Waje Likitan mata: receptions

Mata masu ciki da ba su bar shi kadai tare da su likita matsaloli. Don shirya su isa ya nemi wurin zama a cikin antenatal asibitin, kuma akwai don samun zama dole taimako da bayani. A cikin wadannan asibitoci, akwai wasu dokoki na ciki mace da ta dubawa. Akwai irin wannan abu a matsayin na waje obstetric bincike, wanda yakan haifar da wani taimako zuwa ga wata mace tsammani a baby, a cikin shiri domin haihuwa. Mẽne ne da abin da aka yi da dokokin, tattauna a kasa.

Menene waje zoma bincike?

Mutane da yawa mata san cewa ciki wajibi ne don samun rajista a gundumar asibiti. A ziyararsa ta farko zuwa likitan mata bayan tabbatarwa da wannan yanayin ba ga kowa da kowa ta dandano, domin zai iya daukar har zuwa 40 minutes. Irin wannan dogon lokaci ya wuce ba a banza a cikin ofis likita. Bayan duk, da gwani dole ne ba kawai hadu tare da mace mai ciki, amma kuma ya tattara janar da kuma musamman tarihi. Har ila yau nada ta dakin gwaje-gwaje gwaje-gwaje, da kuma yi waje zoma bincike.

Ya unshi da binciken farko, wanda na da algorithm. Receptions waje zoma bincike da ake bukata da tattara bayanai game da mace. A likita ne mai muhimmanci domin sanin matsayin mata nono, musamman da siffar da nono, domin rinjayar da wani sa na matakan shirya domin ciyar. Likitan mata biya da hankali ga yadda za expectant uwa ya sami kilo daga lokacin da aka haife, kuma blurts nauyi kudi ga dukan zamanin da jiran baby.

Gudanar da waje obstetric bincike ya shafi tattara bayanai game da baya ciki, kuma scarring na mahaifa. Wadannan ayyuka ne na wajibi kafa hadarin ciki pathologies. Bugu da kari to dubawa, har yanzu amfani da hanyoyin da ji, palpation da auscultation, wanda taimaka don samun cikakken hoto na yaro ci gaba da kuma yanayin mace, nurtured shi. Kasa, wadannan hanyoyi za a iya bayyana daki-daki.

Abin da iri irin wannan nazarin ne?

Domin sanin da inganci da matsayi na mace mai ciki ba isasshen kawai ga tambaya ta. Ko ba tare da duk dabaru palpatsionnye waje obstetric binciken zai zama m ga sana'a. Don yin dukan hoto na mace tsammani a jariri, da kuma ta baby ta kiwon lafiya, bukatar mu san abin da tafiyar matakai dauki wuri a cikin jiki na ciki. Wannan za a iya gani da taimakon dakin gwaje-gwaje na nazarin na jini, fitsari, da sauransu. Har ila yau likita kullum jin bugun zuciya crumbs da ma'anar da wuri a cikin mahaifa. Duk wadannan jan aka nuna a babban iri uku na gudanar da bincike da ciki:

• asibiti.
• dakin gwaje-gwaje;
• musamman.

Clinical jarrabawa na ciki

Wannan irin binciken da mata a lokacin daukar ciki fara tare da tarin likita tarihi da kuma ta yanzu jihar. Wadannan ayyuka ba kawai taimaka likita samun da bayanai a kan kiwon lafiya ta jiki da na mace, sun kuma samar da wata damar tantance ta neuro-qwaqwalwa ne qwarai aiki.

Fara asibiti jarrabawa tare da wani binciken a cikinsa, shi dai itace bayanai game da mace.

1. Tabbatarwa na nan gaba uwa na mutum (sunan, fasfo - lambar da jerin).
2. Age a wadda nulliparous kasance a wani rukuni (matasa - su goma sha takwas, da shekaru - bayan shekara talatin).
3. Da ainihin adireshin wurin zama da rajista na mata.
4. Me je likita-likitan mata.
5. Abu mai rai yanayi (da yawa rai mutane da kuma dabbobi a cikin wannan daki mai mace, rayuwa da yanayi), kazalika da inda ya yi aiki don magance (a cutarwa kamata yanke shawara a kan wani karin m aiki domin ita, da kuma 'ya'yan itãcen aiki yanayi).
6. Bayani game da jini da kuma da aka gyara (jini, albumin), allergies, somatic cututtuka, Oncology. Sau da yawa al'ada somatic ba ya nufin cikakken jiki kiwon lafiya, domin wani mutum zai fuskanci katsalandan da shafi tunanin mutum da kuma juyayi aiki. likita ta bi - to gano musabbain da ya kai ga wadannan da suka faru, saboda mata sun fi iya bayar da haihuwa, kuma a kan dace hali ya dogara da kiwon lafiya na uwa da ba a haifa ba. A Sanadin neuroses da sauran cuta da juyayi da kuma shafi tunanin mutum aiki, mai yawa:

