Examinations during pregnancy. Gynecological examinations during pregnancy in the antenatal clinic

In all national health care systems, great attention is paid to women's health, on which the demographic situation and, in many respects, the politics and economy of each country depend. A woman becomes especially vulnerable during pregnancy and breastfeeding. The World Health Organization places great emphasis on healthy pregnancy and lactation.

Constantly introduces the general public to new achievements in this field. However, over many thousands of years of human existence, the course of pregnancy has not changed, although today the most modern knowledge and new diagnostic technologies are available to expectant mothers.

Routine examinations in early and late pregnancy: examinations by week

A normal pregnancy lasts 280 days, or 40 weeks, starting from the first day of the last menstrual bleeding. During the entire period of bearing a child, a doctor must monitor the pregnancy, so it is very important for a pregnant woman to register with the antenatal clinic on time, pass all the necessary tests and tests, and regularly visit the attending physician in accordance with an individual schedule.

All studies that are carried out at the beginning of pregnancy will need to be repeated several times during pregnancy, since the condition of the expectant mother during pregnancy and as the fetus develops and grows inevitably changes. An important task of regular examinations by a gynecologist is to avoid some pregnancy complications and/or their timely prevention.

During regular routine examinations of a pregnant woman, it is possible to identify isthmic-cervical insufficiency, which does not make itself felt in any way, but can pose a serious danger to maintaining the pregnancy. The fact is that with isthmic-cervical insufficiency, the cervix, for various reasons, begins to gradually shorten and open slightly, which entails a high probability of infection of the fertilized egg.

As a result of infection, the membranes that hold both the fetus and the amniotic fluid become thinner and lose their strength, as a result of which they can no longer perform their functions, so the membranes rupture, the amniotic fluid (amniotic fluid) pours out and spontaneous abortion occurs, that is miscarriage - pregnancy ends.

Isthmic-cervical insufficiency does not necessarily lead to serious consequences, since modern medicine is able to correct this pathology - pregnancy can be saved if the necessary measures are taken on time.

Attention! To avoid the danger of spontaneous abortion, a woman must promptly and regularly visit a doctor, take all necessary tests and examinations, and undergo all necessary examinations.

• The first visit to a gynecologist is recommended at 6-8 weeks. During this visit, the obstetrician-gynecologist conducts an examination and initial examination and makes a smear to determine the flora, as well as for a cytological examination. During the same period, the pregnant woman must undergo a general urine test, blood tests for RW, HIV, HbS, HCV, as well as blood to determine the blood group and Rh status. In addition, at the same time, the pregnant woman takes a general blood test, a blood sugar test, a biochemical blood test and a coagulogram.

At the same time, the presence/absence of TORCH infections (toxoplasmosis, rubella, herpes and cytomegalovirus infection) is determined, which can provoke intrauterine infection of fetal systems and organs with a high risk of congenital deformities and malformations, increase the risk of spontaneous termination of pregnancy (miscarriage), as well as the risk stillbirths.

• The next visit to the gynecologist is planned for 10 weeks. In addition to examination by a gynecologist, a pregnant woman should consult with specialized specialists, including an endocrinologist, therapist, otolaryngologist and ophthalmologist. If necessary, other consultations may be scheduled.

At this time, it is necessary to monitor the indicators of a general urine test and a general blood test. Also at this time, a so-called double test is done, including a PAP test (cellular changes in the cervix that can lead to cancer) and a hCG test (human chorionic gonadotropin hormone).

• At 12 weeks of pregnancy, the next mandatory visit to the doctor is planned.

At this time, in addition to an examination by an obstetrician-gynecologist and a urine test, an ultrasound examination is planned to make sure that the child is developing normally and is not in danger.

• If the pregnancy develops normally and the results of all analyzes and tests do not cause any concern, then the next visit to the doctor is scheduled after four weeks, that is, at the 16th week, when the first trimester of pregnancy is already over.

During this visit, the gynecologist conducts the necessary examination, measures the abdominal circumference, controls weight and blood pressure. If the pregnancy develops normally and does not cause any concerns, then of all the tests and tests, only a urine test is taken.

