In the maternity home, women in childbirth usually arrive at the end of pregnancy, or at the beginning of the first period of labor. Having an exchange card. The parturients measure body temperature, examine the skin and mucous membranes, collect epidemics, study the exchange chart. After the examination, the question is resolved at hospitalization in the physiological or observational department. In the waiting room anamnesis is revealed, a general somatic and external obstetric examination is performed, a cleansing enema is performed, sanitary treatment is performed, after which the woman is transferred to the prenatal ward.
In the prenatal ward, rhodium is examined more carefully and is followed by dynamic observation, which consists in the external examination and examination of the woman in childbirth every 2 hours (blood pressure is measured, the frequency of the fetal heart rate, its nature, degree of head movement through the birth canal and the nature of the fights). It is better if the monitoring of contractions and fetal condition is carried out with the help of a cardiac monitor.
The degree of cervical dilatation is determined by vaginal examination. Internal (vaginal) obstetric examination makes it possible to determine the condition of the birth canal, observe the dynamics of the opening of the cervix during labor, the mechanism of circulation and movement of the fetal part, the state of the fetal bladder, and measure the diagonal conjugate.
Vaginal examination in the management of labor should be conducted at the admission of the woman in labor in the hospital and immediately after the discharge of water. In addition, to monitor the dynamics of labor in the first period, a vaginal examination is performed every 6 hours. If there is a deviation from the normal course of labor, the vaginal examination is performed according to the indications.
External obstetric research in the period of disclosure should be carried out repeatedly and systematically. Records in the history of childbirth should be conducted at least every 2 hours. When external obstetric research should pay attention to the shape of the uterus and its consistency during and outside of contractions, the height of the standing of the uterine fundus, the condition of the contraction ring. It is also necessary to determine the position, position, type and presentation of the fetus, as well as the relation of the presenting part to the entrance to the small pelvis. It should also be checked whether the clinical correspondence between the size of the fetal head and the mother's pelvis (Vasten's sign).
The strength and duration of fights can be determined by hand, located on the site of the bottom of the uterus. The uterus between contractions should relax well.
Auscultation of cardiac fetal tones is best at the location of his front shoulder. The heartbeat of the intranasal fetus has 3 basic auscultatory characteristics: frequency, rhythm and clarity. The frequency of strokes in the norm varies from 120 to 160 in 1 min. The heartbeat must be rhythmic and clear. With a whole fetal bladder, the fetal heartbeat is heard every 15-20 minutes, and after the water retreats, after 3-10 minutes
Follow the progress of the fetus during childbirth with the help of:
1) external methods of obstetric research;
2) vaginal examination;
3) the techniques of Piskachek and Genter.
With the saved waters, the women in labor can walk in the ward. It is better to lie on the side of the fetus position, i.e. at the I position of the fetus - on the left side, at the II position - on the right side.
With the passage of water, vaginal examination is necessarily performed, the amount of amniotic fluid, their color, the present part of the fetus and the level of its standing are determined. With full opening of the cervix and preserved membranes, amniotomy is performed. At the end of the cervical dilatation period, rhodium is changed and transferred to the delivery room. The toilet of the external genital organs is administered with a solution of potassium permanganate (1: 6000) followed by treatment with 3-5% iodine solution or other disinfectants (as an operation field). During the fetal ejection, the fetus is continuously monitored, fetal heart function after each attempt) and the fetal movement through the birth canal.
After the eruption of the head, obstetric care is carried out, aimed at protecting the perineum and careful removal of the fetus.
It consists of the following moments of labor management:
1) regulation of attempts;
2) prevention of premature extension of the head;
3) simultaneous decrease in tension of perineal tissues by borrowing tissues;
4) removal of the fetal head outwardly;
5) help with the birth of the shoulders of the fetus and trunk.
The regulation of attempts is carried out in the following way: the woman in labor should strengthen or weaken her in the event of an attempt. To strengthen - the woman giving birth to her feet, taking in her hands, lifts her head to her chest, and takes a deep breath. And when the wave of contractions decreases, then you can weaken the power by putting your hands on your chest, lowering the head end, the types of the woman in childbirth, for example: ask him to count.
In addition, it is necessary to prevent premature extension of the head to the formation of a fixation point. The palm of the left hand is placed on the pubic arch, and 4 fingers of this arm are placed on the head, preventing its extension during attempts and rapid movement through the birth canal.
Reducing the tension of the perineum makes it possible to make it more compliant for the passage of the head to erupt due to the borrowing of tissues from neighboring regions (tissues of the labia majora). The borrowings are made downward towards the perineum, lowering the tissue from the head of the fetus. But it is forbidden to do this during the attempt.
The removal of the fetal head without force is carried out when the nape of the fetus appears and the area of the suboccipital fossa rests against the symphysis. While giving birth, you can not push. She must breathe with her mouth, putting her hands on her chest.
After the birth of the head, the parturient women are offered to strain, if the hangers are not born on their own. We take the head with both hands, without pressing on the face, we deflect it downwards until the front shoulders approach the arch vault. Then lift it up, with your right hand move the perineum from the back of the shoulder and carefully remove it from the genital slit. In the inguinal cavity, from the side of the fetal back, we enter the index fingers of both hands and lift the body forward and upward, which promotes rapid birth. The primary toilet of the newborn is carried out. Observe the general condition of the parturient woman, determine the blood loss, controlling the release of the placenta.
In the consecutive (third) period, the period of birth is distinguished by the phase of placental detachment from the uterine wall and the phase of discharge (birth) of the placenta (placenta, membranes and umbilical cord).
The follow-up period should be watched expectantly and meticulously and begin with the bladder emptying. When the mother is pregnant and there are no signs of internal or external bleeding, one can expect an independent separation of the placenta and the birth of the asphyxia within 30 minutes. In some cases, a delayed separated placenta may occur. In this connection it is necessary to know the signs indicating that the placenta has separated and is in the lower segment of the uterus, cervix and vagina.
Signs of separation of the placenta
Methods for isolating thesequence.
To inspect the birth canal, the mother is placed on the bed of Rakhmanivka. To keep the lower extremities using special tyotrimachi.Naruzhnye genitals, the inner thighs are treated with one of the disinfectant solutions. The vaginal mirror and lift are inserted into the vagina, exposing the cervix. The cervix of the uterus is trapped by the terminal clamps, looks around its entire length, gradually shifting the clamps. After examination, the cervix is examined by the walls of the vagina, the posterior and anterior vault of the vagina. If ruptures are found, deep cracks, then they are sewn.
After the birth, the woman in childbirth should be in the delivery room for 2 hours.