External obstetric examination: techniques

Pregnant women do not remain alone with their medical problems. For their solution, it is enough to apply at the place of residence to a women's consultation, and there to get the necessary help and information. In such medical institutions there are certain rules for the management of a pregnant woman and her examination. There is such a thing as external obstetric research, which implies the help of a woman waiting for a baby, in preparation for childbirth. What this is and by what rules is implemented, we will consider below.

What is external obstetric research?

Many women know that during pregnancy it is necessary to register with a district hospital. The first visit to a gynecologist after confirmation of this condition is not popular with everyone, 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 to not only get acquainted with a pregnant woman, but also to collect a general and special anamnesis. Laboratory tests are also prescribed , and an external obstetric study is performed.

It involves a primary examination, which has its own algorithm. Methods of external obstetric research 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 this depends on the complex of measures to prepare for feeding. The gynecologist pays attention to how much the future mother has already gained kilos from the moment of conception of the child, also the weight norm for the entire waiting period of the baby is pronounced.

Conducting 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 pregnancy pathologies. In addition to the examination, methods of measurement, palpation and auscultation are also used that help to obtain a complete picture of the development of the child and the condition of the woman bearing it. Below these methods will be described in more detail.

What kinds of research are there?

To determine the true state of a pregnant woman, it is not enough simply to interview her. Not even all palpation techniques of external obstetric research will be informative for a specialist. To make up the whole picture of the state of a woman expecting a baby, and the state of her baby's health, it is necessary to know what processes occur inside the pregnant body. This can be seen with the help of laboratory tests of blood, urine and so on. Also, the doctor constantly listens to the heartbeat of the baby and determines its position in the uterus. All these manipulations are deduced in the main three types of study of the pregnant:

• Clinical;
• Laboratory;
• Special.

Clinical examination of a pregnant woman

This type of examination of a woman during pregnancy begins with the collection of anamnesis and her present condition. These actions not only help the doctor to obtain information about the state of the woman's physical health, they also give an opportunity to assess her neuropsychological activity.

Begin a clinical examination from a survey during which information about a woman is revealed.

1. Confirmation of the identity of the future mother (name, passport - his number and series).
2. The age at which the first-borns belong to a certain group (young - up to eighteen years, age - after thirty years).
3. The actual address of residence and residence permit of a woman.
4. Why does he turn to a gynecologist?
5. Material and living conditions (how many people live, animals in the same room with a woman, living conditions), and also where the treatment (with harmful working conditions and fetuses, the problem of more rational work should be solved).
6. Information about blood transfusions and its components (plasma, albumin), allergy, somatic diseases, oncology. Often, normal somatics does not mean complete physical health, because a person can have irregularities in the work of mental and nervous activity. The doctor's duty is to identify the factors that led to these violations, because a woman will soon have to give birth, and the health of the mother and the unborn child depends on adequate behavior. The causes that cause neuroses and other disorders of neuropsychic activity are many:

• Transferred infections;
• Stress;
• Prolonged infertility;
• Abortions;
• Trauma in previous births.

The gynecologist finds out, when signs of disturbances of neuropsychic activity have appeared: before pregnancy or simultaneously with its approach. It is also necessary to find out what the woman herself associates with their occurrence.

7. Epidemiological anamnesis.

8. Constant intoxication (tobacco smoking, alcoholism, drug addiction).

9. Menstrual, sexual and reproductive functions (when menstruation, how the previous pregnancies are going, how the birth, weight and health of previous children, gynecological and venereal diseases of the pregnant woman were).

10. Family history (health of family members living with a woman, heredity, health status, group and rhesus belonging to a future father).

Then go on to an objective examination of the future mother:

• Consultations of the therapist, dentist, oculist and ENT doctor. If necessary, appoint an examination by other specialists.
• Measure the temperature and blood pressure.
• Assess the physique and measure the height, weight and size of the pelvis.
• Examine and palpate the abdomen.
• Examine blood, urine and other excreta.
• Examine the articulation.
• They make an electrocardiogram.
• Ultrasound should be performed by every pregnant woman before the twelfth, from the eighteenth to the twenty-second and from the 32nd to the 34th week.
• Conduct an external obstetric study.

It is very important that a woman should be registered no later than the 12th week of pregnancy. The earlier anthropometry, laboratory studies and blood pressure were measured, the higher the possibility of giving birth to a healthy child or revealing fetal pathologies incompatible with life.

Laboratory studies of women

When the future mother becomes registered, she is assigned a clinical blood test and a general urine test, determine the group and Rh factor, glucose level, check for the effects of RW, hepatitis, HIV, and make scrapings and swabs from the vagina and cervix to the flora, Cytology, chlamydia, gonorrhea, trichomoniasis.

If a history of the birth of dead children, miscarriages (especially in later terms), extragenital pathologies, it is necessary:

• To conduct a study of a woman's blood for the presence of hemolysins;
• As early as possible to study the blood of the future father of the group and the Rh factor, especially if the Rh factor in the pregnant woman is negative or the group 0 (I);
• Identify the presence of urogenital infections;
• To determine the level of necessary hormones, immunorefense;
• If necessary, carry out genetic studies.

Further laboratory tests are carried out at such times:

• A clinical blood test - monthly, after the thirtieth week - once every fourteen days;
• During each appointment, a urine test is administered for general analysis;
• At the sixteenth-twentieth week, determine hCG and ACE;
• For 22-23 weeks. And 36-37 weeks. Examine blood sugar;
• Research on the coagulation system (coagulogram) is performed from 36 to 37 weeks;
• In thirty weeks and two to three weeks before childbirth re-examined for HIV and RW, examine smears and scrapes.

