Types and methods of obstetric examination of pregnant women. What examinations does a pregnant woman undergo?

When registering a pregnant woman, the doctor examines her and records the results in an individual variable card (firm IIIy).

1. Passport data: full name, series and number of the passport.

2. Age (young primipara - up to 18 years; age primipara - 28 years and older).

4. Profession (influence of production factors on the body of a pregnant woman and fetus and observation up to 30 weeks in the medical unit).

5. Anamnesis, transferred general somatic and infectious diseases diseases of the genital organs, ex pregnancies and childbirth, surgeries, blood transfusion history, epidemiological history, allergy, family history, heredity.

6. Laboratory research: general analysis blood - 1 time per month, and from 30 weeks. pregnancy - 1 time in 2 weeks; general urine test - in the first mat of pregnancy monthly, and then 1 time in 2 weeks, blood type and Rh affiliation in both spouses, RW - three times (when registering 28-30 weeks and 34-36 weeks), HIV and Australian antigen - when registering, fecal analysis for helminth eggs when registering: complement fixation reaction with toxoplasmic antigen according to indications; coagulogram; the presence of sugar in the daily amount of urine and blood; analysis of vaginal discharge for microflora at registration and at 36-37 weeks; ECG - at 36-37 weeks.

7. Objective research carried out by an obstetrician, therapist, dentist, otolaryngologist, ophthalmologist, if necessary, endocrinologist, urologist:

a) anthropological measurements (height, weight);

b) blood pressure;

c) external obstetric examination:

Distantia spinarum (25-20 cm);
Distantia cristarum (28-29 cm);
Distautia trochanterica (30-31 cm);
Coniugata externa (20 cm).

If there is a deviation from the indicated dimensions, it is necessary to make additional measurements of the pelvis even before the internal examination:

a) lateral conjugate (between the anterior and posterior iliac spines of the same side - 14-15 cm (if this figure is less than 12.5 cm, natural delivery is impossible);

b) oblique dimensions of the small pelvis:

from the middle of the upper edge of the pubic articulation to the posterior superior awn of the wings of both iliac bones - 17.5 cm each,
from the anterior superior spine of the iliac wing of one side to the posterior superior spine of the other side - 21 cm each,
from the spinous process of the V lumbar vertebra to the anterior superior spinous and other ilium - 18 cm each (the difference between the sizes of each pair is more than 1.3 cm indicates an oblique narrowing of the pelvis),

c) dimensions of the Michaelis rhombus:

vertical - between the supra-sacral fossa and the top of the sacrum - 11 cm,
horizontal - between the posterior upper awns of the wings of both iliac bones - 10 cm;

d) the angle of inclination of the pelvis - the angle between the plane of the entrance to the pelvis and the plane of the horizon (measured with a pelvis in the position of a woman standing) - 45-55 °;

e) dimensions of the outlet of the pelvis:

straight - between the top of the coccyx and bottom edge pubic symphysis- 9 cm,
transverse - between the inner surfaces of the ischial tubercles - 11 cm;

f) determine the values of the true conjugate:

according to the outer conjugate - 9 cm is subtracted from the size of the outer conjugate,
according to the diagonal conjugate - 1.5-2 cm is subtracted from the size of the diagonal conjugate (the figure to be subtracted is determined by the circumference in the area of the wrist joint - with a circumference of up to 14 cm, subtract 1.5 cm, over - 2 cm),
according to USS (most accurately).

At the first examination through the vagina, the size, shape, consistency, mobility of the uterus, the condition of the pelvic bones, soft tissues, muscles are determined. pelvic floor. Additionally, the height of the womb (4 cm), the internal diagonal conjugate, and the pubic angle are measured.

After an increase in the size of the uterus, when its external palpation becomes possible, it is necessary to determine the tone of the uterus, the size of the fetus, the number amniotic fluid, presenting part, articulation of the fetus, its position, position and appearance, using four classic obstetric techniques (according to Leopold).

Auscultation of fetal heart sounds is carried out from 20 weeks of pregnancy. Fetal heart sounds are heard with an obstetric stethoscope in the form of rhythmic double beats with a constant frequency of 130-140 per minute.

M. S. Malinovsky suggested following rules to listen to the fetal heartbeat:

1. When occipital presentation- near the head below the navel on the side where the back is facing. At rear views- on the side of the abdomen along the anterior axillary line.

2 When facial presentation- below the navel on the side where the breast was (in the first position - on the right, in the second - on the left).

3. In the transverse position - near the navel, closer to the head.

4. When presenting with the pelvic end - above the navel, near the head on the side where the back is facing.

IN last years widely used apparatus "Kid" and ultrasound devices, cardiac monitors, which allow you to clarify auscultatory data in difficult cases.

Ed. K.V. Voronin

According to a certain plan, a survey of a pregnant woman and a woman in labor is conducted. The survey consists of a general and a special part. All data obtained is entered into the pregnant woman's card or into the history of childbirth.

a common part

The reasons that made a woman apply for medical care(complaints) heredity and past diseases, working and living conditions, passport data: last name, first name, patronymic, age, place of work and profession, place of birth and residence.

