Vigilant control. Surveys and inspections at the time of delivery At the time of delivery future mother repeatedly examine
and survey. For some vaginal researches can appear especially unpleasant. Whether so so frequent carrying out these procedures is necessary?the Accident ward
If patrimonial activity begins
at the woman of the house (but not in office of pathology of pregnancy), it comes to an accident ward where she is in detail asked (specify when patrimonial activity began or waters departed whether the woman slept at night, whether took some medicine). After that the general inspection is performed: take temperature, arterial pressure, determine growth, carry out weighing, define existence of hypostases and varikozno expanded veins, thickness hypodermically - fatty cellulose, etc.
Then is passed to external obstetric research (heartbeat of a fruit is listened, the external sizes of a bone basin, a stomach circle, height of standing of a bottom of a uterus are measured). By means of a palpation (probing) of a stomach the uterus tone, the provision of a fruit (longitudinal, cross, slanting), the prelying part (a head or the pelvic end) is defined.the main task of the doctor to define
In an accident ward whether childbirth really began. If existence of patrimonial activity or izlity amniotic waters is not confirmed, the woman is hospitalized in office of pathology of pregnancy. If the woman arrived with suspicion on izlity amniotic waters, and it was excluded precisely, more than any complaints (on the pains pulling feelings in the bottom of a stomach) future mother does not show, then she can be allowed to go home. If the beginning of childbirth is confirmed, the woman comes to delivery room. In doubtful cases hospitalization in delivery room is carried out and there constantly watch the patient.by
In the majority of maternity hospitals to the woman in labor coming to a rodblok carries out a cleaning enema. It is made not only of “esthetic“ reasons (that contents of intestines were not allocated at attempts) but because the crowded intestines can prevent patrimonial activity and complicate survey. Besides, the enema promotes development of patrimonial activity.
After a cleaning enema to the woman in labor shave off genital hair and a pubis, so processing by disinfecting solution is more effective. Besides, vulvar lip hair can disturb at suture after the delivery. In some maternity hospitals shaving of genitals is considered optional now, there is enough that hair were shortly cut.
Before receipt in delivery room the woman takes a shower and puts on sterile linen.by
In delivery room makes vaginal research, observation over a condition of a fruit and an assessment of nature of patrimonial activity.by
At receipt in delivery room to the woman performs inspection in mirrors (by means of a gynecologic mirror examine a neck of a uterus and mucous vaginas), vaginal research is carried out. Before its carrying out genitals process disinfecting solution. The doctor conducts research in sterile gloves which he puts on after processing of hands (the doctor washes hands, then processes them special disinfecting solution).by
Originally estimate appearance of genitalia: as are created whether there is a varicosity, whether there are signs of inflammatory process or diseases, sexually transmitted.by
At survey in mirrors estimates appearance of a vagina and neck of a uterus, and also nature of allocations.
At manual (manual) research vaginas (wide or narrow, existence of cicatricial changes), a condition of a neck of a uterus (maturity degree, opening) estimate a condition. Check existence of a fetal bubble (it is whole or is absent), at the whole fetal bubble estimate amount of forward waters (those waters which are before a head). If it is not enough forward waters or too much, opening of a fetal bubble as in these cases the fetal bubble can prevent patrimonial activity can be required. Further diagnose the prelying part (a head or the pelvic end). When prelying a head establish nature of insertion (normal the head goes in the bent state, the nape is born the first). But the head can be inserted not only a nape, but also a forehead or the person, etc. The wrong provision of a head can serve as the reason of discrepancy of a head of a fruit and mother`s basin. To define insertion, on a head palpate seams and fontanels (they serve as reference points). If predlezhit the pelvic end, define a type of pelvic prelying (foot or buttock). Speak about foot prelying if predlezhat legs if legs are bent in coxofemoral joints and ahead of them appear fruit yagodichka, then this buttock prelying. If both legs, and yagodichka (the kid as if squats) are defined - it is called the mixed buttock prelying.by
At vaginal research surely estimate a condition of a bone basin. The doctor tries to reach a finger the cape of a sacrum (the most acting in a point basin cavity). If the cape is not reached, so basin capacity sufficient. If the cape is reached, so there is some narrowing of a basin. Besides existence of deformations of a bone basin is defined. Repeated vaginal research has to be conducted not earlier than in 4 hours as frequent vaginal surveys increase risk of development of infectious complications in the postnatal period. More frequent vaginal research can be conducted only strictly according to indications: at an izlitiya of amniotic waters if took place premature izlity waters - at the beginning of patrimonial activity (emergence of fights); at emergence of bloody allocations; before carrying out anesthesia; at a deviation from the normal course of childbirth (suspicion on development of weakness or a diskoordination of patrimonial activity, lack of advance of a head). The bases for carrying out vaginal research are surely brought in history of childbirth. Carrying out vaginal research without accurate indications is inadmissible. Repeated vaginal researches (more than four) in labor are the indication for prescription of antibiotics in the postnatal period.
