Secret language. What doctors at the time of delivery speak about?
At revenues in maternity hospital to childbirth any woman has the stress connected with change of a house situation on hospital and feels fear of the unknown. And unclear medical terms increase uneasiness. The knowledge of these terms will allow future mother to feel more comfortably.
the Beginning of childbirth
At receipt in maternity hospital, and then several times at the time of delivery the doctor will tell: “Now we will conduct vaginal research“ or:“ Let`s look how there a neck as the kid moves ahead“. It is about internal obstetric research which allows to define a condition of patrimonial ways, to watch dynamics of disclosure of a neck of a uterus at the time of delivery, the mechanism of insertion and advance of the prelying part of a fruit (a head, buttocks). Primary inspection at arrival of the woman in labor in maternity hospital is performed on a gynecologic chair, and in the course of childbirth - on a patrimonial bed. Frequency of vaginal researches depends on features of a course of childbirth. At the physiological (normal) course of childbirth they will be out not more often than in 4 hours, and at emergence of indications (izlity amniotic waters, change of nature of fights, emergence of bloody allocations, change of heartbeat of a fruit) - as required.determine by
At vaginal research a shape of a neck of a uterus, its size, a consistence, maturity degree; the condition of an external opening of a neck of a uterus, edges of a pharynx and extent of its disclosure, measure one of the basin sizes - a diagonal conjugate - between the lower part of a pubis and the speaker in a cavity of a small pelvis the cape of a sacrum. Then perform inspection uterus necks in mirrors, however do it not always, and only when there is bleeding and it is necessary to exclude a uterus neck as a source of this bleeding (it can be at extensive erosion, uterus neck cysts, a vagina varicosity).If vaginal research is conducted by
on the eve of or at the very beginning of childbirth, then the doctor says that the uterus neck mature or, on the contrary, unripe, synonyms - is ready - is not ready to childbirth.
the Maturity of a neck of a uterus is determined by a special scale (Bishop`s scale), consider expressiveness of four signs:
- a uterus neck Consistence (for childbirth the soft neck is favorable):
- dense - 0 points; by
- it is softened, but in an internal pharynx it is condensed - 1 point;
- soft - 2 points.
- - 0 points;
- of 1 - 2 cm - 1 point; is less than 1 have some of
- , it is maleficiated - 2 points.
- , passes a finger-tip - 0 points;
- the channel of a neck passes one finger, but consolidation in an internal pharynx - 1 point is defined; is more than one have some of
- , at a smoothed neck it is more than 2 cm - 2 points.
- of a kzada - 0 points;
- of a kpereda - 1 point;
- median - 2 points.
from 0 to 2 points.
Assessment: 0 - 2 - an unripe neck, 3 - 4 - insufficiently mature, 5 - 6 - mature.Opening of a neck of a uterus the doctor defines
during vaginal research. The size of disclosure of a uterine pharynx is measured in centimeters. Full opening corresponds to 10 cm. Sometimes it is possible to hear expression “opening of a neck of a uterus 2 - 3 fingers“. Really, old obstetricians measured opening in fingers. One obstetric finger is conditionally equal to 1,5 - 2 cm. However thickness of fingers at all different, therefore measurement in centimeters more precisely and more objectively.during vaginal research the doctor also does to
the conclusion about a condition of a fetal bubble and amniotic waters. Then the woman can hear the term “flat fetal bubble“ - a situation at which before a fruit head few amniotic waters. Normal during each fight increase of intrauterine pressure is transferred to fetal egg (fetal covers, amniotic waters and a fruit). Amniotic waters under the influence of intrauterine pressure move down, to an exit from a uterus therefore the fetal bubble in the form of a wedge is stuck out to the canal of a neck of a uterus and promotes its disclosure. Few waters before a head happen from - for few - or abundance of water, existence of a large fruit, weakness of patrimonial activity. In this case it does not carry out function of a wedge and slows down disclosure of a neck of a uterus, the doctor says that such bubble needs to be opened, or to carry out an amniotomiya.
One more term connected with a fetal bubble is “a high lateral rupture of a fetal bubble“ - a situation at which the fetal bubble is broken off not in the lower pole, and is much higher, densely clasps and holds a fruit head, interfering with its lowering and advance in a cavity of a small pelvis, and amniotic waters stream in the small portions or on drops. In this case the obstetrician carries out tool cultivation of covers, that is the opening in a fetal bubble already is, but amniotic covers need to be parted.
