The internal dimensions of the pelvis - obstetrics. Measuring the size of the pelvis in pregnant women (the norm for natural childbirth)
Anatomy of the female pelvis
The structure of the bone pelvis of a woman is extremely important in obstetrics, since, in addition to the supporting function for the internal organs, the pelvis serves as the birth canal through which the fetus is being born.
The pelvis consists of 4 bones: two massive pelvic bones, the sacrum and the coccyx
There are two parts of the pelvis: large and small pelvis. Between them there is a boundary, or nameless, line. The large pelvis is available for external examination and measurement, unlike the small pelvis. The size of the small pelvis is judged by the size of the large pelvis.
In obstetric practice, external measurements of the large pelvis are used, by the size of which one can judge the state of the small pelvis and its size. There are four external conjugates:
1. Distantia spinarum - the distance between the anterior superior iliac spines (spina iliaca anterior superior) is usually 25-26 cm.
2. Distantia cristarum - the distance between the most distant points of the iliac crests (crista iliaca), it averages 28-29 cm.
3. Distantia trochanterica - the distance between the large skewers of the femur (trochanter major). This size is 31-32 cm.
4. Conjugata externa - the distance between the middle of the upper edge of the symphysis and the depression between the spinous process of the V lumbar and I sacral vertebrae. The supra-sacral fossa coincides with the superior angle of the lumbosacral rhombus. The external conjugate is normally 20-21 cm.
In obstetric practice, the state of the small pelvis, which is the bone basis of the birth canal, is of great importance. The course of labor activity, the outcome of childbirth for the mother and fetus (maternal and child injuries) depend on the size of the small pelvis. With anatomically narrow (when the size of the fetal head is larger than the size of the small pelvis), childbirth through natural routes (per vias naturalis) is impossible. In these cases, delivery by caesarean section or fruit-destroying operations is necessary.
Algorithm for examining the external genital organs.
Indications:
Assessment of physical development.
Equipment:
· Gynecological chair.
· Individual diaper.
Sterile gloves.
1. Explain to the woman about the need for this study.
2. Ask the woman to undress.
3. Treat the gynecological chair with a cloth moistened with 0.5% calcium hypochlorite solution and lay out a clean diaper.
4. Lay the woman on the gynecological chair.
5. Perform hand hygiene:
· Apply 3-5 ml of antiseptic on hands (70% alcohol or lather hands thoroughly with soap).
Wash your hands using the following technique:
Vigorous friction of the palms - 10 sec., mechanical, repeat 5 times;
The right palm washes (disinfects) the back of the left hand with rubbing movements, then the left palm also washes the right, repeat 5 times;
The left palm is located on the right hand; fingers interlaced, repeat 5 times;
alternating friction of the thumbs of one hand with the palms of the other (palms clenched), repeat 5 times;
Variable friction of the palm of one hand with closed fingers of the other hand, repeat 5 times;
· Rinse hands under running water, holding and so that the wrists and hands are below the level of the elbows.
Turn off the faucet (using a paper towel).
· Dry hands with paper towels.
· If it is not possible to wash hands hygienically with water, they can be treated with 3-5 ml of antiseptic (based on 70% alcohol), it should be applied to hands and rubbed until dry (do not wipe hands). It is important to observe the exposure time - hands must be wet from the antiseptic for at least 15 seconds.
6. Put on clean sterile gloves:
· Open the upper packaging on disposable gloves and remove the gloves in the inner packaging with tweezers;
Unscrew the top edges of the standard package with sterile tweezers, in which the gloves lie with the palm surface up, and the edges of the gloves are turned outward in the form of cuffs;
With the thumb and forefinger of the right hand, grab the inside-out edge of the left glove from the inside and carefully put it on the left hand;
Bring the fingers of the left hand (wearing a glove) under the lapel of the back surface of the right glove and put it on the right hand;
· Without changing the position of the fingers, unscrew the curved edge of the glove;
· Also unscrew the edge of the left glove;
Keep hands in sterile gloves bent at the elbows raised forward at a level above the waist;
7. Examine the external genital organs: the pubis, the type of hairline growth, whether the large and small labia cover the genital gap.
8. With the first and second fingers of the left hand, spread the labia majora and inspect in sequence: the clitoris, the urethra, the vestibule of the vagina, the ducts of the Bartholin and paraurethral glands, the posterior commissure and the perineum.
9. With the first and second fingers of the right hand in the lower third of the labia majora, first on the right, then on the left, palpate the Bartholin glands.
10. Inspection is over. Ask the woman to get up and get dressed.
11. Removing gloves:
· With the fingers of the left hand in a glove, grab the surface of the edge of the right glove and remove it with an energetic movement, turning it inside out;
Insert the thumb of the right hand (without a glove) inside the left glove and, grabbing the inner surface, remove the glove from the left hand with an energetic movement, turning it inside out;
Drop used gloves into the KBU (Safe Disposal Box)
12. Wash your hands with soap and water
13. Record the results of the inspection in the primary documentation.
Algorithm for measuring the external dimensions of the pelvis.
Target: measurement of the main dimensions of the pelvis using
tazomer and fix in the individual card of the pregnant woman.
Equipment:
· couch;
tazomer;
cotton or gauze balls;
70% ethyl alcohol;
individual card of a pregnant woman;
oilcloth.
1. Explain to the pregnant woman about the need for this measurement.
3. Treat the couch and tazomer with rags moistened with 0.5% calcium hypochlorite solution.
4. Place a clean diaper on the couch.
5. Lay the pregnant woman on the couch, on her back, with straightened legs.
6. The midwife takes the tazomer and sits down to the right of the pregnant woman, facing her.
7. Palpates the anterior-superior iliac spines, applies the buttons of the tazomer and measures: Disitantia spinarum is normally approximately 26 cm.
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8. Moving fingers along the iliac crests, finds more distant points, applies the buttons of the tazomer and measures: Distantia cristarum is normally about 28 cm
9. Transfers the pelvis to the hips, palpating finds large trochanters of the femur, applies the buttons of the tazomer and measures Distiantia trochanterica - normally this size is at least 30 cm.
If it is impossible to palpate the trochanters of the femur due to excess weight, then it is necessary to ask the pregnant woman to move her feet and fix the movement of the trochanter on the thigh.
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10. Asks the woman to change position: lie on her side, turning her back to the midwife, bend the lower leg at the hip and knee joints, while the upper leg should remain straight.
Determines the infrasacral fossa with the left hand, determines the upper edge of the symphysis with the right hand, applies the buttons of the pelvis to these points and measures the external conjugate - Conjugata externa in the normal size of the pelvis is 20 cm or more.
11. The measurement is finished, ask the pregnant woman to stand up.
12. Wash your hands with soap and water.
13. Record the results in the medical records.
Rhombus Michaelis
Rhombus of Michaelis (lumbosacral rhombus) is called the outlines in the region of the sacrum, which have the contour of a diamond-shaped platform.
The upper corner of the rhombus corresponds to the supra-sacral fossa, the lower one - to the top of the sacrum (the place where the large gluteal muscles originate), the lateral corners - to the upper posterior iliac spines.
The value of the Michaelis rhombus in obstetrics
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 is of great importance in determining the tactics of childbirth.
Dimensions and shape of the Michaelis rhombus with a normal pelvis.
With a normal pelvis, the shape of a rhombus approaches a square. Its dimensions are: the horizontal diagonal of the rhombus is 10-11 cm, the vertical one is 11 cm. With various narrowing of the pelvis, the horizontal and vertical diagonals have different sizes, as a result of which the shape of the rhombus will change.
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Algorithm for measuring the Michaelis rhombus.
Target: determining the shape of the pelvis.
Equipment:
Phantom of the female pelvis.
Tape measure.
1. Explain to the pregnant woman about the need for this measurement.
2. Ask the pregnant woman to undress.
3. Clean the measuring tape with a cloth soaked in 0.5% calcium hypochlorite solution.
4. Sit on a chair on the side of the pregnant woman's back.
5. Take measurements:
Vertical diagonal - measure with a centimeter tape
the distance from the upper corner of the Michaelis rhombus (supra-sacral fossa) to the lower (apex of the sacrum), which is 11 cm.
