Obstetric turn

Obstetric turn - operation, with which you can change unfavorable for childbirth fetal position on favourable, and there is always only longitudinal. There are the following ways of obstetric turn : outer turning on the head, and less on the pelvic end; internal rotation with the full opening of the fallopian throat - classic or timely, the turn.
Outer turning the fetus is made by a physician only outer techniques through the abdominal wall without any influence from the vagina. Indications: transverse and oblique position of the fetus, pelvic presentation of the fetus. Conditions for implementation: a good manoeuvrability of the fetus (if retired waters turn not shown); the normal size of the pelvis (true conjugate not less than 8 cm); the absence of indications to the rapid completion of the delivery (asphyxia, premature detachment of the placenta , and others).
The technique. Outer turning, especially in nagaragawa, can be done without anesthesia. When oblique provisions of the fruit sometimes it is enough to put a woman on the one side, the side which rejected predlagaemaya part. For example, if the left oblique position of the fetus (head to the left) the woman is placed on the left side. In this situation the bottom of the uterus with the buttocks of the fetus moves to the left and head in the opposite direction, to the entrance of the pelvis.
When clearly expressed the transverse position of the fetus to turn requires special outdoor receptions. The lying-in 30 minutes before the operation is injected subcutaneously to 1 ml of 1% solution of morphine (for some relaxation of uterine muscles to further manipulation did not cause unnecessary anxiety). The woman lies on a couch (it is better to solid) on the back, with slightly bent and drawn to belly by feet. Sitting sideways on the edge of the couch obstetrician puts both hands on the stomach of the woman so that one of his hands lay on the head, grasping her top and one on the pelvic end of the fetus, covering the lower buttock (Fig. 1). Clasping thus the fruit, with one hand pressed on the head of the fetus in the direction of the entrance into the bowl, and the other pushing pelvic end up to the bottom of the uterus. All these manipulations are made persistently, but very carefully, valid only during pause, a moment of complete relaxation of the uterus; in the ensuing battle hand obstetrician remains in place, hold the fruit in his position.obstetric turnFig. 1. Outer turning on the head when you cross fetal position (front view). Fig. 2. General rules of outdoor preventive rotation (in the direction of the arrows) at fetal pelvic presentation: the offset of the buttocks to the side of the back, back to the side of the head, head towards the entrance to the pelvis. Fig. 3. Captured upper leg (rear view transverse position).
Outer turning on the head when fetal pelvic presentation, so-called preventive turn, is done at 34-36 weeks of pregnancy in hospital doctor. General rules of prevention turn - see Fig. 2. After turning to systematically monitor pregnant. If the head previa again replaced pelvic immediately by turning again.
To prevent pelvic presentation and fix it in the head proposed the following method. Pregnant (in the period from 29 to 40 weeks) prescribed classes: lying on the bed (couch), it shall alternately to turn it on one, on the other side, remaining on each in 10 minutes. Exercises are repeated 3-4 times (in average on each lesson takes 60-80 minutes.), occupied spend 3 times a day before meals. After a few classes (usually within the first 7 days) is the turn of the fetal head. After the establishment of the head in order to prevent recurrence of the pelvic presentation pregnant recommend to lie on its side, the corresponding position of the fetus, and on the back, and should be fixing bandage. Pregnant woman should visit a doctor at least once a week. At relapse spend extra classes.
The classic internal rotation produces the doctor. In urgent cases when it is impossible to call the doctor's classic of internal rotation can produce a midwife. When conducting internal midwifery turn one hand injected into the uterus, the other through the abdominal wall mothers help first. Shows a classic of internal rotation in the transverse position of the fetus, and also for dangerous for the mother predlagay (such as the skull) and ustawieniach head (for example, back-parietal). In the classical rotation you can rotate the fruit of the cross provisions (sometimes longitudinal) on the head and on the legs. Turn the crown currently practical does not matter. Conditions for rotation: full opening of the fallopian throat, full mobility of the fetus. Contraindications to the internal rotation is running lateral position of the fetus.
The technique of internal classical turning on the leg when you cross provisions. It is necessary to distinguish three stages: 1) introduction hands, 2) the search and seizing legs and 3) the actual rotation of the fetus. When you cross the fetal position, it is recommended to enter the hand that matches the pelvic end of the fetus, considering the direction of the midwife.
When the front cross provisions (back to the front) should capture the underlying leg fetus (when grasping the upper legs can easily get back view that is unprofitable for childbirth); at the rear kinds of cross provisions should seize the upper leg (Fig. 3)because it is easier rear view translate in front. When you search for that leg of fruit are recommended two ways short - hand conduct directly to the stem of the fetus and "long" are advancing the arm along the back of the fetal buttocks, then on the thigh, the lower leg to the appropriate legs. Grab always one leg is all hand (Fig. 4) or with two fingers (Fig. 5). When the search legs hand, lying on the abdominal wall ("outside" the hand), help her hand, put into the uterus (the"internal" hand). "Outer" a hand on the pelvic end of the fetus, reducing it to the entrance of the pelvis forward "internal" hand.
Once the foot of the fetus is found and seized, must immediately move "outside" the hand with pelvic end on the head to push it to the bottom of the uterus (Fig. 6). If you do not, leave your hand in the same position and push it on the pelvic end, there could be an infringement of the head - the complication which threatens the complete failure of turn.



obstetric turnFig. 4. Leg captured throughout the hand. Fig. 5. Leg captured two fingers. Fig. 6. Leg captured "internal" hand "outer" hand moved with pelvic end on the head and pushes it to the bottom of the uterus.
Rules povertyline fruit (the turn): traction (attraction) produced outside of the fight; traction doing down towards the perineum (the tractions on themselves, and especially up, would interfere with the symphysis); do traction until such time as of the genital slit not come knee. When the leg is derived knee and took the fruit longitudinal position, turn over.
Further, if there are no contraindications, childbirth, you can provide the forces of the organism and lead as well as with incomplete foot previa. Currently, most midwives took a different tactic: in the interests of the fetus after done by turning now to perform surgery fruit extraction for pelvic end (see Childbirth).
Internal classic turn of the fetus on the leg when the head previa is done according to the same rules as in the transverse position of the fetus.
Indications: the need to urgently complete the delivery. In the vagina and the uterus as deeply as possible (up to the elbow) impose hand, corresponding to small parts of the fetus, considering the direction of the midwife. When holding hands in the uterus have to push his head sideways and, most importantly, not to forget the time to translate "outer" hand with pelvic end on the head, once captured leg. Infringement head in these cases, especially unprofitable.
During obstetric turn from head to foot easily mix the leg with a handle. To avoid this, it is necessary to enter the hand, and then when grasping feet to draw attention to the heel bone, which serves as the difference between the legs from the handle.
Obstetric complications turn and help with them. 1. The loss of the handle, the umbilical cord. Fallen back a portion is not set too part is usually falls again. On the loose knob should impose a loop, so that in the future she could not saprobiotic for the crown. 2. Obstetric turn fails, because traction is done correctly (by yourself or down). 3. Obstetric rotation is wrong - during the fight, whereas it should be done out of the fight. 4. Infringement head (not transferred "outer" hand after seizing legs with pelvic end on the head). You must first carefully to try to push the crown. If that fails should be kept second leg (to create more space in the uterus) and again to try to push the crown. If this fails, you must do the perforation of the head. 5. The crossing of legs: resting in the symphysis leg, pass and cross send down the leg, prevents povertyline the fetus. Should be kept and the second leg.