Every woman wants to know the joy of motherhood. It is a natural impulse connected with the very essence of human nature. However, many find themselves unprepared for the fact that they will have to visit a doctor regularly and endure some not particularly pleasant manipulations. But in order for the pregnancy to go smoothly and smoothly, it is better to follow the instructions of specialists than rely on luck.
Preparation for examination
Before you come to the antenatal clinic to be registered for pregnancy or just for a routine examination, the fair sex needs to put herself in order. No special effort is required, but it is still recommended to take a shower. In no case should you douche or something like that, because the general picture of the disease (if any) will be blurred and the doctor will not find anything. Fresh clean linen and a sanitary napkin (if necessary) will not be superfluous.
General and special history
Like any other doctor, an ob/gyn has a standard form forgetting to know the patient's history. It includes passport data, complaints, records of the place of residence and work, the presence of hereditary diseases and past infections.
Special anamnesis is focused on the fact that the doctor understands the essence of the problem with which the woman applied. It includes questions about menstruation, sexuality, pregnancy and abortion. In addition, brief information about the patient's spouse or partner, as well as his and her childbearing function, is required.
Then begin the examination of the current pregnancy. Set the gestational age, determine the size of the pelvis and the position of the child in the uterus.
Determination of gestational age
There are several ways to calculate gestational age and due date. The first one is calendar. He is the simplest. You need to remember the number of the first day of the last menstruation and add 280 +/- 7 days or 10 lunar months to it. So you can find out the approximate day of a happy event. If a woman manages to remember the date of conception, then you need to add all the same 40 weeks again and get an answer to an exciting question.
Another way is based on ultrasound. The diagnostician, by indirect signs, can determine the gestational age of the fetus and state the approximate date of birth. In an obstetric study, the gestational age is also calculated by the height of the uterine fundus. From 12 to 38 weeks, the height of the uterus in centimeters corresponds to the week of pregnancy. You can also focus on the first stirring of the fetus. In primiparousit is felt from the eighteenth week, and in multiparous - from the sixteenth.
Measurement of the large pelvis
For a doctor, knowing the size of a woman's pelvis matters, and the data is important both during fetal development and during childbirth. The dimensions of the large pelvis include the external conjugate and three distances corresponding to the protruding parts of the pelvic and femoral bones.
1. Distantia spinarum is the gap between the most elevated points of the iliac spines. It is approximately twenty-six centimeters.
2. Distantia cristarum is the space between the iliac crests and is approximately twenty-eight centimeters.
3. Distantia trochanterica - the distance between the large skewers located on the femurs is 31-32 centimeters, respectively.
The outer conjugate has a slightly different size. If the previous three were located in the frontal plane, then this one is in the sagittal one. The external conjugate is the distance between the protruding process of the fifth lumbar vertebra and the superior spine of the pubic symphysis. To measure it, some preparations are necessary. The determination of the external conjugate begins with the patient placed on her side. The leg that lies on the couch, the woman brings to the stomach, and pulls the overlying one. The branches of the tazomer are bred and placed over the pubic articulation and the supra-sacral fossa so that they are almost parallel. This is an external conjugate. Measurement depends onthe constitution of a woman and the thickness of her bones. The thicker they are, the greater the error in the calculation. The size of the outer conjugate is about twenty centimeters. Its calculation is necessary to determine the true conjugate. On average, the difference between them corresponds to 9 centimeters. For example, if the outer conjugate is twenty centimeters, then the true one will be 11 cm.
Pelvic measurements
There is such a thing as a narrowed pelvis. It may be narrowed clinically or anatomically. In order to find out the anatomical parameters of the bone ring, measurements of the small pelvis are made.
- Diagonal conjugate - this is the length from the lower edge of the pubic articulation to the most protruding part of the sacrum. It is equal to 13 centimeters. It can only be determined by vaginal examination. The calculation of the true conjugate from the outer and diagonal consists in subtracting 9 cm from the outer and 2 cm from the diagonal. As a rule, the true conjugate is at least 11 centimeters. It is in order to calculate this parameter that an external conjugate is needed. Its norm may vary, depending on the thickness of the woman's bones, so doctors play it safe and conduct an internal study. The thickness of the bones does not affect the diagonal conjugate.