• After two weeks, that is, at 18 weeks, you will need another visit to the doctor. At this stage, some women already feel fetal movements, although others will feel it a little later.

In addition to an examination by a gynecologist, during this visit you will need to take a urine test and blood tests - general and to determine AFP (alpha fetoprotein) + (human chorionic gonadotropin) + level of unbound estriol - the so-called triple test, which allows you to identify many developmental pathologies fetus, including Down syndrome, trisomy 18, fetal growth restriction and even fetal death. During the same period, the pregnant woman is offered to undergo genetic consultation.

• At 20 weeks (and this is exactly the middle of a normally developing pregnancy), another visit to the gynecologist is necessary.

In addition to the usual examination and measurement of blood pressure and weight, the pregnant woman will need to undergo a general urine test.

• After just two weeks, at 22 weeks, the pregnant woman will have to visit her doctor again.

It is very important that, in addition to a routine examination and general urinalysis, ultrasound examination and Dopplerography (Doppler examination of blood flow in the placenta) are performed at this stage.

• In the second half of pregnancy, gynecologist examinations become a little more frequent. The next time you should see your doctor is at 24 weeks.

At this time, in addition to a standard examination by a gynecologist, you will need to undergo a general urine test and a general blood test.

• At 26 weeks after examination, the pregnant woman must undergo a general urine test.
• Two weeks later, at 28 weeks, the gynecologist again examines the expectant mother, who, after the examination, must pass a general urine test and a general blood test.
• At 30 weeks, when the last trimester of pregnancy has begun, in addition to the usual examination by an obstetrician-gynecologist, you will need to donate general and blood tests to determine dangerous infections: RW, HIV, HbS, HCV.

In addition, a consultation with an ophthalmologist is planned at the same time.

• In the third trimester of pregnancy, visits to the doctor become more intensive with various studies, since it is very important to know how the fetus is feeling and how ready it is to be born. At the 32-week visit, after being examined by a doctor, the pregnant woman must undergo a complete urinalysis and a complete blood count.

In addition, in the same week, an ultrasound examination (ultrasound) with fetometry and Doppler blood flow testing of the placenta is performed.

• The next visit to the obstetrician-gynecologist is planned for 34 weeks

During this visit, in addition to examination and general urine analysis, fetal cardiotocography is planned.

• The visit at week 36 will be quite eventful. During the examination and examination, the gynecologist must take a vaginal smear for flora.

In addition, the pregnant woman undergoes a general urine test and a general blood test, as well as a blood test for hemolysins and again a blood test for RW, HIV, HbS, HCV.

At the 36th week, the woman’s sensitivity to various antibacterial drugs must be clarified in order to avoid any surprises during childbirth.

If the pregnancy develops normally, then at this stage the doctor determines whether the cervix is ​​ready for labor. If the pregnancy is considered full-term, the doctor determines the presentation of the fetus, that is, how the baby is positioned - head down or legs down. With a breech presentation, the obstetrician will try to rotate the fetus into the correct position. For successful childbirth, fetal presentation is quite important.

• A very important visit to the doctor is at the 38th week, when the fetus is almost ripe and is considered quite viable, that is, the child can be born.

In addition to a routine examination and general urine test, a pregnant woman should visit a general practitioner and take a vaginal smear for flora. In the same week, it is necessary to do fetal cardiotocography.

• The 40th week is considered the last week of pregnancy. In addition to the mandatory examination to determine the body’s readiness for childbirth, a pregnant woman undergoes a general urine test. In addition, a pregnant woman may be prescribed an ultrasound examination of the fetus if the doctor wants to make sure that the pregnancy is ending normally.

By this time, the cervix becomes shorter, but stretches more and more, and the cervical canal is located exactly in the center.

If labor does not begin after the 41st week, the pregnant woman is hospitalized to stimulate labor.

Attention! Each pregnancy develops uniquely and has its own characteristics, therefore, as pregnancy develops, some changes may be made to the standard observation calendar that will allow you to effectively monitor the condition of the mother and fetus and ensure the timely birth of a healthy baby.