For an assessment of development of patrimonial activity at least, than each hour the doctor or the midwife estimates the frequency, force and duration of fights. For this purpose the doctor puts a hand to the woman on a stomach and notes time. Normal eventually fights become frequent, accrue on force and duration.of
. The prelying part can be probed in whole or in part over an entrance to a small pelvis (over a pubis). If the prelying part is in narrow part of a small pelvis or at a pelvic bottom, that is the fruit already considerably promoted “to an exit“, then at external research it is not probed through a forward belly wall.by
besides estimates the woman`s condition. Temperature and pressure is periodically taken, pulse is counted (these manipulations can be carried out by the midwife). All data are entered in history of childbirth.
the Assessment of a condition of a fruit
Not less carefully, than behind a condition of mother, needs to watch a condition of a fruit.
Each 20 - 30 minutes the doctor listens to heartbeat of a fruit by means of an obstetric stethoscope (a wooden tubule). It is obligatory to wait at the same time for fight to estimate as heartbeat of a fruit in time and after fight changes.by
At least, 1 - 2 time carries out record of heartbeat of a fruit by means of the special device - a kardiotokograf (the fetalny monitor). To future mother lying on one side or on a back on a stomach the special sensor by means of which the schedule of heartbeat of a fruit - a kardiotokogramm (KTG) registers in a paper tape is attached. In certain cases registration of heartbeat of a fruit by means of a kardiotokograf is carried out continuously during all childbirth. It is necessary in the following cases:
- at a heavy gestoz at mother (gestoz is the state connected with pregnancy which main symptoms are hypostases, increase of arterial pressure and emergence of protein in urine);
- at a rodostimulyation (stimulation of childbirth after the beginning of patrimonial activity by means of medicines) or rodovozbuzhdeniya (when childbirth is caused artificially);
- at premature or perenoshenny pregnancy;
- at polycarpous pregnancy;
- if mother has serious chronic illness (diabetes, it is warm - vascular pathology);
- when carrying out epiduralny anesthesia (as lowering of arterial pressure at the woman and as a result violation of food of a fruit is possible);
- at a fruit arrest of development; if when listening by an obstetric stethoscope violation of heartbeat of a fruit is revealed
Advantage of continuous record of heartbeat is the constant control behind a condition of a fruit, a shortcoming - its inconvenience for the woman, restriction of her freedom and physical activity.
In certain cases the kardiotokograf has 2 sensors, one of which writes down heartbeat of a fruit, and the second registers reductions of a uterus. It is convenient as it is possible to track as heartbeat changes during fight.by
Surely estimate appearance of amniotic waters after their izlitiya. Normal waters have to be light and transparent. If waters are painted in green color, it testifies to a hypoxia (oxygen starvation) of a fruit (green coloring of waters is caused by the fact that at a hypoxia there is a premature release of meconium - first-born a calla of a fruit which paints amniotic waters). In this case the constant control behind heartbeat of a fruit is necessary. Can be painted in yellow color of water at a Rhesus factor - the conflict - color of waters is explained by the fact that at a Rhesus factor - the conflict there is a destruction of blood cells and allocation of a bilirubin pigment from them.
After full opening of a neck of a uterus and the beginning of the second period of childbirth (the period of attempts) everything has to be ready
On a patrimonial table for reception of childbirth. Reception of childbirth is carried out on a special patrimonial table (in some maternity hospitals there are special beds which are transformed to a patrimonial table). the Woman is transferred to
to a patrimonial table after a head prorezyvaniye (the head is shown in a sexual crack during fight and does not disappear after fight). At the time of delivery to the woman in labor there is a grant which carries the name “protection of a crotch“. It is directed to that the head was cut through in a sexual crack by the smallest size, for this purpose it has to be most bent (the chin of the kid has to be pressed to a breast). Therefore until the maximum bending of a head the midwife detains her advance. At pelvic prelying the grant is directed to that yagodichka of a fruit were born the first and there was no loss of a leg. For this purpose, detaining advance of a fruit, the doctor forces it “to sit down“ as if.