Special obstetric examination

A special obstetric study includes:

1. Conducting an external obstetric study.
2. Internal obstetric examination.
3. Other additional studies.

External obstetric examination consists in examining, 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 lone articulation is carried out , as well as the fetation of the fetal heartbeat. The technique of external obstetric research is not simple, only trained health workers conduct it.

Internal obstetric examination. The internal obstetric examination includes examination of the external genitalia, examination of the vagina and cervix using mirrors. It is just as important as the external obstetric examination of parturient women. This procedure is carried out with the emptied intestine and bladder. For his conduct, a woman is asked to lie on her back, legs spread apart and bend at the knees. The pelvis must be raised. The research is necessarily conducted in aseptic conditions.

• The study begins with an examination of the external genitalia. Assess the nature of hair, perineum. Detect pathological processes, if they exist: scars from ruptures in previous births, tumors, inflammation, fistula, condylomas, hemorrhoidal nodes in the anus. The condition of the vulva is assessed by pushing the labia with fingers, determining the condition of the urethra, glands.

• The cervix is examined with the help of mirrors. Pay attention to the mucous, secret, the size of the neck and throat of the uterus. In the first trimester, a two-handed study of the vagina is carried out, in the second and third, only one-handed is appropriate.

First assess the perineum (whether there is stiffness, scars) and vagina (size, walls, the presence of folding).

4 external obstetric examinations

Methods of external obstetric research (Leopold's techniques) are used when palpating the pregnant woman's belly. These techniques are four:

• An estimate of the height of the standing of the bottom of the uterus and the proportion of the fetus that is in it;
• Determination of the location of the fetus, about which conclusions are drawn on finding the back and its arms and legs;
• Finding a part of the fetus that is present, its location relative to the small pelvis;
• Determine how the presenting part of the fetus is located relative to the entrance to the small pelvis.

Purpose of cervical examination

Before birth determine the maturity of the neck, as it shows how the body is ready for childbirth. The methods for determining the maturity of the neck are varied, but in all of them the following parameters are evaluated:

• Consistency;
• What is the length of the vaginal part of the canal;
• Permeability of the cervical canal;
• How is located and where the axis of the neck is directed in the small pelvis;
• The thickness of the wall of the neck part, which is located in the vagina;
• Determine the state of the lower part of the uterus.

Evaluate the cervix according to a special scale. The immature cervix has from 0 to 5 points. If the examination turned out to be more than 10, then a woman can be prepared for childbirth.

A study of a woman's pelvis

To know the size of the small pelvis, use an external obstetric examination of a pregnant woman, like pelviometry. The norms of the external dimensions of the pelvis are as follows:

• Distance spenar, which is equal to 25-26 centimeters;
• Distance kristrum - from 28 to 29 centimeters;
• Distance trochanterika - from 31 to 32 centimeters;
• Conjugate extern - from 20 to 21 centimeters;
• Conjugate diagonal, which should be within 12.5 - 13 cm.

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. In norm it should be from 11 to 12 cm. The true conjugate can be recognized if from the external conjugate (externa) subtract 9 centimeters. 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 lies between the lower edge of the pubic symphysis to the most prominent part of the cape, is also equal to the value of the true conjugate.

If the pelvic dimensions deviate from the norm, then it is advisable to perform external obstetric examinations that are additional measurements: measure the lateral conjugate, which is located between the anterior head of the ilium and its posterior awn on one side. Its normal values are from 14 to 15 centimeters. If it is less than 12 and a half centimeters, physiological births are impossible. Also measured oblique dimensions. There are three of them, and if there is a difference of more than 1.5 centimeters between them, then it is judged about an 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 hollow angle, which should be equal to 90-100 degrees.

In the algorithm of external obstetric research include the output of the small pelvis:

• Straight size, which is equal to nine centimeters. It is located between the lower end of the pubic articulation and the upper point of the coccyx. From the data obtained, two centimeters are taken away from the soft tissue;
• The tachometer measures the transverse dimension, which is 11 centimeters and is located between the ischial tuber (their inner surfaces).

The techniques of Leopold-Levitsky

At any medical reception of the woman during all period of pregnancy necessarily there is an external obstetric research. The techniques of Leopold-Levitsky play the main role in it. Their name, these methods, the principles of which have already been mentioned above, were obtained on behalf of the person who developed them in the late nineteenth century. This person is the German doctor Christian Leopold. These developments have solved many obstetric problems, which are relevant to today.

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 standing of the uterine floor and almost always corresponds to the period of pregnancy. Its accuracy is related to the thickness of the abdominal wall. If there are doubts, now more accurate results will be given by ultrasound.

The third method shows the presentation of the fetus: gluteal, transverse or head. And also how deep the fetus is already in the pelvis. The fourth method is confirmed by the three previous ones.

Algorithm of the research

Many are interested in the algorithm of external obstetric examinations. First, the pelvic measurements of the pregnant woman are made. After the termination of this manipulation the doctor passes to a palpation of a stomach of the woman. This is the stage of application of Leopold's techniques. Then go to auscultation or listening to the heart of the fetus. The heart beat frequency is important here (equal to 120 to 160 beats per minute), their clarity and rhythmicity. Auscultation is performed with a stethoscope or a fetal monitor.

External and internal obstetric examination is very important during pregnancy, childbirth and after them. A woman should understand this, behave adequately and in no case do not shy away from them. They help the doctor to find out whether the pregnancy is normal, whether the expectant mother and her baby are healthy.