Every woman should remember the importance of timely visits to a gynecologist, especially if there is a reason to think about pregnancy. First of all, it is very important to get started in a timely manner so that the doctor can begin to monitor the development of pregnancy as early as possible. In addition, gynecological examinations at very early stages of pregnancy make it possible to diagnose many unwanted and sometimes dangerous pathological conditions, including ectopic pregnancy, as early as possible.

A visit to a gynecologist regarding a possible pregnancy involves a detailed conversation about the state of health of the expectant mother, past illnesses, possible chronic diseases and any hereditary pathologies - all this information will help the doctor draw up the most accurate observation plan during pregnancy.

During pregnancy, during the first visit, the doctor will definitely measure the height and check the woman’s weight, so that in the future you can observe how the body weight changes, which may indicate the normal development of pregnancy or the presence of some abnormalities.

A gynecological chair is a special medical furniture in which it is convenient to carry out both external and internal examinations of a woman, who occupies the most comfortable position for both herself and the doctor. After the woman has taken a seat in the gynecological chair, the doctor begins a gynecological examination.

First, the gynecologist carefully examines the woman’s external genitalia to determine the condition of the skin and the condition of the mucous membranes. Particular attention is paid to examining the labia majora; labia minora; clitoris and urethra, perineum, as well as the inner thighs. With such a visual examination, vein pathologies, pigmentation, and skin rashes can be detected. When examining the area of ​​the anus (anus), anal fissures, if any, and hemorrhoids (if any) are immediately detected.

After the external examination is completed, the gynecologist begins the internal examination. A vaginal speculum is used for internal examination. In fact, there are several varieties of this instrument, but all of them are designed to painlessly and reliably widen the vaginal opening. A gynecological examination using vaginal speculum allows you to determine the condition of the cervix and identify any diseases of the vagina.

Since all women are different and the internal dimensions of their genital organs are also different, gynecological practice uses mirrors of different sizes - from XS to L:

• For a vaginal speculum size XS, the internal diameter is 14 mm, the length of the valves is 70 mm;
• For a vaginal speculum size S, the internal diameter is 23 mm, the length of the valves is 75 mm;
• For a vaginal speculum size M, the internal diameter is 25 mm, the length of the valves is 85 mm;
• For a vaginal speculum of size L, the internal diameter is 30 mm, the length of the valves is 90 mm.

In addition, gynecological speculums can have different shapes - they can be folded or spoon-shaped. In each specific case, the doctor chooses for examination exactly the mirror that will be most convenient for a particular woman.

When examining the vagina using a flap speculum, a closed speculum is first inserted into the vagina, and only then the flaps are spread apart so that the cervix can be examined. When removing the speculum, the walls of the vagina are examined.

If the doctor decides that in a particular case it is better to use spoon-shaped mirrors, then first the lower (posterior) mirror is inserted, which is located on the back wall of the vagina, slightly pressing on the perineum. Then the upper (front) speculum is inserted, with the help of which the anterior wall of the vagina is raised.

Attention! When inserting any type of speculum into the vagina, it is very important not to strain or tighten the muscles - at this moment you need to completely relax.

After any type of speculum is in place, a light (sometimes bright daylight light is enough) is directed into the vagina onto the cervix.

Upon examination, the doctor can almost immediately note a visually noticeable cyanosis of the cervix, which is almost always considered one of the indirect signs of pregnancy.

In addition, when examined using a vaginal speculum, the doctor can detect inflammatory processes, erosion, the presence of polyps and the presence of any neoplasms, including substandard ones.

Cervical erosion looks like redness and spots on its outer surface, but other diseases can also look like this. For an accurate diagnosis, an additional test called colposcopy may be needed.

When examining the cervix, the doctor carefully examines the external os of the cervix (the opening of the cervical canal). By the appearance of the cervical canal, the doctor can determine the threat of spontaneous termination of pregnancy even at very short notice. In addition, the appearance of the external pharynx of the cervical canal allows one to determine isthmic-cervical insufficiency - the pharynx is partially open and often has an irregular shape.