After waters streamed, the doctor estimates their character. “Waters good, light, normal“ - so will be told by the doctor if waters transparent or with a small yellowish shade, without unpleasant smell. It is worse if the doctor says:“ green waters“ muddy, green or brown color of water, having an unpleasant smell, can testify to a hypoxia (pre-natal oxygen starvation of a fruit). At development of a hypoxia of a fruit by one of its early signs meconium hit (first-born a calla) in amniotic waters is. It results from relaxation of a sphincter of a rectum of a fruit against oxygen starvation. At first in waters meconium lumps in the form of a suspension appear, and then waters are painted in green color. Intensity of coloring of waters (from green to untidily - brown) depends on degree of expressiveness and duration of a hypoxemic state at a fruit.
the Condition of a fruit
At the time of delivery future mother usually very fixedly listens to the fact that speak about a condition of the kid. Listening to heartbeat of a fruit, the doctor pays attention to a rhythm, heartbeat frequency, clarity of tones, existence or lack of noise. Normal heart rate makes 120 - 160 beats per minute, tones rhythmical, clear, extraneous noises are absent. At stout women clarity of tones decreases at the expense of thickness of a belly wall (the muffled heartbeat). The doctor can estimate heartbeat as “rhythmical, clear“, or “muffled, rhythmical“, or “arrhythmic, deaf“. Existence of noise at an auskultation can be at an umbilical cord obvitiya around a neck and a trunk of a fruit, existence of knots of an umbilical cord, a hypoxia of a fruit, placentary insufficiency. Clarity of tones is influenced by thickness of a belly wall, degree of expressiveness of subcutaneous fat, a placenta arrangement on a forward wall of a uterus, existence of miomatozny knots, abundance of water. At primary survey the doctor uses a usual obstetric stethoscope, however for specification of a condition of a fruit, and also dynamic supervision at the time of delivery requires more detailed research by means of a kardiotokografiya (KTG). Modern cardiomonitors are based on the principle of Doppler which use allows to register change of intervals between separate cycles of warm activity of a fruit, they are displayed in the form of sound and light signals and a graphic representation on the kardiotokograf monitor. For this purpose the external sensor is placed on a forward belly wall of the woman in a point of the best audibility of warm tones of a fruit. The second sensor has ¬ sya in the field of the right corner of a uterus (the corner of a uterus is in its top part in the place of an otkhozhdeniye of a uterine tube). This sensor registers a uterus tone, frequency and force of fights in labor. Information on warm and patrimonial activity is reflected in the monitor in the form of two curves respectively at once.
For diagnostic application developed a special scale on which in mark system all above-mentioned indicators are estimated. Quite often doctors speak about “an assessment according to Fischer“, i.e. an assessment on the scale developed by W. Fisher. The assessment of 8 - 10 points characterizes a good shape of a fruit, 6 - 7 points - are available initial signs of oxygen starvation of a fruit - a hypoxia (the compensated state). In this case the fruit has small deficiency of nutrients and oxygen, but at timely treatment and an adequate method of a rodorazresheniye the forecast for the kid favorable. Less than 6 points - a serious (dekompensirovanny) condition of a fruit which demands the emergency rodorazresheniye in connection with threat of pre-natal death of a fruit.
As childbirth goes?
After an otkhozhdeniye of waters and insertion of a head for an assessment of compliance of the sizes of a head of a fruit to mother`s basin in labor the doctor surely checks Vasten`s sign and can report about results to future mother. The woman lies on a back. The doctor puts one palm on a surface of a lonny joint, another - on area of the prelying head. At compliance of the sizes of a basin of the woman in labor and a head of a fruit the forward surface of a head is located below the plane of a simfiz (a lonny joint), i.e. the head comes under a lonny bone (Vasten`s sign negative). If the forward surface of a head is flush with simfizy (Vasten`s sign level with), there is a small discrepancy of the sizes. At discrepancy of the sizes of a basin of the woman in labor and a head of a fruit the forward surface of a head is above the plane of a simfiz (Vasten`s sign positive). The negative sign of Vasten speaks about good compliance of the sizes of a head and the woman`s basin. At the second option the favorable result of childbirth in natural patrimonial ways at observance of some conditions is possible:
- good patrimonial activity;
- average sizes of a fruit;
- lack of signs of a perenashivaniye;
- good shape of a fruit at the time of delivery;
- availability of light waters;
- good configurations of a head and its correct insertion when passing a cavity of a basin.
