Every woman wants to know the joy of motherhood. This is a natural impulse associated with the very essence of human nature. However, many are, not ready for the fact that they will have to regularly visit a doctor and endure some not very pleasant manipulations. But in order for the pregnancy to go smoothly and calmly, it is better to follow the instructions of specialists than to rely on luck.
Examination preparation
Before you come to the antenatal clinic to register for pregnancy or just for a routine examination, the fair sex needs to be put in order. No special effort is required, but it is still recommended to take a shower. In no case should you douche or something like that, because the general picture of the disease (if any) will be blurred and the doctor will not find anything. Fresh clean linen and a sanitary pad (if necessary) will not be superfluous.
General and special history
Like any other doctor, the obstetrician-gynecologist has a standard form for familiarizing with the patient’s history. It includes passport data, complaints, records of the place of residence and work, indicates the presence of hereditary diseases and infections.
A special history is aimed at ensuring that the doctor understands the essence of the problem that the woman has addressed. It includes questions about menstruation, sexuality, pregnancy and abortion. In addition, brief data on the spouse or partner of the patient, as well as his and her reproductive function, are required.
Then begin the examination for the current pregnancy. Establish a gestational age, determine the size of the pelvis and the position of the baby in the uterus.
Determination of gestational age
There are several ways to calculate the gestational age and date of birth. The first of them is calendar. He is the easiest. It is necessary to remember the number of the first day of the last menstruation and add to it 280 +/- 7 days or 10 lunar months. So you can find out the approximate day of a happy event. If a woman manages to remember the date of conception, then you need to add the same 40 weeks again and get an answer to an exciting question.
Another method is based on ultrasound. Diagnostic doctor can indirectly determine the gestational age of the fetus and state the approximate date of birth. With an obstetric study, the gestational age is also calculated by the height of the uterine fundus. From 12 to 38 weeks, the height of the uterus in centimeters corresponds to the week of pregnancy. You can also focus on the first stirring of the fetus. In primiparous, it is felt from the eighteenth week, and in multiparous - from the sixteenth.
Sizes of a large basin
For the doctor, knowledge of the size of the pelvis of a woman is important, and the data are important both during the development of the fetus and during the birth. The dimensions of the large pelvis include the external conjugate and three distances corresponding to the protruding parts of the pelvic and femur.
1. Distantia spinarum is the gap between the most elevated points of the iliac spine. It is approximately twenty-six centimeters.
2. Distantia cristarum - the space between the crests of the ilium, and it is approximately twenty eight centimeters.
3. Distantia trochanterica - the distance that is between the large skewers located on the thigh bones is 31-32 centimeters, respectively.
The outer conjugate has a slightly different size. If the three previous ones were located in the frontal plane, then this one is in the sagittal plane . The external conjugate is the distance between the protruding process of the fifth lumbar vertebra and the superior spine of the pubic symphysis. Some measurements are needed to measure it. The determination of external conjugates begins with the patient laying on her side. The leg that lies on the couch, the woman leads to the stomach, and overlying - stretches. The tazomer jaws are bred and placed above the pubic joint and supra-sacral fossa so that they are almost parallel. This is an external conjugate. The measurement depends on the constitution of the woman and the thickness of her bones. The thicker they are, the greater the error in the calculation. The size of the outer conjugates is about twenty centimeters. Its calculation is necessary to determine the true conjugate. On average, the difference between them corresponds to 9 centimeters. For example, if the outer conjugate is equal to twenty centimeters, then the true one will be 11 cm.
Pelvic dimensions
There is such a thing as a narrowed pelvis. It can be narrowed clinically or anatomically. In order to find out the anatomical parameters of the bone ring, small pelvis is measured.
The diagonal conjugate is the length from the lower edge of the pubic joint to the protruding part of the sacrum. It is 13 centimeters. It can only be determined by vaginal examination. The calculation of the true conjugate from the outer and diagonal is that they subtract 9 cm from the outer and 2 cm from the diagonal. As a rule, the true conjugate is at least 11 centimeters. It is in order to calculate this parameter that an external conjugate is needed. Its norm can vary, depending on the thickness of the woman’s bones, so doctors are reinsured and conduct an internal study. The thickness of the bones does not affect the diagonal conjugate.