State educational institution
Secondary vocational education
"Kropotkin Medical College"
Department of Health of the Krasnodar Territory
manipulation notebook
by disciplines:
"Obstetrics and gynecology"
for the specialty
060102 Obstetrics
basic level of secondary vocational education
III - IV course
"Considered" "Approved"
Chairman of the Central Committee Director of MMR
Gavrilova I.G.
"___" ___________20__ "___" ___________20__
"Agreed"
Head of methodical
Gaziyants E.S.
"___" ___________20__
Lecturer GOU SPO "Kropotkin Medical College"
Nekroenko R.P.
Reviewers
The list of credit manipulations in the discipline "Obstetrics"
specialty 060102 “Obstetrics”
| № | Name of manipulations | Number of manipulations | ||
| n\n | UP | SCP | RAP | |
| Technique for measuring the size of the pelvis Determining the Solovyov index Drawing up the passport part of the individual card of the pregnant woman, exchange, history of childbirth Determining the height of the fundus of the uterus Determining the circumference of the abdomen Techniques for external obstetric examination of the pregnant woman Listening and counting the fetal heartbeat Determination of the gestational age Determining the date of birth Sanitary treatment of women in labor upon admission to the maternity hospital Prevention of fetal hypoxia Determination of the nature of contractions Prevention of gonoblenorrhea Treatment of the umbilical cord of a newborn Removal of the placenta according to Abuladze Removal of the placenta according to Genter Removal of the placenta according to Crede - Lazorevich Determination of the diagonal conjugate Determination of the true conjugate Preparation of the mammary glands for lactation Biomechanism of labor in the anterior view of the occipital presentation of the fetus | ||||
| Technique of obstetric aid in anterior occipital presentation of the fetus Biomechanism of labor in posterior occipital presentation of the fetus Suction of mucus from the upper respiratory tract Measurement of blood loss in childbirth External pressure on the abdominal aorta Assistance in suturing the perineum Care of the puerperal with sutures on the perineum Care of the mammary glands in the postpartum period Autopsy of the fetal bladder Technique of manual separation of the placenta Perineotomy, episiotomy Determining the readiness of the cervix for childbirth Preparation of tool kits for mandatory and additional obstetric studies Examination of the placenta Determination of physiological blood loss during childbirth Assessment of the state of the newborn on the Apgar scale Determination of protein in the urine of a pregnant woman (express method) Implementation vaginal examination, taking smears from the genital organs Examination of the cervix in the mirrors Technique for manual examination of the uterine cavity | ||||
| Biomechanism of labor with anterocephalic presentation of the fetus Biomechanism of labor with facial presentation of the fetus Tsovyanov's manual with breech presentation Tsovyanov's manual with foot presentation Manual classical manual Extraction of the fetus by the pelvic end Classical combined rotation of the fetus on the leg. Emergency care for eclampsia |
Manipulation #1
"Pelvic Measurement Technique".
Target: diagnostic.
Indications: determination of external dimensions in women (pregnant women, women in childbirth).
Contraindications: severe condition of the mother.
Equipment: an individual card of a pregnant woman, a tazomer, a couch, a container with a 0.5% solution of lyzafin and 1% solution of lyzafin, sterile rags.
Pelvis measurement algorithm:
Usually 4 sizes of the pelvis are measured. When measuring the first three, the woman lies on her back, her legs are extended.
2. Lay the woman on the couch - on her back.
3. Expose the stomach.
4. Take the tazomer in your hands so that the thumb and forefinger hold the buttons of the tazomer. The scale of the tazometer should be facing up.
5. Stand to the right of the woman face to face.
6. With your index fingers, feel the points between which the distance is measured, pressing the buttons of the tazomer to them, mark the value of the desired size on the scale.
7. Measurement of the distance (distance) between the iliac spines: the buttons of the tazomer are pressed against the outer edges of the anterior-superior spines. The size is 25-26 cm and is called the spinarum distance.
8. Measurement of the distance of the cristarum - between the distant points of the iliac crests: after measuring the distance between the anterior superior iliac spines, the buttons of the tazomer are moved along the outer edge of the ridges, finding the greatest distance between them. The size is 28-29 cm.
9. Measuring the distance between the greater trochanters of the femur: find the most prominent points of the greater trochanters and press the buttons of the pelvis to them. This size is 30-31 cm and is called the trochanteric distance.
10. Measurement of the external conjugate: the woman is laid on her side, the underlying leg is bent at the hip and knee joints, the overlying leg is extended. The button of one branch of the tazomer is installed on the upper outer edge of the symphysis, the other end is pressed against the supracacral fossa (the upper corner of the Michaelis rhombus). The outer conjugate - the externa conjugate is 20 cm.
11. Record the measurement data in the individual card of the pregnant woman.
Treat the tazomer with a 0.5% solution of lyzafin;
Treat the couch with a 1% solution of lyzafin 2 times with an interval of 15 minutes;
Soak the used rags in a 1% solution of lyzafin - 60 minutes.
Manipulation #2.
"Definition of the Soloviev index".
Target: diagnostic.
Indications: pregnancy (to judge the thickness of the bones, the Solovyov index determines).
Contraindications: No.
Equipment: centimeter tape, an individual map of a pregnant woman, a container with 1% and 0.5% solutions of lyzafin, bix with sterile rags.
Algorithm for determining the Solovyov index.
- Hygiene hand treatment.
- A centimeter tape measures the circumference in the area of the wrist joint of a pregnant woman on the right hand.
- Normally, the Solovyov index is 14-15 cm.
- Record the measurement data in the pregnant woman's card.
- If the Solovyov index is more than 15 cm, then the pelvic bones are massive, and the dimensions of its cavity are smaller.
- Infection safety:
Treatment of centimeter tape with 0.5% solutions of lizafin;
Soak used rags in 1% solution of lyzafin for 60 minutes.
7. Processing of hands at a hygienic level.
Manipulation #3
“ Registration of the passport part of the individual card of the pregnant woman, the history of childbirth, exchange”
Target: diagnostic.
Indication: pregnancy.
Contraindications: No.
Equipment: an individual map of a pregnant woman, a bix with sterile rags, containers with a 1% solution of lyzafin.
Manipulation algorithm:
1. Date of completion;
2. Full name, year of birth of the pregnant woman;
3. Nationality;
4. Marital status;
5. Education;
6. Home address, telephone number;
7. Living conditions, nutrition;
8. Profession and place of work;
9. Working conditions (prof. harmfulness);
10. Information about the husband;
11. Information about pregnancy;
Note:
1. a pregnant woman is registered at the place of residence, there may not be a residence permit in the passport;
2. on the front side of the individual card, a mark is made on blood transfusion, Botkin's disease;
3. expose the blood type and Rh - affiliation according to the passport.
12. Infection safety:
After examining the pregnant couch, treat the 1% solution of Lyzafin twice with an interval of 15 minutes;
Soak used rags in 1% chloramine - 60 minutes;
Manipulation #4
"Determination of the standing height of the fundus of the uterus."
Target: diagnostic.
Indications:
Contraindications: No.
Equipment: couch, sterile rags, centimeter tape, individual card of the pregnant woman, containers with 1% and 0.5% solution of lyzafin.
Algorithm for determining the height of the uterine fundus:
Treat your hands hygienically.
3. Expose the stomach.
4. Attach one end of the measuring tape to the upper edge of the symphysis and hold it with your hand.
5. With the second hand, find the most prominent point of the uterine fundus.
6. Measure the distance from the upper edge of the symphysis to the most prominent point of the uterine fundus.
7. Record the measurement data in the individual card of the pregnant woman.
8. Infection safety:
Manipulation #5
"Determination of the circumference of the abdomen of a pregnant woman"
Target: diagnostic.
Indications: diagnosis of pregnancy.
Contraindications: No.
Equipment: sterile rags, centimeter tape, couch, individual card of the pregnant woman, container with 1% and 0.5% solution of lyzafin.