During a vaginal examination, the gynecologist must determine the nature of the discharge from the cervical canal of the uterus:

• If the discharge has streaks of blood, then this should alert you, because in this case you should be wary of spontaneous termination of pregnancy (miscarriage);
• If the cervical discharge is not transparent, but cloudy and has a specific unpleasant odor, then this is one of the signs of an infectious process caused by viruses, bacteria or protozoa. To identify the cause of the infection, it is necessary to do laboratory tests on the discharge, which may also require polymerase chain reaction or other methods. It is very important to obtain reliable information early in pregnancy in order to take the necessary measures for the safe development of the fetus.

How to prepare for a chairside examination?

A visit to a gynecologist involves an examination in a gynecological chair. A modern gynecological chair is the most convenient way for a high-quality, effective and most gentle internal examination of a pregnant woman. A gynecological examination, which is carried out in a gynecological chair, is completely safe, but at the same time very informative - during such an examination, the doctor can obtain the maximum amount of necessary and completely objective information about the condition of the pregnant woman and the fetus.

In order for a medical examination in a gynecological chair to be as comfortable as possible and not cause any awkwardness, as well as for it to be as informative as possible, you should follow some rules for preparing for a gynecological examination during the period of bearing a baby.

It is very important that the expectant mother does not stop keeping a special calendar in which, before pregnancy, the days of the onset of menstrual bleeding and all the days of menstrual bleeding are noted.

After pregnancy, menstrual bleeding stops, because the hormonal background of the female body has changed and ovulation does not occur, that is, the egg does not leave the ovary, but the hormonal cycle does not disappear completely without a trace - the days on which menstrual bleeding could supposedly begin can be dangerous for anyone external intervention in the female reproductive system.

To prevent spontaneous termination of pregnancy from occurring, it is extremely undesirable to conduct an internal examination on a gynecological chair on such days, because it is on these days that the most spontaneous terminations of pregnancy, that is, miscarriages, occur.

Hygienic procedures before visiting a gynecologist are mandatory. However, it is very important to limit yourself to a regular shower.

Before visiting a gynecologist, washing the external genitalia with soap and, moreover, douching is strictly not recommended, since this will wash and destroy all vaginal flora for several hours. Thus, the doctor will not be able to take a vaginal smear to determine the presence of inflammatory processes and/or any infections.

It should be understood that it is impossible to destroy any infectious agents in this way - they will still remain, but the doctor will not receive an objective picture, which can be dangerous for both the health of the pregnant woman and the health of the fetus.

It is very important to abstain from sexual intercourse at least one day before a gynecological examination, and both open sex and protected sex (that is, using a condom) are undesirable.

The fact is that for an adequate assessment of the state of the vaginal microflora, seminal fluid, even in residues, will be a significant obstacle. As for protected sexual intercourse (meaning the use of a condom), in which seminal fluid does not enter the woman’s genital tract, then during sexual intercourse a special lubricant and special mucus are still produced in the woman’s genital tract - and they can also distort the results of the analysis.

Before an examination in a gynecological chair, you must visit the toilet - except for certain cases, which the doctor specifies separately, the visit to the gynecologist must be carried out with the bowels and bladder empty.

The fact is that during an examination in a gynecological chair, the doctor presses the abdominal wall both in the area of ​​the bladder and in the intestines, which can stimulate the separation of urine and/or feces.

For a visit to a gynecologist, you can purchase an individual gynecological kit, which contains both a mirror and a disposable diaper that can be placed on the chair.

However, all instruments in gynecological offices are always thoroughly sterilized, so they do not pose any danger. As for the advisability of purchasing a disposable sterile kit, it is better to clarify this issue with your doctor - not all gynecologists like to work with plastic equipment.

As for a disposable diaper, this is not necessary, although it is desirable. Instead of a disposable diaper, you can use any small towel, which can then simply be washed. In addition, for the same purposes (so that a woman can sit on the surface of a gynecological chair without fear), disposable multi-layer towels are used.