The direct size of the exit from the pelvis is defined as the gap between the lower crest of the pubic joint and the tip of the coccyx. Measurement is carried out by a tazomer, and is equal to 11 cm.
The transverse size of the pelvic outlet is the gap between the ischial tubercles. It can be carried out both with a tazomer and with a centimeter tape. Normally, it is nine centimeters, but if we add the thickness of the soft tissues, we get 11 cm.
The lateral dimensions of the pelvis are necessary to determine the symmetry of the location of the bones. They must be at least 14 cm, otherwise childbirth will be difficult or impossible.
Rhombus of Michaelis
The external conjugate has a certain relation to the Michaelis rhombus, since it also shows the dimensions of the pelvis. This is a platform formed by the posterior surface of the sacrum. The boundaries of it:
- the spinous process of the fifth lumbar vertebra;
- paired posterior iliac spine bones;
- the top of the sacrum.
The size in the norm is 11 by 11 centimeters. The external conjugate has a common point with the rhombus.
Manual techniques in obstetrics
After the twentieth week, the obstetrician-gynecologist can touch the baby's head, back and limbs in the womb. For this, methods of external obstetric research are used.
First technique: the doctor determines the height of the bottom of the uterus and the part of the fetal body that is adjacent to it. To do this, the doctor puts his palms on the upper abdomen and feels it.
The second technique determines the position and type of the child. To do this, the obstetrician slowly lowers his hands from the top of the abdomen, spreading them apart. While pressing on the lateral surfaces of the uterus, the doctor feels the back or small parts of the fetal body with the fingers and palm, thus determining the position of the child.
The third technique is necessary to determine the underlying part, that is, that part of the body that is located above the pubic joint. He can also determine the mobility of the head.
The fourth technique complements the third. It allows not only to identify the underlying part, but also to understand how it is located in relation to the entrance to the small pelvis. For this, the doctor becomes the back to the patient and positions the hands so that the fingers converge above the pubic symphysis.
The type and position of the fetus in the uterus
The position is the position of the back of the baby to the side of the uterus. Distinguish the first position when the back is on the left side, and the second - when the child is turned with his back to the right. The first position is more common than the second.
Type of position - the ratio of the back to the anterior or posterior wall of the uterus. Accordingly, if the child is leaning against the front wall of the uterus, they talk about the front position, and vice versa.
With an external obstetric study, the methods of Leopold-Levitsky give the doctor the opportunity to determine the location of the fetus and predict the course of childbirth.
Internal research
Internal obstetric examination can be carried out with two or four fingers or with the whole hand. To the touch, the doctor can determine the degree of cervical dilatation, reveal the underlying part, the integrity of the fetal bladder, and the condition of the birth canal. In addition, this method fixes the dynamics of the child's progression through the birth canal.
However, this is a fairly serious intervention, and the procedure must be strictly according to the regulations: upon admission to the hospital, and then no more than once every two hours. The less often, the better.
The study begins with an examination of the external genitalia and perineum. Then, fingers are inserted into the vagina and its length, width, elasticity of the wall, the presence of scars, adhesions or strictures, which can interfere with the normal course of labor, are determined. After that, they advance to the cervix. It is examined for maturity, shape, size and consistency, shortening and softening. If a woman arrives during childbirth, then the opening of the neck is measured in the patency of the fingers. In addition, the doctor is trying to grope the present part and determine the position of the head in order to prepare for possible complications.
Determining the position of the head of a child
There are three degrees of extension of the head when passing through the birth canal.
The first degree (anterior head insertion) means that the head will pass through the pelvis with its direct size. It is 12 cm. This means that the cervix and vagina should be stretched by this amount.
The second degree (frontal insertion) corresponds to a large oblique size (13-13.5 cm). This will be the largest part that must pass through the birth canal.
The third degree (facial insertion) tells the obstetrician that the child moves forward through the small pelvis, which means that the largest head size will correspond to 9.5 cm.