Algorithm for determining the circumference of the abdomen:
Treat your hands hygienically.
1. Before measurement, the bladder must be emptied.
2. Lay the pregnant woman on her back on the couch, legs straightened.
3. Expose the stomach.
4. Bring the measuring tape under the back and measure the circumference of the abdomen at the level of the navel.
6. Infection safety:
Treat the centimeter tape with a 0.5% solution of lyzafin;
Treat the couch with a 1% solution of lyzafin twice with an interval of 15 minutes;
Soak the used rags in a 1% solution of lyzafin - 60 minutes.
Manipulation #6
"External obstetric examination of a pregnant woman".
Target: diagnostic.
Indications: second half pregnancy.
Contraindications: No.
Equipment: individual map of a pregnant woman, a pregnant woman, a phantom, an obstetric doll, a couch, a container with 1% lyzafin solution, a sterile rag.
Algorithm for external obstetric examination of a pregnant woman:
Treat your hands hygienically.
Lay the woman on the couch on her back. The legs are bent at the hip and knee joints.
1. First reception: the palms of both hands are placed on the bottom of the uterus, the fingers are brought together and by careful pressure down determine the level of standing of the bottom of the uterus and part of the fetus in it.
2. Second reception: both hands are placed on the lateral surfaces of the uterus and palpation of the fetus parts is performed alternately with one or the other hand. With the longitudinal position of the fetus, on one side, the back is probed, and on the opposite side, the small parts of its handle and legs. This technique determines the position and type of the fetus.
3. Third technique: used to determine the presenting part of the fetus. To do this, with the open palm of the right hand located above the symphysis, the presenting part of the fetus is determined. The head of the fetus is felt as a large, round, fetal part, and the buttocks as a large, but soft part of it.
4. Fourth technique: complements the third technique and clarifies the level of standing of the presenting part. The subject stands facing the legs of the pregnant woman and, deepening the fingers of both hands above the symphysis, establishes the ratio of the presenting part to the entrance to the small pelvis.
5. Record the measurement data in the individual card of the pregnant woman.
6. Infection safety:
Treat the couch with a 1% solution of lyzafin twice with an interval of 15 minutes;
Soak the used rags in a 1% solution of lyzafin - 60 minutes.
7. Processing of hands at a hygienic level.
Manipulation #7
Listening and counting the fetal heartbeat
Target: diagnostics.
Indications: pregnant women.
Contraindications: No.
Equipment: individual card of a pregnant woman, container with 1% and 0.5% solution of lyzafin, sterile rags, couch, stethoscope, stopwatch (clock).
Algorithm for listening to fetal heartbeats:
Treat your hands hygienically.
1. The pregnant woman lies on her back, her legs are straightened.
2. Expose the stomach.
3. A stethoscope with a narrow funnel is tightly installed on the pregnant woman's stomach; a wide funnel to the ear and within 1 minute is considered a heartbeat.
4. The heartbeat is better heard from the side of the back and closer to the head.
5. With occipital presentation, the heartbeat is heard:
I position - on the left, below the navel of the pregnant woman.
II position - on the right, below the navel of the pregnant woman.
6. With breech presentation, the heartbeat is heard:
I position - on the left, above the navel.
II position - on the right, above the navel.
7. With the transverse position of the fetus:
I position - on the left, at the level of the navel.
II position - on the right, at the level of the navel.
8. Normally, the fetal heart rate is 130-140 beats per 1 minute, rhythmic, clear.
9. Record the listening data in the individual card of the pregnant woman.
Treat the stethoscope with 0.5% lizafin solution;
Treat the couch with 1% lizafin solution twice with an interval of 15 minutes;
Manipulation #8
"Determining the duration of pregnancy"
Target: diagnostic.
Indications: pregnant women.
Contraindications: No.
Equipment: individual card of the pregnant woman, calendar, centimeter tape, couch, sterile gloves, mask, tazomer, container with 0.5% and 1% lyzafin solution, sterile double-wing mirrors, bix with sterile rags, sterile tweezers, alcohol 70 degrees.
Algorithm for determining the gestational age:
1. Explain to the pregnant woman the purpose and course of the manipulation, obtain voluntary consent to its implementation.
2. Treat the lining oilcloth with 0.5% solution of lyzafin.
3. Hand treatment at a hygienic level, put on gloves, treat with 70 degree alcohol.
4. Prepare a sterile mirror on a sterile table.
5. The gestational age is determined by the last menstruation, the first movement of the fetus and by objective data.
6. The data of an objective obstetric examination are of the greatest importance for the correct determination of the gestational age.
In the first 3 months of pregnancy - the gestational age is determined by the size of the uterus during a vaginal examination (which is done by a teacher or a leading pregnant doctor).
From 4 months, the gestational age is judged by the height of the fundus of the uterus (measured with a centimeter tape - see man. No. 4 and No. 5).
At the end of the first obstetric month (4 weeks), the size of the uterus reaches the size of a chicken egg.
At the end of the II obstetric month (8 weeks), the size of the uterus reaches the size of a goose egg.
At the end of the III obstetric month (12 weeks), the bottom of the uterus reaches the upper edge of the symphysis.
At the end of the IV obstetric month (16 weeks), the bottom of the uterus is 6-7 cm above the womb.
At the end of the V obstetric month (20 weeks), the bottom of the uterus is 12-13 cm above the womb.
At the end of the VI obstetric month (24 weeks), the bottom of the uterus is at the level of the navel, 20-24 cm above the womb.
At the end of the VII obstetric month (28 weeks), the bottom of the uterus is 24-28 cm above the womb.
At the end of the VIII obstetric month (32 weeks), the bottom of the uterus is 28-30 cm above the womb.
At the end of the IX obstetric month (36 weeks), the bottom of the uterus is located at the xiphoid process, 32-34 cm above the womb.
At the end of the X obstetric month (40 weeks), the bottom of the uterus descends and is 28-32 cm above the womb.
7. These values of the uterus are recorded in the card of the pregnant woman.
8. Infection safety:
Soak the mirrors in 1% solution of lyzafin - 60 minutes;
Soak the tweezers in 1% solution of Lizafin - 60 minutes;
9. Processing of hands at a hygienic level.
Manipulation #9
"Determining the date of birth"
Target diagnostic.
Indications: pregnancy.
Contraindications: No.
Equipment: calendar, tazomer, gloves, mask, centimeter tape, container with 0.5% and 1% solution of lyzafin, lining oilcloth, bix with sterile rags.
Algorithm for determining the date of birth:
Treat your hands hygienically.
Pregnancy lasts an average of 40 weeks.
The probable date of birth can be determined:
1. On the first day of the last menstruation - from the date of the first day of the last menstruation, count back three calendar months and add 7 days.
2. by fetal movement - in nulliparous, the first fetal movement is at 20 weeks of gestation, in multiparous at 18 weeks of gestation.
When calculating the date of birth in primiparous, 20 weeks are added according to the calendar to the date of the first stirring, in multiparous - 22 weeks.
3. According to objective data (see Man. No. 8). Knowing the gestational age in weeks, add up to 40 weeks according to the calendar.
4. By measuring the length of the fetus:
The study of the pregnant woman is carried out in the supine position, the bladder must be emptied.
The buttons of the tazomer are installed one on the lower pole of the head, the other on the buttocks, the resulting length is multiplied by 2 and subtracted 2-3 cm (depending on the thickness of the abdominal wall). Divide the resulting length of the fetus by 5 and get the gestational age. (For example, the distance from the lower pole of the head to the pelvic end (26cm * 2) -2cm results in a fetal length of 50cm, 50/5 = 10 obstetric months.
5. Infection safety:
Treat the tazomer and centimeter tape with 0.5% lizafin solution;
Treat the couch with 1% solution of lyzafin;
Soak lined oilcloths in 1% lizafin solution - 60 minutes;
Soak a rag in 1% solution of Lizafin - 60 minutes;
Remove and soak the mask in 1% solution of lyzafin - 60 minutes.
6. Processing of hands at a hygienic level.
Manipulation #10
Sanitary treatment of women in labor upon admission to the maternity hospital
Target: preventive.