• haifa cututtuka.
• danniya.
• shafe tsawon rashin haihuwa.
• zubar da ciki;
• rauni a baya haihuwa.

Likitan mata ta san cewa akwai alamun keta daga cikin neuro-qwaqwalwa ne qwarai aiki: kafin daukar ciki, ko kuma lokaci guda tare da abin da ya faru. Haka ma wajibi ne don gano abin da mace ta haɗu da asali.

7. ANNOBA tarihi.

8. Constant maye (shan taba, shan barasa, miyagun ƙwayoyi zagi).

9. hailar da kuma tarawa da haihuwa ayyuka (lokacin haila ya fara, kamar yadda wani ya kwarara, baya ciki da yadda da haihuwa, nauyi da kuma kiwon lafiya da matsayi na baya yara, gynecological da kuma jima'i cututtuka ciki).

10. Family tarihi (jiha na kiwon lafiya na 'yan uwa da suke zaune tare da wata mace, gadar hali, kiwon lafiya, kungiyar da kuma RH akidar nan gaba mahaifin).

Next, matsa zuwa wani haƙiƙa jarrabawa na gaba uwa:

• Bayar da shawarwari ilimin, likitan hakori, ophthalmologist da ENT. Idan ya cancanta, sanya dubawa kwararru sauran.
• Auna da zafin jiki da kuma jini.
• Tantance jiki da kuma auna tsawo, nauyi da kuma girma na kafafuwa.
• Duba da kuma tausa ciki.
• Bincika jini, fitsari da kuma sauran secretions.
• Tantance symphysis pubis.
• Shin, wani electrocardiogram.
• Duban jarrabawa wajibi ne a wuce dukan mai ciki mace har goma sha biyu, sha takwas zuwa ashirin da biyu ga kuma tare da minti 32 a kan 34th mako.
• Gudanar da wani waje zoma bincike.

Yana da muhimmanci cewa mace aka rajista ba daga baya fiye da 12 makonni na gestation. A baya yi anthropometry, dakin gwaje-gwaje gwaje-gwaje da kuma kimantawa na jini, da hakan da yiwuwar ciwon lafiya baby ko gano fetal abnormality m da rai.

Laboratory da karatu na mata

Lokacin da expectant uwa samun rajista, shi ne sanya wani asibiti jini gwajin da urinalysis, ayyana kungiyar da kuma RH factor, jini glucose, duba ga Nalia RW, hepatitis, HIV, da kuma ma sa scrapings da kuma swabs daga cikin farji da kuma cervix a kan Flora, cytology, chlamydia, kabba da ciwon sanyi, trichomoniasis.

Idan tarihin saukar da haihuwar matattu yara, rashin (musamman a baya, saukarwa), extragenital Pathology, shi ne zama dole:

• yin karatu a mace ta jini ga gaban hemolysin.
• nan gaba jini mahaifinsa kungiyar za a iya amfani da su gano da kuma RH, musamman idan ciki rhesus factor korau ko kungiyar 0 (I);
• domin sanin gaban urogenital cututtuka.
• ƙayyade da matakin na zama dole hormones, immunoresistance.
• idan ya cancanta, za su gudanar da kwayoyin bincike.

Bugu da ari, dakin gwaje-gwaje gwaji ne da za'ayi a cikin irin sharuddan:

• CBC - wata bayan da talatin mako - sau daya a cikin kwana goma sha huɗu.
• a lokacin kowace liyafar rubũta fitsari a kan sauran bincike.
• a kan sha shida zuwa ashirin mako ƙayyade hCG da ACE;
• a 22-23 makonni. da kuma 36-37 makonni. bincika jini sugar.
• Nazarin a kan coagulation tsarin (coagulation) nuna 36 zuwa 37th mako.
• a talatin makonni, da kuma a gare biyu ko uku makonni kafin haihuwa sake yi kariya ga cutar HIV da kuma RW, bincika swabs da scrapings.