It is important to obtain information about all communicable and non-communicable diseases and operations carried out in early childhood, during puberty and adulthood, their course and methods and duration of treatment. Hereditary diseases (tuberculosis, syphilis, mental and oncological diseases, multiple pregnancies etc.) are of interest because they can provide adverse effect on the development of the fetus, as well as intoxication, in particular, alcoholism and drug addiction in parents.

Special part

Sexual function: at what age did you start sexual life, what marriage is in a row, the duration of the marriage, the period from the beginning of sexual activity to the onset of the first pregnancy, the time of the last sexual intercourse.

Secretory function: the nature of vaginal discharge, their quantity, color, smell.

Menstrual function: the time of appearance and establishment of menstruation, the type and nature of menstruation, whether menstruation has changed after the onset of sexual activity, childbirth, abortion; date of the last, normal menstruation.

Postponed gynecological diseases: time of occurrence, duration of the disease, treatment and outcome

Husband's age and health

Generative ( childbearing function). It collects detailed information about previous pregnancies in chronological order, which one real pregnancy, flow previous pregnancies(were there any toxicosis, gestosis, diseases of cardio-vascular system, kidneys, liver and other organs), their complications and results.

The course of a real pregnancy

- Common diseases, complications of pregnancy (toxicosis, threat of miscarriage, etc.), date of first appearance in women's consultation and the gestational age established at the first visit - 1 trimester (up to 12 weeks).
- Common diseases and complications during pregnancy, weight gain, numbers blood pressure, test results, date of the first fetal movement-2 trimester (13-28 weeks).
General weight gain during pregnancy, its uniformity, blood pressure measurements and blood and urine tests, diseases and complications of pregnancy 3rd trimester (29 - 40 weeks)
To detect diseases the most important organs and systems that can complicate the course of pregnancy and childbirth. Pregnancy can cause an exacerbation of existing diseases, decompensation, etc. An objective examination is carried out according to generally accepted rules, starting with an assessment of the general condition, temperature measurement, examination skin and visible mucous membranes. Then the organs of blood circulation, respiration, digestion, urinary, nervous endocrine systems are examined.

External obstetric examination, internal obstetric examination and additional methods research is a special obstetric examination

By inspection, measurement, palpation and auscultation, an external obstetric examination is performed.

Particular attention is paid to the size and shape of the abdomen, the presence of pregnancy scars, skin elasticity. Inspection allows you to identify the correspondence of the type of pregnant woman to her age. At the same time, attention is paid to the woman's height, physique, condition of the skin, subcutaneous tissue, mammary glands and nipples.

On examination, pay attention to the entire pelvic area, but attach special importance to the lumbosacral rhombus. The study of the pelvis is carried out by examination, palpation and measurement of its size. The structure and size of the pelvis have a decisive influence on the course and outcome of childbirth. A normal pelvis is one of the main conditions right flow childbirth. Deviations in the structure of the pelvis, especially a decrease in its size, complicate the course of childbirth or present insurmountable obstacles to them.

The outlines in the region of the sacrum, which have the contours of a diamond-shaped area, are called the Rhombus of Michaelis. The upper corner of the rhombus corresponds to the spinous process of the 5th lumbar vertebra, the lower one corresponds to the apex of the sacrum, the lateral corners correspond to the superior posterior iliac spines. At normal pelvis rhombus corresponds to the shape of a square. Its dimensions: the horizontal diagonal of the rhombus is 10-11 cm, the vertical one is 11 cm. With various narrowings of the pelvis, the horizontal and vertical diagonals will different sizes, which will change the shape of the diamond. Based on the shape and size of the rhombus, it is possible to assess the structure of the bone pelvis, to detect its narrowing or deformation, which has great importance in childbirth.

Measurements are made with a centimeter tape during an external obstetric examination (the circumference of the wrist joint, the dimensions of the Michaelis rhombus, the circumference of the abdomen and the height of the bottom of the uterus above the womb) and an obstetric compass in order to determine the size of the pelvis and its shape. With a centimeter tape measure the largest circumference of the abdomen at the level of the navel (at the end of pregnancy it is 90-100 cm) and the height of the fundus of the uterus - the distance between the upper edge of the pubic joint and the fundus of the uterus. At the end of pregnancy, the height of the uterine fundus is 32-34 cm.

Measuring the abdomen and the height of the fundus of the uterus above the womb allows the obstetrician to determine the gestational age, the estimated weight of the fetus, to identify disorders of fat metabolism, polyhydramnios, and multiple pregnancies.

The pelvis is measured with a tazometer. Only some measurements (exit of the pelvis and additional measurements) can be made with a centimeter tape. By the external dimensions of the large pelvis, one can judge the size and shape of the small pelvis. Usually four sizes of the pelvis are measured - three transverse and one straight. The subject is in the supine position, the obstetrician sits to the side of her and facing her.

The distance between the inner surfaces of the ischial tuberosities is called the transverse size of the outlet of the pelvis. The measurement is carried out with a special tazomer or centimeter tape, which are applied not directly to the ischial tuberosities, but to the tissues covering them; therefore, it is necessary to add 1.5-2 cm to the obtained sizes of 9-9.5 cm. Normally, the transverse size is 11 cm. It is determined in the position of the pregnant woman on her back, she presses her legs to the stomach as much as possible.