the Positive sign demonstrates that the basin of mother is an obstacle for passing of a fruit and natural childbirth in this case is impossible.during vaginal research the doctor estimates
as the fruit head is located. If everything goes well, most likely, in this respect you will hear nothing from lips of the doctor if he wants to emphasize that everything is normal, will tell that prelying of a fruit occipital. Normal the head of a fruit falls to a cavity of a small pelvis in a condition of bending, i.e. the chin of the kid is pressed to a breast, the point which is ahead on patrimonial ways - a fruit nape. In this case it passes all planes of a basin the smallest circle rather easily. There are wrong types of head prelying when the head is unbent and the basin cavity the first is entered by either a forehead, or a fruit face. These types of head prelying and are called - frontal and front. In these cases childbirth quite often comes to an end with operation of Cesarean section for the purpose of decrease in traumatism of a fruit and mother. But at small extent of extension of a head, good patrimonial activity, the small sizes of a fruit perhaps natural rodorazresheniye.
the Woman can hear expressions “a forward look“, “rear view“. You should not worry. At head prelying it means that at a forward look the nape of a fruit is turned to a forward wall of a uterus, and at back - kzad. Both options are normal, but in the latter case attempts last longer.the doctor can tell
After vaginal external research about how the head on patrimonial ways moves ahead.the Head is pressed by
to an entrance to a small pelvis. In two weeks prior to childbirth at pervorodyashchy women the head of a fruit begins to fall and nestle on an entrance to a small pelvis. Thanks to it pressure upon the lower segment and a neck of a uterus amplifies that promotes maturing of the last. At povtornorodyashchy the head falls for 1 - 3 day or even in several hours prior to childbirth.
the Head a small segment in an entrance to a small pelvis. At this obstetric situation the head is not mobile, its greatest part is located above the plane of an entrance to a small pelvis, it is still probed through a forward belly wall. It happens in the first period of childbirth - during fights.
the Head a big segment in an entrance to a small pelvis. In this case it is a big circle in the plane of an entrance to a small pelvis, through a forward belly wall is almost not probed, but at vaginal research the doctor well defines it, and also all seams and fontanels. So the head settles down at the end of the first period of childbirth before attempts.the Head in a cavity of a small pelvis - at external research is not defined by
, at vaginal research the doctor sees that it fills all cavity of a small pelvis. This obstetric situation is observed in the potuzhny period.
the Birth of the kid
With each attempt the head gradually passes a cavity of a basin and begins to be shown from a sexual crack, doctors call it a vrezyvaniye - the head is shown from a sexual crack only during an attempt and a head prorezyvaniye (the head is constantly visible in a sexual crack). Means, the kid will be born soon. At threat of a rupture of a crotch obstetricians quite often resort to a crotch section - then warn that they will make a perineotomiya or an epiziotomiya. This compulsory measure allows to prevent injuries at mother and the kid. Operation of a perineotomiya is called the crotch section in the direction from back soldering of a crotch to a rectum sphincter. Thus, the section passes across the median line of a crotch. At an epiziotomiya the section is carried out on the one hand, through a big vulvar lip (at an angle 45 ° from the median line).
Right after the birth to the kid by means of a rubber barrel suck away slime from a nose and a mouth in order that it did not get into lungs at its first breath. The assessment of a condition of the newborn child is carried out on a scale Apgar on 1 - y and 5 - y minutes. The following signs are considered: heartbeat, breath, coloring of skin, reflexes, tone of muscles. Expressiveness of each of five signs in points from 0 to 2 is defined. If a score on all signs from 7 to 10, then a condition of the newborn satisfactory, 4 - 6 points - a condition of average weight, 1 - 3 point - heavy.
After the child`s birth the obstetrician - the gynecologist watches signs of office of a placenta. “Separated, we give birth an afterbirth“ - the doctor so will tell if when pressing by a palm edge over a bosom the umbilical cord is not involved inside if the clip which is earlier imposed on an umbilical cord about a sexual crack fell a little.
Of course, at the time of delivery and then, after the birth of the kid, to you it is necessary to face a large number of new words and concepts. And than you learn about them from reliable sources more, that will more reliably relieve yourself of unreasonable fears.