Indications: childbirth.
Contraindications: a cleansing enema is contraindicated in women in labor at the end of the first stage of labor and in the second period, pregnant women with a scar on the uterus, with suspected placenta previa, with severe gestosis, and also with the threat of premature birth.
Equipment: history of childbirth, couch, sterile linen, sterile oilcloth, forceps - 2pcs, tweezers - 2pcs, scissors - 1pc, trays - 2pcs, Esmarch's mug, enema tip, shaving machine (disposable) - 2pcs, liquid soap, sterile washcloth, solid soap in disposable packaging, 3% iodine solution, brilliant green solution, bix with sterile rags, containers with 1% lyzafin solution, sterile vessel, alcohol 80 degrees.
Algorithm for sanitizing women in labor:
1. Wear a mask.
2. Carry out a thorough examination of the woman in labor in the presence of a doctor.
3. Registration in the journal of applicants.
4. Filling in the passport part of the birth history.
Hand treatment at a hygienic level, put on gloves and treat with 80 degree alcohol.
5. Lay the woman on a couch treated with 1% solution of lysophine twice with an interval of 15 minutes. and covered with a sterile lined oilcloth.
6. Place a sterile tray under the pelvic end.
7. Lather the pubic area with liquid soap using a sterile swab on the forceps.
8. Shave the hairline with a single use blade.
9. In the armpits, shave with other razors.
10. Make a cleansing enema.
11. Trim fingernails and toenails.
12. After a bowel movement, the patient takes a shower using a solid soap in a disposable package and a disinfected washcloth.
13. Wipes the body with a sterile towel, puts on a sterile shirt, dressing gown, slippers.
14. Treat women in labor with nipples and around nipple circles with brilliant greens, and nails of hands and feet with 3% iodine solution.
15. Transfer a woman in labor to the prenatal ward.
16. Infection safety:
Soak used tampons in 1% solution of lyzafin - 60 minutes;
Soak used scissors in 1% solution of Lyzafin for 60 minutes, store in a dry place;
Soak the trays in 1% solution of lyzafin - 60 minutes;
Treat the couch with 1% lizafin solution 2 times with an interval of 15 minutes;
Soak the enema tip in 1% solution of lyzafin - 60 minutes;
Soak the oilcloth in 1% solution of Lizafin for 60 minutes;
Soak the bedpan in 1% lizafin solution - 60 minutes;
Soak the used washcloth in 1% lizafin solution for 60 minutes;
Soak used rags in 1% solution of lyzafin - 60 minutes;
Soak the razor (single use) in 1% solution of lyzafin - 60 minutes;
Soak forceps, tweezers in 1% lizafin solution - 60 minutes;
Remove and soak gloves in 1% solution of lyzafin - 60 min.
17. Processing of hands at a hygienic level.
Manipulation #11
"Prevention of fetal hypoxia".
Target: therapeutic and prophylactic.
Indications: prevention and treatment of fetal oxygen deficiency during pregnancy and childbirth.
Contraindications: No.
Equipment: apparatus (oxygen supply system), sterile disposable syringes, disposable system for intravenous drip administration of drugs, medications (40% glucose solution, 5% ascorbic acid solution, 1% sigetin solution, 2.4% solution eufelina, trental, 10% calcium gluconate solution), sterile cotton balls, 70 and 80 degrees alcohol, covered sterile tray with sterile tweezers, sterile trays - 2 pcs, sterile gloves, mask, containers with 1% lizafin solution.
Algorithm for the prevention of fetal hypoxia:
1. The midwife puts on a sterile mask.
2. Inhalation of humidified oxygen by a pregnant woman for 10-15 minutes, in the amount of 10-15 l / min with an interval of 10-15 minutes.
3. Processing of hands at a hygienic level, put on gloves and treat hands with a ball in 80% alcohol, throw the balls into the waste tray.
4. Collect a disposable syringe, draw up medicine, change the needle, release air and put the finished syringe into a sterile tray.
5. Put 3 cotton balls in 70% alcohol into a sterile tray with sterile tweezers.
6. Centrifugally treat a large area of the skin with the first ball in alcohol, treat the injection site directly with the second ball, throw the balls into the waste material tray.
7. Proceed to the introduction of drugs:
a) intravenously 20 ml of 40% glucose solution and 5 ml of 5% unithiol solution and 4 ml of 5% ascorbic acid solution;
With severe therapy-resistant fetal hypoxia, the following drugs are added to the administered drugs:
Intravenously 2.4% eufelin solution 5-10 ml slowly in 10% glucose solution,
Intravenously drip partusisten (trental) 5 mg per 1 kg of woman's weight in 10% glucose solution,
Intravenous 10% solution of calcium gluconate.
8. Infection safety:
Soak the ball with blood in 1% solution of lyzafin - 60 minutes;
Soak syringes and needles in different containers with 1% solution of Lyzafin - 60 minutes;
Treat the couch with 1% lizafin solution 2 times with an interval of 15 minutes;
Soak the used rags in 1% lizafin solution - 60 minutes;
Remove and soak the mask in 1% solution of lyzafin - 60 minutes.
9. Processing of hands at a hygienic level.
Manipulation #12
"Determination of the nature of contractions"
Target: diagnostic.
Indications: performed for all women in labor in the 1st and 2nd stages of labor.
Contraindications: No.
Equipment: history of childbirth, clock with a second hand (stopwatch), hysterograph, containers with 0.5% and 1% solution of lyzafin, bix with sterile rags, mask, sterile gloves, alcohol 80 degrees.
Algorithm for determining the nature of contractions:
1. Hand treatment at a hygienic level, put on a mask, gloves, treat your hands with 80 percent alcohol.
2. The woman in labor lies on her back, her stomach is exposed.
3. Place the palm of your hand on the uterus.
4. Hold a stopwatch in your left hand.
5. With the start of contractions, turn on the stopwatch and record the end of the contraction.
(The contraction is felt as tension, tightening of the uterus, a pause as its relaxation).
6. Assess the duration and intensity of contractions in 1 minute.
7. Fix the duration of the pause between contractions.
8. To determine the duration of the regularity of contractions, it is necessary to count 3-4 contractions.
9. Record the results in the birth history.
10. Infection safety:
Treat a stopwatch or hysterograph with 0.5% solution of lyzafin;
Remove and soak gloves in 1% solution of lyzafin - 60 min.
11. Processing of hands at a hygienic level.
Manipulation #13
"Prevention of gonoblenorrhea of the newborn"
Target: preventive.
Indications: all newborns.
Contraindications: No.
Equipment: Rokhmanov bed (changing table), fresh 30% sulfacyl sodium solution, sterile cotton balls, sterile pipettes - 2 pcs; sterile gloves, masks, medical gown, apron, bix with sterile rags, containers with 1% lizafin solution, 80% alcohol, tweezers - 2 pcs, trays - 2 pcs.
Preparation for manipulation:
2. Stage I - the child is on Rokhmanov's bed.
Stage II - the child is on the changing table.
Gonoblenorrhea prevention algorithm:
1. Treat hands with balls dipped in 80% alcohol; drop the balls into the waste tray.
2. Remove the cheese-like lubricant from the skin of the eyelids of a newborn with separate cotton balls from the outer corner of the eye to the inner one. Drop the balls into the waste tray.
3. Fill the pipette with Albucid solution.
4. With two fingers of the left hand, pull down the lower eyelid of the child so that the cornea of the eye is closed by the folds of the conjunctiva.
5. Drop alternately into both eyes 2 drops of 30% sulfacyl-sodium solution so that the solution gets on the mucous membrane of the eyelids.
6. For girls, instill 2 drops of 30% sodium sulfacyl solution into the genital slit.
7. Drop the pipette into the tray.
Repeat the whole procedure after 2 hours on the changing table.
8. Infection safety:
Soak the spent balls in 1% solution of lyzafin - 60 minutes;
Soak the trays in 1% lizafin solution - 60 min;
Soak pipettes in 1% solution of lyzafin - 60 minutes;
Soak the tweezers in 1% solution of Lizafin - 60 minutes;
Remove and soak gloves in 1% solution of lyzafin - 60 min.