The distance from the lower edge of the symphysis to the most prominent point of the promontory of the sacrum (13 cm) is called the diagonal conjugate. The diagonal conjugate is determined by a vaginal examination of a woman, which is performed with one hand.

The distance between the middle of the lower edge of the pubic joint and the tip of the coccyx is called the direct size of the exit of the pelvis. During the examination, the pregnant woman lies on her back with her legs divorced and half-bent at the hip and knee joints. The measurement is carried out with a tazometer. This size, equal to 11 cm, is 1.5 cm larger than the true one due to the thickness of the soft tissues. Therefore, it is necessary to subtract 1.5 cm from the resulting figure of 11 cm, we get the direct size of the exit from the pelvic cavity, which is 9.5 cm.

The distance between the anteroposterior and posterior superior iliac spines of the same side (14 cm) is called the lateral dimensions of the pelvis. Measure it with a tasometer. Lateral dimensions must be symmetrical and not less than 14 cm. With a lateral conjugate of 12.5 cm, childbirth is impossible.

The oblique dimensions of the pelvis have to be measured with oblique pelvises. To identify the asymmetry of the pelvis, the following oblique dimensions are measured: the distance from the anteroposterior spine of one side to the posterior superior spine of the other side (21 cm); from the middle of the upper edge of the symphysis to the right and left posterior superior spines (17.5 cm) and from the supracross fossa to the right and left anteroposterior spines (18 cm). The oblique dimensions of one side are compared with the corresponding oblique dimensions of the other. With a normal structure of the pelvis, the size of the paired oblique dimensions is the same. A difference greater than 1 cm indicates an asymmetric pelvis.

The angle between the plane of the entrance to the pelvis and the plane of the horizon is the angle of inclination of the pelvis. Pregnant. It is determined using a special device - a pregnant woman standing, it is equal to 45-50 tazouglomera.

The longer the gestation period, the clearer the palpation of parts of the fetus. In the second half of pregnancy and childbirth, palpation determines the head, back and small parts of the fetus. Receptions outdoor obstetric research- this is a sequentially performed palpation of the uterus, consisting of a number of specific techniques.

The first method determines the height of the uterine fundus, its shape and the part of the fetus located in the uterine fundus. To do this, the obstetrician places the palmar surfaces of both hands on the uterus so that they cover its bottom.

The second method determines the position of the fetus in the uterus, the position and type of the fetus. The obstetrician gradually lowers his hands from the bottom of the uterus to its right and left sides. Gently pressing the palms and fingers on the lateral surfaces of the uterus, on the one hand, determines the back of the fetus along its wide surface, on the other - small parts of the fetus. This technique allows you to determine the tone of the uterus and its excitability, to feel the round ligaments of the uterus, their thickness, soreness and location.

The third technique is used to determine the presenting part of the fetus. The third method is to determine the mobility of the head. To do this, they cover the presenting part with one hand and determine whether it is the head or the pelvic end, a symptom of balloting the fetal head.

The fourth technique, which is an addition and continuation of the third, allows you to determine not only the nature of the presenting part, but also the location of the head in relation to the entrance to the small pelvis. To perform this technique, the obstetrician becomes face to the feet of the subject, puts his hands on both sides of the lower part of the uterus so that the fingers of both hands seem to converge with each other above the plane of the entrance to the small pelvis, and palpates the presenting part. In the study at the end of pregnancy and during childbirth, this technique determines the ratio of the presenting part to the planes of the pelvis.

The degree of insertion of the head by a large or small segment is judged by palpation. With the fourth external reception, the fingers are advanced inward and slide them up the head. If at the same time the hands converge, the head stands as a large segment at the entrance to the pelvis or sank deeper, if the fingers diverge, the head is located at the entrance as a small segment. If the head is in the pelvic cavity, it is not determined by external methods.

During childbirth, it is important to find out in which plane of the pelvis the head is located with its largest circumference or large segment. The large segment of the head is the largest part of it that passes through the entrance to the pelvis in this presentation. With an occipital presentation of the head, the border of its large segment will pass along the line of a small oblique size, with anterior head presentation - along the line of its direct size, with frontal presentation- along the line of large oblique size, with facial presentation - along the line of vertical size. A small segment of the head is any part of the head located below the large segment.

Fetal heart sounds are heard with a stethoscope, starting from the second half of pregnancy, in the form of rhythmic, clear beats, repeated 120-160 times per minute. With head presentations, the heartbeat is best heard below the navel. With breech presentation - above the navel. The study of the fetal heart rate in dynamics is carried out using monitoring and ultrasound. The following rules were established for listening to the heartbeat of the fetus M.S. Malinovsky:

1) with occipital presentation - near the head below the navel on the side where the back is facing, with rear views - on the side of the abdomen along the anterior axillary line,
2) with facial presentation - below the navel on the side where the breast is located (in the first position - on the right, in the second - on the left),
3) in a transverse position - near the navel, closer to the head,
4) when presenting with the pelvic end - above the navel, near the head, on the side where the back of the fetus is facing.

