An objective examination of the pregnant woman

An objective examination of the pregnant woman (woman) consists of the General survey of the organism and special midwifery studies.
General examination is made by organs and systems. Conducted laboratory tests: urine analysis, the clinical analysis of blood, determination of blood group and rhesus facilities. Of great importance to determine the exact condition of the psyche pregnant, her attitude to the upcoming birth, as this determines the effect of psycho preparation for childbirth.
In General, the survey should also pay attention to hypotension and anaemia in pregnant because in these conditions often occur threatening abortion, premature birth, anomalies labour forces, threatening asphyxia, bleeding in succession and early postnatal periods.
Special obstetric the study includes both the inner and outer midwifery research.
1. Outer obstetric investigation is made by examination of a pregnant, feelings (palpation), listening to the abdomen (auscultation) and measuring the size of the pelvis, abdomen, index Solovyov. During the examination of a pregnant celebrate features of its Constitution (right, wrong), the state of the abdominal muscles, the turgor of tissues; identify pigmentation and scarring of pregnancy (fresh, old), a defect in the structure of the spine (kyphosis, scoliosis, lordosis), skull and chest (signs transferred rickets); define the size and shape of the abdomen (pointed prune belly with a narrow pelvis), the mammary glands. Inspect and measure sacral diamond for possible deviations in the structure of the basin, its form and size.
Sacral diamond is a square, longitudinal and transverse size of which is equal to 11 see the Diamond becomes irregular shape with a sharp strain of the pelvis. So, when the flat basin of the longitudinal size of the diamond shorter cross, when observeman Suzanna the pelvis is the transverse size of the diamond in short lengthwise.
Feeling (palpation) is one of the main methods midwifery studies, which allows to get necessary information about the position of the fetus, its magnitude. Before the test pregnant should empty your bladder and intestines. Palpation is produced on the couch or in the gynecological chair in position pregnant on the back with bent legs. In this position, eliminates muscle tension of the abdominal wall that facilitates feeling. Using the so-called outer manual techniques midwifery studies, proposed Leopold, determine the height of standing of the fundus of the uterus, its size, shape, movement, position of the fetus, predlagayu part and its relation to the pelvis, back and limbs of the fetus.
The first outdoor reception midwifery studies lets you define the height of standing of the fundus of the uterus, which in turn gives an opportunity to judge the form of the uterus (ovoid, saddle, bicornis), pregnancy, part of the fetus is in the bottom of the uterus (head, buttocks). When researching be to the right of the pregnant facing it. The Palmar surface of both hands lay on her stomach above the navel so that they densely adjoined to the bottom of the uterus (Fig. 1). This technique is relatively easy to determine located at the bottom of the uterus buttocks fruit in their lower weight, less than a smooth surface and no pronounced roundness, typical head.
The second outdoor reception allows to determine the position and the position of the fetus. The position of the fetus is the ratio of the axis of the fetus to dlinnykh uterus; it can be longitudinal (right position), transverse and oblique (wrong position).
The position of the fetus is the ratio of the back of the fetus to the sides of the uterus. When the longitudinal position of the fetus distinguish the position of the left (first)when the back is facing left and right (second)when the back turned to the right. When you cross the fetal position position is determined by the position of the head: if she converted to the left - the left position, if the right-right. By palpation define and position of the fetus: front, if the back is facing toward the front and rear, if the back is facing backwards.
When conducting the second dose, the doctor is the right of the pregnant woman, facing it. The palms of both hands have on the sides of the abdomen and gently pressing your palms and fingers, feel the lateral departments of the uterus (Fig. 2). Back relatively easily recognized in a wide oblong ground plotnostei consistency with wide and curved surface. Limbs and small pieces of fruit felt in the form of small dense Bugrov, are able to move. The movement of small parts indicates that the fetus is alive.
The third external reception midwifery studies are used to determine the nature predlagay parts (head, or buttocks), its mobility (if movable, it is located above the entrance to the pelvis, a still - at the entrance to the pelvis or in the pelvic cavity), the provisions predlagay head (folded or unfolded). The third technique midwifery studies produce one hand which is situated above the fold, and terminal phalanges thumb and middle finger cover predlagayu part (Fig. 3). The head of the fetus recognize on its rounded form dense consistence; during pregnancy it is movable and bellatorum. Buttocks are uneven texture, less mobile (they tend not running), the wrong form.
Fourth outdoor reception midwifery studies conducted to Refine the data received from the application of the third session, i.e. to determine the location of predlagay parts (especially drivers). Using this technique, set the height of standing predlagay parts, specify the position predlagay head (folded or unfolded), irregularity of its insertion. To implement this technique become face to feet pregnant (mothers), arms have on both sides of the lower part of the uterus.
Fingertips pointing to the entrance of the pelvis, seek to penetrate between predlagay part and lateral departments of the pubic bone (Fig. 4).

Fig. 1-4. The methods of the outer midwifery studies.

To determine predlagay of the head or pelvic end distinguish with bent head occipital (normal delivery), for extension head - prednamerennoe, frontal, facial previa; fetal pelvic presentation - buttock and leg.
To determine the position for longitudinal provisions of the fetus can be applied obstetric manual reception C. D. Istrinskogo based on siblani amniotic fluid. Mild tremors finger (SAC in the determination of ascites) into the right or left side of the gravid uterus wave amniotic fluid is sent in the opposite direction, where it is perceived by the hand firmly attached to the uterus. If shocks are on the side of the uterus, where predlagat small part of the fruit, a hand pressed to the uterus where the back of the fetus, does not perceive siblani, as the wave of the amniotic fluid, the excited-side presentation of small parts, fade out (Fig. 5).
On the other side, where palm perceived zublena fluid, are small pieces of fruit (Fig. 6). Consequently, when the left (first) position the palm of perceives a wave of amniotic fluid to the right, and at the right (second) on the left.
This method of research is less traumatic than a second reception Leopold, which also define the back and a small part of the fruit.