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Obstetric research

Midwifery research - methods of examination of women during pregnancy and childbirth for recognition and evaluation of their flow. Obstetric the study includes General clinical (visual inspection, palpation, auscultation), laboratory data (blood, urine and other), as well as special health examination.
Obstetric the study started with a survey of pregnant or mothers. Find out the age of the woman (marked increase in the incidence of complications in the very young nulliparous and older than 30 years)than it was before pregnancy. It is especially important to determine whether rickets (deformation of the pelvis), rheumatism (heart diseases). Clarifies the nature of menstrual function (violations may indicate the pathology of the endocrine system, or sexual apparatus), the date of the last menstrual period. Among multiparous collect information on the number and outcome of previous births (whether in the history of stillbirth, caesarean section, manual separation of the placenta and others), and also find out if there was any infertility.
The objective of the study begins with a definition of height and weight pregnant. A judgment on the thickness of the bones of the pregnant woman (these data should be taken into account when establishing the amount of the pelvis) you should use the index Solovyov - arm circumference in the area of the wrist joint average of 14 cm; the increase in the index indicates a greater thickness of the bones. At the first visit of a pregnant medical institutions should carefully examine, to listen to the heart, lungs, to determine blood pressure, to undertake a study of urine, blood. In the first months of pregnancy for its establishment is bimanual vaginal examination (see Gynaecological examination). There are some early signs of pregnancy: Garvina - Hagara, Snegireva and Piskacek (see Pregnancy).
dimensionStarting from the 4th month of pregnancy, the height of standing of the uterus bottom define external palpation; more precise the measurement of fundal height measurement tape on the white line of the abdomen from the symphysis (Fig. 1). The height of standing of the uterus in different stages of pregnancy - see Pregnancy.  Measurement of the circumference of the abdomen measuring tapesince the second half of pregnancy, measured maximum abdominal circumference measuring tape (Fig. 2); circumference of more than 100 cm in the last month indicates the presence of large fruit, multiple births or polyhydramnios.
In the second half of pregnancy and before childbirth particularly important are the methods of the external examination, the so-called methods of Leopold. Pregnant asked to lie down on the couch, inquirer sits facing it on a stool on the right. the methods of the external examinationthe First reception (Fig. 3) - the hands are placed on the bottom of the uterus and determine the height of the symphysis in relation to the xiphoid process. The second method (Fig. 4) - the hands are placed on the lateral departments of the uterus; palpation on the one hand is palpated usually small ledge (the small part - leg of the fetus), and for another, more dense part (back)of the fetus; this technique is determined by the position of the fetus (see Childbirth). The third technique (Fig. 5) - right-hand palmerait predlagayu part, however, took the thumb, capture predlagayu part that allows you to set the ratio predlagay part to the entrance in the small pelvis. Fourth reception (Fig. 6) - get up, turning face to feet pregnant and palmerait fingertips predlagayu part of the fetus. This technique is used in the survey to determine predlagay parts (head, or buttocks), and the examination mothers - to check the insertion (promote) the head of the fruit at the entrance of the small pelvis. If the head of his greatest circumference not passed yet plane login, most of it remains above it (the head is small segment at the entrance of the small pelvis), and in the survey fourth reception Leopold pull up his hands apart (Fig. 7).



The definition inserting head
Fig. 7 and 8. The definition of the recommendation of the head: Fig. 7 - the head is a small segment at the entrance to the pelvis pull up hands diverge; Fig. 8 - the head is large segment at the entrance to the pelvis pull up his hands together.
If the head is almost gone plane login, you are able to touch only a small part (the head is large segment of the entrance of the small pelvis); draw up hands converge (Fig. 8). If the head sank down into the cavity and small pelvis, over the bosom with deep palpation it is not felt.
Auscultation (listening) of fetal heart rate is obstetric stethoscope, which is put to the area of the location of the back of the fetus, as it held heartbeat (Fig. 9).the Scheme distribution of heart sounds fruit Only when the extensor abnormal presentations (skull and facial) palpitations heard from breast fruit, that is, where palpable small parts. The frequency of fetal heart rate of approximately 120-140 strikes in 1 minute, the rhythm of their significantly different from heart rhythm pregnant and reminds the ticking of watches. With increased heart rate (fever) in women of fetal heartbeat can be confused with the current colors of the abdominal aorta. Listening uterine noises on the rhythm corresponds to the frequency of the pulse pregnant and have a blowing character. In all cases of doubt, in addition to listening to the heartbeat of the fetus to count the pulse of the pregnant woman.