm) and the horizontal (normally 10 cm) of its diagonals (a woman stands back to the doctor);

Solovyov index (gives information about the thickness of the bones of the pelvis) - the value of the circumference of the beam-based joint, which is measured by a centimeter ribbon (in the norm is 14 cm);

The height of the symphiz (gives an idea of \u200b\u200bthe thickness of the pelvic bones, the measurement is carried out in a vaginal study).

3. Receptions Leopold - Levitsky. First receptionallows you to determine the layout of the bottom of the uterus in relation to the Mesao-shaped process (matching the height of the base of the bottom of the duration of pregnancy) and part of the fetus, which is in the bottom of the uterus. The pelvic end is defined as a large, soft and non-drawing part of the fetus, the head is like a large, with a clear contour, a dense running part. To do this, it is necessary to arrange the palm of the hands on the bottom of the uterus and determine the distance between the bottom of the uterus and the sword-shaped process or the navel, clarify the part of the fetus in the bottom of the uterus.

Second receptionoutdoor obstetric study aims to define the situation, position and type of fetus.

The position of the fetus is the ratio of the longitudinal axis of the fetus to the longitudinal axis of the uterus. The following provisions are distinguished: a) the longitudinal - the longitudinal axis of the fetus and the longitudinal axis of the uterus coincide; b) transverse - the longitudinal axis of the fetus crosses the longitudinal axis of the uterine at right angles; c) oblique - the longitudinal axis of the fetus forms an acute angle with a longitudinal axis.

The position of the fetus is the ratio of the backrest of the fetus to the right and left side of the uterus. At the first position of the back of the fetus (dense and wide surface) addressed to the left side of the uterus, with the second position to the right.

Type of fruit is the ratio of the backrest of the fetus to the front (front view) or rear (rear view) of the wall of the uterus.

To fulfill the second reception of Leopold - Levitsky palm of both hands of the obstetrician palprate the side portions of the uterus, determining the position of the fetus and the location of its back.

Third receptionoutdoor obstetric study serves to determine the pre-port part of the fetus (head, pelvic end) - for its fulfillment of the obusser, it is necessary to make a thumb with the right hand as much as possible from the rest of four, clasping the prerequisite part of the fetus and determine its mobility with respect to the entry plane in a small pelvis.

Fourth receptionallows you to determine the level of the presets. When pregnancy, the fetal head can be mobile or pressed to the entrance to a small pelvis. This technique is especially important to assess the advance of the fetus head along the generic channel in the process of childbirth.

4. Auscultation. Cardiac tones of the fetus are heard from the period of pregnancy 20 weeks at the primary and from the period of 18med - in repeated. Auscultation is carried out with each appearance of a pregnant woman in female consultation, evaluate the frequency, rhythmic and soundness of the heart tones of the fetus (normal heartbeat 120-160 ot / min, clear, rhythmic).

Interior obstetric studyin taking to dispensary accounting for pregnancy and at hospitalization in the prenatal separation with a complicated course of pregnancy or to prepare for childbirth. It is performed in order to assess the state of the soft tribute, the characteristics of the building of the bone poles, the nature of the presenter part, as well as to address the issue of the method and period of the delivery. The study includes:

Inspection and evaluation of external genital organs (type of lobcas - male or female, correctness of the development of large and small sexual lips, the presence of pathological changes, scars in the field of vulva and crotch);

Research with mirrors (folded and lucid) with an assessment of the form of the outer zea of \u200b\u200bthe cervix, the color of the mucous membrane of the vagina and the cervix, pathological changes and the nature of the selection;

Vaginal research (finger) (according to the testimony in any time of pregnancy).

Vaginal research in early pregnancy time allows you to establish a term of pregnancy and identify the pathology of the internal genital organs. At the same time, the condition is consistently assessed:

Vagina is a narrow (at an unborn woman) or a capacious (in the giving birth);

Cervical cervix - length, consistency, shape (conical at primible and cylindrical in repeated), the state of the external zea (the outer ZEV is closed at the primordial and passes the finger tip in repeated);

Uterus - position, period of pregnancy in weeks, consistency (mushroom), its mobility and pain in palpation; In the early periods of pregnancy, it is possible to identify a comb-shaped protrusion on the front surface of the uterus in the middle line (a sign of a gente), asymmetry of the uterus due to the protrusion of one of its corners (a sign of the piscal), a reduction and sealing of the uterine during palpation (Snaging sign);

The appendages of the uterus (sizes, consistency, soreness);

Vagina arch (high, free);

bone pelvis (reachability of cape, pelvis deformation, exostosis).

Vaginal study with docking pregnancy makes it possible to establish the degree of readiness of the soft trudge paths to childbirth. When executing the study, the status estimate consistently:

Vagina (narrow or capacious, presence of pathological changes);

Cervix with the determination of its "maturity" (Table 1);

Fercent bubble (its presence or absence); the predatory part and its attitude to the pelvis planes;

kos of that pelvis - the height of the standing of the symphysis, the presence of bone protrusions and deformations, the shape and depth of the sacral depression, the achievability of the cape and the measurement of the diagonal conjugate (the cape is not achieved).

During the examination of a pregnant woman or women in labor, these general and special history data is used, the general objective and special obstetric examination, laboratory and additional research methods are carried out. The latter refers hematologic, immunological (serological, etc.), bacteriological, biochemical, histological, cytological studies; Study of cardiac activity, endocrinological, mathematical methods of research to identify possible diseases, complications of pregnancy and disorders of the development of the fetus. With appropriate indications, x-ray and radiography, amniocentesis, ultrasound and other modern diagnostic methods are used.

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):

 1Trumster (up to 12) - common diseases, complications of pregnancy (toxicosis, threat of interrupts, etc.), the date of the first turnout in the female consultation and the period of pregnancy, established during 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) - total weight gain for pregnancy, its uniformity, 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. 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. In the study at the end of pregnancy and during childbirth, this technique determine the ratio of the predatory 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 large segment of the head is the greatest part of it, which 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:

 When the headpoint is near the head below the navel on the side where the back is turned, with rear views - 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 smoothing of the neck (preserved, shortened, smoothed), the degree of disclosure of the oz in centimeters, the state of the edges of the zea (soft or dense, thick or thin) is determined. 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 fed to the lower edge of the symphysis and mark on the hand the place that directly comes into contact 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.

Topic number 5.

Biomechanism of childbirth in front and rear types of occipital prediction

The regular set of all movements that makes the fruit by passing by the generic paths of the mother, called biomechanism of childbirth. Against the background of the progressive movement along the generic channel, the fruit carries flexible, rotational and extensive movements.

Calcule pretext They call such a prevention when the fetal head is in the bent state and the lowest area of \u200b\u200bit is the back of it. Birth in the occipital preclination account for about 96% of all genera. When the occurrence can be front and back view. The front view is more often observed at the first position, the rear - with the second.

The heading of the head in the inlet of the pelvis is made in such a way that the fumes is located in the middle line (along the axis of the pelvis) - at the same distance from the Lonnoy Joint and Cape - sinclitic(axial) insert. In most cases, the fetus head begins to insert into the entrance to the state of moderate rear asclothism. In the future, in the physiological flow of childbirth, when the fights are enhanced, the direction of pressure on the fruit is changing and, in connection with this, asinclitism is eliminated.

After the head fell to the narrow part of the cavity of the small pelvis, the obstacle encourages here causes an increase in generic activity, and with this strengthening and different movements of the fetus.

Biomechanism of childbirth in the lead of the occipital preview

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 - Internal turn of the head (correct).

The fetus head, continuing its progressive movement in the cavity of the pelvis, 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 fetal head continues to move along the generic channel and at the same time begins to bend. 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 - inner turn of the shoulders and the outer turn of the fetus head.

During the extension of the head, the fruit's shoulders have already been inserted into the transverse size of the entrance in a 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 the thoracic spine and the birth of the fetal shoulder belt. The front shoulder is born first, the rear is somewhat delayed with the tailbone, but soon flexings it, protrudes the crotch and is born above the rear spike with the side bending of the body.

After the birth of the shoulders, the rest of the body, due to the good preparedness of the generic paths born, is easily released. The head of the fetus born in the forefront of the occipital presence, has a dolchocephalic form by configuration and generic tumor.

Biomechanism of childbirth at the rear of the occipital presence

With a tight preview, regardless of whether the population is faced at the beginning of the kingdom of Kepened, to Lona or the Forward, to the sacrum, by the end of the expulsion period, it is usually established under the Lona joint and the fruit is born in 96% in the forefront. And only in 1% of all the occipital prediction, the child is born in the rear.