Remove and soak the mask in 1% solution of lyzafin - 60 minutes.
Treat the changing table with 1% solution of Lizafin twice with an interval of 15 minutes.
9. Processing of hands at a hygienic level.
Manipulation #14
"Processing the umbilical cord of a newborn"
Target: preventive.
Indications: all newborns.
Contraindications: No.
Equipment: umbilical cord treatment kit (three Kocher clamps, 2 scissors, 8 tweezers, Rogovin clamp, Rogovin staples, sterile cotton balls, sterile wipes), 96% alcohol, 5% iodine solution, 5% potassium permanganate solution, containers 1 % lizafin solution, sterile trays - 2 pcs, sterile gloves, masks, alcohol 80%.
Preparation for manipulation:
1. The midwife is dressed - a cotton dress, a sterile gown, an apron, a mask, gloves, washing shoes.
2. Stage I - the child is on Rokhmanov's bed - the primary processing of the umbilical cord is performed.
Stage II - the child is on the changing table - the final processing of the umbilical cord is performed.
The algorithm for processing the umbilical cord of a newborn:
1. The primary treatment of the umbilical cord is performed after the complete cessation of the pulsation of its vessels, approximately after 2-3 minutes. after birth:
The umbilical cord is wiped with 96% alcohol at a distance of 10-15 cm from the umbilical ring.
Apply three clamps:
One is near the vulvar ring of the mother, the second is at a distance of 8-10 cm from the umbilical ring of the newborn, the third is 2 cm below the second.
The umbilical cord between two clamps is treated with 5% iodine solution and crossed with sterile scissors.
Blood is taken from the child's end of the umbilical cord to determine the group and Rh-affiliation of the child.
We show the newborn to the mother and transfer it to the changing table.
2. Finishing the umbilical cord:
Nurse (midwife), repeatedly washes hands with soap, treats with 80% alcohol, puts on gloves - treats with 80% alcohol.
The fetal segment of the umbilical cord is treated with alcohol, the remaining blood is squeezed out of it.
At a distance of 0.5 cm from the umbilical ring, a Rogovin clamp is applied and clamped with a Rogovin clamp.
Stepping back 1 cm from the Rogovin bracket cuts off the umbilical cord.
The cut surface is treated with 5% potassium permanganate solution and covered with a sterile napkin.
After 5-6 hours, the napkin is removed, the remainder of the umbilical cord is treated with a film-forming antiseptic and healing occurs in an open way.
3. Infection safety:
Treat the changing table with 1% lizafin solution;
Soak in 1% lizafin solution - tweezers, clamps, Rogovin's clamp - 60 minutes;
Soak used cotton balls in 1% lizafin solution - 60 minutes;
Soak the trays in 1% solution of lyzafin - 60 minutes;
Soak a rag in 1% solution of Lizafin - 60 minutes;
Remove and soak gloves in 1% lizafin solution - 60 minutes;
Remove and soak the mask in 1% solution of lyzafin - 60 minutes.
4. Processing of hands at a hygienic level.
Manipulation#15
“ Removal of placenta according to Abuladze”
Target: preventive.
Indications:
Contraindications:
Equipment: Rokhmanov's bed, a woman in labor, a sterile tray, a sterile catheter, sterile gloves, a sterile mask, tweezers, sterile cotton balls, containers with a 1% solution of lyzafin.
Manipulation algorithm:
3. Removes urine with a catheter;
5. With both hands captures the anterior abdominal wall in the longitudinal fold;
6. Offers the woman in labor to push - the afterbirth is born.
7. Infection safety:
8. Processing of hands at a hygienic level.
Manipulation #16
“Removal of placenta according to Genter”
Target: preventive.
Indications: a woman in labor with a detached but not separated placenta.
Contraindications: no signs of separation of the placenta.
Equipment: Rokhmanov's bed, a woman in labor, a sterile tray, a sterile catheter, sterile gloves, a mask, containers with a 1% solution of lyzafin, tweezers, sterile cotton balls.
Algorithm for isolating the separated placenta according to Genter:
1. A woman in labor lies on Rokhmanov's bed with legs bent at the knee and hip joints;
2. The midwife conducting childbirth wipes with a sterile cotton ball in the area of \u200b\u200bthe entrance to the urethra;
3. Removes urine with a catheter;
4. The doctor, dressed in a sterile gown, medical cap, sterile mask, gloves, performs an external massage of the uterus through the anterior abdominal wall in order to enhance its contraction;
5. The doctor stands to the left of the woman in labor facing her feet;
6. The fists of both hands are located in the area of \u200b\u200bthe corners of the uterus and gradually press down and inwards;
7. Afterbirth is born;
8. Infection safety:
Soak the catheter in 1% solution of lyzafin - 60 minutes;
Soak the tweezers in a 1% solution of lyzafin - 60 minutes;
Soak spent cotton balls in a 1% solution of lyzafin - 60 minutes;
Soak the tray in 1% lyzafin solution - 60 minutes;
Remove and soak gloves in 1% lyzafin solution - 60 minutes;
Remove and soak the mask in 1% lyzafin solution - 60 minutes.
9. Processing of hands at a hygienic level.
Manipulation #17
“Removal of placenta according to Crede-Lazorevich”
Target: preventive.
Indications: a woman in labor with a detached but not separated placenta.
Contraindications: no signs of separation of the placenta.
Equipment: Rokhmanov's bed, a woman in labor, a sterile tray, a sterile catheter, sterile gloves, a mask, tweezers, cotton balls, containers with a 1% solution of lyzafin.
Algorithm for isolating the separated placenta according to the Krede-Lazorevich method:
1. A woman in labor on Rokhmanov's bed with legs bent at the knee and hip joints;
2. The midwife conducting childbirth wipes with a sterile cotton ball in the area of \u200b\u200bthe entrance to the urethra;
3. Removes urine with a catheter;
4. The doctor, dressed in a sterile gown, cap, mask, gloves, performs an external massage of the uterus through the anterior abdominal wall in order to enhance its contraction;
5. Stands to the left of the woman in labor facing her feet;
6. With his right hand, he captures the uterus through the anterior abdominal wall so that four fingers are located on its back wall, the palm is at the bottom, and the thumb is on the anterior wall of the uterus;
7. Produces squeezing of the placenta, directing the force of the right hand down and forward;
8. The separated placenta is born;
9. Infection safety:
Soak the catheter in a 1% solution of lyzafin - 60 minutes;
Soak used cotton balls in 1% lyzafin solution - 60 minutes;
Soak the tweezers in a 1% solution of lyzafin - 60 minutes;
Soak the tray in a 1% solution of lyzafin - 60 minutes;
Remove and soak gloves in 1% lyzafin solution - 60 minutes;
Remove and soak the mask in 1% lyzafin solution - 60 min.
10. Processing of hands at a hygienic level.
Manipulation #18.
"Definition of the Diagonal Conjugate".
Target: diagnostic.
Indications:
Contraindications: No.
Equipment: gynecological chair, pregnant woman (parturient woman), obstetric orantom, mask, gloves, sterile oilcloth, tazomer (measurement tape), bix with sterile rags, container with 0.5% -1% mesofin solution, sterile tweezers, sterile cotton balls, solution potassium permanganate 1/6000, sterile tray,.
Algorithm for determining the diagonal conjugate:
- Hygiene hand treatment.
- Wear a mask and sterile gloves.
- Using sterile tweezers, take a sterile diaper from the bix and place it on the gynecological chair.
- Ask the pregnant woman to lie on the gynecological chair, on her back, legs bent at the knee and hip joints.
- Diagonal conjugate is determined during vaginal examination, the distance from the lower edge to the most prominent point of the cape of the sacrum.
- Treat the external genitalia with a solution of potassium permanganate 1/6000 (a cotton ball soaked in a solution of potassium permanganate taken with a forceps), dry the genitals with a cotton ball.
