Scheduled examination of pregnant women. Examination of a pregnant woman. Internal obstetric research: pros and cons
In this article:
Obstetric research is a set of methods and techniques for examining a woman during pregnancy and the birth itself, for an objective assessment of their condition and course. Examination of a woman consists of the following components: external obstetric research, laboratory and clinical.
External examination
External research includes:
- Examination of a pregnant woman. The doctor evaluates the height, body weight and body type of the woman, as well as the condition of the skin, pigmentation on the face, and determines the shape of the abdomen.
- Measurement of the abdomen. Using a centimeter tape, the doctor measures the circumference of the abdomen at the level of the navel, and also measures the length of the fundus of the uterus.
- Palpation of the abdomen. The woman should be in a supine position. The doctor determines the condition by palpation skin, elasticity of the skin, the thickness of the fat layer, the condition of the rectus abdominis muscles, as well as the location of the fetus.
It is especially important in the first obstetric examination to determine the direct size of the entrance to the small pelvis. In general, pelvic examination has a very importance, since its position and structure affects the course of pregnancy and directly on the birth itself. Narrowing of the hip joint can lead to serious complications that will provoke a difficult birth.
Studies of pregnant women are conducted in several ways:
- First reception. The purpose of this method of examining a woman is to determine the height of the fundus of the uterus and the part of the fetus that is on its bottom. This technique also allows you to judge the estimated timing of pregnancy, the position of the fetus and its presentation.
- Second reception. This method allows you to determine the position of the fetus in the uterus. Gently pressing your fingers on the walls of the uterus, the doctor can determine which way the child will turn. In addition, this technique allows you to determine the number amniotic fluid and excitability of the uterus.
- Third take. The purpose of the third reception of an external obstetric examination is to determine the presentation and its relationship to the small pelvis, as well as general state uterus.
- The fourth technique allows you to determine the state of the presenting head (it is bent or unbent), as well as the level of its relationship to the small pelvis.
OB study factors
During an obstetric examination of women, the doctor must determine several factors that will assess the state of pregnancy and its course.
The position of the fetus is the ratio of the axis of the uterus to the back of the child. The fetal axis is an imaginary line passing through the back of the head and buttocks. If the axis of the fetus and the axis of the uterus coincide in direction, the position of the fetus is called longitudinal. If the axis of the fetus passes through the axis of the uterus at a right angle - this is called the transverse position of the fetus, if under a sharp - oblique.
The position of the fetus is the ratio of the position of the walls of the uterus and the back of the fetus. This factor allows you to find out in what position the baby lies in the uterus. Of course, the longitudinal position of the fetus is the most favorable, as it contributes to the good progress of the fetus through the birth canal.
The articulation of the fetus allows you to find out the ratio of the limbs of the fetus and its head to the entire body. The normal position is when the head is bent and pressed to the body, the arms are bent at the elbows, crossed and pressed to the chest, and the legs are bent at the knees and hip joints, crossed and pressed to the tummy.
Internal obstetric research: pros and cons
Some women believe that an internal obstetric examination is not necessary. Moreover, they believe that it can harm the fetus. Actually it is not. This method of research, in some cases, allows for early dates identify pathologies and developmental disorders of pregnancy.
An internal obstetric examination should be performed in the first 3 to 4 months of pregnancy. This technique allows you to detect pregnancy on initial stages(when the belly is not yet visible), its estimated timing, as well as possible pathologies genitals. Internal obstetric examination on later dates determines the state of the birth canal, the dynamics and degree of uterine opening, as well as the advancement of the presenting part of the fetus through the birth canal.
All these factors of examination at a later date allow us to make predictions about the course of childbirth. Why else is it necessary to conduct an internal obstetric study?
Thus, the gynecologist examines the external genital organs for the presence of pathologies, infections or other abnormalities. After that, with the help of mirrors, an examination of the internal genital organs is performed. In this case, the condition of the mucosa is assessed for the presence of infections, the vagina and cervix, as well as the condition and nature of the discharge.
With help this study it is possible to identify pathologies in the early stages of pregnancy that can lead to complications and even termination of pregnancy. For example, some infections can cause serious complications not only to the entire cycle, but also to the fetus.
Other research methods
Of course, external and internal obstetric studies largely determine the nature of the course of pregnancy, and also make it possible to predict how the process of childbirth itself will take place. However, these surveys are often not enough to paint the full picture.
In order to most accurately determine the gestational age, the position of the fetus, the condition of the uterus, as well as many other factors, gynecologists use additional research methods.
Auscultation of the fetus is performed using an obstetric stethoscope. This method allows you to hear the fetal heartbeats, determine their frequency in the early stages, as well as during attempts and fetal hypoxia. In addition, you can hear the heart rate with the help of the "Kid" apparatus, whose operation is based on the principle of the Doppler effect.
Equally important is the obstetric examination of pregnant women using an ultrasound machine, which allows you to fully assess the condition of the fetus, identify exact dates pregnancy, as well as in the early stages to identify possible pathologies.
In addition to the above methods of obstetric research, the following methods take place in medical practice: the study of amniotic fluid, which is obtained using amniocentesis, the study of uteroplacental blood flow, as well as amnioscopy, fetoscopy, and much more. In addition, do not forget about the numerous analyzes and measurements that show the full picture of pregnancy.
Any woman in this exciting period of her life should be extremely attentive to her health. After all, the health of her baby depends on it.
Useful video about research during pregnancy
A convincing two lines on a pregnancy test showed that yes, it happened. You are pregnant. And, the world for you, immediately, has changed dramatically in two stages - before pregnancy and after. You began to listen to yourself, to identify additional evidence of pregnancy. But, along with pleasant and good news comes the realization that now you will have to spend a significant part of your personal time not on your favorite pastimes and hobbies, but in medical institutions to visit numerous doctor's offices there.
Not all visits are pleasant for a woman, but one cannot do without them. Sometimes you unwittingly become a witness various conversations in the circle of women giving birth and pregnant women. Some are glad that there were few procedures during pregnancy, while others complain that they were tortured to follow all the instructions of their doctor. Is there a golden mean?
Getting ready for the first visit
Your first pregnancy examination will take place using a gynecological chair. Few women like this procedure, but there is nowhere to go and therefore, in order to reduce the percentage of discomfort, you should prepare for it in advance. It is necessary to draw up a calendar with notes on when you would have had your period if you had not become pregnant.
Agree, this is easy to do, especially with a regular cycle. Therefore, do not plan a visit to the doctor directly on these days, as they are considered critical periods, and therefore dangerous, for the development of pregnancy. Also postpone ultrasounds and physical examinations, unless, of course, nothing bothers you, until the eighth week, counting from the first day of your last period.