Children in the posterior view of the occipital presence call the variant of biomechanism, in which the birth of the fetus head occurs when the head turned to the sacrum. The reasons for the formation of the rear view of the occipital presence of the fetus may be changes in the shape and capacity of the small pelvis, the functional inferiority of the muscles of the uterus, the features of the form of the fetus head, premature or dead fruit.

With a vaginal study Determine the small springs at the sacrum, and the big - at the left. Biomechanism of childbirth at the background is composed of five points.

First moment - flexion of the fetus head.

With the rear of the occipital preposition, 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 addressed to the left and the stop, to the sacrum (first position) or right and the post, to Sleep (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 Turn the head.

The sweat-shaped seam made of oblique or cross-dimensions makes a turn on 45  or 90 , so that small springs turns out to be behind the sacrum, and the big one is in front of the leave. 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 support point was formed (the front surface of the tailbone) and the fixation point (podental yam). 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 - outer turn of the head, the inner turn of the shoulders.

Due to the fact that in the biomechanism of childbirth at the injection of the occipital presence, an additional and very difficult moment is included - the maximum flexion of the head is the expulsion period is delayed. This requires additional work of the muscles of the uterus and the abdominal press. The soft tissues of the pelvic bottom and the crotch are exposed to strong stretching and are often injured. Long-term delivery and increased pressure from the side of the generic paths, which tests the head with its maximum flexion, often lead to the asphyxia of the fetus, mainly due to the violated cerebral circulation.

Topic number 6.

Childbirth clinic with head preview

Rodami. They call a complex biological process, as a result of which the exile of the fruit eggs from the uterus through the natural generic paths after reaching the fruit of maturity. Physiological gifts occur on the 280th day of pregnancy, starting from the first day of the last menstruation.

Causes of the onset of birth

Roda - This is a reflex actor arising due to the interaction of all the systems of the mother and fetus organism. The reasons for the occurrence of childbirth have not yet been studied. There is a lot of hypotheses. Currently, the search and accumulation of actual material on the study of the causes of generic activity continues.

Births occur in the preformal generic dominant, in which nervous centers and executive bodies take part. In the formation of the generic dominant, the impact of sex hormones on various formations of the central and peripheral nervous system are important. A significant increase in the electrical activity of the brain is observed in 1-1.5 weeks before the occurrence of childbirth (E. A. Chernuha, 1991). The beginning of childbirth should be considered as a result of the process of gradual communication of morphological, hormonal, biophysical conditions. Reflexes begin with uterine receptors, which perceive irritation from the fetal egg. Reflex reactions depend on the impact on the nervous system of humoral and hormone factors, as well as on the tone of sympathetic (adrenergic) and parasympathetic (cholinergic) departments of the nervous system. The sympathetic-adrenal system is involved in the regulation of homeostasis. Adrenaline, norepinephrine and catecholamines are involved in the motor function of the uterus. Acetylcholine and norepinephrine enhance the tone of the uterus. In myiometry, various mediator and hormonal receptors are revealed: -adrenoreceptors, serotonino-, cholino and histamine processors, estrogen and progesterone, prostaglandin receptors. The sensitivity of the uterus receptors depends mainly on the ratio of genital steroid hormones - estrogen and progesterone, which plays a role in the occurrence of generic activity. Corticosteroids also participate in the development of labor. An increase in the concentration of corticosteroids is associated with an increase in their synthesis of mother and fetus adrenal glands, as well as an increased synthesis of the placenta. In the regulation of the motor function of the uterus, serotonin, kinines, enzymes take part in the regulation of the uterus along with hormonal factors. The hormone of the rear lobe of the pituitary gland and hypothalamus - oxytocin - is considered the main in the development of labor. The accumulation of oxytocin in the blood plasma occurs throughout the pregnancy and affects the preparation of the uterus to active generic activity. The oxytocinase enzyme (oxytocin destroying) generated by the placenta maintains a dynamic equilibrium of oxytocin in the blood plasma. Prostaglandins also take part in the emergence of generic activities. The mechanism of their action on the uterus continues to study, but its essence is in the disclosure of the calcium canal. Calcium ions take part in the complex process of transferring the muscles of the uterus from the state of rest to the active state. With normal generic activity in myiometry, the synthesis of proteins is increased, the accumulation of RNA, a decrease in the level of glycogen, an increase in redox processes. Currently, the functions of the fetotic placental system and the epiphyse-hypothalamic-pituitary-hypothalamm-hypothalamic and hypothalamic and hypothalamic and hypothalamic and hypothalamic and hypothalamic and hypothalamic and hypothalamic and hypothalamic and hypothalam-hypothelimo-hypothalamic and hypothalamic-hypothame. The contraction function of the uterus has an influence of intrauterine pressure, the magnitude of the fetus.

The onset of childbirth is preceded harbingers of birth and prinformer period.

Harbingers of birth - These are the symptoms, coming in one month or two weeks before delivery. These include: Moving the center of gravity of the body of a pregnant Kepened, shoulders and heads are distinguished back ("Proud Tread"), omitting the bottom of the uterus due to the pressed part of the fetus to the entrance to a small pelvis (at the foregorous, this occurs a month before delivery), reducing the volume of spindle waters; The extension of the "mucous" tube from the cervical cervix; lack of weight gains of body for the last two weeks or a decrease in body weight up to 800 g; Improving the tone of the uterus or the appearance of irregular grabs in the lower abdomen, etc.

Prinformer period Not more than 6-8 hours (up to 12 hours). It occurs immediately before childbirth and is expressed in irregular painless contractions of the uterus, which are gradually moving to regular contractions. The preliminary period corresponds to the time of formation of the generic dominant in the cerebral cortex and is accompanied by a biological "ripening" of the cervix. The cervix softens, occupies the central position on the wired pelvis axis and sharply shortening. The rhythm driver is formed in the uterus. Its function performs a group of cells of nerve ganglia, which is most often located closer to the right tube corner of the uterus.

Regular contractions indicate the origin. From the beginning of childbirth and before their ending is called pregnant hife, and after childbirth - row birth. The generic act consists of the interaction of the expelled forces (contractions, swelling), the generic channel and the object of the genus - the fetus. The generation process occurs mainly due to the contractile activities of the uterus - battle.

Battle- These are involuntary rhythmic cuts in the uterus. In the future, rhythmic (arbitrary) abbreviations of the abdominal press occur simultaneously with involuntary cuts in the uterus - potumes.

Fights are characterized by duration, frequency, force and soreness. At the beginning of childbirth, the fight lasts 5-10 seconds, reaching 60 seconds and more by the end of the birth. Pause between the fights at the beginning of the birth - 15-20 minutes, by the end of their gaps gradually shrinking to 2-3 minutes. The tone and strength of the cutting of the uterus are determined by palpator: the hand is put on the bottom of the uterus and the stopwatch determines the time from the beginning of one before the start of another cutting in the uterus.

Modern methods of registration of generic activities (hysterographer, monitor) make it possible to obtain more accurate information about the intensity of the contraction of the uterus.

The gap from the beginning of one contraction before the other is called the uterine cycle. There are 3 phases of its development: the beginning and increasing of the cutting of the uterus; Maximum tone of myometrium; Relaxing muscle tension. Methods of outer and internal hysterography with uncomplicated births made it possible to establish the physiological parameters of the cutting of the uterus. The contractile activity of the uterus is characterized by the characteristics - a triple downward gradient and dominant bottom of the uterus. The cutting of the uterus begins in the region of one of the pipe corners, where it is laid " paismaker."(The driver of the muscular activity of myometrium in the form of ganglia of the vegetative nervous system) and from there is gradually spreading down to the lower segment of the uterus (the first gradient); at the same time, the strength and duration of the reduction (second and third gradients) decrease. The strongest and long-lasting cuts in the uterus are observed in Day of the uterus (DNA dominant).

Second - recipe. The relationship of contraction of the body of the uterus and its lower parties: the contraction of the body of the uterus contributes to the stretching of the lower segment and increase the degree of opening of the cervix. In physiological conditions, the right and left half of the uterus during the contraction is reduced simultaneously and coordinated - coordination of horizontal contractions. Triple downward gradient, dominant bottom of the uterus and reciprocality coordination of vertical cuts.

During each contraction in the muscular wall of the uterus, the reduction of each muscular fiber and each muscular layer occurs at the same time - contraction, and the displacement of muscle fibers and layers in relation to each other - retraction. During the pause, the contract is eliminated completely, and the retraction is partially. As a result of the contraction and retraction of the myometrium, the muscles displacement occurs from the coastal to the body of the uterus ( distraction - Stretching) And the formation and thinning of the bottom segment of the uterus, smoothing the cervix, the opening of the cervix canal, dense fret of the fruit egg with the walls of the uterus and the exile of the fruit egg.