- With the left hand, push the labia apart, the index and middle fingers of the right hand are inserted into the vagina, the ring and little fingers are bent, they rest against the perineum.
- The fingers inserted into the vagina are advanced towards the promontory; if the cape is achievable, then the tip of the middle finger is fixed at its top, and the edge of the palm rests against the lower edge of the symphysis.
- The index finger of the left hand marks the place of contact of the examining hand with the lower edge of the symphysis.
- The measurement is made with a tazomer or centimeter tape. Normally, the size of the diagonal conjugate is 12.5-13 cm
- Infection safety:
- treat the tazomer (centimeter tape) with 0.5% lyzafin solution;
- soak treated cotton balls in 1% lyzafin solution for 60 minutes;
- soak tweezers, forceps, tray in 1% lyzafin solution for 60 minutes;
- treat the gynecological chair with a 1% solution of lyzafin;
- soak the lining oilcloth in a 1% solution of lyzafin for 60 minutes;
- remove and soak gloves in 1% lyzafin solution for 60 minutes;
- remove and soak the mask in 1% lyzafin solution for 60 minutes.
Manipulation number 19.
"Identification of a true conjugate".
Target: diagnostic.
Indications: pregnancy (determination of the size of the pelvis).
Equipment: couch, tazomer, sterile mask, gloves, gynecological chair, sterile underclothes, bix with sterile rags, containers with 0.5% and 1% lyzafin, tweezers, sterile cotton balls, potassium permanganate solution 1/6000, sterile tray.
Algorithm for determining the true conjugate:
- Hygiene hand treatment.
- The true cojugate can be determined;
a) on the outside (see Manipulation No. 1);
b) diagonally (see Manipulation #18).
- To determine the true conjugate by the outer, from the length of the outer conjugate, subtract 8.5 - 9 cm. If the Solovyov index is 14 - 15 cm, then 9 cm is subtracted from the outer conjugate. If the Solovyov index is less than 14 cm, then subtract 8.5 cm.
- To determine the true conjugate along the diagonal, it is necessary to determine the diagonal conjugate (see Manipulation No. 18), and then 1.5 - 2 cm are subtracted from the diagonal conjugate.
- With normal pelvic dimensions, the true conjugate is 11 cm.
- Infection safety (see Manipulation #1 and #18).
- Hygiene hand treatment.
Manipulation number 20.
"Preparation of the mammary glands for lactation."
Target: preventive.
Indications: pregnancy, second half.
Contraindications: No.
Equipment: talcum powder, terry towel.
Manipulation algorithm:
- Hand treatment at a hygienic level, nails should be cut short
- Wash the mammary glands daily with water at room temperature, rub with a terry towel.
- Apply air baths before going to bed for 10-15 minutes.
- With flat and elongated nipples, starting from the 34th - 35th week of pregnancy, it is necessary to massage the nipples 2 - 3 times a day for 3 - 4 minutes:
a) wash your hands thoroughly;
b) sprinkle fingers and nipple with talcum powder;
c) during the massage, the nipple is grasped with two fingers and pulled out, starting from near the nipple circle to the top of the nipple with a simultaneous light circular massage.
- Hygiene hand treatment.
Manipulation #21.
"Biomechanism of labor in anterior occiput presentation of the fetus".
Target: preventive.
Indications: childbirth with an anterior view of the occipital presentation of the fetus.
Contraindications: severe condition of the mother.
Equipment: phantom, obstetric doll, sterile mask, gloves, apron, gown, honey. cap, container with 1% solution of lyzafin.
Manipulation algorithm:
First moment: head flexion. At the entrance to the small pelvis, the head is bent and set so that the chin approaches the chest, the back of the head descends into the entrance to the small pelvis, the small fontanel is located below the large one, the swept seam is in transverse size. As a result of bending, the head passes through all the planes of the small pelvis with its smallest smallest oblique size, the diameter of which is 9.5 cm. With a circumference of 32cm.
Second point: Internal rotation of the head. The head of the fetus simultaneously with the translational movement turns into a circle of the longitudinal axis. In this case, the nape of the fetus turns to the front, to the pubic joint, and the face - to the back, to the sacrum. The sagittal suture from the transverse dimension of the first plane passes into an oblique one in the pelvic cavity, and then into a straight one at the outlet of the small pelvis.
Third moment: Extension of the head. Extension of the head occurs at the outlet of the small pelvis. Extension of the head occurs after the suboccipital fossa has established itself under the lower edge of the pubic joint. The fulcrum around which the head rotates at birth is called the fixation point.
In the anterior view of the occipital presentation, the point of fixation is the suboccipital fossa. The extension of the head corresponds to the cutting and eruption of the head. In the anterior view of the occipital presentation, the eruption of the head occurs in a correspondingly small oblique size equal to 9.5 cm, the circumference is 32 cm.
Fourth moment: Internal rotation of the shoulders and external rotation of the head.
The shoulders at the exit of the small pelvis are rotated from a transverse dimension into a straight section. The birth of the shoulders occurs in the following way: first, the anterior shoulder fits under the pubic arch after fixation, which body is bent in the cervicothoracic region, while the posterior shoulder is born. After the birth of the shoulder girdle, the torso and legs of the fetus are easily born. At the moment of the internal rotation of the shoulders, the external rotation of the head is performed. The face of the fetus turns to the mother's thigh: in the first position - to the right thigh, in the second position - to the left thigh.
Infection safety:
Soak a dressing gown, an apron in a 1% solution of lyzafin for 60 minutes;
Remove and soak gloves in 1% lyzafin solution for 60 minutes;
remove and soak the mask in a 1% solution of lyzafin for 60 minutes;
hygienic hand treatment.
Manipulation #22.
"Technique of obstetric assistance with anterior occiput presentation".
Target: preventive.
Indications: woman in labor during exile.
Contraindications: No.
Equipment: woman in labor, phantom, obstetric doll, medical gloves, tweezers, forceps, cotton balls, scissors, mask, apron, honey. dressing gown, 5% iodine solution, alcohol 70 0, sterile diapers, bix with rags, a container with 0.5% and 1% lyzafin solution.
Manipulation algorithm:
- The woman in labor lies on Rakhmanov's bed, sterile shoe covers are put on her feet, and a sterile diaper is placed under the woman's pelvis.
- Raise the head end of the bed, the mother's legs are bent at the knee joints, the feet rest against special supports, and she holds on to the edges of the bed with her hands.
- The midwife puts on an apron, treats her hands as before a surgical operation, puts on a sterile gown, mask, honey, gloves, treats her hands with 70 0 alcohol.
- The external genitalia of the woman in labor, the perineum and the inner surface of the thighs are treated with a 5% iodine solution, the anus area is covered with sterile gauze.
- During the insertion of the fetal head, the midwife stands to the right of the woman in labor, places her left hand on the pubis, so that with four fingers, carefully holding the fetal head that appears, restrain her rapid birth.
- The right hand is located on the perineum as follows: the thumb on the right labia majora and the other four on the left labia.
- In the pauses between attempts to weave the clitoris and labia minora, do not harass towards the perineum in order to avoid injury.
- After the exit of the occiput, the stage of removing the entire head begins. At this moment, the woman in labor is asked not to push, the pillow is removed from under the head to facilitate breathing. With the left hand, they grab the protruding part of the head, carefully and gradually lift it to the top, and with the right hand, carefully reduce the perineum until the forehead, face, and chin appear.
- When the shoulders are cut through, the midwife carefully alternately removes the perineal tissues from them.
- When the independent exit of the shoulder is delayed, the head is clasped with both hands without affecting the neck, and the front shoulder is carefully pulled down. Then, with the left hand, the fetal head is lifted to the front, and the back shoulder is released from the perineum with the right hand.
- After the birth of the shoulder girdle, both hands grasp the fetus in the chest area and lift it to the front - the torso and legs are born.
- Infection safety:
- Tweezers, forceps are soaked in 1% solution of lyzafin for 60 minutes.
- I soak the tray in a 1% solution of lyzafin for 60 minutes.
Manipulation #23.
"Biomechanism of labor in posterior occiput presentation of the fetus".
Target: diagnostic.
