General survey pregnant

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When solving special problems in the sphere of obstetrics and gynecology, you should take into consideration some specific features of the structure of the female body, such as the structure of the spine, the inclination angle of the pelvis, the development and the location of the fur, the severity of secondary sexual characteristics, anomalies physique and other
From the correct development of the spine and the appropriate location it bends largely depends slim women.
Any deviation of the spine from the vertical to the front (lordosis), posterior (kyphosis) (scoliosis) is reflected in the formulation of the body, and to some extent affects the capacity of the bone pelvis and chest. In this connection, it inevitably change the contours of the body and shifted the center of gravity. Therefore, when viewed women in the vertical position, obstetrician should always pay attention to the shape as front (abdomen)and rear (back and buttocks) curves (paths) of the body.
Particularly important inspection profile back (at the height of the blades), for the more outstanding forward belly, the
more moves the center of the upper part of the body back to balance the body. Consequently loin served anteriorly, increases the concavity of this part of the spine (lumbar notch) and change the inclination angle of the pelvis.
The angle formed by the outer conjugacy with the horizon, determines the degree of tilt of the pelvis (Fig. 3).


Fig. 3. Inclination angle of the pelvis and lumbar lordosis in standing position.
1 - plane entrance to the pelvis (true conjugate), - outer conjugate.

Fig. 4. Inclination angle of the pelvis and lumbar lordosis in the prone position.
a - with his legs stretched; b legs, bent at the knee joints, apart and resting his feet on the bed; in - with flexed and tightened to the stomach feet; e - down to the bottom of foot (valikhanovskie position).

The angle of inclination of the pelvis is impermanent, it varies from 40 up to 50 degrees; this value especially changing under load of the body, and in this regard, moved the centre of gravity of the latter.
In non-pregnant women inclination angle of the pelvis average of 46 degrees lumbar lordosis is 4.6 cm (W. J. the Mikeladze).
Moving the center of gravity, and therefore the change in the value of the inclination angle of the pelvis, especially revealed in the course of pregnancy and childbirth. If no pregnancy center of gravity in the vertical position of a woman's body is located in region II sacral vertebra, during pregnancy it moves to the front. Due to this increased lumbar curve (lordosis) of the spine and changing the angle of inclination of the pelvis. The reduction of the lumbar curvature cause a decrease in the value of the angle of inclination of the pelvis. Up to 4-5 months of pregnancy in setting body no change is observed. After this period, the centre of gravity is usually much moved.
If in early pregnancy lumbar lordosis equal usually 4.5 cm, and the inclination angle of the pelvis is 45 degrees to 8-9-th month of pregnancy lumbar lordosis reaches 5-6 cm, and the inclination angle of the pelvis increases by 3-4 degrees, reaching 48-49 degrees.
Pregnant women curvature of the spine and changes in setting body come sooner, with the progression of pregnancy posture has changed.
Small inclination angle of the pelvis not prevent the recording of the head of the fruit at the entrance to the pelvis and has no obstacles in the subsequent promotion of the fetus; childbirth in these cases occur quickly and without damage to the soft tissues of the vagina and perineum.
Big inclination angle of the pelvis predisposes during pregnancy to the development of a flabby belly, as the head not recorded in the entry in the pelvis and is often incorrectly inserted (pronounced degree of acyclicity), childbirth progress slowly and often there are gaps soft tissues of the vagina and perineum.
Especially great is the value of the inclination angle of the pelvis, which may vary at different position of the body, in the process of descent act (see Fig. 4, a, b, C). About it has long been known. Back in 1594 the Scipio Mercurio (Scipione Mercurio), and then, much later in 1889 Walcher (Walcher) has recommended that pregnant women to take an appropriate position on the back with overhanging hips.
Thanks to this provision, known in obstetric literature called valihanovich, direct the size of the entrance to the pelvis (true conjugate) is increased by 0.75 cm (see Fig. 4 in).
The Ilkevich spent many observations about the feasibility of changing the body position of the woman in the moments of birth.
In the accompanying table. 1 presents estimates of changing the angle of inclination of the pelvis and lumbar lordosis for various positions of the body and lower extremities woman (feverously, almarashi, valikhanovskie provisions and other) (see also Fig. 3, 4, 5).