With one hand, an internal obstetric examination is performed (with two fingers, index and middle, with four - with a semi-hand, with the whole hand).

The presenting part, the state of the birth canal, observing the dynamics of the opening of the cervix during childbirth, the mechanism of insertion and promotion of the presenting part, etc., allows you to determine the internal study. Vaginal examination of pregnant women and women in labor is a serious intervention that must be performed in compliance with all the rules of asepsis and antisepsis. Vaginal examination is performed upon admission to the obstetric institution, and after the outflow of amniotic fluid. In the future, vaginal examination is performed only according to indications. This procedure allows you to timely identify complications of the course of childbirth and provide assistance.

They begin with an examination of the external genital organs, the perineum and the vestibule of the vagina. The middle and middle phalanges are inserted into the vagina. index finger and carry out an examination. Next, the cervix is found and its shape, consistency, size, degree of maturity, shortening, softening, location along the longitudinal axis of the pelvis, and patency of the pharynx for the finger are determined. The presenting part (buttocks, head, legs) is determined, where they are located (above the entrance to the small pelvis, at the entrance by a small or large segment, in the cavity, at the exit of the pelvis).

In parturient women, a vaginal examination reveals the condition amniotic sac(integrity, violation of integrity, degree of tension, amount of front waters). When examining childbirth, the degree of cervical smoothness (preserved, shortened, smoothed), the degree of opening of the pharynx in centimeters, the condition of the edges of the pharynx (soft or dense, thick or thin) are determined. Then the fingers are removed from the vagina and washed. The assistant measures the marked distance on the hand with a centimeter tape or a pelvis meter. Identification points on the head are sutures, fontanelles, at the pelvic end - the sacrum and coccyx. Palpation of the inner surface of the walls of the pelvis allows you to identify the deformation of its bones, exostoses and judge the capacity of the pelvis. At the end of the study, if the presenting part is high, measure the diagonal conjugate (conjugata diagonalis), the distance between the cape (promontorium) and the lower edge of the symphysis (normally 13 cm). To do this, they try to reach the cape with the fingers inserted into the vagina and touch it with the end of the middle finger, bring the index finger of the free hand under the lower edge of the symphysis and mark on the hand the place that is directly in contact with the lower edge of the pubic arch.

The circumference, which the head will pass through the cavity of the small pelvis, corresponds to its direct size at the first degree of extension of the head. This circle is a large segment.

The largest circumference of the head corresponds to a large oblique size at the second degree of extension. This circle is a large segment of the head when it is inserted frontally.

The lower pole of the head is determined 3-4 cm above or at its level, the sacral cavity is free for 2/3 - the head is a small segment at the entrance to the small pelvis. The posterior surface of the pubic symphysis is palpated in the lower and middle sections. pregnant checkup fetus heartbeat

The largest is the circle corresponding to the "vertical" size at the third degree of extension of the head. This circle corresponds to a large segment of the head when it is inserted facially.

The lower pole of the head 4-6 cm below the ischial spines is not determined, almost the entire sacral cavity is made by the head-head in the cavity of the small pelvis. The posterior surface of the pubic symphysis is not accessible for palpation.

The head fills the entire sacral cavity, including the coccyx area, only soft tissues- head on the pelvic floor; the inner surfaces of the bone identification points are difficult to access for examination.

The entire anterior surface of the sacrum and the posterior surface of the pubic symphysis are accessible to palpation. The possibility of determining the ratio of the lower pole of the head underlies the determination of the height of the head during vaginal examination. With gentle pressure with your finger up, the head moves back and returns to its original position.

A convincing two lines on a pregnancy test showed that yes, it happened. You are pregnant. And, the world for you, immediately, has changed dramatically in two stages - before pregnancy and after. You began to listen to yourself, to identify additional evidence of pregnancy. But, along with the pleasant and joyful news, comes the realization that now you will have to spend a significant part of your personal time not in your favorite activities and hobbies, but in medical institutions to visit numerous medical offices there.

Not all visits are pleasant for a woman, but one cannot do without them. Sometimes you unwittingly become a witness various conversations in the circle of women giving birth and pregnant women. Some are glad that there were few procedures during pregnancy, while others complain that they were tortured to follow all the instructions of their doctor. Is there a golden mean?

Getting ready for the first visit

Your first pregnancy examination will take place using a gynecological chair. Few women like this procedure, but there is nowhere to go, and therefore, in order to reduce the percentage of discomfort, you should prepare for it in advance. It is necessary to draw up a calendar with notes on when you would have had your period if you had not become pregnant.

Agree, this is easy to do, especially with a regular cycle. Therefore, do not plan a visit to the doctor directly on these days, as they are considered critical periods and therefore dangerous for the development of pregnancy. Also postpone ultrasounds and physical examinations, unless, of course, nothing bothers you, until the eighth week, counting from the first day of your last period.

Before visiting a medical institution, you should take a bath or shower, put on fresh underwear. There is no need to wash especially, and even more so to douche. The doctor should examine the condition of your vagina in a normal state. The use of perfumes and intimate deodorants is not recommended. They are often the cause allergic reaction regarded by the doctor as inflammation.