Periods of birth

During each contraction, intrauterine pressure up to 100 mm RT increases. Art. (M.S. Malinovsky). The pressure is transmitted to the fruit egg, which, due to the accumulating waters, takes the same shape as the cavity of the barking uterus during each contraction. The accumulating waters rush down to the predatory part with the lower pole of the fetal shells - the fetal bubble, pressure irritating the end of the nerve receptors in the walls of the cervix, contributing to the strengthening of the bouts.

Musculature of the body and lower segment of the uterus while reducing stretch the walls of the cervical cervical on the side and up. Abbreviations of muscle fibers of the uterine body are aimed at tangent to the circular muscles of the cervix, this makes it possible to take place the cervix in the absence of a fruit bubble and even the predatory part. Thus, various directions of muscle fibers of the body and cervix in the reduction of the muscles of the uterus body (contract and retraction) lead to the disclosure of the inner seva, the smoothing of the neck and the disclosure of the outer seva (distraction).

During the battle, part of the body of the uterus, which is preparing to the curvature, stretches and is involved in the lower segment, which is significantly thinner than the so-called upper segment of the uterus. The border between the lower segment and the upper segment of the uterus has the form of a groove and called contracting Ring. It is determined after influencing the accumulating waters, the height of its standing over Lone in centimeters shows the degree of disclosure of the cervical neck.

The bottom segment of the uterus tightly covers the preeble head, forms inner fabric of fit or contact. The latter shares the oily water on " front water", located below the belt of contact and" rear waters"- above the belt of contact. When pressed the head, tightly covered by the lower segment, to the walls of the pelvis throughout the circumference, it is formed outdoor belt fit. Therefore, with a violation of the faith of the fetal bubble and the influence of the octal water, the rear waters are not poured.

The cervical disclosure and smoothing from first and repeated women occurs differently. Before childbirth, primary and inner zev are closed. The disclosure begins with the inner sewer, the cervical canal and the cervix are somewhat shortening, then the cervical canal stretches more and more, the neck is converted accordingly and is completely smoothed. It remains closed only the outer zev (" obstetric zev") The external zev begins to open. With full disclosure, it is defined as a narrow border in the generic channel. In repeatedly, at the end of pregnancy, the cervical channel is passing for one finger due to its stretching by previous birth. Disclosure and smoothing of the cervix takes place simultaneously.

Fruit bubble In physiological childbirth, it breaks with full or almost complete disclosure of the uterine zea - timely opening of the fruit bubble. The rupture of the fruit bubble before childbirth or with incomplete opening of the cervix (up to 6 cm opening) is called premature opening of the fetal bubble (respectively - derodova, early). Sometimes due to the density of the fetal shells, the fruit bubble is not opening with the full cervical disclosure - it is late opening of the fruit bubble.

Birth separated For three periods: the first is the period of disclosure, the second is the period of expulsion, the third is the last one.

The period of disclosure Call time from the beginning of regular battles to the full opening of the cervix. Currently, the average duration of the first birthday period of the primary is 11-12 hours, and in repeatedly 7-8 hours.

Exile period Call time from the moment of complete opening of the cervix before the birth of the fetus. In the period of expulsion to the fights, abdominal cuts, diaphragms and muscles of the pelvic bottom are joined, develop potumesI expel the fruit of the uterus. The period of expulsion at the primordin continues until the 1st hour, in repeatedly - from 10 to 30 minutes.

Along with the birth of the fetus, the rear waters are poured.

Substitutional period Call time from the birth of the fetus before the birth of the last.The front is a placenta, fetal shells, umbilical cord.

After the birth of the fetus, the uterus is a few minutes at rest. The bottom of it stands at the navel level. Then the rhythmic cuts of the uterus begin - last fightsAnd the branch of the placenta begins on the wall of the uterus, which occurs in two ways: from the center or from the periphery.

The placenta is peeled from the center, the uterine-placental vessels are broken, the plowing blood forms a retroplated hematoma, which contributes to the further detachment of the placenta. The separated placenta with shells is lowered down and is born at sweat, and blood is poured with it. More often, the placenta is separated from the periphery, therefore, with each recent battle, part of the placenta is separated and the blood portion is poured. After a complete pair of placenta from the wall of the uterus, it also lowers in the lower parts of the uterus and is born at sweat. The last period lasts from 7 to 30 minutes. The average blood loss after childbirth is from 150 to 250 ml. Physiological consider blood loss equal to 0.5% of the body weight of the woman in labor.

After the birth of the post, the postpartum period comes, and the feminine is called palmice.The first 2 hours allocate as an early postpartum period.

Clinical course of childbirth

The flow of the disclosure

Fights are characterized by duration, pauses, power and soreness. At the beginning of the clans, the fights are repeated every 15-20 minutes to 10-15 seconds, weak power, painless or little painful. Gradually, the pauses between the fights are shortened, the duration of the fight is extended, the fight force increases, and they become painful. During battles, round bundles are strained, the bottom of the uterus is approaching the front abdominal wall. Contractive Ring It becomes more and more pronounced and rises above the Lona Arc. By the end of the revelation period, the bottom of the uterus rises to the hypochondrine, and the contract ring - on 5 transverse fingers above the Lonnie arc. The effectiveness of the fights are judged by the degree of disclosure of the cervix, determined by the vaginal study. In the process of disclosure, disorders occur (shallow) intake of the mucous membrane and muscle fibers of the cervix. The fetal bubble is strained during each fight and with almost complete disclosure of the uterine zone open, about 100-200 ml of light waters are poured. The fetal bubble is usually bursting within the cervical cervix.

Maintaining a period of disclosure

The feminine enters the maternity hospital with a maternity exchange card, filled in women's consultation, where there is information about the course of pregnancy, about the state of health pregnant. In the receiving department, the fever will examine: they collect history, they produce a general and special obstetric study (measuring the outer sizes of the pelvis, the standing height of the uterus, the circumference of the abdomen, listen to the palpitation of the fetus, etc.), vaginal research.

In the prenatal ward, the woman inherine holds the first period of childbirth. Outdoor obstetric study in the disclosure period produce systematically, paying attention to the state of the uterus during battles and outside of them, determine all four properties of bouts. Records in the history of labor every 3 hours. Listened fetal heartbeat every 15 minutes. Watch out for the nature of the insertion and promotion of the fetus head on the generic channel. This can be determined by outer palpation techniques, with a vaginal study, listening to the fetal heartbeat, ultrasound examination.

Vaginal research They are produced upon admission to the maternity hospital, with an infringement of accumulating waters and in the occurrence of the pathological flow of labor.

It is estimated and fixed in the history of labor, the general state of the feminine: the color of the skin and visible mucous membranes, pulse, blood pressure, the function of the bladder and the intestine. When the oral spill waters are determined by their number, color, transparency, smell.

To estimate the flow of labor, it is advisable to lead a partograph (see Figure).

During labor distinguishes latent and active phase (E.A. Chernuha). Latent phase - this is a period of time from the beginning of regular bouts before the appearance of structural changes in the cervix, and this is smoothing and opening of the cervix up to 3-4 cm. The duration of the latent phase is 6.4 hours at primordin and 4.8 hours in repeated.

Behind the latent phase comes active phase. The revelation rate of the cervix in the active phase of the primary - 1.5-2 cm per hour, in repeated - 2-2.5 cm per hour. With the complete disclosure of the uterine zoom and the beginning of the period of expulsion, the feminine is transferred to the maternity hospital.

The flow of labor in the period of expulsion

In the period of expulsion of the fight - after 2-3-4 minutes to 50-60 seconds and the abbreviation (arbitrary) abdominal press is associated with each fight. This process is called Purchase. Under the action of fertility, the fetus is gradually born through the generic channel, there is a presets in front - the head. The muscles of the pelvic bottom are reflexively reduced, especially when the head falls on the pelvic bottom, the pain is joined from the pressure of the head to the nerves of the sacrive plexus. At this point, the desire to drive out the head of the birth paths.

You can soon see the head movement soon: the crotch is protruding, then it stretches, the skin color becomes blue. The back pass is protruding and gaps, the floor slot is revealed and, finally, the lower pole of the fetus head appears. At the end of the sweeze, the head is hidden behind the germ. And so several times the head is shown, it is hidden. It is called cutting head. After some time, the head at the end of the sweat is not hidden - starts head rubberingwhich coincides with the beginning of the third moment of biomechanism of childbirth - the extension of the head (birth to dark bugs). By extending the head gradually comes out from under the lane arc, the occipital fossa is under a walled joint, dark bugs are tightly covered with stretched fabrics. A forehead and face is born through the sex slot when scolding the crotch with them. The head was born, the outer turn is performed, then the shoulders and torso are born together with the plowing rear waters.