Before visiting a medical institution, you should take a bath or shower, put on fresh underwear. There is no need to wash especially, and even more so to douche. The doctor should examine the condition of your vagina in a normal state. The use of perfumes and intimate deodorants is not recommended. They are often the cause allergic reaction regarded by the doctor as inflammation.
Most women shave their perineum before visiting the doctor. But, is it really worth it? No, not necessarily. Of course, it is not always convenient for a doctor to examine a woman with excess on the external genitalia. hairline, but if you don’t do this regularly, then it’s not worth it, because this intimate process can lead to severe irritation skin.
Must be emptied bladder. During the examination, the doctor should assess the condition of the internal genital organs, and not an overfilled bladder. In addition, the intestines must also be empty. Sexual contacts should be excluded a day before the visit to the doctor. This is due to the fact that a small amount of seminal fluid remains in the vagina after intercourse, which distorts the results of the analysis. Of course, sometimes there is a long queue to the gynecologist, therefore, it will not be superfluous to visit the toilet before your appointment.
What you will wear also plays important role. You should be comfortable, but you should also quickly undress or empty your chest at the gynecologist's appointment. Socks or slippers will not be superfluous so that you do not walk barefoot on the cold floor to the gynecological chair. Take your towel as well, despite the fact that the gynecologist will offer you a paper one.
It will also be desirable to purchase a disposable gynecological kit so that you are not tormented by thoughts about the conscientiousness of the sterilization of examination instruments by the medical staff. By the way, they are inexpensive and, as a rule, are sold in most pharmacies. The kit includes: a plastic mirror designed to examine the cervix, sterile gloves, special brushes or sticks for taking material for analysis, and a disposable film that replaces a towel.
Before the examination itself, a preliminary conversation between the doctor and the patient, measurement of pressure, then examination on the couch and weighing is preceded. Let's leave some recommendations for women. Leave your shoes in front of a separate examination room, if available. Ask the midwife or doctor where it is possible to undress, so as not to accidentally put clothes on a radiator or a sterile table.
Undress slowly, during this time the medical staff will fill out the necessary documents.
Put on slippers or put on socks, put a towel or a film on the chair so that it lines up with the edges, but does not hang from it. Climb onto the chair slowly up the stairs and take a position so that the buttocks are on the very edge of it. Next, on the stands on the chair, place your legs, while the slingshots should be fixed in the popliteal fossa.
If the design of the chair is not familiar to you, ask your gynecologist about it without hesitation. Try to relax and calm down, while placing your hands on your chest. Consider what the doctor does should not be. It makes it worse discomfort and makes inspection difficult. About everything that interests you, you can ask the doctor after the examination.
What does 1 examination during pregnancy mean?
The examination begins, as a rule, with an examination of the woman's external genital organs. At the same time, the doctor professionally assesses the condition of the skin and mucous membrane of the perineum, clitoris, large and small labia, and necessarily the external opening urethra.
The doctor also examines the inner thighs, allowing you to predict in advance varicose veins veins, areas of elements of the rash or pigmentation. viewed in without fail and area anus for cracks and hemorrhoids, other pathologies.
The second stage is the examination in the mirrors. An examination is directed mainly to identify certain diseases of the vagina or the condition of the cervix is determined. There are two types of mirrors: spoon-shaped and folding. The introduction of a mirror is the most unpleasant procedure during the examination.
The nature of the discharge from the cervix is given special attention. Allocations with streaks of blood indicate the risk of abortion. An infection is indicated by an unusual smell of discharge and if it is cloudy.
Required tests
A smear on the flora is the first analysis when registering during pregnancy. The doctor, with a special spoon, "scoops" the substance from the cervical canal, urethra, vagina and puts it on the glass. The material is examined in the laboratory under a microscope.
This analysis reveals the presence inflammatory process, some types of infection are also detected, namely: gonorrhea, candidiasis, fungal, bacterial vaginosis, trichomoniasis.
A smear on the flora, during the entire bearing of the child, is repeated 3-4 times, even in the case of its positive results.
This frequency is explained by the fact that during pregnancy, long-forgotten and not making themselves felt infections “wake up”. An example is candidiasis, which occurs in women during pregnancy, 2-3 times more often. The body of a woman is rebuilt, which leads to an increase in the level of female sex hormones. The vaginal environment becomes more acidic, in which the candida feels great.
It should be noted that hormonal changes reduce cellular immunity and leukocyte activity, which leads to increased reproduction in the genital tract of a pregnant woman of this fungus. The number of microorganisms is higher, the longer the gestational age. Therefore, candidiasis strongly worries expectant mothers in the last trimester.
A cytological examination is the second mandatory analysis, in which the structural features of the surface cells and the cervical canal are examined. A smear is taken with a special tool - a brush or spatula. The analysis is important for the detection of cancer in the early stages. During pregnancy, it is extremely necessary, because pregnancy itself only exacerbates the course of such diseases. For analysis, a cytological smear directly taken from the vaginal fornix is also important.
Allows you to correctly assess a woman's hormonal status, determine abnormalities in the uteroplacental blood flow, or predict the risk of abortion.
In many antenatal clinics in last years Examine pregnant women for sexually transmitted infections. At the first visit, such an analysis is not taken, usually during a second examination on a chair.
Also, the doctor will prescribe without fail and urine. By the way, rented during the first visit antenatal clinic, and the analysis itself turns out to be the most frequent due to the fact that the kidneys may not be able to cope with the increased load during pregnancy. Blood is taken from a vein to determine the blood type and Rh factor. Also, with the help of this analysis, malignant changes are detected.
Determined by blood test and hemoglobin level. Its low level, in addition to feeling unwell women, and leads to a violation of the course of pregnancy. To increase the level of hemoglobin, iron preparations are indicated. But, women in the early stages, these drugs are poorly tolerated due to toxicosis. Therefore, as a substitute, it is recommended proper nutrition. It is also necessary to detect the presence of antibodies to rubella and other infections: herpes, cytomegalovirus.
At the first examination, the doctor will also take an interest in your husband's health. Find out his age, the presence of hereditary diseases, blood type and. An anamnesis of relatives will also be collected, and on both sides. With hormonal, metabolic and hereditary diseases Naturally, other additional examinations will be assigned.
Inspection by hand
After examination with a mirror, a two-handed vaginal examination is performed. In this regard, the doctor determines the position, size and condition of the uterus, ovaries, fallopian tubes. To do this, the doctor spreads his arms large labia and gently inserts the middle and index fingers of the right hand into the vagina. Left hand lies on the stomach. At the same time, the condition of the vagina is assessed: the extensibility of the walls, the width of the lumen, the presence of partitions, tumors, scars, and other pathological conditions affecting the course of pregnancy and subsequent childbirth.
