Determination of organism readiness for childbirth. The data of the anamnesis allow only to determine the duration of pregnancy, and to determine the degree of maturity of the fetus and differentiation of the transferred and prolonged pregnancy, this data is not enough. The gestation period is determined by the date of the last menstruation, by the day, expectation of ovulation, the first appearance in the consultation, the date of the first fetal movements, the results of an objective examination and ultrasound.
Data of obstetric examination. One of the symptoms of a pregnant pregnancy is a reduction in abdominal girth, explained by dehydration of the fetus and low water as a result of a lack of production of amniotic fluid.
For a pregnant pregnancy is characterized by a decrease in the skin turgor of a pregnant woman. Together with the decrease in the volume of the abdomen, a delay in the body weight of the pregnant woman is revealed, and its mass comes down, which can reach 1 kg or more.
With a pregnant pregnancy, the lobno-xiphoid distance decreases, which is due to the effect of those factors that contribute to a decrease in the volume of the abdomen and a decrease in the body weight of the pregnant woman.
Dynamic observation indicates an increase in uterine density, which is due to a decrease in the number of amniotic fluid and retraction of the uterine muscles. The scaring leads to a certain restriction of mobility of the fetus due to denser oboplyuvannya its uterus.
With a vaginal examination, the condition of the cervix is determined, an increase in the density of the bones of the skull, narrowing of the sutures and fontanels. The degree of readiness of the cervix is one of the main criteria for the preparation of the woman's organism for childbirth.
Of the additional research methods, to confirm the diagnosis of a pregnant pregnancy, use the study of blood indicators: Overstimulation is accompanied by an increase in the number of reticulocytes in peripheral blood to 2.4% (in women who give birth in a timely manner, this figure varies within 1%). This is explained by the response of the bone marrow to fetal hypoxia, so the reaction can not be considered specific.
When pregnancy is overdone, there is a sharp decrease in the concentration of estrogens in the blood serum (especially estriol). In the ratio of the amount of progesterone and estriol is 41: 1 (with full term pregnancy 10: 1). Decreased percentage of the determination of sexual chromatin, which is associated with changes in hormonal activity (with full term pregnancy, it is found in 40% of women, with 20% transferred).
Informative is colpositology studies. According to the Zidovsky classification (1964), four types of smears are identified that occur at the end of pregnancy.
I type ("late gestation") characterized by the prevalence in the smear of intermediate cells in a ratio of 3: 1. There are practically no leukocytes and mucus. Eosinophilia is not more than 1%, pycnotic index is 3%. With this type of smear, labor begins 10 days later.
II type ("shortly before birth") - the ratio of intermediate cells is 1: 1. Find the cells of the surface layer. Leukocytes and mucus are few. The eosinophilic index is 2%, pycnotic - 6%. With this smear, birth begins in 4-8 days.
III type ("term of birth") - the intermediate cells predominate, their ratio is 3: 1. The number of surface cells reaches 25-35%. The number of leukocytes and mucus increases, eosinophilic and pycnotic indices increase (respectively 8% and 20%). With this smear, birth begins in 1-5 days.
IV type ("unquestionable term of labor") - surface cells predominate (40-80%), the eosinophilic index rises to 20%, pycnotic - up to 40%. A lot of mucus and leukocytes. With this type of smear, labor occurs within the next 2-3 days.
The cytological sign of masturbation of pregnancy is considered the extension of III and IV type of smear during pregnancy, is born longer than expected time. The accuracy of the method varies within 90%.
During ultrasound with a pregnant pregnancy, attention is drawn to reducing the thickness of the placenta and a significant amount of its calcifications, reducing the amount of amniotic fluid, lack of growth in the biparietal size of the head, thickening of the skull bones, and increased fetal size.
Amniascopic examination reveals a mild amount of amniotic fluid during pregnancy and a lack of amniotic fluid in it. In the early stages of the overdraft, the amniotic fluid becomes turbid, opalescent, in the later stages they acquire a greenish tinge.
Preparedness of the pregnant woman for delivery, in addition to assessing the degree of maturity of the cervix, is determined with the help of oxytocin test. To do this, enter a solution of oxytocin (in 1ml of 0010 D oxytocin) at a rate of 1 ml per minute. If the tone of the uterus increases after the introduction of 001-003 ED oxytocin, the birth occurs in the next 24-48 hours (positive test), if after the introduction of 004 ED or more - after 3-8 days (test negative).
To assess the functional state of the fetoplacental complex, CTG with stress tests is performed, as well as functional non-medicinal tests: cold, respiratory, "step-test" and others.