OBSTETRIC TURN: evidence, contraindication and operation.

Obstetric rotation (versio obstetrica) is an operation with which you can translate the wrong or unseen position of the fetus to another, more profitable, but always longitudinal.

Distinguish:

1. External turn.

2. External-internal (combined) turn:

a) classical with full disclosure of the cervix;

b) turn with incomplete opening of the cervix (Braxton-Hicks).


Classic combined external-internal turn on the leg with full opening of the cervix



Indication for the operation:

The transverse and oblique position of the fetus.

Preposition and insertions that are unfavorable for delivery (frontal, front view of facial presentation, high direct stance of the arrow-shaped suture).

The state of the mother and fetus that require urgent delivery.

Contraindications to surgery obstetric turn:

1. The transverse position of the fetus.

2. Threat of uterine rupture.

3. Rupture of the uterus.

4. Scar on the uterus after any operations or perforation of the uterus.

5. The discrepancy between the size of the pelvis and the fetus.

6. Hydrocephalus of the fetus.

7. Dead fruit.

Conditions for operation obstetric turn:

1. Full disclosure of the cervix.

2. The whole amniotic fluid or water has recently poured out: if the fetal bladder is intact, it is ruptured immediately before the operation.

3. The fetus is sufficiently mobile in the uterine cavity.

4. The size of the pelvis corresponds to the size of the fetus.

The parturient is in the midwife's bed in a position on the back with lower limbs bent in the knee and hip joints.

Anesthesia should be complete - mask or intravenous anesthesia.

Technique of operation - midwifery coup

The operation has three main stages:

1) the introduction of the hand into the uterus;

2) finding and gripping the leg

3) the actual turn.

1 moment - the introduction of the hand into the uterus. One hand bred the shameful lips of women in childbirth, the second compound cone-shaped (all fingers together), the back surface to the mallard, is introduced into the vagina. After that, the outer arm is placed on the bottom of the uterus, and the inner arm is inserted into the uterine cavity. Depending on the position, the obstetrician enters this or that hand: at the first position of the fetus, the left arm is introduced, while the second hand is inserted in the left arm. If the fetal bladder is intact, it is ruptured, but the water is released slowly to prevent the loss of small parts and umbilical cord.

2 moment - finding and grasping the legs. The search for the leg can be done in two ways: short (the hand directly penetrates to the place where the obstetrician thinks the legs should be or longer), the latter consists in finding the fetal ribs after inserting the hand into the uterus, in the opposite direction of the pelvic end and to the legs of the fetus.

Given that sometimes finding a leg can create certain difficulties, the longest path is the most susceptible.In this case, it is less likely that the casual hobby is not a knife but the knobs of the fetus, and yet you should remember the features that distinguish them: the toes of the feet are level, short, the thumb has limited mobility, is not retracted or pressed against the sole, the heel bone is palpated, the knee, unlike the elbow, has a round, movable calyx

You can grasp the leg with two fingers (index and middle) slightly above the ankle joint, or by the method of Fenamenov - with the whole hand so that the thumb is located along the crimson muscle and the tip rests against the popliteal fossa. In the case of the latter, the arm is less tired and the leg is rarely vyprisnuty.

The important thing is which foot should be seized. At the same time, they follow the rule: it is necessary to grasp that leg, when pulling back, the fetal back turns to the back wall of the uterus, that is:

- When turning from the head end, it is necessary to grasp the leg, which lies in front (closer to the abdominal wall of the mother);

- With the front view of the transverse position, the leg that lies lower is carried away, while the posterior one is the one that lies above.

This method allows you to prevent the formation of the rear view when removing the fetus. 3 moment - actually turn. The obstetrician acts with both hands. The outer hand, having grasped the head, pushes it to the bottom of the uterus, and the hand inserted into the uterus reduces the legs into the vagina. The leg leg should be traced along the leading axis of the pelvis (strictly back and down). The turn is considered complete if the fetus is translated into the longitudinal position, the head is at the bottom, the buttocks in the plane of the entrance to the pelvis, and from the gap in the gap the leg is withdrawn to the knee (popliteal fossa).

It should be remembered that immediately after the turn you need to carry out the operation of extracting the fetus by the foot. This is carried out necessarily because of the possibility of injuring the umbilical cord, the development of asphyxia and fetal death, if it does not receive emergency care.

The output of the leg must necessarily be made in the direction of the abdominal wall of the fetus, because otherwise a fracture of the hip is possible.