Next, the doctor examines the cervix and determines its size, shape, location, consistency. The cervix in the normal course of pregnancy is tilted back, its length is over 2 cm, dense to the touch, the finger channel is not passable. In the event of an abortion, the cervix softens, shortens, shifts to the center, and the canal opens. An experienced gynecologist needs only to touch it to assess the condition of the cervix.
Next, the doctor feels the uterus, the size of which, most often, corresponds to the gestational age. But, if a woman is diagnosed with uterine fibroids, she expects twins, she is pregnant for the third or fourth time in a row, with some gynecological diseases, then the size of the uterus may be larger. The doctor also pays attention to the shape and consistency of the uterus. During pregnancy, the uterus is softer than normal. The softening of the part of the uterus, which is closer to the cervix, is especially observed.
Various irregularities on the uterus are often a sign of various anomalies in the development of the uterus or fibroids. The uterus is mobile for a short time and occupies a middle position in the small pelvis. In case of restriction of its mobility or deviation to the side, this indicates inflammatory disease uterine appendages or adhesive process. The next to be examined by a doctor are the ovaries and the fallopian tubes to exclude ectopic pregnancy in which the examination is painful. At the end of the examination, the doctor feels the inner surface of the symphysis, sacrum, side walls of the pelvis.
As you can see, there is nothing wrong with the first visit to the doctor, so feel free to go - this is important for your future pregnancy.
When registering a pregnant woman, the doctor examines her and records the results in an individual variable card (firm IIIy).
1. Passport data: full name, series and number of the passport.
2. Age ( juvenile primipara- up to 18 years; age primiparous - 28 years and older).
4. Profession (influence of production factors on the body of a pregnant woman and fetus and observation up to 30 weeks in the medical unit).
5. Anamnesis, past general somatic and infectious diseases, diseases of the genital organs, former pregnancies and childbirth, surgeries, blood transfusion history, epidemiological history, allergies, family history, heredity.
6. Laboratory research: general analysis blood - 1 time per month, and from 30 weeks. pregnancy - 1 time in 2 weeks; general urine test - in the first mat of pregnancy monthly, and then 1 time in 2 weeks, blood type and Rh affiliation in both spouses, RW - three times (when registering 28-30 weeks and 34-36 weeks), HIV and Australian antigen - when registering, fecal analysis for helminth eggs when registering: complement fixation reaction with toxoplasmic antigen according to indications; coagulogram; presence of sugar in daily amount urine and blood; analysis of vaginal discharge for microflora at registration and at 36-37 weeks; ECG - at 36-37 weeks.
7. An objective examination is carried out by an obstetrician, therapist, dentist, otolaryngologist, ophthalmologist, if necessary, endocrinologist, urologist:
a) anthropological measurements (height, weight);
b) blood pressure;
c) external obstetric examination:
- Distantia spinarum (25-20 cm);
- Distantia cristarum (28-29 cm);
- Distautia trochanterica (30-31 cm);
- Coniugata externa (20 cm).
In case of deviation from the indicated dimensions, it is necessary to internal research take additional measurements of the pelvis:
a) lateral conjugate (between the anterior and posterior iliac spines of the same side - 14-15 cm (if this figure is less than 12.5 cm, natural delivery is impossible);
b) oblique dimensions of the small pelvis:
- from the middle of the upper edge of the pubic articulation to the posterior superior awn of the wings of both iliac bones - 17.5 cm each,
- from the anterior superior spine of the iliac wing of one side to the posterior superior spine of the other side - 21 cm each,
- from the spinous process of the V lumbar vertebra to the anterior superior spinous and other ilium - 18 cm each (the difference between the sizes of each pair is more than 1.3 cm indicates an oblique narrowing of the pelvis),
c) dimensions of the Michaelis rhombus:
- vertical - between the supra-sacral fossa and the top of the sacrum - 11 cm,
- horizontal - between the rear upper awns wings of both iliac bones - 10 cm;
d) the angle of inclination of the pelvis - the angle between the plane of the entrance to the pelvis and the plane of the horizon (measured with a pelvis in the position of a woman standing) - 45-55 °;
e) dimensions of the outlet of the pelvis:
- straight - between the top of the coccyx and the lower edge of the pubic symphysis - 9 cm,
- transverse - between the inner surfaces of the ischial tubercles - 11 cm;
f) determine the values of the true conjugate:
- according to the outer conjugate - 9 cm is subtracted from the size of the outer conjugate,
- according to the diagonal conjugate - 1.5-2 cm is subtracted from the size of the diagonal conjugate (the figure to be subtracted is determined by the circumference in the area of the wrist joint - with a circumference of up to 14 cm, subtract 1.5 cm, over - 2 cm),
- according to USS (most accurately).
At the first examination through the vagina, the size, shape, consistency, mobility of the uterus, the condition of the pelvic bones, soft tissues, muscles are determined. pelvic floor. Additionally, the height of the womb (4 cm), the internal diagonal conjugate, and the pubic angle are measured.
After an increase in the size of the uterus, when its external palpation becomes possible, it is necessary to determine the tone of the uterus, the size of the fetus, the amount of amniotic fluid, the presenting part, the articulation of the fetus, its position, position and appearance, using four classical obstetric appointments(according to Leopold).
Auscultation of fetal heart sounds is carried out from 20 weeks of pregnancy. Fetal heart sounds are heard with an obstetric stethoscope in the form of rhythmic double beats with a constant frequency of 130-140 per minute.
M. S. Malinovsky suggested following rules to listen to the fetal heartbeat:
1. With occiput presentation - near the head below the navel on the side where the back is facing. With rear views - on the side of the abdomen along the anterior axillary line.
2 With facial presentation - below the navel on the side where the breast was (in the first position - on the right, in the second - on the left).
3. In the transverse position - near the navel, closer to the head.
4. When presenting with the pelvic end - above the navel, near the head on the side where the back is facing.
In recent years, the "Kid" apparatus and ultrasound devices, cardiac monitors have been widely used, which allow clarifying auscultatory data in difficult cases.
Ed. K.V. Voronin
Attachment 1
medical and diagnostic
discipline manipulation
gynecology, obstetrics
by specialties
2-79 01 31 "Nursing"
2-79 01 01 "Medicine".
Examination of a pregnant woman and a woman in labor.
External examination of a pregnant woman.
Inspection often provides very valuable data for the diagnosis. On examination, attention is paid to the growth of the pregnant woman, physique, body weight, the condition of the skin, hairiness, the condition of the visible mucous membranes, mammary glands, the size and shape of the abdomen.
Indications: 1) examination of a pregnant woman, a woman in labor.
