The position of the patient

The most convenient to study gynecological patients is horizontal position on the back with a raised top Department of the trunk, legs bent at the knees and divorced feet - so-called Spino-breech position (Fig. 6); it is better, if the lower part of the body, i.e. the pelvic area, also raised, which is achieved by putting under the patient pelvis hard valikoobraznye pillows, or the patient puts under the sacrum hands, clenched fists. In this situation there is the least tension in the muscles of the abdomen and the passage intestinal loops of the small pelvis in the upper abdomen that is especially important for the clarity of the picture, resulting from the study. During the study, the patient should breathe freely, not holding the breath, not to strain the muscles of the abdominal wall.
Also used the side of the patient (Fig.7). While the patient lies on his side so that his buttocks had on the edge of the table, bed or sofa. The upper leg is given to the stomach. The doctor standing behind the patient. This situation is very convenient for exploring the perineum and the anus.
In some cases, for example in the study of urinary fistulas, applies the knee-elbow position of the patient (Fig. 8)where the sick woman stands on her knees and leans on his elbows. However, the more often the knee-chest position at which the patient is on his knees in such a position that the chest touches the table (Fig. 9); the advantage of it is that the abdominal viscera depart to the diaphragm and the abdomen creates a negative pressure. With the introduction of the mirrors of the air pushing the walls of the vagina and makes them available for a detailed study.
It is often necessary to give the patient the so-called Trendelenburg position as research purposes, and especially when different kinds of operative interventions; in this position the head and upper body is lowered, and the pelvis is held high (Fig. 10).