When planning a visit to the gynecologist, it is better to take thin cotton socks with you - it will be more convenient to walk to the chair in them.

As for clothing, clothing should be as comfortable as possible. First, for a gynecological examination in a chair, you will have to remove all clothing below the waist. Secondly, in order for the doctor to look and examine the breasts, you will have to remove clothing above the waist. So the dress in this case will not be the best choice.

Attention! If before or during the examination a pregnant woman has any questions or becomes uncomfortable and/or has unpleasant sensations, she should immediately inform the doctor.

Continuation of the series of articles.

Prenatal care is a careful, systematic examination of pregnant women, providing for the best results for the health of the mother and fetus.

Concept of prenatal care (examination)

The purpose of prenatal examination is:

1) prevention, screening and management of possible complications for the mother and fetus, including socio-economic, emotional, general medical and obstetric factors;

2) education of patients in physiology and pathology, childbirth, postpartum and early neonatal period; recommendations for improving maternal and child health;

3) ensuring adequate psychological support from the doctor, partner and family, especially in the case of the first pregnancy.

So, prenatal care should begin in the preconception period (preconception care) and end one year after birth.

Prenatal care includes a systematic outpatient examination of the pregnant woman, which is carried out according to a clearly defined plan and includes screening tests to identify any deviations from the physiological course of pregnancy.

Prenatalcare includes:

• Detailed clarification of the pregnant woman’s complaints and careful collection of anamnesis, identification of high-risk disease factors existing before pregnancy and, if necessary, consultation of related specialists;
• General objective clinical and laboratory examination of pregnant women; body weight control;
• External obstetric examination;
• Internal obstetric examination;
• Prenatal examination of the fetus’s condition, identifying possible complications;
• Recommendations on hygiene, regimen, diet during pregnancy;
• Preparing for childbirth.

First visit of a pregnant woman

During a pregnant woman's first visit to a doctor, it is necessary to obtain a complete life history and perform standard clinical and laboratory tests. It is advisable for this visit to take place between 6 and 10 weeks of pregnancy.

Anamnesis. When collecting complaints, they find out the date of the last pregnancy, the peculiarities of the course of this pregnancy. The patient is asked about symptoms that may indicate any complications of pregnancy: vaginal discharge, vaginal bleeding, leakage, dysuric symptoms. After 20 weeks of pregnancy, the nature of fetal movements and uterine contractions is determined.

The obstetric history includes data on the presence and course of previous pregnancies (year, the consequence of pregnancy - spontaneous (spontaneous) or medical abortion, or childbirth, the date of abortion or childbirth, features of the course of previous pregnancies, abortions and childbirth, the presence of sexually transmitted diseases, operations, injuries, ectopic pregnancy, multiple pregnancy, data on the type of delivery, duration of labor periods, birth weight of children (fetal growth retardation, low birth weight, macrosomia - fetal weight > 4000 g), presence of complications (hypertension, preeclampsia, premature abruption or placenta previa, postpartum hemorrhage and inflammatory diseases)).

The general history includes clarification of social, marital status, heredity, the presence of bad habits (alcohol, tobacco, drugs, medication abuse), domestic violence, chronic extragenital diseases, surgical operations, complications of anesthesia that can affect the course of pregnancy. All data is clearly recorded in medical documentation (individual card of the pregnant woman and / or birth history).

Objectiveexamination. An exclusively complete objective physical examination of the pregnant woman is carried out (body weight, height, examination of the skin, sclera, oral cavity, throat, mammary glands, detection of edema, varicose veins, determination of body temperature, pulse, blood pressure, heart and lungs, palpation of the abdomen).

The gestational age of the fetus and the expected date of birth are determined. At the first visit, pregnant women are examined by a therapist, dentist, otolaryngologist, ophthalmologist, dermatovenerologist, and, if necessary, other specialists.