The fetus head changes its shape, adapting to the shape of the generic channel, the bones of the skull enter each other - this is called configuration of the fruit head. In addition, the head is formed on the head generic tumor - Skin swelling of subcutaneous fiber, located below the internal belt of contact. In this place, the vessels are sharply filled with blood, into the fiber, the surrounding vessels, the fluid and uniform elements are leaving. The generic tumor occurs only after the waters and only in the living fetus. When the situation, the generic tumor is located in the field of small spring, or rather on one of the rabbits adjacent to it. The generic tumor does not have clear contours, a soft consistency, can move through the seams and springs, is located between the skin and the periosteum. The tumor is independently absorbed a few days after delivery.

The generic tumor has to differentiate with kefalohematoma (Head Blood Tumor), which occurs during pathological acquisitions and is hemorrhage under the periosteum.

Maintaining exile period

In the period of expulsion, relentless monitoring of the common state of the feminine, the fetus and the generic paths are carried out. After each swelling, the palpitations of the fetus necessarily listened, since during this period the sharp hypoxia of the fetus occurs more often and intrauterine fetal death may occur.

Promotion of the fetus head in the period of expulsion should pass gradually, constantly, and it should not stand in the same plane with a large segment for more than an hour. During the teething of the head, it is processed to handle manual. When extension, the fetal head has a strong pressure on the pelvic bottom, and it is strongly stretched, the crust may occur. On the other hand, the fetal head is subjected to strong squeezing from the walls of the generic channel, the fruit is exposed to the threat of injury - blood circulation impaired brain. The provision of manual benefits at the head premium reduces the possibility of these complications.

Manual guide with head preview Aims on protecting the crotch. It consists of several points performed in a specific sequence.

First moment - Pretending to premature extension of the head. The head, breaking through the sexual slot, must pass the smallest of its circumference (32 cm), carried out on a small oblique size (9.5 cm) in a state of bending.

The receiving childbirth becomes the right of the man in labor, puts the palm of the left hand on the pubery, and the palm surfaces of the four fingers have on the head, closing the entire surface, shown from the germ. Light pressure is delayed by the extension of the head and warns the rapid advancement to its generic channel.

Second moment - Reducing the crotch voltage. To do this, the right hand is put on the crotch so that four fingers were tightly pressed to the left side of the pelvic bottom in the field of a large sexual lip, and the thumb is the right side. Soft fabrics gently stretch with all the fingers and are reduced towards the crotch, reducing the crotch voltage. Palm of the same hand is supported by the crotch, pressing it to the teething head. Excess soft tissues reduces the crotch stress, restores blood circulation and prevents the break.

Third moment - The removal of the head of germ outside the dyg. At the end of the sweat, the high and index fingers of the right hand gently stretch the vulvar ring over the rubber head. The head is gradually excreted from the germ. At the beginning of the next, the sweat stops stretching the vulvar ring and again prevent the head extension. So repeat until the head is suitable for dumplings to the germ. During this period, the crotch stretches sharply, the danger of gaping it.

Fourth moment - Potoch regulation. The greatest stretching and threat of the crotch break occurs when the head in the sex gap is in dark grouses. At the same time, the head is experiencing the maximum compression, creating a threat to intracranial injury. To eliminate trauma of the mother and the fetus, it is necessary to regulate the pathered, i.e. Turning off and weakening them or, on the contrary, extension and amplification. This is carried out as follows: when the fetal head was installed in the dumplings in the sexual gap, and the podgotnaya fossa is under a walled joint, when the fever occurs, the fever is forced to breathe deeply to reduce the power of the sweat, since during the deep breath of the sweat is impossible. At this time, both hands are delayed the head promotion, while the fight is ended. Outside the right hand squeeze the crotch over the crotch of the fetus in such a way that she squeaks from the lipper, her left hand slowly lifting the head up and extension it. At this time, the woman is offered to surprise that the birth of the head occurred at a low voltage strength. Thus, the leading childbirth teams "climb", "not climbing" reaches the optimal tank of the crotch tissues and the well-tight birth of the most dense and large part of the fetus - head.

Fifth moment - Liberation of the brachial belt and the birth of the fetal body. After the birth of the head of the woman in labor should be rebuilt. At the same time, there is an outer turn of the head, the inner turn of the shields (at the first position, the head turns to the opposite position - to the right thigh of the mother, at the second position - to the left hip). Usually the birth of the shoulders is spontaneously. If this did not happen, the head is captured by palms in the right and left temporal bones and cheeks. The head is easily and carefully delayed the book and the stop, while the front shoulder is not suitable for the Lonnoy Artication. Then with his left hand, the palm of which is located on the bottom cheek, capture the head and lifted it up, and with his right hand, gently remove the back shoulder, shifting the crotch cloth from it. The shoulder belt was born. The midwife introduces the index fingers of the hands from the back of the fetus into the axillary depressures, and the torso lift the kleon (up, on the belly of the mother). The child was born.

Depending on the state of the perineum and the size of the fetus head, it is not always possible to preserve the crotch and the break occurs. Considering that the cutting wound heals better than the torn, in cases where the gap is inevitable, produce perineotomy or episotomy.

The course of childbirth in the last period

After the birth of the fetus, the third birth period begins. Lenadic tired. Skin surfaces of normal coloring, pulse is aligned, the blood pressure is normal.

The bottom of the uterus stands at the navel level. A few minutes of the uterus is in a state of rest arising painless contracenesses. When grabbing, the uterus becomes dense. Bleeding from the uterus is minor or absent. After the full separation of the placenta from the placental site, the bottom of the uterus rises above the navel and deflects to the right. The contours of the uterus change somewhat, it acquires the shape of an hourglass, as in the lower part of it is a separated orphanage. With the appearance of sweat, the last is born. The blood loss with the lastness does not exceed 150-250 ml (0.5% mass of the body of the woman in labor). After the birth of the lateral, the uterus becomes dense, rounded, is located in the middle, the bottom of it is between Pupkom and Lona.

Leading a leader

In the last period, it is impossible to palpate the uterus in order not to disturb the natural course of the leaders and the correct branch of the placenta, but to avoid bleeding. During this period, attention is paid to the newborn, the overall state of the feminine and signs of the separation of the placenta.

Born baby sucks mucus from the upper respiratory tract. The child shouts, actively moves the limbs. The doctor assesses his condition in the first minute and on the fifth minute after birth along the apgar scale. Produce primary toilet newborns and primary treatment of umbilical cord: It is wiped with a sterile tampon moistened in 96 alcohol, and at a distance of 10-15 cm from the umbilical ring intersect between two clips. The end of the newborn cord along with the clip is wrapped into a sterile napkin. Eyelids wipe sterile tampon. Blenorrey's prevention is carried out: they pull out the lower eyelid of each eye and in the twisted eyelids are buried with a sterile pipette of 1-2 drops of a 30% solution of albacide or freshly prepared 2% solution of nitric silver. On both handles of the child put on bracelets, on which the desired paint write a date of birth, the floor of the child, the last name and initials of the mother, the number of childbirth, date and time of birth.

Then a child wrapped in a sterile diaper is transferred to a nursery for a changing table. At this table, the midwife produces the first toilet of the newborn and secondary processing of umbilical residue. The culture of umbilical cord between the clamp and the umbilical ring is wiped with 96 alcohol and tied up with a thick silk ligature at a distance of 1.5-2 cm from the umbilical ring, if it is very thick or necessary for further treatment of the newborn. The umbilical cord is compressed by 2 cm above the dressing site with scissors. The cut surface is wiped with a sterile gauze tampon and treated with 10% iodine solution or a 5% potassium permanganate solution. Healthy children instead of the ligature applied a corner or plastic clamp on the cord. Before applying a bracket or clamp, the location of the umbilical cord is also wiped with 96 alcohol, with two fingers squeeze the jelly warrts and apply a bracket, retreating 0.5 cm from the umbilical ring. Over the bracket, the umbilical cord is cut off, wipe the dry gauze tampon and treated with a 5% solution of potassium permanganate. In the future, care for the umbilical residue is performed in an open way.

Skin areas, thickly coated with raw lubrication, are treated with cotton swab, impregnated with sterile vaseline or sunflower oil.

After the primary toilet, the centimeter ribbon is measured, the circle of the head, chest, the stomach of the newborn and is weighed, determining the mass of the fetus. Then it is wrapped in warm sterile linen and leave on a heating changing table for 2 hours. After 2 hours are transferred to the department of newborns. Premature newborns, with a suspicion of injury to be transferred to the department of newborns immediately after the primary toilet for conducting special medical events.