- The direct size of the exit from the pelvis is defined as the gap between the lower crest of the pubic articulation and the tip of the coccyx. The measurement is carried out by a tazometer, and is equal to 11 cm.
- The transverse size of the outlet of the pelvis is the gap between the ischial tuberosities. Can be carried outboth a tazomer and a centimeter tape. Normally, it is nine centimeters, but if we add the thickness of the soft tissues, we get 11 cm.
- The lateral dimensions of the pelvis are necessary to determine the symmetry of the location of the bones. They must be at least 14 cm, otherwise childbirth will be difficult or impossible.
Michaelis Rhombus
The outer conjugate has a certain relation to the Michaelis rhombus, as it also shows the size of the pelvis. This is a platform formed by the back surface of the sacrum. Its boundaries:
- spinous process of the fifth lumbar vertebra;
- paired posterior superior iliac spines; - apex of the sacrum.
The normal size is 11 by 11 centimeters. The outer conjugate has an upper point in common with the rhombus.
Manual techniques in obstetrics
After the twentieth week, the obstetrician-gynecologist can feel the head, back and limbs of the child in the womb. For this, external obstetric examination techniques are used.
First appointment: the doctor determines the height of the fundus of the uterus and the part of the body of the fetus that is adjacent to it. To do this, the doctor puts his hands on the top of the abdomen and feels it.
The second technique determines the position and appearance of the child. To do this, the obstetrician slowly lowers his hands from the top of the abdomen, spreading them apart. By pressing on the lateral surfaces of the uterus, with fingers and palms, the doctor feels the back or small parts of the body of the fetus, thus determining the position of the child.
The third appointment is necessary fordetermining the underlying part, that is, that part of the body that is located above the pubic joint. They can also determine the mobility of the head.
The fourth technique complements the third. It allows not only to identify the underlying part, but also to understand how it is located in relation to the entrance to the small pelvis. To do this, the doctor stands with his back to the patient and positions his hands in such a way that the fingers converge over the pubic symphysis.
View and position of the fetus in the uterus
Position is the position of the back of the baby towards the side of the uterus. Distinguish the first position when the back is on the left side, and the second - when the child is turned with his back to the right. The first position is more common than the second.
Type of position - the ratio of the back to the anterior or posterior wall of the uterus. Accordingly, if the child leaned against the anterior wall of the uterus, they speak of the anterior position, and vice versa.
In an external obstetric examination, the Leopold-Levitsky techniques give the doctor the opportunity to determine the location of the fetus and predict the course of childbirth.
Internal Research
Internal obstetric examination can be performed with two or four fingers or with the whole hand. By touch, the doctor can determine the degree of disclosure of the cervix, identify the presenting part, the integrity of the fetal bladder, the state of the birth canal. In addition, this method fixes the dynamics of the child's progress through the birth canal.
However, this is a rather serious intervention, and the procedure must be performed strictly according to the regulations: upon admission to the hospital, and thenno more than once every two hours. The less often, the better.
The study begins with an examination of the external genitalia and perineum. Then fingers are inserted into the vagina and its length, width, elasticity of the wall, the presence of scars, adhesions or strictures, which can interfere with the normal course of childbirth, are determined. After that, they move to the cervix. It is examined for maturity, shape, size and consistency, shortening and softening. If a woman arrives in childbirth, then the opening of the cervix is measured in the patency of the fingers. In addition, the doctor tries to feel for the presenting part and determine the position of the head in order to prepare for possible complications.
Determining the position of the baby's head
There are three degrees of head extension as it passes through the birth canal.
First degree (anterior head insertion) means that the head will pass through the pelvis with its straight size. It is equal to 12 cm. This means that the cervix and vagina should stretch by this amount.
The second degree (frontal insertion) corresponds to a large oblique size (13-13.5 cm). This will be the largest part that must pass through the birth canal.
The third degree (facial insertion) tells the obstetrician that the baby is moving through the small pelvis facing forward, which means that the largest head size will correspond to 9.5 cm.
