11. Physical examination (continued)

Cervix

Opening degree The cervix is ​​measured in centimeters: from 0 (cervix closed) to 10 cm (fully dilated).

Smoothing the cervix is one of the indicators of her maturity and readiness for childbirth. In primiparous women, smoothing first occurs, and after the opening of the cervix. With repeated births, smoothing and opening of the cervix occurs almost simultaneously.

Fetal presentation determined by palpation. With an occipital presentation, you can palpate the sutures and fontanels on the fetal head, with a pelvic presentation - determine the buttocks and feet, with a facial presentation - the front of the fetal head.

Fetal position. In the anterior position, the presenting part faces the pubic symphysis, and in the posterior position, it faces the sacrum. Transverse (right or left) position - the presenting part faces the right or left wall of the pelvis. In case of pelvic presentation - along the sacrum of the fetus, in case of facial presentation - according to the location of the chin. In the anterior position of the occipital presentation, the back of the head is turned towards the pubic symphysis. In the right transverse position of the occipital presentation - to the right vaginal wall.

Examine the pelvic bones. The size and shape of the small pelvis are determined by the size of the large pelvis.

Entrance to the pelvis anteriorly formed by the upper edge of the pubic articulation of the symphysis, posteriorly by the apex of the promontorium, lateral borders by the arcuate lines of the ilium. The direct size of the small pelvis is determined by the size of the diagonal conjugate, which is normally 12 cm or more.

pelvic cavity anteriorly formed by the posterior surface of the pubic symphysis, posteriorly by the anterior surface of the sacral vertebrae, and the lateral walls by the ischial bones. The transverse size of the pelvic cavity is normally more than 9 cm.

Exit from the pelvis in front is in the region of the lower edge of the pubic arch, in the back - in the region of the apex of the coccyx, on the sides - between the ischial tubercles. The transverse size of the small pelvis is not less than 8 cm with normal sizes. An acute subpubic angle most often indicates a narrow pelvis. Usually there is a combined reduction of all sizes of the small pelvis.

Laboratories undergo laboratory tests: a general blood and urine test and a serological test for syphilis, if they belong to a high-risk group - and for HBsAg.

Assessment of the state of the fetus in childbirth is carried out for the purpose of early diagnosis of intrauterine hypoxia and fetal death. For this, a number of examinations are carried out: auscultation of the fetal heart at certain intervals, continuous CTG (direct or indirect), determination of the acid-base composition of the blood.

Auscultation of the fetal heart in the phase of the first stage of labor is carried out every 15 minutes, and in the second stage of labor - every 5 minutes (or after each attempt).

Author: Ivanov A.I.

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