The last period is expecting. The doctor watches the feminine: skin cover should not be pale, pulse - not exceed 100 shots in 1 minute, blood pressure should not decline for more than 15-20 mm Hg. Art. Compared to the source. Follow the condition of the bladder, it should be emptied, because The overflowing bladder prevents the cutting of the uterus and disrupts the normal flow of the placenta detachment.

To diagnose whether the placenta separated from the uterus, use signs of the branch of the placenta. The placenta separated and sank into the bottom department of the uterus, the bottom of the uterus rises up above the navel, deflects to the right, the lower segment is protruding above the Lona (sign Schröder). The ligature imposed on the culture of umbilical cord in the sex gap, with a separated placenta descending by 10 cm and more (sign Alfelda). When pressing the brush's hand with a brush over Lone, the uterus rises up, the umbilical cord is not drawn into the vagina, if the placenta separated, the umbilical cord is drawn into the vagina, if the placenta has not separated (the sign Kustener-Chukalova). The feminine makes a deep breath and exhale, if, when inhaling the umbilical, it is not drawn into the vagina, therefore, the placenta separated (a sign Dovzhenko). The feminine is offered to surprise: with a detached placenta, the umbilicals remain in place; And if the placenta is not separated, the umbilical cord after the fence is drawn into the vagina (a sign Klein). The correct diagnosis of the placenta separation is made by the totality of these signs. The woman in labor is asked to surprise, and the last is born. If this does not happen, then apply external methods for posting the last From the uterus.

Method Abladay (enhancing the abdominal press). The front abdominal wall is captured by both hands in a fold so that the straight muscles of the belly are tightly covered with their fingers, the discrepancy of the abdominal muscles is eliminated, the abdominal cavity is reduced. The feminine is offered to surprise. The separated later is born.

Method Gentera (Imitation of the generic forces). The brushes of both hands are compressed in fists, put the surfaces on the bottom of the uterus. Gradually, the pressure of the book is slowly born.

Method Credit-Lazarevich (imitation of contractions) can be less careful if not fulfilling the main conditions when performing this manipulation. The conditions are as follows: the emptying of the bladder, bringing the uterus to the middle position, a slight stroking of the uterus in order to reduce it. Technique method: the bottom of the uterus clasp with a brush of the right hand, the palm surfaces of the four fingers are located on the back of the uterus, palm - at the bottom of it, and the thumb - on the front wall of the uterus; At the same time, the brush is pressed into the uterus aside towards the Lonnoy Jim, until the post is born.

Next responsible task of the doctor - inspection of the last and soft tripes. For this, the submissions are put on the smooth surface and carefully examine the placenta; The surface of the little smooth, brilliant. If there is a doubt of the transmission of the last or a defect of the placenta, they immediately produce a manual examination of the uterine cavity and removing the remnants of the placenta.

When inspecting the shells, they determine their intake, do not pass by the shells of blood vessels, as it happens with the addition valve of the placenta. If there are vessels on the shells, they break up, therefore, the added slices remained in the uterus. In this case, it is also a manual separation and removal of the detention added lobby. If torn shells are found, it means that scraps were detained in the uterus. In the absence of bleeding, artificially shells are not removed. A few days later they will allocate themselves.

At the place of breaking the shells, it is possible to determine the location of the placental platform relative to the internal zev. The closer to the placenta, the rupture of the shells, the lower the placenta was attached, the greater the danger of bleeding in the early postpartum period. The doctor who visited the last, signs in the history of childbirth.

Internships in the last period are not transportable.

The blood loss during childbirth is determined by measuring the mass of blood in graded vessels and weighing the wipes.

Inspection of external genital organs produce in the maternity bed. Then in the small operating room in all primary and repeatedly examine with the vaginal mirrors of the vagina wall and the cervix. Detected breaks are sewn.

After the birth of the post, the postpartum period comes, and the guinea is called row birth. Within 2-4 hours (early postpartum period), the parent's is in the maternity department, where it is followed by its general condition, the state of the uterus, the size of blood loss. After 2-4 hours, the ployer is transferred to the postpartum separation.

Topic number 7.

Alestruction of childbirth

Students remind of changes in the body during pregnancy. The rapid growth of the pregnant uterus is accompanied by a high standing of the diaphragm and the liver, which, in turn, leads to a displacement of the heart, pushing the lungs up and limits their excursion. The main changes in hemodynamics associated with an increase in the period of pregnancy is an increase of up to 150% of the original OCC, a moderate increase in peripheral resistance, the occurrence of uterine-placental blood circulation, an increase in pulmonary blood flow with a tendency to hypertension, partial occlusion in the system of the lower hollow vein.

The lower vein (postural hypotensive syndrome) syndrome is expressed in the rapidly occurring hypotension (sometimes in combination with bradycardia, nausea, vomiting, shortness of breath) when placing the fempics on the back. It is based on a partial squeezing of a pregnant uterus the bottom hollow vein with a sharp drop in the venous tributary to the heart. Restoration of the initial blood pressure occurs after the rotation of the female in labor on the side (better on the left).

The anesthesia of labor is the basis of obstetric anesthesiology. In contrast to surgical operations, in childbirth, it does not require the achievement of deep stages III 1-2, and is a sufficient stage of analgesia (I 3) while maintaining the consciousness in the female internships, contact with the doctor, if necessary, active participation in childbirth.

Direct reasons for generic pains are:

the disclosure of the cervix, which possesses highly sensitive painful receptors;

reducing the uterus and tension of round uterine bonds, parietal peritoneum, which is a particularly sensitive reflexogenic zone;

irritation of the peright of the inner surface of the sacrum due to the tension of the sacratral ligaments and the mechanical squeezing of this area during the passage of the fetus;

excessive contraction of the uterus as a hollow organ in the presence of relative obstacles to its emptying, the resistance of the muscles of the pelvic bottom, especially with an anatomical narrowing of the input of the pelvis;

compression and stretching during the contraction of the uterus of blood vessels representing an extensive arterial and venous network and having highly sensitive baroranoreceptors;

changes in chemistry of tissues - accumulation during a long-term reduction of the uterus of unsophisticated tissue metabolism products (lactate, pyruvate), temporarily created by the uterus ischemia due to periodically repetitive battles.

NEARMACOLOGICAL METHODS ANALGESIA

Preparation for childbearing, hypnosis, acupuncture and percutaneous electronostimulation (CHANS) are methods of impact on the psycho-physiological aspect of pain. Individual perception of pain in the patient depends on a number of interdependent and complicating circumstances, such as physical condition, expectation, depression, motivation and education. Pain in childbirth is enhanced by such factors as fear of unknown, danger, concerns preceding negative experiences. On the other hand, the pain is weakened or is better transferred if the patient has confidence, understanding the process of childbirth, if expectations are realistic; Respiratory exercises, developed reflexes, emotional support and other methods of distraction are used. The patient's own choice is important for the success of all physiological techniques. Among the factors associated with the success of these methods are the sincere interest of the feminine and instructing or service personnel, a higher socioeconomic and educational level, positive preceding experience and normal childbirth.

Preparation for childbirth

Preparation for childbearing consists of a series of conversations, participation in which the future father is very desirable. Training Parents The essence of the processes accompanying pregnancy and childbirth is carried out in the form of lectures, audiovisual classes, group discussions. Mother must be educated with proper relaxation, exercises that strengthen the muscles of the abdomen and spins that increase the total tone, relaxing joints (mainly hip). It should also be trained using different respiration methods in the uterine contractions in the first and second stages of childbirth, as well as directly at the time of the born of the fetus head. Although preparing for childbirth reduces the reaction to pain, the need for other methods of anesthesia remains approximately the same as in the control group. At the same time, the need for pain relief in prepared women in the process of childbirth is still later. It is advisable to discuss the possible way of anesthetia even during prenatal conversations and avoid the use of medicines without serious necessity or might harm the fetus. If this is not done, the result can be a significant decrease (sometimes - the complete absence) of the effect of drug pain relief, if the need for it is still occurring. It should be clearly explained that the use of epidural anesthesia or other necessary anesthesia techniques with proper execution for the child harmlessly.

It should be noted that the psychoprophylactic preparation of pregnant women for childbirth, developed and implemented in general practice for the first time in Russia (in Europe, this method is called - the Lamase method, or "Russian Method"), is to increase the cortex excitability threshold Brain and create a so-called positive generic dominant in the cerebral cortex. Psychophylactic preparation is not an independent method, but is carried out in a complex with physical preparation of pregnant women. It should be started from the first visit to a pregnant consultation and shut down 7-10 days before delivery. The first session does the doctor conducts individually, the following classes are specially trained midwife by a group method. Outcomes Total 5. Psycho-philactic preparation of pregnant women to childbirth is that with the help of individual classes to increase the cortex of the cerebral cortex and create a so-called positive generic dominant in the cerebral cortex. Psychophylactic preparation is not an independent method, but is carried out in a complex with physical preparation of pregnant women. It should be started from the first visit to a pregnant consultation and shut down 7-10 days before delivery. The first occupation, the doctor conducts individually, the subsequent - specially trained midwife by the group method. Classes only 5. Disassemble the goal of each of them.