1. Remove outer clothing.
Pay attention to the growth of the pregnant woman. With a low height of 150 cm and below, women often show signs of infantilism (narrowing of the pelvis, underdevelopment of the uterus). Among women tall other features of the pelvis are observed (wide, male-type pelvis).
Pay attention to the physique of the pregnant woman, the development of subcutaneous fat, the presence of deformation of the spine, lower extremities, joints. Severe emaciation or obesity is often a sign of metabolic disorders, endocrine diseases.
Determine the color and purity of the skin and visible mucous membranes.
Paleness of the skin and visible mucous membranes, cyanosis of the lips, yellowness of the skin and sclera, swelling are signs of a number of serious diseases.
Examine the mammary glands, determine the shape of the nipples (convex, flat, retracted), the presence of discharge (colostrum) from the nipples.
Examine the abdomen, determine the shape, with correct position fetus - ovoid (ovoid) shape. With polyhydramnios, the spherical shape and size of the abdomen is greater than the corresponding gestational age. With the transverse position of the fetus, the abdomen takes the form of a transverse oval. The shape of the abdomen may change with narrow pelvis(pendulous, pointed).
Examine the growth of hair on the genitals, anatomical structure labia, clitoris. Determine the type of hair growth: female or male.
Examine the Michaels rhombus. Determine its shape.
Determine the presence of edema on the lower extremities and other parts of the body.
The final stage.
10. Record the obtained data in medical documentation.
Weighing a pregnant woman.
A pregnant woman is weighed at each visit to the antenatal clinic. The normal weight gain of a pregnant woman is 300-350 grams per week.When controlling body weight, the pregnant woman is weighed in the same clothes on the same scales.
Indications: 1) determination of the body weight of a pregnant woman, control over weight gain.
Workplace equipment: 1) medical scales;
2) an individual card of a pregnant woman and a puerperal; 3) exchange card.
Preparatory stage of the manipulation.
1. Inform the pregnant woman about the need and essence
manipulation.
Before weighing, it is necessary to offer the pregnant woman to empty her bladder and intestines.
Check the balance of the scales by setting the weights on both scales to the zero position.
Adjust the balance, close the shutter.
The main stage of the manipulation.
5. The pregnant woman takes off her shoes and stands on the base of the scale, which
covered with oilcloth.
6. Open the shutter and, by moving the weights, balance the two
shooter.
The final stage.
7. Mark the readings of the scales, close the shutter.
8. After weighing, treat the oilcloth with a disinfectant
solution.
9. Wash your hands.
10. Write down the result in the medical documentation.
Measuring the circumference of the abdomen.
Indications: 1) determination of the gestational age and the estimated weight of the fetus.
Workplace equipment:1) measuring tape;
2) couch; 3) individual card of a pregnant woman;
4) individual diaper, 5) disinfectant.
Preparatory stage of the manipulation.
1. Inform the pregnant woman or the woman in labor of the need
2. Empty the bladder and intestines.
4. Wash your hands.
The main stage of the manipulation.
5. Apply a measuring tape around the abdomen: in front at the level
navel, behind - in the middle of the lumbar region.
The final stage.
7. Wash your hands.
8. Record the result in the individual card of the pregnant woman, history
disinfectant.
Determination of the standing height of the fundus of the uterus.
To determine the gestational age and find out the date of birth great importance have objective examination data: determination of the size of the uterus, abdominal circumference.
At 12 weeks of gestation, the fundus of the uterus reaches the upper edge of the pubic symphysis. At 16 weeks, the bottom of the uterus is located in the middle of the distance between the pubis and the navel (6-7 cm above the womb). At 20 weeks, the bottom of the uterus is 2 transverse fingers below the navel (12-13 cm above the womb). At 24 weeks, the bottom of the uterus is at the level of the navel (20-24 cm above the womb). At 28 weeks, the bottom of the uterus is two to three fingers above the navel (24-28 cm above the womb). At 32 weeks, the bottom of the uterus is in the middle of the distance between the navel and the xiphoid process (28-30 cm above the womb). At 36 weeks, the bottom of the uterus is at the level of the xiphoid process (32-34 cm above the womb). At 40 weeks, the bottom of the uterus is 28-32 cm above the womb.
Indications: 1) determination of the height of the uterine fundus.
Workplace equipment:1) measuring tape;
2) couch; 3) an individual card of the pregnant woman and the puerperal (history of childbirth); 4) individual diaper,
5) disinfectant.
Preparatory stage of the manipulation.
execution and essence of manipulation.
2. Invite the pregnant woman to empty her bladder and intestines.
3. Lay the pregnant woman on a couch covered with individual
diaper, on the back, straighten the legs.
4. Wash your hands.
The main stage of the manipulation.
5. Apply a measuring tape along middle line belly and
measure the distance between top edge symphysis and most
protruding (upper) point of the fundus of the uterus.
The final stage.
6. Help the pregnant woman get up from the couch.
7. Wash your hands.
8. Record the result in the individual card of the pregnant woman and
puerperas (history of childbirth).
9. Put on gloves and process the centimeter tape
disinfectant.
External obstetric examination (4 appointments).
External obstetric examination refers to the main methods of examination of a pregnant woman. During palpation of the abdomen, the parts of the fetus, its size, position, position, presentation, the ratio of the presenting part of the fetus to the mother's pelvis are determined, the movement of the fetus is felt, and they also get an idea of the amount of amniotic fluid and the condition of the uterus.
Indications: 1) determination of the position of the fetus in the uterus.
Workplace equipment: 1) a couch covered with disinfected oilcloth; 2) an individual card of a pregnant woman and a puerperal (history of childbirth); 3) individual diaper.
Preparatory stage of the manipulation.
1. Inform the pregnant woman about the need to perform and
essence of manipulation.
joints.
3. Wash your hands.
4. Stand to the right of the pregnant woman facing her.
The main stage of the manipulation.
5. With the help of the first reception, the height of the uterine fundus is determined
and that part of the fetus that is at the bottom of the uterus.
To do this, the palms of both hands are located at the level of the fundus of the uterus,
fingers approach, gently pressing down
the level of standing of the fundus of the uterus and the part of the fetus, which
located at the bottom of the uterus.
6. Using the second technique, determine the position and type of position
fetus.
Both hands from the bottom of the uterus are moved downwards, placing them on the side surfaces. Palpation of the parts of the fetus is performed alternately with the right and left hand to determine in which direction the back of the fetus and its small parts are facing. The back of the fetus is defined by touch as a wide, smooth, dense surface. Small parts of the fetus are determined with opposite side in the form of moving small parts (legs, handles). If the back is turned to the left - the first position. If the back is turned to the right, the second position.