Most women shave their perineum before visiting the doctor. But, is it really worth it? No, not necessarily. Of course, it is not always convenient for a doctor to examine a woman with excessive hair on the external genital organs, but if you do not do this regularly, then you should not, because this intimate process can lead to severe irritation skin.

Must be emptied bladder. During the examination, the doctor should assess the condition of the internal genital organs, and not an overfilled bladder. In addition, the intestines must also be empty. Sexual contacts should be excluded a day before the visit to the doctor. This is due to the fact that a small amount of seminal fluid remains in the vagina after intercourse, which distorts the results of the analysis. Of course, sometimes there is a long queue to the gynecologist, therefore, it will not be superfluous to visit the toilet before your appointment.

What you wear also plays an important role. You should be comfortable, but you should also quickly undress or empty your chest at the gynecologist's appointment. Socks or slippers will not be superfluous so that you do not walk barefoot on the cold floor to the gynecological chair. Take your towel as well, despite the fact that the gynecologist will offer you a paper one.

It will also be desirable to purchase a disposable gynecological kit so that you are not tormented by thoughts about the conscientiousness of the sterilization of examination instruments by the medical staff. By the way, they are inexpensive and, as a rule, are sold in most pharmacies. In the set: a plastic mirror designed to examine the cervix, sterile gloves, special brushes or sticks for taking material for analysis, always a disposable film that replaces a towel.

Before the examination itself, a preliminary conversation between the doctor and the patient, measurement of pressure, then examination on the couch and weighing is preceded. Let's leave some recommendations for women. Leave your shoes in front of a separate examination room, if available. Ask the midwife or doctor where it is possible to undress, so as not to accidentally put clothes on a radiator or a sterile table.

Undress slowly, during this time the medical staff will fill out the necessary documents.

Put on slippers or put on socks, put a towel or a film on the chair so that it lines up with the edges, but does not hang from it. Climb onto the chair slowly up the stairs and take a position so that the buttocks are on the very edge of it. Next, on the stands on the chair, place your legs, while the slingshots should be fixed in the popliteal fossa.

If the design of the chair is not familiar to you, ask your gynecologist about it without hesitation. Try to relax and calm down, while placing your hands on your chest. Consider what the doctor does should not be. It makes it worse discomfort and makes inspection difficult. About everything that interests you, you can ask the doctor after the examination.

What does 1 examination during pregnancy mean?

The examination begins, as a rule, with an examination of the woman's external genital organs. At the same time, the doctor professionally evaluates the condition of the skin and mucous membranes of the perineum, clitoris, labia majora and labia minora, and necessarily the external opening of the urethra.

The doctor also examines the inner thighs, allowing you to predict in advance varicose veins veins, areas of elements of the rash or pigmentation. viewed in without fail and region anus for cracks and hemorrhoids, other pathologies.

The second stage is the examination in the mirrors. An examination is directed mainly to identify certain diseases of the vagina or the condition of the cervix is determined. There are two types of mirrors: spoon-shaped and folding. The introduction of a mirror is the most unpleasant procedure during the examination.

The nature of the discharge from the cervix is given special attention. Allocations with streaks of blood indicate the risk of abortion. talking about infection unusual smell secretions and if they are cloudy.

Required tests

A smear on the flora is the first analysis when registering during pregnancy. The doctor, with a special spoon, "scoops" the substance from the cervical canal, urethra, vagina and puts it on the glass. The material is examined in the laboratory under a microscope.

This analysis reveals the presence inflammatory process, some types of infection are also detected, namely: gonorrhea, candidiasis, fungal, bacterial vaginosis, trichomoniasis.

A smear on the flora, during the entire bearing of the child, is repeated 3-4 times, even in the case of its positive results.

This frequency is explained by the fact that during pregnancy, long-forgotten and not making themselves felt infections “wake up”. An example is candidiasis, which occurs in women during pregnancy, 2-3 times more often. The body of a woman is rebuilt, which leads to an increase in the level of female sex hormones. The vaginal environment becomes more acidic, in which the candida feels great.

It should be noted that hormonal changes reduce cellular immunity and leukocyte activity, which leads to increased reproduction in the genital tract of a pregnant woman of this fungus. The number of microorganisms is higher, the longer the gestational age. Therefore, candidiasis strongly worries expectant mothers in the last trimester.

A cytological examination is the second mandatory analysis, in which the structural features of the surface cells and the cervical canal are examined. A swab is taken special tool- brush or spatula. The analysis is important for the detection of oncological diseases on early stages. During pregnancy, it is extremely necessary, because pregnancy itself only aggravates the course similar diseases. For analysis, a cytological smear directly taken from the vaginal fornix is also important.

It allows you to correctly assess a woman's hormonal status, determine abnormalities in the uteroplacental blood flow, or predict the risk of abortion.

In recent years, many antenatal clinics have been examining pregnant women for sexually transmitted infections. At the first visit, such an analysis is not taken, usually during a second examination on a chair.