Indication: childbirth.
Contraindications: No.
Equipment: font, obstetric doll, sterile gloves, mask, apron gown, honey. cap, container with 1% solution of lyzafin.
Manipulation algorithm:
The midwife is dressed in all sterile, ready to receive childbirth.
First moment- flexion of the head. The small fontanel area becomes the leading point on the head, that is, the wire point.
second moment- internal rotation of the head. The bent head descends into the pelvis and at the same time turns with the back of the head to the back; the swept suture in the pelvic cavity becomes oblique, in the exit - into the straight size of the pelvis.
After the end of the turn, the small fontanel (occiput) faces the sacrum, the large fontanelle - towards the symphysis.
Third moment: During eruption, a) additional flexion and b) extension of the head occurs. The border of the hairy part of the forehead rests against the pubic arch and around it (the first point of fixation) the head is strongly bent. During this additional flexion of the head, the parietal tubercles and the occiput are cut through.
After that, the head rests against the sacrococcygeal joint with the area under the occipital fossa (the second fixation point). And does the extension. During extension, the forehead, face, and chin are released from under the pubic arch. The head is cut through with a circle corresponding to the average oblique size (33).
Fourth moment– external rotation of the head and internal
The finally formed female pelvis consists of the sacrum, coccyx and two pelvic bones, interconnected by ligaments and cartilage. Compared to the male, the female pelvis is wider and more voluminous, but not as deep.
The main condition for the correct course of childbirth is the optimal size of the pelvis during pregnancy. Deviations in its structure and symmetry can lead to complications and make it difficult for the child to pass naturally through the birth canal, or completely prevent independent childbirth.
Measuring the size of the pelvis during pregnancy
The study of the pelvis includes such manipulations as examination, then feeling the bones, and finally determining the size of the pelvis.
The Michaelis rhombus or lumbosacral rhombus is examined in a standing position. Normally, its vertical size is 11 cm, and the transverse size is 10 cm. If there are violations in the structure of the small pelvis, the Michaelis rhombus is fuzzy, with a changed shape and size.
After palpation, the pelvic bones are measured using a special tazomer. In the antenatal clinic, the gynecologist is interested in the following dimensions of the pelvis during pregnancy:
- Interosseous size - shows the distance between the most prominent points on the front surface of the pelvis, its norm is 25-26 cm;
- The distance between the crests (the most distant points) of the ilium is 28-29 cm;
- The distance between the large skewers of the two femurs is 30-31 cm;
- External conjugate. Represents the distance between the upper corner of the Michaelis rhombus (supra-sacral fossa) and the upper edge of the pubic articulation - 20-21 cm.
The first two sizes of the pelvic bones during pregnancy are measured when the woman lies on her back, and her legs are extended and shifted. The third indicator is examined with the lower limbs slightly bent at the knees. The direct size of the pelvis (external conjugate) is measured in the position of a pregnant woman lying on her side, when the overlying leg is extended, and the underlying one is bent at the knee and hip joints.
Wide and narrow pelvis during pregnancy
A wide pelvis, which occurs most often in tall large women, is not considered a pathology, its dimensions exceed the norm by 2-3 cm. It is detected during a standard examination and measurement of the pelvic bones. With a wide pelvis, the course of labor is normal, but sometimes it can be rapid. The time of passage of the child through the birth canal is reduced, which is fraught with ruptures of the vagina, cervix and perineum.
If at least one of the sizes is below the norm by 1.5-2 cm, they speak of an anatomically narrow pelvis during pregnancy. But even with such a narrowing, a normal course of childbirth is possible, for example, in the case when the baby is small and the head easily passes through the pelvis of the woman in labor.
A clinically narrow pelvis also occurs with normal sizes and occurs when the child is large, that is, the size of his head does not correspond to the mother's pelvis. In this situation, natural childbirth is dangerous, as it can lead to a complication of the condition of both the fetus and the mother. In this case, the possibility of a caesarean section is considered.
The influence of a narrow pelvis on the course of pregnancy
The narrowed pelvis has its adverse effect only in the last months of pregnancy. The fetal head cannot descend into the small pelvis, as a result, the growing uterus rises, and this greatly complicates the breathing of the pregnant woman. A woman has shortness of breath, and it is more pronounced than in expectant mothers with normal pelvic sizes.
Another consequence of a narrow pelvis during pregnancy is the incorrect position of the fetus. According to statistics, in 25% of women in labor with an oblique or transverse position of the fetus, narrowing of the pelvis is observed to varying degrees. Also, cases of breech presentation are becoming more frequent: in pregnant women with a narrow pelvis, this pathology occurs 3 times more often.
Management of pregnancy and childbirth with a narrow pelvis
Pregnant women with a narrowed pelvis are at risk for the development of complications, therefore they are on a special account with a gynecologist. This is necessary in order to timely identify abnormalities in the position of the fetus and some other complications.
Pregnancy is especially unfavorable with a narrow pelvis, so it is important to accurately determine the date of birth, and 1-2 weeks before it, hospitalize the pregnant woman in the pathology department. This is necessary to clarify the diagnosis and make a decision on a rational method of delivery.
As noted earlier, the course of childbirth also depends on the size of the pelvis during pregnancy. If the narrowing is insignificant, and the fetus is small or medium in size, natural childbirth is possible under the close supervision of a doctor.
Absolute indications for caesarean section are:
- Anatomically narrow pelvis (with III-IV degree of narrowing);
- Bone tumors in the pelvis;
- Pelvic deformities due to injury or disease;
- Pelvic injuries in previous births.
Pelvic pain during pregnancy
During pregnancy, many women notice the appearance of pain in the pelvic bones, in the sacrum and in the spine. This is due to the fact that the center of gravity of the body changes, and due to the natural increase in mass, the load on the musculoskeletal system increases. In addition, under the influence of a special hormone relaxin, there is a change in the sacroiliac and pubic joints, as well as other connective tissue formations, that is, the pelvic bones during pregnancy "prepare" for childbirth.
Often, women experience lumbar and pelvic pain, which are the result of curvature of the spine, osteochondrosis and poor muscle development in the "pre-pregnant" state. The frequency of such pain is 30-50% during pregnancy and 65-70% after childbirth.
If in the second and third trimester there is not enough calcium in the blood of a pregnant woman, symphysitis may develop. It is manifested by severe long-term pain in the pubic joint, aggravated by a change in the position of the body in space. The woman's gait is disturbed, the bosom swells. The appearance of symphysitis is also associated with some hereditary features.
Prevention of pelvic pain during pregnancy
The basis for the prevention of pelvic pain during pregnancy, first of all, is a calcium-rich diet: meat, fish, low-fat dairy products, greens, nuts. In diseases of the gastrointestinal tract, when the absorption of calcium is disturbed, their correction is necessary. For example, you can take bificol and digestive enzymes.
In addition, attention must be paid to sufficient physical activity to strengthen the rectus and oblique abdominal muscles, hip flexors and extensors, gluteal and dorsal muscles. For this, therapeutic exercises and swimming are well suited.
Of the other preventive measures, it is worth noting staying in the fresh air, since under the influence of sunlight, vitamin D is produced in the skin, and it is necessary for normal calcium metabolism.
If pain in the pelvic bones during pregnancy begins to disturb regularly, it is necessary to move on to more drastic measures: start taking calcium supplements in a daily dose of 1000-1500 mg, limit physical activity somewhat, and if you have problems with the lower back, be sure to wear a bandage. It is also advisable to start taking complex multivitamins for pregnant women, as they contain all the necessary trace elements and vitamins.
Video from YouTube on the topic of the article:
- Distantia spinarum - the distance between the anterior-superior iliac spines is 25-26 cm.
- Distantia cristarum - the distance between the distant points of the iliac crests is 28-29 cm.
- Distantia trochanterica - the distance between the large trochanters of the femur, normally 30-31 cm.
- Conjugata externa (external conjugate, direct size of the pelvis) - the distance from the middle of the upper outer edge of the symphysis to the supra-sacral fossa, located between the spinous process of the V lumbar vertebra and the beginning of the middle sacral crest (coincides with the upper corner of the Michaelis rhombus), is 20-21 cm.