7. With the help of the third method, the presentation of the fetus is determined.
The study is carried out as follows: right hand need
put a little above the pubic joint so that a large
If the fetal head completely fills the pelvic cavity, then
it is not possible to probe it with external methods.
The final stage.
9. Wash your hands.
10. The data obtained are noted in the individual card of the pregnant woman and the puerperal (history of childbirth).
Diagnosis of malpositions of the fetus
transverse and oblique position fetuses are classified as incorrect positions and occur in 0.5 - 0.7% of the total number of births. Unlike longitudinal position the axis of the fetus forms a straight or acute angle with the longitudinal axis of the uterus, the presenting part is absent. In childbirth with a transverse and oblique position of the fetus, serious and very life-threatening complications for the mother and fetus are possible - neglected transverse position of the fetus, rupture of the uterus, death of the mother and fetus. To prevent these complications, timely diagnosis of incorrect fetal positions is needed.
Indications: examination of a pregnant woman and a woman in labor to determine the position of the fetus.
Workplace equipment: 1) couch; 2) measuring tape; 3) obstetric stethoscope; 4) ultrasonic scanning apparatus.
Preparatory stage of the manipulation.
1. Inform the pregnant woman or the woman in labor of the need
execution and essence of manipulation.
2. Lay the pregnant woman (woman in labor) on the couch.
3. Examine the shape of the abdomen (pregnant, parturient): the shape of the abdomen in
in the form of a transverse or oblique ovoid, low standing of the uterine fundus.
4. Wash your hands.
The main stage of the manipulation.
Measure the height of the fundus of the uterus. In the transverse position of the fetus, the height of the uterine fundus is less than the corresponding gestational age.
Make a palpation of the abdomen of a pregnant woman (parturient woman).
the uterus is missing a large part of the fetus. At the second admission
external obstetric research - large parts (head,
pelvic end) are palpated in the lateral sections of the uterus.
At the third and fourth reception over the bosom, the presenting part is not
determined
The fetal heartbeat is heard at the level of the navel on the left or right, depending on the position of the fetus.
During vaginal examination, the presenting part of the fetus is not determined. During childbirth, when the cervix opens, it is possible to feel the fetal shoulder, ribs, shoulder blade, and spine.
fetal head, that is, the position of the fetus.
When the pen falls out of the genital slit, the diagnosis of the transverse position of the fetus is beyond doubt.
11. You can clarify the position of the fetus with ultrasound
research.
The final stage.
12. Record the research data in the medical documentation.
Listening to the fetal heartbeat.
Auscultation is performed with an obstetric stethoscope primarily to detect fetal heart sounds after 20 weeks, which serve reliable sign pregnancy. By listening to heart tones, they also find out the condition of the fetus, which is especially important during childbirth.
Currently, electrocardiography (ECG), phonocardiography (PCG) are also used to assess fetal cardiac activity. One of the leading methods for assessing the condition of the fetus is currently cardiotocography (CTG). Normal fetal heart rate is 120-160 beats per minute.
Indications: 1) determination of fetal heart rate
Workplace equipment: 1) obstetric stethoscope;
2) stopwatch; 3) couch; 4) cardiotocograph; 5) individual diaper.
Preparatory stage of the manipulation.
1. Inform the pregnant woman or the woman in labor of the need
execution and essence of manipulation.
2. Lay the pregnant woman on a couch covered with individual
3. Wash your hands.
4. Conduct an external obstetric examination to determine
position and presentation of the fetus.
The main stage of the manipulation.
5. Apply an obstetric stethoscope with a wide funnel to a bare
pregnant belly.
6. When occipital presentation fetal heartbeat is audible
below the navel: on the left - in the first position, on the right - in the second
positions. At breech presentation most clearly
fetal heartbeat is audible above the umbilicus
fetal position on the left or right. At transverse position fetus
- at the level of the navel, closer to the head.
7. When listening to the fetal heartbeat, you can catch the beat
abdominal aorta, large vessels of the uterus. They match the pulse
9. Monitoring the fetal heart activity using
cardiotocography. The pregnant woman is laid on the couch and carried out
external obstetric examination. to the ultrasonic receiver
contact gel is applied and placed on the mother's abdomen in
the best place to hear heart sounds. Fasten
belt and record for 40 minutes in the position of the patient
on the left side.
The final stage.
10. After the end of the examination, wipe the stethoscope with a rag,
moistened with a disinfectant solution.
11. Wash your hands.
12. Record the received data in the individual card of the pregnant woman
and puerperas (history of childbirth).
Measurement of the external dimensions of the pelvis. Solovyov index.
Measurement of the size of the large pelvis allows us to indirectly judge the size of the small pelvis, allows us to establish the degree of narrowing of the pelvis. Solovyov's index makes it possible to get an idea of the thickness of the bones of a pregnant woman. Normally, the Solovyov index is 14-16 cm. To determine the true conjugate, 9 cm is subtracted from the outer one. If the Solovyov index is more than 16 cm, the pelvic bones are thick, 10 cm is subtracted from the outer conjugate. If the Solovyov index is less than 14 cm, the bones the pelvis is thin, 8 cm is subtracted from the outer conjugate.
Indications: 1) measurement of the external dimensions of the pelvis;
2) measurement of the Solovyov index.
Workplace equipment: 1) couch; 2) tazomer;
3) measuring tape; 4) individual diaper;
5) disinfectant.
Preparatory stage of the manipulation.
1. Inform the pregnant woman or the woman in labor of the need
execution and essence of manipulation.
2. Place the patient on a couch covered with an individual
diaper, on the back, legs straightened.
3. Wash your hands.
4. Stand to the right of the woman, facing her.
5. Take the tazomer so that the scale is facing up, and large and
index fingers lay on the buttons of the tazomer.
6. With your index fingers, feel the points between which
measure the distance by pressing the buttons of the tazomer to them and mark
on the scale the value of the resulting size.
The main stage of the manipulation.
7. Distancia spinarum - the distance between the anterior superior spines
iliac bones. The buttons of the tazomer are pressed against the outer
edges of the anterior superior spines. Normally 25-26 cm.
8. Distancia cristarum - the distance between the most distant points
iliac crests. I move the buttons from the awns along
outer edge of the iliac crests until
define greatest distance, this will be
distance Cristarum. Normally 28-29 cm.
9. Distancia trachanterica - distance between large skewers
thigh bones. The most prominent points of the large trochanters are found (the patient is offered to turn the feet inward and outward) and the buttons of the pelvis are pressed. Normally 30-31 cm.
10. For measuring the longitudinal dimension (outer conjugate)
the pregnant woman should be laid on her side, the lower leg bent in
hip and knee joints, overlying - straighten.