Special likitan mata

Special obstetric bincike ya hada da:

1. Gudanar da waje obstetric bincike.
2. Ciki zoma bincike.
3. Sauran ƙarin karatu.

Outdoor obstetric bincike ne jarrabawa, ji na da girman da kafafuwa. Bayan ta ashirin mako m size daga cikin mafi girma karkara na ciki, yi probing ciki da kuma da pubic symphysis, kuma prolushivaniya fetal zuciya. external obstetric bincike kayan aiki ne ba sauki, shi ne da za'ayi kawai ta samu} warewa ma'aikatan jinya.

Ciki zoma bincike. A ciki zoma bincike ya hada da binciken na waje al'aurar, farji da kuma cervix binciken yin amfani da madubai. Shi ne kawai kamar yadda muhimmanci kamar yadda waje obstetric bincike haihuwa. Wannan hanya ne da za'ayi a hanji da kuma mafitsara. Domin da gamuwa da mace tambayi kwanta a ka dawo, ƙafa ta soke a hannunka kuma tanƙwara a gurfãne. A ƙashin ƙugu kamata a dauke. Bincike dole za'ayi a karkashin aseptic yanayi.

• A binciken da ta fara da wani jarrabawa na waje genitalia. Kimanta da yanayin jiki da gashi, crotch. Gane pathological tafiyar matakai, idan sun kasance: scars daga ruptures a baya haihuwa, marurai, inflammations, fistulas, warts, basur a cikin dubura. Tantance Jihar vulvar labia turawa tare da yatsunsu, kuma ƙayyade jihar na urethral gland.

• bincika cervix da taimakon madubai. Kula da mucous m, mahaifa da kuma igiyar ciki makogwaro size. A na-st trimester ɗauke da wani biyu bangaren jarrabawa daga cikin farji, a karo na biyu da kuma na uku kawai dacewa daya bangaren.

Da farko kimanta da crotch (ko rigidity, scarring) da farji (size, bango nadawa kasancewa).

4 samun waje obstetric nazarin

Receptions waje zoma bincike (Leopold dabaru) amfani da palpation na ciki na mace mai ciki. Wadannan hudu hanyoyin:

• kimanta da tsawo na tsaye mahaifa, da kuma raba 'ya'yan itace, wanda shi ne;
• tabbatas da wuri da tayin, wanda yin karshe game da gano da baya da kuma hannunwansa da ƙafafunsa.
• tabbatar da dalilin da 'ya'yan itace, wanda aka kafa kafin, ta wurin dangane da kananan kafafuwa.
• m kamar yadda fetal Gabatar part tana wurinta dangi zuwa ƙofar kafafuwa.

Dalilin da dubawa na cervix

Kafin haihuwa da cervix m balaga, tun da shi ya nuna yadda jiki yake shirye su bar. Hanyar for kayyade balaga da cervix ne bambancin, amma wadannan sigogi da aka kiyasta a cikin dukkan su:

• daidaito;
• abin da yake da tsawon farji rabo daga tashar.
• patency na mahaifa canal.
• located da kuma yadda nisa wuyansa axis ne directed a ƙashin ƙugu.
• bangon kauri daga cikin wuyansa rabo, wanda aka shirya a cikin farji.
• ƙayyade da yanayin ƙananan ɓangare na mahaifa.

Kimanta da cervix ga wani musamman sikelin. M cervix ne daga 0 zuwa 5 da maki. Idan dubawa ne ya jũyar da fiye da 10, sa'an nan a mace iya shirya domin haihuwa.

Nazarin na mata kafafuwa

Don san pelvic girma, amfani da external Likitan mata ciki kamar yadda pelviometriya. Norms waje pelvic girma ne kamar haka:

• spinarum nesa, wanda yake daidai da 25-26 santimita.
• kristarum nesa - daga 28 zuwa 29 santimita.
• trohanterika nesa - daga 31 zuwa 32 santimita.
• Conjugate externa - daga 20 zuwa 21 santimita.
• diagonalis conjugate, wanda ya kasance a cikin zangon 12.5 - 13 santimita.

