Obstetric research is the methods of examination of women during pregnancy and childbirth to recognize and evaluate their course. Obstetric research includes general clinical (examination, palpation , auscultation), laboratory (blood, urine, etc.), as well as special obstetric examination.
Obstetric research begins with a survey of a pregnant woman or a woman in labor. Find out the woman's age (there is an increase in the frequency of complications in very young primiparas and over 30 years) than she was ill before pregnancy. It is especially important to establish whether there was rachitis (pelvic deformity), rheumatism ( heart defects ). The nature of the menstrual function is clarified (violations may indicate the pathology of the endocrine system or the sexual apparatus), the date of the last menstruation . Multiple people collect information on the number and outcome of previous births (if there is a history of stillbirths, cesarean section , manual separation of the afterbirth , etc.), and also find out if there was no infertility .Go
Objective research begins with determining the height and weight of the pregnant. For judging the thickness of the bones of a pregnant woman (these data should be taken into account when determining the size of the pelvis), you should use the Soloveva index - the circumference of the arm in the wrist area is on average 14 cm; an increase in the index indicates a greater thickness of the bones. At the first visit to a pregnant medical facility, it is necessary to carefully examine it, listen to the heart , lungs, determine blood pressure, conduct a study of urine and blood. In the first months of pregnancy, a vaginal bimanual examination is performed to establish it (see. Gynecological examination ). There are some early signs of pregnancy: Horwitz - Hegara, Snegiryov and Piskachek (see. Pregnancy ).
Starting from the 4th month of pregnancy, the height of standing of the bottom of the uterus is determined by external palpation; more accurate is the measurement of the height of the bottom of the uterus with a centimeter tape along the white line of the abdomen from the symphysis (Fig. 1). The height of the uterus in different periods of pregnancy - see Pregnancy. Starting from the second half of pregnancy, measure the maximum abdominal circumference with a measuring tape (Fig. 2); a circumference of more than 100 cm in the last month indicates the presence of a large fetus, multiple fetuses or polyhydramnios.
Fig. 1. Measurement of the height of standing of the uterus bottom with a measuring tape.
Fig. 2. Measuring the circumference of the abdomen with a measuring tape.
In the second half of pregnancy and before childbirth, the techniques of outdoor research, the so-called Leopold techniques, are particularly important. The pregnant woman is asked to lie down on a couch, the examiner sits facing the stool on the right. The first reception (Fig. 3) - hands are placed on the bottom of the uterus and determine the height of the bottom standing in relation to the xiphoid process. The second method (Fig. 4) - hands are placed on the side sections of the uterus; on palpation, on the one hand, usually a small protrusion is palpable (the small part is the leg of the fetus ), on the other - the denser part (the back of the fetus); this method determines the position of the fetus (see Childbirth ). The third method (Fig. 5) is to palpate the presenting part with the right hand, while extending the thumb, they seize the presenting part, which allows to establish the ratio of the presenting part to the entrance to the small pelvis . The fourth method (Fig. 6) - stand, turning to face the pregnant woman and palpating with the tips of the fingers the presenting part of the fetus. This technique is used when examining a pregnant woman to determine the presenting part (head or buttocks), and when examining a parturient woman - to check the insertion (advancement) of the fetal head in the entrance of the pelvis. If the head with its largest circle has not yet passed the entrance plane, then most of it remains above it (the head stands as a small segment at the entrance of the pelvis), and when examined with the fourth intake of Leopold, the uplifted arms diverge (Fig. 7).
Fig. 3 - 6. Receptions outdoor study
Fig. 7 and 8 . Definition of head insertion: fig. 7 - the head is a small segment in the entrance to the pelvis, tightened up arms diverge; Fig. 8 - the head is a large segment in the entrance to the pelvis, tightened up arms converge.
If the head has almost passed the entrance plane, then it is possible to palpate only a small part of it (the head is a large segment at the entrance of the small pelvis); the arms being pulled upward converge (Fig. 8). If the head is lowered into the pelvic cavity, it is not felt above deep bosom with deep palpation.
Auscultation (listening) of fetal heartbeats is carried out by an obstetric stethoscope, which is attached to the area of the back of the fetus, since there are better heartbeats (Fig. 9). Only with extensor abnormal presentations (frontal and facial), the heartbeats are heard from the side of the breast of the fetus, that is, where small parts are palpable. The heart rate of the fetus is about 120-140 beats per 1 minute, their rhythm is significantly different from the heart rate of a pregnant woman and resembles the ticking of a wristwatch. With increased heart rate (fever) in a woman, the fetal heartbeat can be confused with the abdominal aorta tones. The rhythm of uterine noises heard by the rhythm correspond to the pulse rate of the pregnant woman and have a blowing character. In all doubtful cases, it is necessary simultaneously with the hearing of fetal heartbeats to count the pulse of a pregnant woman.
Fig. 9. Scheme of the proliferation of fetal heart rumors.