In all national health systems, great attention is paid to female health, on which the demographic situation depends, and largely politics and the economy of each country. A particularly vulnerable woman becomes during pregnancy and breastfeeding. The World Health Organization pays great attention to healthy pregnancy and lactation.

Constantly introduces wide community circles with new achievements in this area. However, for many thousand years of human existence, the course of pregnancy has not changed, although today the most advanced knowledge and new diagnostic technologies are available for future mothers.

Planned examinations in the early and later grades of pregnancy: inspections for weeks

Normal pregnancy lasts 280 days, or 40 weeks, counting from the first day of the last menstrual bleeding. Throughout the time of the baby, the doctor should watch the doctor, so the pregnant woman is very important in time to account in the female consultation, to pass all the necessary analyzes and tests and regularly attend the attending physician in accordance with the individual schedule.

All studies that are held at the beginning of pregnancy, during the tooling of the baby will need to repeat several times, since the state of the future mother during pregnancy and as the development of the fetus develops inevitably changes. An important task of regular inspections of a gynecologist is to avoid some pregnancy complications and / or timely warning.

During regular planned inspections of the pregnant woman, it is possible to identify erection-cervical insufficiency, which does not make itself felt, but it may be a serious danger to preserve pregnancy. The fact is that in the endless cervical insufficiency of the neck of the uterus for various reasons, it begins to gradually shorten and open, which entails the high probability of infection of the fetal egg.

As a result of infection, the fruit shells, which hold both the fruit and the oily water, are thinned and lose their strength, as a result of which can no longer perform their functions, therefore the fruit shells are broken, the amniotic fluid (spindle water) is poured and a spontaneous interruption of pregnancy occurs, that is, Wake up - pregnancy stops.

Eastic-cervical insufficiency does not necessarily lead to severe consequences, since modern medicine is capable of correcting this pathology - pregnancy can be preserved if the necessary measures will be taken on time.

Attention! To avoid the danger of spontaneous interruption of pregnancy, a woman must attend the doctor in a timely manner and regularly pass all the necessary tests and tests, as well as undergo all necessary research.

• The first visit to the gynecologist is recommended for a period of 6-8 weeks. During this visit, the obstetrician-gynecologist conducts an inspection and primary examination and makes smear to determine the flora, as well as for a cytological study. In the same period, pregnant must pass the overall urine analysis, blood tests on RW, HIV, HBS, HCV, as well as blood to determine the group and reserves-status of blood. In addition, at the same time, pregnant is a common blood test, analysis of blood sugar, biochemical blood test and coagulogram.

At the same time, the presence / absence of Torch infections (toxoplasmosis, rubella, herpes and cytomegalovirus infection) is determined, which can provoke intrauterine infection of systems and organs of the fetus with a high risk of congenital deformations and malformations, increase the risk of spontaneous interruption of pregnancy (miscarriage), as well as risk Stretching.

• The next visit to the gynecologist is planned for a period of 10 weeks. In addition to inspection of a gynecologist, pregnant should consult with narrow specialists, including with an endocrinologist, therapist, otolaryngologist and oculist. If necessary, other consultations may be appointed.

On this time it is necessary to check the indicators of the overall analysis of urine and the overall analysis of blood. Also at this time, the so-called double test is made, including pap-test (cellular changes in the uterus, which can lead to cancerous diseases) and the HGG test (human chorionic gonadotropin hormone).

• In 12 weeks of pregnancy, the next mandatory visit to the doctor is planned.

On this period, in addition to inspecting an obstetrician-gynecologist and urine analysis, an ultrasound study is planned to make sure that the child develops normally and nothing threatens him.

• If pregnancy develops normally and the results of all analyzes and tests do not cause any concerns, the next visit to the doctor is appointed four weeks, that is, at the 16th week, when the first trimester of pregnancy is already behind.

During this visit, the gynecologist conducts the necessary inspection, measures the abdomen circumference, controls the weight and blood pressure. If pregnancy develops normally and does not cause any concerns, then only urine analysis is surrendered from all tests and analyzes.

• Two weeks, that is, on a period of 18 weeks, you will need another visit to the doctor. On this period, some women already feel the fetal movements, although others will feel it a little later.

In addition to examining a gynecologist, during this visit, you will need to pass the urine analysis and blood tests - the general and for the definition of AFP (alpha-fetoprotein) + (human chorionic gonadotropin) + the level of unrelated estriol is the so-called triple test, which allows you to identify many pathology of development Fetal, including Down syndrome, Trisomy 18, delay in the development of the fetus and even the death of the fetus. In the same period, pregnant women are invited to pass genetic advice.

• On the period of 20 weeks (and this is just the middle of a normal developing pregnancy) the next visit to the gynecologist is needed.

In addition to the usual inspection and measurement of blood pressure and weight, pregnant will need to pass the overall analysis of urine.

• After two weeks, on the period of 22 weeks, pregnant will have to visit his doctor again.

It is very important that, in addition to the usual inspection and overall analysis of urine, this period is carried out ultrasound examination and doppler (dopplerometric examination of blood flow in the placenta).

• In the second half of pregnancy, the examination of the gynecologist becomes a little more often. The next time you should come to the doctor on the 24th week

On this period, in addition to the standard inspection of the gynecologist, you will need to pass the overall analysis of urine and a general blood test.

• For a period of 26 weeks after inspection, the pregnant woman should pass the overall analysis of urine.
• Two weeks, at 28 weeks, the gynecologist again examines the future mother, which, after the inspection, should pass the overall analysis of urine and a general blood test.
• For a period of 30 weeks, when the last trimester of pregnancy began, besides the usual inspection of the obstetrician-gynecologist, you will need to pass the overall and blood for the definition of hazardous infections: RW, HIV, HBS, HCV.

In addition, at the same time it is planned to consult an eyepiece doctor.

• In the third trimester of pregnancy, visits to the doctor are becoming more rich different studies, because it is very important to know how the fruit feels and as far as he is ready to appear. During a visit to 32 weeks after inspection, the doctor should be pregnant to pass the overall analysis of urine and overall blood test.

In addition, in the same week an ultrasound study (ultrasound) is carried out with fetometry and dopplerometry placenta blood flow.

• The next visit to the akuster-gynecologist is scheduled for a period of 34 weeks

During this visit, in addition to inspection and overall urine analysis, the fruit cardiography is planned.

• A visit to the 36th week will be quite saturated. During inspection and surveys, the gynecologist must necessarily take a vaginal smear on the flora.

In addition, pregnant woman gives a general urine analysis and a general blood test, as well as blood test for hemolysins and once again, blood test on RW, HIV, HBS, HCV.

At the 36th week, the sensitivity of a woman to various antibacterial drugs is necessarily clarified to avoid any surprises during childbirth.

If pregnancy develops normally, then on this time the doctor determines whether the cervical activity is ready for the generic activity. If pregnancy is considered to be a docking, then the doctor defines the prevention of the fetus, that is, as a child is located, down his head or down legs. With a pelvic preview, the obstetra will try to deploy the fetus in the correct position. For successful genera, the prelationship of the fetus is quite important.

• A very responsible visit to the doctor at the 38th week, when the fruit is almost matured and is considered quite viable, that is, the child can be born.

In addition to the usual inspection and overall analysis of urine, pregnant must visit the doctor's doctor and pass the vaginal smear on the flora. At the same week, you need to make the cardiotokography of the fetus.

• The last week of pregnancy is considered the 40th week. In addition to the mandatory inspection, to find out the preparedness of the body to childbirth, pregnant gives a general urine analysis. In addition, a pregnant woman can be appointed an ultrasound study of the fetus, if the doctor wants to make sure that the pregnancy ends normally.

By this time, the neck of the uterus becomes shorter, but more and more stretching, and the cerval canal is located exactly in the center.

If childbirth does not begin after the 41st week, the pregnant women hospitalize to stimulate generic activities.

Attention! Each pregnancy develops uniquely and has its own characteristics, so as pregnancy develops into a standard observation calendar, some changes can be made that will allow you to effectively observe the state of the mother and the fetus and ensure the timely appearance of a healthy kid.

Each woman should remember the importance of timely visits to the gynecologist, especially if an occasion appeared to think about pregnancy. First of all, it is very important to get up in a timely manner that the doctor can start as soon as possible to observe the development of pregnancy. In addition, gynecological examinations in very early pregnancy make it possible to diagnose many undesirable, and sometimes dangerous pathological conditions, including ectopic pregnancy.