Small pelvis dimensions
1. The plane of entry into the pelvis is limited by the upper edge of the symphysis, the upper-inner edge of the pubic bones (in front), the arcuate lines of the ilium (from the sides), and the sacral promontory (behind). This border between the large and small pelvis is called the boundary (nameless) line.
- Conjugata vera (true conjugate, direct size of the entrance to the small pelvis) - the distance from the inner surface of the symphysis to the cape of the sacrum; to determine the true conjugate, subtract 9 cm from the dimensions of the outer conjugate. Normally, the true conjugate is 11 cm.
- Anatomical conjugate - the distance from the cape to the middle of the upper inner edge of the symphysis (11.5 cm).
- Transverse size - the distance between the most distant points of the arcuate lines (13-13.5 cm).
- The oblique dimensions are 12-12.5 cm. The right oblique dimension is the distance from the right sacroiliac joint to the left iliopubic eminence (eminentia iliopubica). Left oblique size - the distance from the left sacroiliac joint to the right iliopubic eminence (eminentia iliopubica).
2. The plane of the wide part of the pelvic cavity is limited by the middle of the inner surface of the symphysis (in front), the middle of the acetabulum (from the sides) and the junction of the II and III sacral vertebrae (behind).
- Direct size - the distance from the junction of the II and III sacral vertebrae to the middle of the inner surface of the symphysis is 12.5 cm.
- Transverse size - the distance between the middle of the acetabulum (12.5 cm).
3. The plane of the narrow part of the pelvic cavity is limited by the lower edge of the symphysis (in front), the spines of the ischial bones (from the sides) and the sacrococcygeal junction (behind),
- Direct size - the distance from the sacrococcygeal junction to the lower edge of the symphysis (11-11.5 cm).
- Transverse size - the distance between the spines of the ischial bones (10.5 cm).
4. The plane of the exit of the pelvis is limited by the lower edge of the symphysis (in front), ischial tubercles (from the sides) and the tip of the coccyx (behind).
- Direct size - from the top of the coccyx to the lower edge of the symphysis (9.5 cm). When the coccyx moves backward during childbirth - 11.5 cm.
- Transverse size - the distance between the inner surfaces of the ischial tubercles (11 cm).
sacral rhombus
When examining the pelvis, pay attention to the sacral rhombus (Michaelis rhombus) - a platform on the back surface of the sacrum. Borders: upper corner - a depression between the spinous process of the V lumbar vertebra and the beginning of the middle sacral crest; lateral angles - posterior superior iliac spines; lower - the top of the sacrum. From above and outside, the rhombus is limited by protrusions of the large dorsal muscles, from below and outside - by protrusions of the gluteal muscles.
During pregnancy, gynecologists pay increased attention to the size of the pelvis of the expectant mother. In our article, we will look at what the norms should be for natural childbirth, as well as what to do if you have a deviation from the norm.
Measuring the size of the pelvis during pregnancy
A mandatory procedure is to determine the size of this area. This is necessary to determine whether a natural resolution is possible or whether surgical intervention will have to be resorted to.
Important! To determine the internal narrowing, obstetricians measure the coverage of the wrist using the Solovyov index: if the girth exceeds 14 cm, then a narrow pelvis can be assumed.
The structure and measurements are determined by doctors by palpation and using a tazomer. The measurement is carried out several times: first, when a woman is registered for registration, and then before the birth itself. Particular attention is paid to the study of the sacral region - the Michaelis rhombus. To do this, measurements are taken between the dimples above the coccyx. If the rhombus is a square, the diagonals of which are approximately 11 cm, then we can conclude that there is no deformation. If they are different, then it can be assumed that the pregnant woman has a pathology. 
Measurements are carried out as follows:
- The woman should lie on her back, provide access to the hips, remove clothing from this area.
- Using a pelvis meter, the doctor takes 1 longitudinal and 3 transverse measurements.
- Distantia spinarum- the line between the anterior superior iliac spines is approximately 26 cm;
- Distantia cristarum- the greatest distance between the scallops of the iliac bones - 24-27 cm;
- Distantia trochanterica- the line between the large skewers of the thigh bones - 28-29 cm;
- Conjugata externa- lines between the upper edge of the pubic joint and the V-lumbar vertebra - 20-21 cm.
Normal parameters of the pelvis
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narrow pelvis
Consider when it is considered narrowed, and what to do with such a pathology for a pregnant woman.
Did you know? Only in 5% of cases, children are born on time. In other cases, childbirth occurs 7-10 days earlier than the expected date.
First, it is worth noting that it is customary to distinguish two concepts - anatomically and clinically narrow pelvis. An anatomically narrow pelvis is characterized by a decrease in indicators when measured by at least 1.5-2 cm. In some situations, childbirth proceeds well - this happens if the child has a small head. A clinically narrow pelvis may well correspond to normal measurements, but due to the fact that the child may have a large head, there is a discrepancy between the head and the pelvis. In such a situation, childbirth can cause difficulties in the health of the mother and baby, so doctors often consider the possibility of an operation. 
Causes
The main causes of an anatomically narrow pelvis include:
- the presence of rickets;
- poor nutrition in childhood;
- the presence of poliomyelitis;
- the presence of congenital anomalies;
- the presence of pelvic fractures;
- the presence of tumors;
- the presence of kyphosis, scoliosis, spondylolisthesis and other deformities of the spine and coccyx;
- the presence of diseases and dislocations of the hip joints;
- rapid growth during puberty with elevated androgen levels;
- the presence of strong psycho-emotional and physical stress in adolescence.
Influence on the course of pregnancy
The presence of pathology almost does not affect the course of pregnancy. If an anatomically narrowed pelvis is present, you should definitely see a doctor. In the last trimester, some difficulties often arise, for example, the wrong position of the child. Since the head is not able to press against the entrance to the small pelvis due to the fact that it is narrow, a woman may suffer from shortness of breath. 
Management of pregnancy
Women with pathology are put on a special account. This is due to the fact that there is a high risk of complications during pregnancy. Difficulties in management lie in the fact that it is very important to identify the abnormal position of the fetus in time. Also, the term of childbirth is determined with particular accuracy - this will eliminate overwearing, which negatively affects the general condition of the woman and the baby. Approximately 1-2 weeks before delivery, it is recommended to hospitalize the pregnant woman in order to clarify the diagnosis and choose the method of delivery.
Indications for caesarean section
There are two types of indications for intervention. Let's consider them. Absolute readings:
- the presence of a narrow pelvis of 3 and 4 degrees;
- the presence of severe pelvic deformity;
- damage to the joints of the pelvic bones;
- the presence of bone tumors.
Important! During contractions, women with a similar pathology are advised to lie more so as not to damage the amniotic sac, as it can provoke too early outflow of amniotic fluid.
Relative indications are the presence of a narrowed pelvis of the 1st degree simultaneously with the following factors:
- big fruit;
- presentation in the pelvic region;
- excess of terms of pregnancy;
- child's suffocation;
- uterine scar;
- abnormal deviations of the genital organs.
Possible complications during childbirth
Unfortunately, in the presence of an anatomically narrow pelvis, it is impossible to give birth on your own. This is due to the fact that it is very difficult for a child to overcome the path, and this can lead to injuries and even death. It is for these reasons that obstetricians strongly advise women with this pathology to perform a planned caesarean section. However, if grade 1 narrowing is present, the expectant mother may be allowed to give birth on her own.
But such a decision can lead to:- early rupture of amniotic fluid;
- weakened activity in childbirth;
- placental abruption;
- rupture of the pelvic ligaments;
- uterine rupture;
- hemorrhages;
- fetal suffocation;
- trauma to the baby.
Did you know? A newborn baby has 300 bones, while an adult has only 206.
A narrow pelvis is a specific feature of the structure of the female body. But even with such a pathology, modern medicine allows you to endure pregnancy and give birth to a child. The main thing is to follow the instructions of the doctor and take care of yourself. Video: female pelvis during pregnancy
