Pregnant women are not left alone with their medical problems. To solve them, it is enough to contact the antenatal clinic at the place of residence, and there you will receive the necessary help and information. In such medical institutions there are certain rules for conducting a pregnant woman and her examination. There is such a thing as external obstetric research, which implies assisting a woman who is expecting a baby in preparation for childbirth. What is it and by what rules is carried out, we consider below.
What is an external obstetric study?
Many women know that during pregnancy it is necessary to register with a district hospital. After the confirmation of this condition, not everyone likes the first visit to the gynecologist, because it can last up to 40 minutes. Such a long time is not in vain in the doctor’s office. After all, a specialist needs not only to get acquainted with a pregnant woman, but also to collect a general and special history. Laboratory tests are also prescribed , and an external obstetric study is performed.
It involves an initial inspection, which has its own algorithm. External obstetric examination techniques are needed to collect data about a woman. It is important for the doctor to determine the condition of the woman’s mammary glands, in particular the shape of the nipples, since a set of measures for preparing for feeding depends on this. The gynecologist draws attention to how much the expectant mother has already gained kilograms from the moment of the conception of the child, the norm of weight for the entire period of expectation of the baby is also pronounced.
An external obstetric study involves collecting information about previous pregnancies and scars on the uterus. These actions are necessary to establish the risks of developing pathologies of pregnancy. In addition to examination, methods of measurement, palpation and auscultation are also used, which help to get a complete picture of the development of the child and the condition of the woman carrying him. Below these methods will be described in more detail.
What types of research are there?
To determine the reliable condition of a pregnant woman, it is not enough just to interview her. Even not all palpation techniques of external obstetric research will be informative for a specialist. In order to compose the whole picture of the state of a woman expecting a baby and the well-being of her baby, it is necessary to know what processes are taking place inside the pregnant woman's body. This can be seen with laboratory tests of blood, urine and so on. Also, the doctor constantly listens to the baby's heartbeat and determines its position in the uterus. All these manipulations are derived in the main three types of research pregnant:
- clinical;
- laboratory;
- special.
Clinical examination of a pregnant
This type of examination of a woman during pregnancy begins with a medical history and her present condition. These actions not only help the doctor to get information about the woman’s physical health, they also provide an opportunity to evaluate her neuropsychic activity.
Begin a clinical examination with a survey during which information about a woman is found out.
- Proof of identity of the future mother (name, passport - his number and series).
- The age at which primiparous belongs to a certain group (young - up to eighteen years old, age - after thirty years).
- Actual address of residence and registration of the woman.
- Why goes to the gynecologist.
- Material and living conditions (how many people live, animals in the same room with a woman, living conditions), as well as where the applicant works (if working conditions are harmful to her and the fetus, the issue of more rational work should be resolved).
- Information about blood transfusions and its components (plasma, albumin), allergies, somatic diseases, oncology. Often, normal somatic does not mean complete physical health, because a person may experience disturbances in the work of mental and nervous activity. The doctor’s duty is to identify the factors that led to these disorders, because the woman will soon have to give birth, and the health of the mother and the unborn child depend on adequate behavior. The causes of neurosis and other disorders of neuropsychiatric activity are many:
- previous infections;
- stress
- prolonged infertility;
- abortions
- injuries in previous births.
The gynecologist finds out when there are signs of neuropsychiatric activity disorders: before pregnancy or simultaneously with its onset. It is also necessary to find out with what the woman herself associates their occurrence.
7. Epidemiological history.
8. Permanent intoxication (smoking, alcoholism, drug addiction).
9. Menstrual, sexual and reproductive functions (when menstruation began, how it proceeds, previous pregnancies, how the birth took place, weight and health of previous children, gynecological and sexually transmitted diseases of a pregnant woman).
10. Family history (state of health of family members living with a woman, heredity, state of health, group and Rhesus affiliation of the future father).
Next, proceed to an objective examination of the expectant mother:
- Consultations of the therapist, dentist, optometrist and ENT doctor. If necessary, an examination is prescribed by other specialists.