When rendering a manual grant watch a condition of a crotch. If there is a threat of its gap (pobledneny skin, emergence of cracks), it is necessary to make a crotch section - an epiziotomiya as the section begins to live better than a gap.
In parallel the doctor after each attempt listens to heartbeat of a fruit. If heartbeat of a fruit worsens, it is necessary to finish childbirth as soon as possible. The epiziotomiya is for this purpose carried out, in rare instances resort to imposing of obstetric nippers.the doctor or the midwife tell
in the course of reception of childbirth to the woman in labor when it is necessary to make an effort when, on the contrary, it is necessary “to prodyshat“ an attempt. It depends on location of the prelying part and speed of its advance. It is important to listen attentively to medical personnel to avoid gaps and injuries of a fruit.
After the birth of the kid are put by mothers on a stomach and put to a breast (if its state allows). The umbilical cord is crossed, then the kid looks round the pediatrician. >
After appearance of the baby
After the birth of a fruit the posledovy period begins p. It is the shortest period of childbirth on time, but during it there is a danger of bleeding from a uterus.the Doctor watches
emergence of signs of office of an afterbirth - the woman can feel weak fight, at deep breath of the woman the piece of an umbilical cord is not involved, the bottom of a uterus rises above and deviates to the right. Only after office it is possible to bring an afterbirth out of a genital tract if he is not born independently. A pandiculation of not separated afterbirth for an umbilical cord, expression it through a forward belly wall are not applied as it is dangerous by developing of bleeding.Mending of gaps is usually carried out by
to faster office of an afterbirth and the best reduction of a uterus is promoted by applying of the child to a breast right after the birth. This results from the fact that at irritation of a nipple oxytocin having the reducing effect on a uterus is allocated hormone.
After the afterbirth birth he surely looks round, the doctor has to be convinced of a placenta integrity because at a placenta segment delay in a uterus there can be bleeding. Therefore at suspicion on defect of placentary fabric manual examination of a cavity of a uterus against anesthesia is conducted.by
Survey of patrimonial ways
After the delivery surely perform inspection of patrimonial ways regarding gaps. For this purpose enter special spoon-shaped mirrors into a vagina. At first the doctor examines a uterus neck. For this purpose the neck undertakes special clips, and the doctor bypasses it on perimeter, reclinging clips. At the same time the woman can feel the pulling feelings in the bottom of a stomach. If there are ruptures of a neck of a uterus, their mending is made, anesthesia at the same time is not required as in a neck of a uterus there are no pain receptors. Then the vagina and a crotch look round. In the presence of gaps their mending is made.Mending of gaps is usually carried out by
under local anesthesia (novocaine is entered into the area of a gap or genitals are sprayed by lidocaine spray). If the manual office of an afterbirth or inspection of a cavity of a uterus under an intravenous anesthesia was carried out, then survey and mending are also carried out under an intravenous anesthesia (the woman is brought out of an anesthesia only after completion of survey of patrimonial ways). If there was an epiduralny anesthesia, then the additional dose of anesthesia through the special catheter left in epiduralny space since childbirth is entered. After survey processing of patrimonial ways is made by disinfecting solution.by
Surely estimate the number of bloody allocations. At the exit from a vagina the tray where all bloody allocations gather is put, also the blood which remained on napkins, diapers is considered. Normal blood loss makes 250 ml, is admissible to 400 - 500 ml. Big blood loss can testify to hypotonia (relaxation) of a uterus, a delay of parts of a placenta or not sewn up gap.Two hours after the delivery
the Early postnatal period includes
the first 2 hours after the delivery. During this period there can be various complications: bleeding from a uterus, formation of a hematoma (a blood congestion in the closed space). Hematomas can cause a sdavleniye of surrounding fabrics, feeling of a raspiraniye, besides, they are a sign of not sewn up gap from which bleeding can proceed, after a while hematomas can nagnaivatsya. Periodically (each 15 - 20 minutes) the doctor or the midwife approaches young mother and estimates reduction of a uterus (for this purpose the uterus is probed through a forward belly wall), nature of allocations and a condition of a crotch. After two hours if everything is normal, the woman with the kid is transferred to postnatal office.
Doctors always try to reduce the number of surveys and medical manipulations in labor to a minimum to allow childbirth to proceed most naturally and to allow the woman to concentrate on this most important process in life, to feel the predominating role in the child`s birth.