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Obstetric research

Of great importance in obstetrics is the study of the pelvis, normal size and structure of which have a major impact on the course of delivery. To determine the size of the pelvis pregnant asked to lie down on the couch on his back. Tatomir take the ends of the branches with the tips of three fingers (thumb, index and middle) so that it can simultaneously to touch the point to which he puts the branches of tanamera. When measuring the distance between the front upper awn Ilium (distantia spinarum) buttons of the branches should be placed on the outer surface of the spine (Fig. 10); measuring the distance between the top awn iliac bones OK, this size is 25-26 see When measuring the distance between the most distant points scallops Ilium (distantia cristarum) buttons of the branches move under the control of the fingers on the outer edge scallops iliac bone and celebrate the greatest distance; in norm it is 28-29 see In determining the distance between large skewers hips (distantia trochanterica) buttons of the branches press to most wystawiam points large skewers; normal size equal 31-32 see At difficulties in finding these points (pronounced subcutaneous fat layer) asked the girl to be raised and lowered outstretched leg, which facilitates the definition of the spit. When you lie on your side, back to exploring the lower leg bent at the knee, and the upper pulling; in this situation it is more convenient to touch the symphysis. Before you can measure this dimension, it is necessary to examine the lumbar diamond (diamond Michaelis, Fig. 11).the diamond Michaelis under normal pelvis Button one of the branches put in a hole between the fifth lumbar and I sacral vertebrae (the hole is determined when holding two fingers on the spine), the second - on the upper, outer edge of the symphysis. OK outer conjugate equal 20-22 see
Internal (vaginal) research mothers should be done under sterile conditions, prepared as for laparotomy, hands. It should be remembered that even in this case the internal investigation is not indifferent, as can be entered in the birth canal microbes, vegetating on the external genitals. Therefore vaginal examination of the woman in the home and out-patient conditions to make not necessary. From it, you should abstain premature rupture of water and the absence of labor activity in the preparatory period of childbirth, when bleeding (the placenta previa). Internal (vaginal) study required: if it was not clear which part slated to be actually (head or buttocks); in the case of ruptured membranes with high standing head (the risk of loss of the umbilical cord); while changing the rhythm (deceleration or acceleration) of the heart rate of the fetus. The internal investigation is essential when prolonged labor, especially in the second half of the period of the opening.
Before the examination the mother washed, lay down on the couch, she put a sterile plain diaper. The vulva, adjacent departments thighs and pubic hair cuticles 5% alcoholic iodine solution. The domestic investigation produced extended index and middle fingers; the ring finger and little finger pressed against the palm of the hand, thumb razognat and taken aside. Before the introduction of fingers in the vagina with the other hand widely pushing large and small labia; the area of the anus should be closed with a cotton ball or a clean diaper. In the study, determine the condition of the cervix; when it is smoothing the cervical canal is missing and the neck has the form of a ring with thin or thick edges. The value of open approximately determined on the basis of the possibility to place in the shed some number (2, 3, 4) spread slightly fingers; when the full opening of the cervix is not specified; sometimes can palpable semiuscate front lip throat. Establish the presence or absence of voltage membranes. Then determine predlagayu part of the fetus. When the head previa and sufficient opening throat should try to identify the fontanels the head of the fruit (in a small fontanel converge three joint, large - four), the location of the arrow-shaped bead (direct and longest). Location of the small brook and swept seam (Fig. 12) the position of the arrow-shaped bead and springsjudge mechanism of passing head through the birth canal.
High standing predlagay part should try to reach the Cape of the sacrum and measure the diagonal of the conjugate (if the woman has addressed in the later stages of pregnancy and this amount has not been determined earlier) - the distance between the Cape and the bottom of the symphysis, the rate is 12.5-13 see When pelvis normal size Cape is not achieved. In moderately Suzanna the pelvis can be achieved Cape fingers extended. Reaching Cape, keep your fingers exploring hands on the spot, and forefinger of one hand to come under the symphysis and mark on exploring hand the place of contact with the bottom edge of the pubic joint. Then the fingers extract, and attendant measures the distance from the tip of the middle finger to the mark on the hand (Fig. 13).the Study diagonal conjugates To establish the true conjugates from the received amount is deducted from 1,5-2 see
When the internal investigation, it is important to determine the height of standing of the head of the fruit in relation to the planes of the small pelvis. The head can stand above the entrance and hardly be achieved; when standing her in the plane of the entrance fight it out easily with a little pressure may go up.
It is impossible to judge the progress of the head in her position. If the head comes into the narrow part of the pelvic cavity, to approach the awn ischial bones cannot.
Among the methods midwifery studies include a range of obstetric manual of diagnostic techniques. The method of determining the edge of the ring (the border between shrinking body of the uterus and lower uterine segment): standing to the left of the woman, tips slightly bent fingers of her right hand out of the fight palmerait from the navel to the bosom; this is in the form of a "cliff" is defined edge ring. In delivery defined in the norm above the symphysis not above the cross-section of the palm, its high standing indicates the hyperextension of the lower uterine segment (see Childbirth). Manual techniques used for the determination of separation of the placenta,see Succession period.