- Measure temperature and blood pressure.
- The physique is assessed and the height, weight and dimensions of the pelvis are measured.
- Inspect and palpate the stomach.
- Examine blood, urine and other secretions.
- Examine the pubic joint.
- Make an electrocardiogram.
- An ultrasound examination must be done for every pregnant woman until the twelfth, from the eighteenth to the twenty second and from the 32nd to the 34th week.
- An external obstetric study is performed.
It is very important that a woman is registered no later than the 12th week of pregnancy. The earlier anthropometry, laboratory tests and blood pressure were measured, the higher the ability to give birth to a healthy baby or to identify fetal pathologies incompatible with life.
Laboratory studies of a woman
When the expectant mother is registered, she is prescribed a clinical blood test and a general urine test, the group and Rh factor, glucose level are determined, checked for the presence of RW, hepatitis, HIV, and she also makes scrapings and smears from the vagina and cervix on the flora, cytology, chlamydia, gonorrhea, trichomoniasis.
If a history of birth of dead children, miscarriages (especially in the later stages), extragenital pathologies is revealed, it is necessary:
- to conduct a blood test of a woman for the presence of hemolysins;
- as early as possible to examine the blood of the future father for the group and the Rh factor, especially if the pregnant Rh factor is negative or group 0 (I);
- determine the presence of urogenital infections;
- determine the level of hormones needed, immunoresistance;
- conduct genetic studies if necessary.
Further laboratory studies are carried out in such terms:
- clinical blood test - every month, after the thirtieth week - once every fourteen days;
- during each appointment, a urine test is prescribed for a general analysis;
- at sixteenth to twentieth week, hCG and ACE are determined;
- for 22-23 weeks. and 36-37 weeks. examine blood sugar;
- a study on the coagulation system (coagulogram) is performed from 36 to 37 weeks;
- at thirty weeks and two to three weeks before birth, they are re-examined for HIV and RW, smears and scrapings are examined.
Special obstetric research
Special obstetric research includes:
- Conducting an external obstetric study.
- Internal obstetric research.
- Other additional research.
External obstetric examination consists in examination, measuring the size of the pelvis. After the twentieth week, the size of the largest circumference of the abdomen is determined, palpation of the abdomen and pubic joint is carried out , as well as prolushivanie fetal heartbeat. The technique of external obstetric research is not easy, it is carried out only by specially trained medical personnel.
Internal obstetric research. An internal obstetric study includes examining the external genitalia, examining the vagina and cervix using mirrors. It is as important as an external obstetric examination of women in labor. This procedure is carried out with an empty intestine and bladder. To conduct it, a woman is asked to lie on her back, legs apart to the side and bend at the knees. The pelvis must be raised. The study is necessarily carried out in aseptic conditions.
- The study begins with an examination of the external genital organs. Assess the nature of hair growth, perineum. Pathological processes are detected, if any: scars from ruptures in previous births, tumors, inflammation, fistulas, condylomas, hemorrhoids in the anus. The condition of the vulva is assessed by spreading the labia with the fingers, the condition of the urethra and glands is also determined.
- The cervix is examined using mirrors. Pay attention to the mucous membranes, secretion, size of the cervix and pharynx of the uterus. In the first trimester, a two-handed study of the vagina is performed, in the second and third only one-handed is appropriate.
First, the perineum (whether there is rigidity, scars) and the vagina (size, walls, the presence of folding) are evaluated.
4 external obstetric examinations
External obstetric examination techniques (Leopold's techniques) are used for palpation of the abdomen of a pregnant woman. There are four of these tricks:
- assessment of the height of the uterine fundus and the proportion of the fetus that is in it;
- determining the location of the fetus, about which conclusions are drawn on finding the back and its arms and legs;
- finding part of the fetus, which is the precursor, its location in relation to the pelvis;
- determine how the underlying part of the fetus is located relative to the entrance to the pelvis.