Also, the doctor will prescribe without fail and urine. By the way, it is given during the first visit to the antenatal clinic, and the analysis itself turns out to be the most frequent due to the fact that the kidneys may not be able to cope with the increased load during pregnancy. Blood is taken from a vein to determine the blood type and Rh factor. Also, with the help of this analysis, malignant changes are detected.

Determined by blood test and hemoglobin level. Its low level, in addition to the woman's poor health, also leads to a violation of the course of pregnancy. To increase the level of hemoglobin, iron preparations are indicated. But women on early dates, these drugs are poorly tolerated due to toxicosis. Therefore, as a substitute, it is recommended proper nutrition. It is also necessary to detect the presence of antibodies to rubella and other infections: herpes, cytomegalovirus.

At the first examination, the doctor will also take an interest in your husband's health. Find out his age, the presence of hereditary diseases, blood type and. An anamnesis of relatives will also be collected, and on both sides. In case of hormonal, metabolic and hereditary diseases, other additional examinations will naturally be prescribed.

Inspection by hand

After examination with a mirror, a two-handed vaginal examination is performed. In this regard, the doctor determines the position, size and condition of the uterus, ovaries, fallopian tubes. To do this, the doctor spreads his arms large labia and gently inserts the middle and index fingers right hand. Left hand lies on the stomach. At the same time, the condition of the vagina is assessed: the extensibility of the walls, the width of the lumen, the presence of partitions, tumors, scars, and other pathological conditions affecting the course of pregnancy and subsequent childbirth.

Next, the doctor examines the cervix and determines its size, shape, location, consistency. The cervix during the normal course of pregnancy is tilted back, its length is over 2 cm, dense to the touch, the channel for the finger is not passable. In the event of an abortion, the cervix softens, shortens, shifts to the center, and the canal opens. An experienced gynecologist needs only to touch it to assess the condition of the cervix.

Next, the doctor feels the uterus, the size of which, most often, corresponds to the gestational age. But, if a woman is diagnosed with uterine fibroids, she expects twins, she is pregnant for the third or fourth time in a row, with some gynecological diseases, then the size of the uterus may be larger. The doctor also pays attention to the shape and consistency of the uterus. During pregnancy, the uterus is softer than normal. The softening of the part of the uterus, which is closer to the cervix, is especially observed.

Various irregularities on the uterus are often a sign of various anomalies in the development of the uterus or fibroids. Uterus on short term mobile and in the pelvis occupies a middle position. In case of restriction of its mobility or deviation to the side, this indicates an inflammatory disease of the uterine appendages or an adhesive process. The next to be examined by a doctor are the ovaries and the fallopian tubes to exclude ectopic pregnancy in which the examination is painful. At the end of the examination, the doctor feels inner surface symphysis, sacrum, lateral walls of the pelvis.

As you can see, there is nothing wrong with the first visit to the doctor, so feel free to go - this is important for your future pregnancy.

Every expectant mother who is observed during pregnancy must undergo mandatory examinations of a pregnant woman, which are provided for by the Orders of the Ministry of Health Russian Federation and Standards of Medical Care.

If the woman is somatically healthy, the doctor determines basic examinations for her. If a pregnant woman has a concomitant somatic pathology or the disease was identified during pregnancy, the range of diagnostics is expanded. Dispensary examination of a pregnant woman in her work time paid by the state.

Pregnancy Diagnosis

The first and main symptom of pregnancy is the delay in menstruation. In case of delayed menstruation, it is recommended to take a pregnancy test. This test is a cardboard strip that must be dipped into morning urine for a few seconds (it has the highest content of the “pregnancy hormone”).

According to the number of strips that appeared after a certain period of time, a woman will know whether she is pregnant or not. Two stripes mean that pregnancy is present, one stripe - no. In the case when the test demonstrates the absence of pregnancy, and there are no periods, you should donate blood from a vein for the presence of chorionic gonadotropin.

In addition, an ultrasound (ultrasound examination) of a pregnant woman is often performed. Its purpose is to determine the presence and duration of pregnancy, and exclude the diagnosis of "ectopic pregnancy".

Examinations of a pregnant woman in the first trimester (0-12 weeks)

After the detection of pregnancy, the woman becomes registered in her antenatal clinic. Although, observed in given period You can also visit a paid medical clinic that specializes in this.

During registration, the gynecologist issues a list of tests that should be passed. Usually this is: a blood test for the Rh factor, group, syphilis, AIDS, hepatitis, general and biochemical research blood, a blood test for sugar levels, a general urine test, a swab taken from the vagina.

In addition, according to indications, tests for the presence of urogenital infections, as well as an analysis for hormones, are possible. If there is a possibility of a Rh conflict (the wife has a negative Rh factor, and the man has a positive one), the pregnant woman’s blood is examined several more times during the pregnancy for the presence of specific antibodies to the erythrocytes of the embryo and their number is detected. Up to the thirty-second week, this study is carried out once a month, and in the period from 32-35 weeks - twice a month, and then until childbirth - every week.

In addition, a pregnant woman needs to go through the following doctors:

therapist;
otolaryngologist;
ophthalmologist;
dentist
undergo an ECG (electrocardiogram).