11. The buttons of the tazomer are installed in the middle of the upper outer
edges of the symphysis and to the supracacral fossa on the back, which is located
under the spinous process of the fifth lumbar vertebra, which
corresponds to the upper corner of the Michaels rhombus - the size is equal to
The Solovyov-circumference index in the area of the wrist joint is measured with a centimeter tape. Normally, the Solovyov index is 14 cm.
The final stage.
13. Record the data obtained in the individual card of the pregnant woman
and childbirth.
14. Wash your hands,
15. Treat the tazometer with a ball dipped in a disinfectant
means.
Measurement of the dimensions of the pelvic outlet plane.
If during examination of a pregnant woman there is a suspicion of a narrowing of the pelvic outlet, then the dimensions of this plane are determined. The direct size of the pelvic outlet is from the top of the coccyx to the lower edge of the symphysis: it is 9.5 cm; up to 11.5 cm.
The transverse size of the pelvic outlet is determined between the inner surfaces of the ischial tuberosities: it is 11 cm.
Indications: 1) measuring the dimensions of the pelvic outlet plane
Workplace equipment: 1) tazomer; 2) measuring tape; 3) gynecological chair; 4) medical couch;
5) individual diaper; 6) individual card of the pregnant woman and the puerperal; 7) history of childbirth.
Preparatory stage of the manipulation.
1. Inform the pregnant woman or the woman in labor of the need
execution and essence of manipulation.
2. Lay the pregnant woman on a gynecological chair covered with
disinfected oilcloth and individual diaper, on the back,
legs bent at the hips and knee joints, divorced in
sides and as close to the stomach as possible.
3. Wash your hands.
The main stage of the manipulation.
To measure the direct size of the pelvic outlet, one button of the pelvis
coccyx. From the resulting size subtract 1.5cm (fabric thickness)
- we get the true distance.
The transverse dimension is measured with a centimeter tape or a pelvis with crossed branches. Feel the inner surfaces of the ischial tuberosities and measure the distance between them. To the obtained value, you need to add 1-1.5 cm, taking into account the thickness of the tissues located between the buttons and the buttocks.
The final stage.
Record the received data in the individual card of the pregnant woman,
Examination of the cervix with the help of mirrors.
This research method allows you to determine the shape of the cervix, the shape of the external os, to identify cyanosis of the cervix and vaginal mucosa ( probable sign pregnancy), diseases of the cervix and vagina (inflammation, erosion, polyp, cancer), assess the nature of the discharge, examine the walls of the vagina.
Indications: 1) examination of gynecological patients;
2) examination of pregnant women and puerperas; 3) carrying out preventive examination.
Workplace equipment: 1) gynecological chair;
2) sterile gloves; 3) mirrors spoon-shaped Sims or folding Cuzco are sterile; 4) sterile diapers; 5) containers with a disinfectant; 6) an individual card of a pregnant woman and a puerperal (outpatient medical card), 7) rags.
Preparatory stage of the manipulation.
1. Inform the pregnant woman, the puerperal and the gynecological
patient about the need to fulfill and the essence of this
manipulation.
2. Invite the patient to empty her bladder.
3. Place the patient on the gynecological chair in the “on
back, legs bent at the hip and knee joints and
pulled apart."
4. Wash your hands and put on sterile gloves.
The main stage of the manipulation.
5. With the thumb and forefinger of the left hand, spread the large and
small labia.
6. Insert the Cusco speculum in a closed form longitudinally into the vagina
the length of the genital slit along back wall half vagina.
7. Then turn so that one sash is in front, the other is behind,
mirror handle - facing down.
8. Then press on the lock, move the mirror open
to the vaults so that the cervix is visible, and fix it.
9. Examine the cervix, determine the shape of the cervix, condition
external pharynx, position, size, color of the mucous membrane,
Availability pathological processes. The walls of the vagina are examined
when removing mirrors
10. Spoon-shaped mirrors are first introduced with an edge along the back wall
means.
12. Wash your hands.
13. Record the data obtained in the history of childbirth or in
an individual pregnancy card.
14. Put on gloves and process the pelvis and gynecological chair
disinfectant.
Preparing a pregnant woman and a puerperal for an ultrasound scan.
Ultrasound scanning is a highly informative, harmless research method and allows for dynamic monitoring of the fetal condition.
In the first trimester of pregnancy:
1) early diagnosis pregnancy (3-3.5 weeks);
2) monitor the growth and development of the fetus;
3) establish the symptoms of a threatened abortion
(hypertonicity); the state of the internal os and the length of the cervix;
4) determine the area of chorion detachment, determine
non-developing pregnancy;
5) determine multiple pregnancy;
6) define hydatidiform mole and ectopic pregnancy.
In the second trimester of pregnancy:
diagnose fetal malformations and diseases: hydrocephalus, anencephaly, absence of limbs, intestinal obstruction, hernia of the anterior abdominal wall;
determination of the gestational age, hypo- and hypertrophy of the fetus when measuring the size of the head and body;
determination of the sex of the fetus.
AT third trimester of pregnancy:
determination of presentation and position, type of fetus;
by the size of the head and body of the fetus, determination of its mass.
assessment of the amount of amniotic fluid;
the condition of the scar on the uterus after a caesarean section;
the exact location of the placenta, the degree of maturity of the placenta;
measurement of the size of the pelvis, conjugates of the pelvis.
In the postpartum period:
monitoring of uterine involution;
detection of endometritis, remnants of placental tissue.
Indications:
1) examination of a pregnant woman, a woman in labor and a puerperal.
Workplace equipment: 1) ultrasonic device; 2) contact gel; 3) individual diaper; 4) couch; 5) form ultrasound; 6) condom, 7) disinfectant, 8) rubber and cotton gloves.
Preparatory stage of the manipulation.
1. Inform a pregnant woman, a woman in labor or a puerperal about
the need to perform and the nature of the manipulation.
2. Lay an individual diaper on the couch.
3. Put the pregnant woman on couch on the back.
4. Front abdominal wall lubricated with gel.
5. For transvaginal ultrasound, put on the vaginal probe
condom.
The main stage of the manipulation.
6. Moving the abdominal sensor along the abdomen and examine
screen image.
The final stage.
7. Help the pregnant woman get up from the couch.
8. Record the obtained data in the conclusion of the ultrasound
research
9. Treat the sensor with a disinfectant.
Determination of the expected due date and date of prenatal leave.
In accordance with the legislation in the Republic of Belarus, all working women are granted maternity leave at 30 weeks of pregnancy, lasting 126 days (70 days before childbirth and 56 days after childbirth). Women living in areas with radioactive contamination of 1 Ci / sq. km and above - from 27 weeks of pregnancy to 146 days. In the event of complicated childbirth or the birth of two or more children, this allowance is paid for 140 and 160 calendar days, respectively.