A visit to a doctor-gynecologist about possible pregnancy provides for a detailed conversation about the state of the health of the future mother, about the suffering diseases, about possible chronic diseases and any hereditary pathologies - all this information will help the doctor to draw up the maximum accurate observation plan when making pregnancy.

When pregnancy during the first visit, the doctor will definitely measure the growth and check the weight of the woman so that in the future it was possible to observe how the body weight indicator changes, which may indicate the normal development of pregnancy or the presence of some deviations.

The gynecological chair is a special medical furniture in which it is convenient to spend outdoor and the inner inspection of a woman who takes the most convenient for themselves for itself, and for a doctor's doctor. After the woman took a place in the gynecological chair, the doctor starts a gynecological examination.

At first, the gynecologist carefully examines the outdoor genitals of a woman to find out the condition of the skin and the condition of the mucous membranes. Special attention is paid to the inspection of large germ lips; small germ lips; Clitoris and urethra, crotch, as well as the inner surface of the hips. With such a visual inspection, it is possible to detect veins pathology, pigmentation, skin rashes. When examining the area of \u200b\u200bthe anal hole (rear pass), anal cracks are immediately revealed if they are, and hemorrhoidal nodes (if available).

After the outdoor inspection is completed, the gynecologist is starting to insperse. For internal inspection, a vaginal mirror is used. In fact, there are several varieties of this tool, but they are all intended to be painless and reliably expand the entrance to the vagina. Gynecological examination using vaginal mirrors allows you to find out the state of the cervix and identify any vagina disease.

Since all women are different and the internal dimensions of the genital organs are also different, then in gynecological practice mirrors use of different sizes - from XS to L:

• For the vaginal mirror of the XS size, the inner diameter is 14 mm, the length of the flaps is 70 mm;
• For the vaginal mirror s size S, the inner diameter is 23 mm, the length of the flaps is 75 mm;
• For the vaginal mirror of size M, the inner diameter is 25 mm, the length of the flaps is 85 mm;
• For the vaginal mirror of size L, the inner diameter is 30 mm, the length of the flaps is 90 mm.

In addition, gynecological mirrors can have a different shape - they can be coached and spoofy. In each specific case, the doctor chooses for inspection exactly the mirror that will be most convenient for a particular woman.

When examining the vagina with the help of a furniture mirror, a closed mirror is introduced into the vagina, and only then the sash is bred so that the cervix can be examined. When removing the mirror, the walls of the vagina are examined.

If the doctor decided that in a particular case, it is better to use spoon-shaped mirrors, then the lower (rear) mirror is introduced first, which is located on the back wall of the vagina, slightly pressed on the crotch. Then the upper (front) mirror is entered, with which the front wall of the vagina is rising.

Attention! When I was introduced into the vagina, the mirror of any type is very important not to strain and do not clamp the muscles - at this moment you need to fully relax.

After the gynecological mirror of any type is set, the light is sent to the vagina on the neck (sometimes enough bright daytime).

When examining, the doctor can almost immediately note the visually noticeable sinusiness of the cervical cervix, which is almost always considered one of the indirect signs of pregnancy.

In addition, when inspection with the help of a vaginal mirror, the doctor can detect inflammatory processes, erosion, the presence of polyps and the presence of any neoplasms, including poor-quality.

Erosion of the cervix has the form of redness and spots on its outer surface, but other diseases may look like this. For accurate diagnosis, an additional study may be needed, which is called colposcopy.

In case of inspection of the cervix, the doctor carefully examines the outer zev of the cervix (hole of the cerval canal). According to the appearance of the cervical canal, the doctor can determine the threat of spontaneous interruption of pregnancy even in very small timing. In addition, the appearance of the outdoor zoom of the cervical channel allows you to determine the Eastic-cervical insufficiency - ZEV is partially ajar and often has an incorrect shape.

In the vaginal inspection, the gynecologist necessarily facilitates the nature of the selection from the cervical canal of the uterus:

• If the allocations have (streying blood), it should alert, because in this case the spontaneous interrupt of pregnancy should be feared (miscarriage);
• If the cable selection is not transparent, but muddy and have a specific unpleasant odor, then this is one of the signs of an infectious process caused by viruses, bacteria or protozoa. To identify the cause of infection, you need to make laboratory tests of discharge, including the method of polymerase chain reaction or other methods. Get reliable information at the very beginning of pregnancy is very important to take the necessary measures to safely develop the fetus.

How to prepare for a survey on the chair?

A visit to the gynecologist provides inspection in the gynecological chair. The modern gynecological chair is the most convenient way of high-quality, efficient and maximally gentle inspection of a pregnant woman. The gynecological examination, which is carried out in a gynecological chair, is completely safe, but at the same time very informative - a doctor with such an inspection can get the maximum number of necessary and quite objective information about the state of pregnant and fetus.

In order for the medical examination in the gynecological chair as comfortable as possible and did not cause any awkwardness, as well as for its maximum informativeness, some rules for the preparation for the gynecological examination should be carried out during the nesting period of the baby.

It is very important that the future mother does not stop conducting a special calendar, in which the days of the beginning of menstrual bleeding and all days of menstrual bleeding were noted before the occurrence of pregnancy.

After the occurrence of pregnancy, menstrual bleeding ceases, since the hormonal background of the female body has changed and ovulation does not occur, that is, the egg from the ovary does not go out, but the hormonal cycle does not disappear completely without a trace - the days in which the menstrual bleeding could be started may be dangerous for any External intervention in the female sex system.

In order not to have a spontaneous interruption of pregnancy, it is extremely undesirable to carry out an internal examination on the gynecological chair at such days, because it is for these days most of the spontaneous interruption of pregnancy, that is, miscarriage.

Hygienic procedures before visiting the gynecologist are required. However, it is very important to limit the usual shower.

Before visiting the gynecologist's gynecologist washed outdoor genitals with soap and, moreover, the douching is categorically not recommended, as this will be washed and all the vaginal flora is destroyed for several hours. Thus, the doctor will not be able to take a vaginal smear to determine the presence of inflammatory processes and / or any infections.

It should be understood that the destruction of any infectious agents is impossible in this way - they will still remain, but the doctor will not receive an objective picture, which may be dangerous and for health pregnant, and for the health of the fetus.

It is very important for no less than a day to a gynecological inspection to refrain from sexual contacts, and unwanted and open sex, and protected (that is, using a condom).

The fact is that for an adequate assessment of the state of the microflora of the vagina, the seed fluid, even if the residues will be a significant obstacle. As for the protected sexual acts (it means the use of a condom), in which the seed liquid into the genital paths of the woman does not fall, then during sexual intercourse in the genital paths, a special lubricant and special mucus are still produced - and they can also distort the results of the analysis.

Before inspecting in the gynecological chair, you need to visit the toilet - except for some cases that the doctor negotiates separately, a visit to the gynecologist must be carried out with a mooring intestine and a bladder.

The fact is that when inspection in the gynecological chair, the doctor presses the wall of the abdomen and in the urinary bubble area, and in the area of \u200b\u200bthe intestine, which can stimulate the separation of urine and / or feces.

For a visit to a gynecologist, an individual gynecological set can be purchased, in which there is a mirror, and a one-time diaper that can be seated on the chair.

However, the entire tool in gynecological cabinets is always carefully sterilized, so no danger is. As for the feasibility of buying a one-time sterile set, it is better to clarify this question from a doctor - not all gynecologists like working with plastic equipment.

As for the disposable diaper, it is optional, although it is desirable. Instead of a one-time diaper, you can use any small towel, which is then easy to wash. In addition, for the same goals (so that the woman could sit on the surface of the gynecological chair, nothing fear) uses disposable multilayer towels.

When planning a visit to the gynecologist, it is better to take trees with you thin cotton socks - it will be more convenient to reach the chair.

As for clothing, the clothes must be as comfortable as possible. First, for the gynecological examination in the chair will have to shoot all the clothes below the waist. Secondly, that the doctor can see and examine the breast, you will have to shoot clothes above the waist. So the dress in this case will not be the best choice.

Attention! If before inspection or during its pregnant woman, any questions arise or it becomes uncomfortable and / or there is an unpleasant feeling, it must immediately report this to the doctor.

Continuing a series of articles.

The main task of female consultations is a systematic observation of pregnant women, starting with early pregnancy terms, timely identification of pregnancy pathology and providing qualified medical care. All pregnant women are under dispensary supervision; On average, a woman during pregnancy should visit the female consultation 13-14 times.

You need to visit the female consultation until the 12th week of pregnancy - in these terms is solved whether pregnancy is admissible.

Until the 28th week you will be offered to come once a month (in the absence of pathology).

Later visits will become more often: twice a month - until the 37th week, before childbirth - every 7-10 days.