A pregnant woman should visit a gynecologist once a month. Before each visit to the doctor, it is necessary to do a general urine test, according to its results, the gynecologist will evaluate the work of the woman's kidneys. During each visit, the pregnant woman is weighed, blood pressure is measured on both arms, the height of the uterine fundus is measured, and the fetal heartbeat is heard.

Examination of a pregnant woman in the second trimester (13-24 weeks)

When a woman is in her second trimester, she is sent for an ultrasound. Ultrasound examination of a pregnant woman at this time allows:

determine the number of fruits;
determine the duration of pregnancy;
identify possible malformations of limbs, organs abdominal cavity, nervous system fetus.

From 16 to 18 weeks expectant mother offer to take a "triple test", which is designed to determine the "genetic health" of the baby. The levels of chorionic gonadotropin (CG), alpha-fetoprotein (AFP), unconjugated estriol (NE) are determined in the blood. If there is a deviation of the level of these substances from normal one may suspect certain chromosomal abnormalities in the fetus (Down syndrome, including). It is recommended to do this study twice, with an interval of a couple of weeks at 15-20 weeks of pregnancy.

There is no need to panic if the result triple test"demonstrates a deviation from the norm. Sometimes the test gives erroneous results - about 9.3% of the time. To clarify the results, the woman is sent for an additional study - amniocentesis. Amniocentesis is a study of amniotic fluid to confirm the absence or presence of a chromosomal abnormality in the fetus. It is performed under the control of an ultrasound examination of a pregnant woman. Before this study, the doctor should warn the patient that in a small percentage of cases (1 percent), amniocentesis provokes a miscarriage.

During the second half of pregnancy, a woman needs to visit her gynecologist a little more often: once every two weeks (in case of normal course pregnancy).

Examinations of a pregnant woman in the third trimester (from 24 weeks until childbirth)

At a period of 24 to 26 weeks of pregnancy, a woman is prescribed the next scheduled ultrasound. During this ultrasound examination of a pregnant woman, the doctor examines the structure of the baby's body, the doctor identifies birth defects development internal systems and organs, sees the sex of the child, the quality and quantity of amniotic fluid in the pregnant woman, the place of attachment of the placenta, as well as its condition.

A woman at this time also needs to pass a clinical blood test, which demonstrates the level of hemoglobin in the blood, and, therefore, the absence or presence of anemia.

After the thirtieth week, the pregnant woman begins to go to the gynecologist every two weeks. At the same time, the doctor issues an exchange card to the pregnant woman, in which the results of all examinations and analyzes are entered. Now with this card she needs to go everywhere, because childbirth can begin at any time, and without exchange card doctors can see a woman in labor only in a specialized maternity hospital, where pregnant women without a fixed place of residence, without a local residence permit, from other cities, without tests, and so on, enter.

After 32 weeks, the gynecologist issues maternity leave if the woman works. Until this date, the state must pay for all dispensary examinations of a pregnant woman during working hours.

Within 33-34 weeks, Dopplerography is performed - an examination that allows you to evaluate the placenta, blood flow in the vessels of the uterus, as well as the main vessels of the baby. Modern technologies make it possible to find the vessel under study with high accuracy, assess the nature of the blood flow and perform dopplerometry - a quantitative assessment of the blood flow in the area of interest. The study provides an opportunity to find out if the baby is getting enough nutrients and oxygen. If the blood flow rate is reduced, then cardiotocography (CTG) may be prescribed by the gynecologist.

With the help of CTG, the tone of the uterus, the presence of its contractions, and the motor activity of the baby are revealed. According to motor activity, an assessment of the possible intrauterine hypoxia fetus. To conduct the study, the pregnant woman is placed on the couch, tapes with sensors are fixed in the abdomen. For 30 - 40 minutes, the readings of the device are printed on a paper tape or they can be seen on the display monitor.

For a period from 35 to 36 weeks, a biochemical blood test, a blood test for syphilis, AIDS, a vaginal swab is taken. At the same time, the last ultrasound examination of a pregnant woman is done, with the help of which the doctor evaluates the condition of the placenta, the weight and height of the baby, its position in the uterus ( breech presentation or head), the quality and quantity of female amniotic fluid (oligohydramnios, polyhydramnios, their transparency).

If the results of the examinations are normal, then the pregnant woman needs to go to the gynecologist weekly and take urine tests, waiting for the onset of labor.

If the results of analyzes or studies demonstrate some kind of trouble in the state of the baby or the pregnant woman, the patient is taken under special control. Namely, medications are prescribed that improve blood flow through the placenta, additional ultrasound examinations and dopplerometry are carried out. The last two studies are also carried out when the expected day of birth has come, but at the same time generic activity does not start.

However, there is no need to panic and be nervous due to the fact that the birth is delayed. At each consultation, the doctor will evaluate your condition and, if necessary, give you a referral to the maternity hospital.

In this article:

Obstetric research is a set of methods and techniques for examining a woman during pregnancy and the birth itself, for an objective assessment of their condition and course. The examination of a woman consists of the following components: external obstetric examination, laboratory and clinical.