The purpose of the examination of the cervix
Before the birth, the neck maturity is determined, since it shows how much the body is ready for childbirth. The methods for determining the maturity of the neck are diverse, but in all of them the following parameters are evaluated:
- consistency;
- what is the length of the vaginal part of the canal;
- patency of the cervical canal;
- how it is located and where the axis of the neck is directed in the pelvis;
- the wall thickness of the part of the neck that is located in the vagina;
- determine the condition of the lower part of the uterus.
Evaluate the cervix on a special scale. The immature cervix has from 0 to 5 points. If during the examination it turned out more than 10, then a woman can be prepared for childbirth.
Pelvic examination of a woman
To know the size of the small pelvis, an external obstetric study of the pregnant woman is used, such as pelviometry. The norms of the external dimensions of the pelvis are as follows:
- the distance of the spinarum, which is equal to 25-26 centimeters;
- Kristarum distance - from 28 to 29 centimeters;
- trochanteric distance - from 31 to 32 centimeters;
- externa conjugate - from 20 to 21 centimeters;
- diagonalis conjugate, which should be within 12.5 - 13 centimeters.
Most doctors already at the first visit to a woman try to measure the conjugate faith (true), which determines the size of the entrance to the small pelvis. Normally, it should be from 11 to 12 cm. The true conjugate can be recognized if 9 centimeters are subtracted from the external conjugate (externa). Its size also corresponds to the Michaelis rhombus, as well as the size of Frank (determined from the seventh cervical vertebra to the middle part of the jugular fossa). The diagonal conjugate, which is located between the lower edge of the pubic symphysis to the most prominent part of the cape, also equals the value of the true conjugate.
If the pelvic dimensions deviate from the norm, then it is advisable to conduct external methods of obstetric research, which are additional measurements: measure the lateral conjugate, which is located between the anterior spine of the ilium and its posterior spine on one side. Its normal values are from 14 to 15 centimeters. If it is less than 12 and a half centimeters, physiological birth is impossible. Also measure oblique dimensions. There are three of them, and if the difference between them is more than 1.5 centimeters, then they are judged about oblique narrowing, which is also dangerous in childbirth.
The angle of inclination of the small pelvis, which should not deviate from 45-55 degrees, is also determined. No less important is the pubic angle, which should be equal to 90-100 degrees.
In the algorithm of external obstetric research include the output of the small pelvis:
- direct size, which is nine centimeters. It is located between the lower end of the pubic joint and the top of the coccyx. Two centimeters on soft tissue are taken from the data obtained;
- the transverse size, which is 11 centimeters and is located between the sciatic tubercles (their inner surfaces), is measured with a tazometer.
Receptions of Leopold-Levitsky
With any medical appointment of a woman, an external obstetric study is necessarily carried out throughout the entire period of pregnancy. Receptions Leopold-Levitsky play a major role in it. These techniques, the principles of which were mentioned above, got their name from the name of the person who developed them at the end of the nineteenth century. This person is a German doctor Christian Leopold. These developments have solved many obstetric problems that are relevant to this day.
They help determine the size and position of the fetus in late pregnancy. The first of these techniques is done before each ultrasound. It indicates the height of the uterine fundus and almost always corresponds to the gestational age. Its accuracy is associated with the thickness of the abdominal wall. If in doubt, ultrasonic testing will now give more accurate results.
The third method shows the presentation of the fetus: buttock, transverse or head. And also how deep the fetus is already in the pelvis. The fourth technique confirms the three previous ones.
Research Algorithm
Many are interested in the algorithm of methods of external obstetric research. First, measurements of the pregnant pelvis are made. After the end of this manipulation, the doctor proceeds to palpation of the abdomen of a woman. This is the stage of applying Leopold's techniques. Then they proceed to auscultation or listening to the fetal heart. Here the frequency of heart beats is important (normally equal to 120 to 160 beats per minute), their clarity and rhythm. Auscultation is performed using a stethoscope or fetal monitor.
External and internal obstetric examinations are very important during pregnancy, childbirth and after. A woman should understand this, behave appropriately and in no case should he shy away from them. They help the doctor to find out whether the pregnancy is proceeding normally, whether the expectant mother and her baby are healthy.