Indications: 1) determination of the term of childbirth and the date of prenatal leave.
Workplace equipment: 1) medical couch;
2) measuring tape; 3) tazomer; 4) calendar;
5) an individual card of the pregnant woman and the puerperal (history of childbirth).
The main stage of the manipulation.
Determine the date of birth by menstruation. By the first day
obstetric months). Or from the first day of your last period
subtract 3 months and add 7 days.
2. Determine the date of birth by stirring. By the date of the 1st stirring
add 140 days for primiparas (20 weeks, 5 obstetric
months). In multiparous - 154 days (22 weeks, 5.5 months).
3. Determine the date of birth by the first appearance at the antenatal clinic.
This takes into account the data of an objective examination:
the size of the uterus, the volume of the abdomen, the height of the bottom
uterus, fetal length and fetal head size.
4. Determine the date of delivery according to the ultrasound data.
5. Date maternity leave determined from the same data.
Determination of protein in urine.
Proteinuria (the appearance of protein in the urine) is an important prognostic sign late preeclampsia pregnancy and kidney disease. There are qualitative and quantitative reactions to determine the protein in the urine. In the waiting room maternity hospital the determination of protein in the urine is carried out by qualitative reactions to incoming pregnant women and women in childbirth.
Indications: 1) determination of protein in the urine of a pregnant woman, a woman in labor, a puerperal, a gynecological patient.
Workplace equipment: 1) 2 test tubes; 2) pipette;
3) 20% sulfate solution salicylic acid; 4) an individual card of a pregnant woman and a puerperal (history of childbirth); 5) gloves;
6) kidney-shaped tray.
Preparatory stage of the manipulation.
1. Inform the pregnant woman or the woman in labor of the need
execution and essence of manipulation.
2. Make a toilet of the external genitalia.
3. Offer a pregnant woman or a woman in labor to urinate in a tray.
4. Put on sterile gloves.
The main stage of the manipulation.
Sample with sulfosalicylic acid.
5. Pour 4-5 ml of filtered urine into a test tube and add 8-10 drops of sulfosalicylic acid.
6. In the presence of protein in the urine, a flocculent sediment or turbidity is formed.
The final stage.
7. Remove gloves, place in a container with a disinfectant
means.
8. Wash your hands.
9. Record the result in medical documentation.
10. Place the test tubes and the tray in a container with a disinfectant
means.
Annex 2
to the Instructions for the execution technique
medical and diagnostic
"Nursing in obstetrics and
gynecology, obstetrics
by specialties
2-79 01 31 "Nursing"
2-79 01 01 "Medicine".
Physiological childbirth.
Sanitary treatment of the mother.
Indications: 1) treatment of the skin in order to prevent the development of purulent-inflammatory diseases in puerperas and newborns.
Contraindications: 1) bleeding; 2) the threat of abortion; 3) the threat of uterine rupture; 4) high blood pressure; 5) upon admission in the pressing period, the question of the amount of sanitization is decided by the doctor.
Workplace equipment: 1) an individual package for a woman in labor; 2) disposable machines 2pcs; 3) vial with liquid soap; 4) soap in disposable packaging; 5) Esmarch's mug; 6) couch; 7) oilcloth; 8) disinfected toilet pad; 9) scissors;
10) forceps; 11) sterile washcloth; 12) enema tip; 13) antiseptic; 14) iodine (iodonate solution 1%); 15) cotton swabs; 16) gloves.
Preparatory stage of the manipulation.
Inform the woman in labor about the need to perform and the essence of the manipulation.
Cover the couch with disinfected oilcloth.
Wash the hands.
The main stage of the manipulation.
Nails are cut on the hands and feet using disinfected scissors - 2 pcs.
We treat the armpits and genitals with liquid boiled soap using a cotton swab on the forceps and shave the hair with a disposable razor as prescribed by the doctor.
The midwife puts on gloves.
The midwife puts a cleansing enema (uses a one-time plastic tip or a sterile tip), after 5-10 minutes the woman in labor empties her intestines (do not rush her). Cover the toilet before use with a disinfected gasket. The midwife is present.
Remove gloves and wash hands.
After a bowel movement, the woman in labor takes a shower using an individual piece of soap and a washcloth (sterile). Be sure to wash your hair.
The woman in labor is dried with a sterile towel, puts on sterile underwear from the kit, disinfected slippers.
The external genital organs, the perineum are treated with an antiseptic agent for the prevention of pyoderma.
The final stage:
12. A mark is made in the history of childbirth about the sanitization carried out.
Determining the duration of contractions and pauses.
To assess the contractile activity of the uterus during childbirth, palpation control and objective methods of recording the contractile activity of the uterus using external and internal hysterography (tokography) are used, computer technology can be used, which makes it possible to obtain constant information about the contractile activity of the uterus.
Indications: 1) assessment of the contractile activity of the uterus during childbirth.
Workplace equipment: 1) stopwatch;
2) cardiotocograph; 3) couch; 4) individual diaper.
Preparatory stage of the manipulation.
Lay the woman in labor on the couch, covered with an individual diaper, on her back.
Wash the hands.
The main stage of the manipulation.
The subject sits on a chair near the woman in labor and puts his hand on the area of the uterine fundus.
The time is determined by the stopwatch. During which the uterus, which was previously soft and relaxed, will be hard, this is a fight. Using a stopwatch, the time during which the uterus is relaxed is recorded - this is a pause.
When registering the contractile activity of the uterus using external hysterography, we put the uterine sensor on the bottom of the uterus in the area of the best probing of contractions, we record for 40 minutes. Position on the left side.
The final stage.
Wash the hands.
Record the data obtained in the history of childbirth.
Preparation of the necessary drugs for labor pain relief in the first period.
Childbirth is usually accompanied by pain varying degrees expressiveness. The strength of the pain sensation depends on the state of the central nervous system, individual characteristics and the relationship of the woman in labor to the upcoming motherhood. Pain during contractions is due to the opening of the cervix, hypoxia of the uterine tissues, compression nerve endings, tension of the uterine ligaments.
Indications: 1) 1 stage of labor
Workplace equipment: 1) work table;
2) sterile disposable syringes; 3) tourniquet; 4) antiseptic;
5) sterile balls; 6) containers with a disinfectant;
7) medicines: diazepam (seduxen solution 0.5% -2.0), diphenidramine (dimedrol solution 1% -1.0), droperidol solution 0.25% -5.0, atropine sulfate solution 0.1% -1 -2 ml, trimeperidine (promedol solution 1% -2% -1.0), papaverine hydrochloride solution 2% -2.0, sodium hydroxybutyrate solution 20%, moradol 0.025-0.03 mg / kg, tramadol (tramal 50- 100mg/in/muscularly); no-shpa 2.0.