External examination

External research includes:

Examination of a pregnant woman. The doctor evaluates the height, body weight and body type of the woman, as well as the condition of the skin, pigmentation on the face, and determines the shape of the abdomen.
Measurement of the abdomen. With help measuring tape the doctor measures the circumference of the abdomen at the level of the navel, and also measures the length of the fundus of the uterus.
Palpation of the abdomen. The woman should be in a supine position. The doctor determines by palpation the condition of the skin, the elasticity of the skin, the thickness of the fat layer, the condition of the rectus abdominis muscles, as well as the location of the fetus.

It is especially important in the first obstetric examination to determine the direct size of the entrance to the small pelvis. In general, pelvic examination has a very importance, since its position and structure affects the course of pregnancy and directly on the birth itself. Narrowing of the hip joint can lead to serious complications that will provoke a difficult birth.

Studies of pregnant women are conducted in several ways:

First reception. The purpose of this method of examining a woman is to determine the height of the fundus of the uterus and the part of the fetus that is on its bottom. This approach also makes it possible to judge estimated dates pregnancy, the position of the fetus and its presentation.
Second reception. This method allows you to determine the position of the fetus in the uterus. Gently pressing your fingers on the walls of the uterus, the doctor can determine which way the child will turn. In addition, this technique allows you to determine the amount of amniotic fluid and the excitability of the uterus.
Third take. The purpose of the third reception of an external obstetric examination is to determine the presentation and its relationship to the small pelvis, as well as general state uterus.
The fourth technique allows you to determine the state of the presenting head (it is bent or unbent), as well as the level of its relationship to the small pelvis.

OB study factors

During an obstetric examination of women, the doctor must determine several factors that will assess the state of pregnancy and its course.

The position of the fetus is the ratio of the axis of the uterus to the back of the child. The fetal axis is an imaginary line passing through the back of the head and buttocks. If the axis of the fetus and the axis of the uterus coincide in direction, the position of the fetus is called longitudinal. If the axis of the fetus passes through the axis of the uterus at a right angle - this is called the transverse position of the fetus, if under a sharp - oblique.

The position of the fetus is the ratio of the position of the walls of the uterus and the back of the fetus. This factor allows you to find out in what position the baby lies in the uterus. Undoubtedly, longitudinal position the fetus is the most favorable, as it contributes to the good progress of the fetus through the birth canal.

The articulation of the fetus allows you to find out the ratio of the limbs of the fetus and its head to the entire body. The normal position is when the head is bent and pressed to the body, the arms are bent at the elbows, crossed and pressed to the chest, and the legs are bent at the knees and hip joints, crossed and pressed to the tummy.

Internal obstetric research: pros and cons

Some women believe that an internal obstetric examination is not necessary. Moreover, they believe that it can harm the fetus. Actually it is not. This method of research in some cases allows you to determine the pathology and developmental disorders of pregnancy in the early stages.

An internal obstetric examination should be performed in the first 3 to 4 months of pregnancy. This technique allows you to detect pregnancy on initial stages(when the belly is not yet visible), its estimated timing, as well as possible pathologies genitals. Internal obstetric examination on later dates determines the state of the birth canal, the dynamics and degree of uterine opening, as well as the advancement of the presenting part of the fetus through the birth canal.

All these factors of examination at a later date allow us to make predictions about the course of childbirth. Why else is it necessary to conduct an internal obstetric study?

Thus, the gynecologist examines the external genital organs for the presence of pathologies, infections or other abnormalities. After that, with the help of mirrors, an examination of the internal genital organs is performed. At the same time, the condition of the mucosa is assessed for the presence of infections, the vagina and cervix, as well as the condition and nature of the discharge.

With the help of this study, it is possible to early stages pregnancy to identify pathologies that can lead to complications and even termination of pregnancy. For example, some infections can cause serious complications not only to the entire cycle, but also to the fetus.

Other research methods

Of course, external and internal obstetric studies largely determine the nature of the course of pregnancy, and also make it possible to predict how the process of childbirth itself will take place. However, these surveys are often not enough to paint the full picture.

In order to most accurately determine the gestational age, the position of the fetus, the condition of the uterus, as well as many other factors, gynecologists use additional research methods.
Auscultation of the fetus is performed using an obstetric stethoscope. This method allows you to hear the fetal heartbeats, determine their frequency in the early stages, as well as during attempts and fetal hypoxia. In addition, you can hear the heart rate with the help of the "Kid" apparatus, whose operation is based on the principle of the Doppler effect.

Equally important is the obstetric examination of pregnant women using an ultrasound machine, which allows you to fully assess the condition of the fetus, identify exact dates pregnancy, as well as in the early stages to identify possible pathologies.

In addition to the above methods of obstetric research, the following methods take place in medical practice: the study of amniotic fluid, which is obtained using amniocentesis, the study of uteroplacental blood flow, as well as amnioscopy, fetoscopy, and much more. In addition, do not forget about the numerous analyzes and measurements that show the full picture of pregnancy.

Any woman in this exciting period of her life should be extremely attentive to her health. After all, the health of her baby depends on it.