Mai likitoci riga a ziyararsa ta farko, mata kokarin don auna conjugate bangaskiya (gaskiya), wanda kayyade size of ƙofar a kananan kwari. Yadda aka saba, shi ya zama 11 zuwa 12 cm. A gaskiya conjugate za a iya samu, sai dai idan m conjugates (externa) debewa 9 santimita. Its size ma ya gana da rhomb Michaelis da kuma Frank size (ƙaddara da bakwai mahaifa vertebrae zuwa tsakiyar lakar fossa). A diagonal na wani conjugate wanda aka located tsakanin ƙananan baki na pubic symphysis ga mafi salient sassa krestsovogo kabido, kuma daidai da darajar gaskiya conjugates.

Idan kafafuwa masu girma dabam karkacewa daga na kullum, shi ne bu mai kyau da za su gudanar na waje obstetric bincike dabaru da suke da karin girma: aunawa gefen conjugate, wanda aka located tsakanin gaban kashin baya na ilium da kuma raya kashin baya a gefe daya. Its al'ada dabi'u na 14 zuwa 15 santimita. Idan shi ne kasa da 12 da rabi santimita, physiological haihuwa ba zai yiwu ba. Har ila yau auna girman da QFontDatabase. Uku daga cikinsu, kuma idan bambanci tsakanin su fiye da 1.5 centimeters, da hukunci QFontDatabase takaita, wanda shi ne ma m, a haihuwa.

Ƙayyade ma da pelvic kwana na son, wanda ba ya ratse daga 45-55 digiri. Daidai da muhimmanci pubic kwana wanda ya zama daidai 90-100 digiri.

A algorithm na waje obstetric bincike hada da darajar da fitarwa na karamin kwari:

• line size, wanda shi ne daidai da tara santimita. An located tsakanin ƙananan ƙarshen pubic sanarwa akan abinda kuma na sama batu na coccyx. Daga cikin bayanan samu fashi biyu santimita a kan m kyallen takarda.
• tazometrom auna mai gangara girma wanda shi ne 11 santimita kuma dake tsakanin ischial tuberosity (su ciki saman).

Receptions Leopold-Levitsky

Ga wani likita ta yarda da mata a ko'ina cikin tsawon ciki ne dole ya ciyar a waje zoma bincike. Receptions Leopold-Levitsky taka muhimmiyar rawa a cikin shi. Sunan wadannan dabaru a kan ka'idodin da aka riga aka ambata a sama, poluchli a madadin mutumin da ya ɓullo da su a cikin marigayi karni na sha tara. Wannan mutum ne mai Jamus likita Kirista Leopold. Wadannan aukuwa sun warware yawa obstetric matsaloli da suke dacewa da ba rana.

Suna taimaka ƙayyade girman da matsayin da tayin a makara ciki. A farko daga cikin wadannan fasahohi sa kafin kowane duban dan tayi. Ya nuna ga tsawo uwar tsaye kasa da kuma kusan ko da yaushe yayi dace da lokaci na ciki. Daidaito ta hade da na ciki bango kauri. Idan a cikin shakka, yanzu mafi m sakamakon zai ba duban dan tayi.

The uku ya nuna da liyafar fetal gabatar: breech, mai gangara ko shugaban. Kuma ma, yadda za warai da 'ya'yan riga a cikin kafafuwa. A karo na hudu liyafar tabbatar da baya uku.

shikenan lissafin nazari

Mutane da yawa ban sha'awa algorithm waje obstetric bincike dabaru. pelvic ma'aunai farko sanya ciki. Bayan karshen wannan magudi da likita fitowa to palpation na ciki na mata. Wannan shi ne mataki na aikace-aikace Leopold receptions. Next, zuwa auscultation, ko sauraron fetal zuciya. Akwai muhimmanci mita na zuciya beats (shi ne kullum daga 120 zuwa 160 lashe minti daya.), Su tsabta da kuma kari. Auscultation aka yi amfani da wani stethoscope ko wani fetal duba.

External da ciki zoma bincike yana da muhimmanci sosai a lokacin daukar ciki da kuma bayan bayarwa. A mace fahimce shi, sai su dõra ayi kasafi da kuma a cikin wani hali ba Ya jin kunya daga gare su. Suna taimakon likita gano ko al'ada gudana ciki ne da lafiya idan expectant uwa da jaririnta.