8) for regional and local anesthesia prepare:
2% lidocaine solution, 0.5% anecaine solution 20.0,
0.25% -0.5% solution of butevacaine, procaine (0.5% solution of novocaine - 200.0).
Preparation of everything necessary for the delivery and treatment of the newborn.
When taking delivery and processing a newborn, it is very important to comply with measures to prevent nosocomial infections in accordance with the orders of the Ministry of Health of the Republic of Belarus.
Indications: 1) childbirth.
Workplace equipment:
1) alcohol iodine 5%; 2) iodine (iodonate 1%); 3) sterile Vaseline oil; 4) sodium sulfacyl solution 30%; 5) ethanol 70°;
6) sterile forceps in a kraft bag; 7) 5% potassium permanganate solution;
8) antiseptic; 9) disinfectant;
10) glasses; 11) apron; 12) delivery bed;
13) sterile oilcloth; 14) a sterile delivery kit is disposable; 15) a jug for washing women in labor;
16) obstetric stethoscope; 17) apparatus for measuring blood pressure;
18) graduated flask for measuring blood loss during childbirth;
19) ice pack; 20) disposable sterile children's catheter;
21) electric pump; 22) electronic scales;
23) filled dropper with isotonic sodium chloride solution 0.9% -400.0;
24) bix for childbirth, which should include a kit for a woman in labor (sterile shirt, mask, scarf, shoe covers), a kit for primary treatment of the umbilical cord (2 trays, 3 hemostatic clips, 2 sticks with cotton, scissors, 6 gauze wipes, pipette, catheter), umbilical cord reprocessing kit (sterile cotton balls, 2 sticks with cotton wool, silk ligature, centimeter tape, scissors), a set for swaddling a newborn (3 sterile diapers, a blanket), a set for a midwife (sterile cap, mask, gown, gloves), a set with bracelets and a medallion (sterile bracelets 2 piece, medallion 1);
25) disposable sterile umbilical cord bracket;
26) methylergometrine solution 0.02% 1 ml, oxytocin 1 ml, isotonic sodium chloride solution 0.9% -400.0; 27) enameled basin;
28) wooden sticks with cotton.
Physical examination
See chapter " Clinical Methods examinations of pregnant women.
Laboratory research
When registering a pregnant woman, a general blood and urine test, determination of the group and Rh-affiliation of the blood, and determination of the level of glucose in the blood are mandatory.
If there is a history of stillbirth, miscarriage, extragenital diseases follows:
Determine the content of hemolysins in the blood of a pregnant woman;
- to establish the blood group and Rh belonging of the husband's blood, especially when determining the negative Rh; factor or blood group 0 (I) in a pregnant woman;
- conduct research on the presence of pathogens of urogenital infection by the method of quantitative PCR diagnostics;
To determine the excretion of hormones, indicators of immunoresistance, as well as all necessary research to judge the presence and nature of the course of extragenital diseases;
- for pregnant women with aggravated obstetric, family and gynecological history spend medical genetic counseling.
· Further laboratory research carried out at the following times:
Complete blood count - 1 time per month, and from 30 weeks of pregnancy - 1 time per
2 weeks;
- general urinalysis - at each visit;
- blood test for AFP, hCG - at 16–20 weeks;
- blood glucose level - at 22–24 and 36–37 weeks;
- coagulogram - at 36–37 weeks;
- bacteriological (desirable) and bacterioscopic (required) examination of vaginal discharge - at 30 weeks
Infection screening (see chapter "Infection screening"). Most infections diagnosed during pregnancy, do not deserve special concern, since in most cases they do not affect the course pregnancy, the risk of intrauterine or intranatal infection. Therefore, those who lead pregnant woman, it is important not to impose unnecessary restrictions on pregnancy and not to waste the available resources.
When registering a pregnant woman, they are examined for syphilis (Wasserman reaction), hepatitis B and C, HIV infection. In addition, microscopic, microbiological and cytological examination
smears and scrapings from the vagina and cervix to detect STIs (gonorrhea, trichomoniasis, chlamydia).
- Retest for syphilis and HIV at 30 weeks and 2–3 weeks before delivery.
Additional research methods
ECG is performed for all pregnant women at the first appearance and at 36-37 weeks, if there are special indications - if necessary.
Ultrasound during pregnancy is performed three times: the first, to exclude developmental pathology gestational sac- on the up to 12 weeks; the second, for the purpose of diagnosing fetal CM - for a period of 18–20 weeks; the third - for a period of 32-34 weeks.
Investigation of clinical significance additional methods Ultrasound in late pregnancy revealed an increase in antenatal hospitalizations and induced labor without any improvement outcomes.
The feasibility of ultrasound in special clinical situations has been proven:
- when determining exact signs life or death of the fetus;
- when assessing the development of a fetus with suspected IUGR;
- when determining the localization of the placenta;
– confirmation multiple pregnancy;
- assessment of the volume of AF in case of suspicion of a lot or oligohydramnios;
- clarification of the position of the fetus;
- with some invasive interventions.
· KTG. There is no evidence for the routine use of CTG in the antenatal period as a additional verification of the well-being of the fetus during pregnancy. This method is only shown for a sudden decrease in fetal movements or prenatal bleeding.
Assessment of fetal movement is a simple diagnostic method that can be used in integrated assessment fetal status in high-risk pregnant women.
Subjective assessment of fetal movement. Pregnant women should be offered informal supervision of fetal movements for self-control. Deterioration of fetal movement during the day is an alarming symptom during pregnancy, which must be reported to the expectant mother at one of the first appointments (no later than the 20th weeks) so that she could orient herself in time and seek medical help.
Counting the number of fetal movements. Two various methods, but there is no data on advantages of one over the other.
– Cardiff Method: Starting at 9 am, the woman, lying or sitting, should concentrate on the movements of the fetus and record how long it takes for the fetus to make 10 movements. If the fetus has not made 10 movements to 9 evening, the woman should consult a specialist to assess the condition of the fetus.
– Sadowski method: within one hour after eating a woman should, if possible, lying down, focus on fetal movements. If the patient does not feel 4 movements within an hour, she should fix them within the second hour. If after two hours the patient has not felt 4 movements, she should contact a specialist.
Routine counting of fetal movements leads to more frequent detection of decreased fetal activity, more frequent use of additional methods for assessing the condition of the fetus, to more frequent hospitalizations pregnant women and to an increase in the number of induced births. However, there is no data on the effectiveness of counting fetal movements to prevent late antenatal fetal death.