Obstetrics and gynecology. Physical examination (most important)

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Obstetrics and gynecology. Physical examination (most important)

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10. Physical examination

General inspection

Basic physiological indicators. The pulse rate is measured, blood pressure is measured in pauses between contractions.

External obstetric examination

Uterus dimensions. By the end of the 1st obstetric month, the uterus reaches the size of a chicken egg. It is usually not possible to determine pregnancy with a vaginal examination. By the end of the 2nd month (8th week), the uterus increases to the size of a goose egg. By the end of the 3rd month (12th week), asymmetry of the uterus (Piskachek’s sign) is noted; it increases to the size of a man’s fist, its bottom reaches the upper edge of the symphysis. By the end of the 4th month (16th week), the uterine fundus is determined at the middle of the distance between the symphysis and the navel or 6 cm above the navel. By the end of the 5th month (20th week), the fundus of the uterus is located 11-12 cm above the womb or 4 cm below the navel. By the end of the 6th month (24th week), the fundus of the uterus is at the level of the navel or 22-24 cm above the womb. By the end of the 7th month (28th week), the uterine fundus is determined two transverse fingers above the navel or 25-28 cm above the womb. By the end of the 8th month (32nd week), the fundus of the uterus is located in the middle of the distance between the navel and the xiphoid process, 30-32 cm above the womb.

By the end of the 9th month (36th week), the fundus of the uterus reaches the xiphoid process and costal arches. By the end of the 10th month (40th week), the fundus of the uterus descends to the level of the 32-week pregnancy. The method of palpation of the uterus determines the approximate size of the fetus, the amount of amniotic fluid.

External obstetric research includes four Leopold's receptions.

Location of the fetus in the uterus. According to the basic research methods, it is possible to easily determine the position of the fetus in the uterus, its position, position and type of fetus.

Fetal position is the ratio of the longitudinal axis of the fetal body to the longitudinal axis of the mother's body. The position of the fetus is longitudinal, transverse and oblique.

Fetal presentation. This is the relationship of the large part of the fetus to the entrance to the pelvis. The presenting part is the part of the fetal body that is located above the entrance to the pelvis. The fetal head, pelvis or shoulder may be present. If the pelvic part of the fetus is located above the entrance to the pelvis, the presentation is called breech. Breech presentation can be purely breech, mixed breech, full or incomplete.

Fetal position called the ratio of the back of the fetus to the left or right wall of the uterus. There are first (left) and second (right) positions of the fetus.

Type of fetus - the ratio of its back to the anterior wall of the uterus. The first position is more often combined with the front view, the second - with the rear view.

auscultation fetal hearts have recently been increasingly replaced by CTG. This method helps to record heart rate and heart rate variability (acceleration and deceleration).

Conducting a vaginal examination begins with examination and palpation of the perineum and pelvis. When amniotic fluid breaks, the buttocks of the fetus, or the head, or loops of the umbilical cord can be detected during vaginal examination.

Author: Ivanov A.I.

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