Gestational age	Analyzes and examinations	For what we pass
first inspection 7-8 weeks	Poll and inspection of a pregnant obstetrician-gynecologist	The term of pregnancy and alleged childbirth is specified. The state of pregnant woman is estimated, the schedule of visiting LCD is coordinated. Recommendations of pregnant on receiving folic acid, gland preparations, polyvitamins are given. Inspection of the chest, checking the shape of the nipples.
	Clinical blood test	One of the most important examination methods for most diseases.
	Blood group and Rh factor	If the RH factor is a negative need to examine a group of group and Rh-accessory. With a rhesus conflict, this analysis is carried out once a month before the 32nd week of pregnancy, from the 32nd to the 35th - twice a month, and then up to delivery weekly.
	Blood test on RW	Treatment of identified patients is carried out in a venereological dispensary.
	HIV blood test	Pregnant women with an established diagnosis of HIV infection are observed jointly by the infectiousness of the territorial center for the prevention and control of AIDS and the obstetrician-gynecologist, in the female consultation at the place of residence.
	Blood test on antibodies to the hepatitis B and C virus	The appointment of drug therapy and the tactics of pregnant women are carried out jointly by the doctor infectious player and an obstetrician-gynecologist, given the severity of hepatitis, the stage of its flow.
	Blood test for sugar	Allows you to determine hidden sugar diabetes.
	Coagulogram	Blood analysis for coagulation. If the coagulation is increased, then the blood is more viscous and the formation of blood clots is possible. If reduced, there is a tendency to bleeding.
	Analysis of urine	According to the results, the gynecologist assesses the work of the kidneys of pregnant.
		To identify the inflammatory process (by the number of leukocytes), hidden infections, candidiasis, bacterial vaginosis, etc.
	Torch infection	Toxoplasm, mycoplasma, cytomegalovirus, herpes - infections that can lead to fetal vices. If they are detected in a pregnant woman, the doctor prescribes her special therapy.
	Arterial pressure measurement (AD)	General and uterine circulation, is one of the important indicators of the course of pregnancy. Hell control reduces the likelihood of complications from mother and child.
	Weighing	Control over the increase in body weight. From the 16th week of pregnancy there is a weight gain; From the 23rd of the 24th week, the increase is 200 g per week, and from the 29th week does not exceed 300 - 350 g. A week before the birth, the mass is usually reduced by 1 kg, which is associated with the loss of fluid with tissues. For the entire pregnancy, the body weight should increase by about 10 kg (due to the mass of the fetus, spindle water and placenta).
	Measuring sizes of pelvis	The sizes and shape of the pelvis are important for the generic process and are subject to measurement and evaluation in all pregnant women.
	consultation therapist, endocrinologist, oculist, otolaryngologist, and it is also necessary to make an electrocardiogram (ECG).	Therapist - 2 times; Okulist, otolaryngologist, dentist, endocrinologist - 1 time. In the future, according to the indications; Other specialists - by testimony.
after 7-10 days 10-weeks		Determining the tactics of making a pregnant woman taking into account the analyzes received and conclusions from other specialists.
	Analysis of urine	The appearance of a protein in the urine in a pregnant woman can be an initial sign of toxicosis.
12 weeks	Inspection of the obstetrician-gynecologist (measuring hell, weighing)
	Analysis of urine	The urine test gives an idea of \u200b\u200bboth the state of the kidneys and the exchange in other organs and tissues and the body as a whole.
	Uzi (screening)	On the period of 10-14 weeks. To clarify the period of pregnancy and measure the thickness of the collar space (normal - up to 2 mm; an increase of up to and more than 3 mm is a sign of a Daun disease).
	Double Test (Rarr-A, HCG)	The analysis of RARR-A is used to identify the risk of various deviations in the development of the child in the early pregnancy.
16 weeks	Inspection of the obstetrician-gynecologist (measuring hell, weighing)
	Determination of the height of the bottom of the uterus	In the height of the base, the bottom of the uterus approximately determines the term of pregnancy. In addition, knowing the base height of the uterus, according to the Johnson formula, it is possible to calculate the estimated mass of the fetus: from the value of the base of the bottom of the uterus (in centimeters) subtract 11 (with a mass of pregnant to 90 kg) or 12 (with a mass of more than 90 kg) and the resulting number multiply by 155; The result corresponds to the approximate mass of the fetus in grams.
	Measurement of the circumference of the abdomen	A very rapid increase in abdomen in size, accompanied by weight gain, may indicate the accumulation of excess fat, fluid delay and internal edema.
	Listening to the fetal heartbeat.	The fetal heartbeat is determined using an obstetric stethoscope (the hollow tube one end of which is applied to the belly of pregnant, and the other to the doctor's ear) starting from 16-18 weeks.
	Analysis of urine
18 weeks
	Clinical blood test	The diagnosis of anemia (Malokrovia) is a complication of pregnancy, which is characterized by a decrease in hemoglobin levels. Anemia promotes the development of various pregnancy complications.
	Analysis of urine
	Blood test on AFP, hgch	Screening to identify chromosomal diseases congenital malformations (PRD) pregnant women in terms of 16-20 weeks (blood test to alpha-fetoprotein - AFP and chorionic gonadotropin - xg). These are serum proteins, the change in the level of which may indicate the presence of a chromosomal disease in the fetus (for example, Daun's disease, etc.). On other times of pregnancy, the level of blood proteins (AFP and XG) becomes not indicative and cannot be a diagnostic sign.
22 weeks
	Analysis of urine
	Planned ultrasound	In the period of 20-24 weeks. For the study of the fetus organs and evaluating the state of the placenta, the number of arrogant water.
	Doppler Study of the Mounty Placentamentar Bloodfield	Formation of a group of risk for the development of gestosis, delays in the development of the fetus and placental insufficiency in the 3 trimester
26 weeks	Inspection of an obstetrician-gynecologist (blood pressure measurement, weighing, determination of the standing height of the uterus, measuring the abdomen circle, listening to the fetal heartbeat).
	Analysis of urine
30 weeks	Inspection of an obstetrician-gynecologist (blood pressure measurement, weighing, determination of the standing height of the uterus, measuring the abdomen circle, listening to the fetal heartbeat).	The doctor issues a pregnant generic certificate and an exchange card, which fits the results of all analyzes and surveys. Now this card is a pregnant woman to carry with me, as the childbirth can happen at any time, and without the exchange card, doctors can take a giving birth to a woman only in a specialized maternity hospital, where women come without a certain place of residence, without analyzes, non-resident without registration, etc. . Registration of prenatal leave.
	Clinical blood test
	Analysis of urine
	Microscopic study of the discharge vagina (smear per flora)
	Blood test on RW
	HIV blood test
	Definition of the position and prelation of the fetus	The pelvic premium is detected when examining an obstetrician-gynecologist, and then confirmed when ultrasound. Starting from 32 weeks of pregnancy in women's consultation should recommend to perform a set of exercises to translate pelvic preview to the head.
33 weeks
	Analysis of urine
	Uzi (screening)	On time 32-34 weeks. For a functional assessment of the fetus, identifying some defects of the development, manifested in the late period of pregnancy, determining the tactics of pregnancy, the method of the delivery.
35 weeks	Inspection of the obstetrician-gynecologist (measuring blood pressure, weighing, determination of the base height of the bottom of the uterus, the position and presence of the fetus, measure the circumference of the abdomen, listening to the palpitation of the fetus).
	Cardiomonitorial Study of the Fetal (CTG Fruit)	In 34-39 weeks, CTGs of the fetus are carried out to determine the possibilities of the cardiovascular system of the fetus. Possible intrauterine hypoxia is estimated by the motor activity of the fetus.
	Analysis of urine
37 weeks	Inspection of the obstetrician-gynecologist (measuring blood pressure, weighing, determination of the base height of the bottom of the uterus, the position and presence of the fetus, measure the circumference of the abdomen, listening to the palpitation of the fetus).
	Analysis of urine
38 weeks	Inspection of the obstetrician-gynecologist (measuring blood pressure, weighing, determination of the base height of the bottom of the uterus, the position and presence of the fetus, measure the circumference of the abdomen, listening to the palpitation of the fetus).
	Analysis of urine
	Blood test on RW	2-3 weeks before delivery
39-40 weeks	Inspection of the obstetrician-gynecologist (measuring blood pressure, weighing, determination of the base height of the bottom of the uterus, the position and presence of the fetus, measure the circumference of the abdomen, listening to the palpitation of the fetus).
	Analysis of urine
	Ultrasound (by testimony)	To determine the prelation of the fetus, the positions of its body parts and umbilies, the state of the placenta and the well-being of the child to choose tactics in childbirth.

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