During a gynecological examination, attention is paid to the presence of anomalies of the vulva, vagina, uterus and appendages, the size of the uterus in weeks of pregnancy, the length, location and consistency of the cervix. A study of the cervical epithelium and vaginal microflora is performed. The dimensions of the pelvis are determined (clinical pelvimetry) for pregnant women for the first time and for repeat pregnant women who had a complicated course of labor.

In the second half of pregnancy, the height of the uterine fundus above the symphysis is determined (at 18-34 weeks, the height of the uterus above the symphysis in cm corresponds to the gestational age in weeks). If the height of the uterine fundus is 3 cm less than expected for a given gestational age, an ultrasound examination is performed to exclude possible intrauterine growth restriction. After 10-14 weeks, a Doppler study of fetal cardiac activity is used. Auscultation of the fetal cardiac activity and external obstetric examination are carried out to determine the position, position, and type. The tone of the uterus and the nature of its contractions are determined.

External obstetric examination in the third trimester of pregnancy consists of 4 Leopold maneuvers, with the help of which the position of the fetus is determined; the presenting part of the fetus and its descent into the pelvis; fetal position:

• Step I - palpation of the uterine fundus in the upper quadrant of the abdomen and identification of the part of the fetus that is located in the fundus of the uterus;
• II reception - palpation of the uterus on the right and left sides of the mother to determine the position of the fetus;
• III reception - palpation of the presenting part of the fetus, the presence of insertion of the presenting part into the pelvis;
• IV reception - the degree of descent of the presenting part of the fetus into the pelvis is determined.

Laboratoryexamination includes a general blood test, level of hemoglobin, glucose, determination of blood group, Rh factor, biochemical blood test (total protein and fractions, liver tests, coagulogram), screening for syphilis (presence of antibodies to rubella, hepatitis B, HIV, chickenpox (in the latter case - in the absence of a history of it), according to indications - antibodies to toxoplasma, general urine analysis (presence of hematuria, glucosuria, proteinuria, leukocyturia). In doubtful cases, a pregnancy test is performed to confirm pregnancy (presence of hCG). discharge or pain in the lower abdomen determine the level of hCG in the blood serum.

Further visits, according to ASOS recommendations, should be carried out every 4 weeks until 28 weeks, every 2-3 weeks until 36 weeks and every week until delivery. For healthy pregnant women who have a low risk of perinatal complications, the following examination periods are recommended: for pregnant women again at 6-8, 14-16, 24-28, 32, 36, 39 and 41 weeks of gestational age; for pregnant women for the first time - additional visits at 10, 12 and 40 weeks. For high-risk pregnant women, prenatal visits should be individualized and usually be more frequent.

Repeated visits of a pregnant woman to the doctor

In the firsttrimester(during a second visit) they find out the symptoms of pregnancy, changes in body weight, take a general blood test and urine test. Decrease in hematocrit<32% свидетельствует об , увеличение>40% - about hemoconcentration. Patients are advised regarding diet, regimen and hygiene during pregnancy, and are introduced to the physiology of pregnancy and childbirth.

In the second trimester, the focus is on genetic screening and identifying possible fetal abnormalities, which makes it possible to terminate the pregnancy if necessary. Screening for alpha-fetoprotein (AFP) levels in the mother's blood is usually carried out at 15-18 (15-21) weeks of gestation. An increase in AFP levels (2.5 times higher than average values) correlates with malformations of the neural tube, anterior abdominal wall, gastrointestinal tract and fetal kidneys, as well as nonspecific adverse pregnancy outcomes - fetal death, low birth weight, fetal bleeding); decreased AFP levels - with some forms of aneuploidy, including Down syndrome (trisomy 21), Edwards syndrome (trisomy 18) and Turner syndrome (X0). The sensitivity of screening is increased by simultaneously determining the level of hCG and estriol in the mother's blood (triple screening).

Genetic amniocentesis or chorionic villus biopsy, followed by determination of the fetal karyotype, is performed for pregnant women over 35 years of age, and those who have a high risk of having a child with (1: 270 and above) and structural chromosomal abnormalities.

Between 18 and 20 weeks, an ultrasound examination (ultrasound) is prescribed to exclude anatomical abnormalities of fetal development, assess the volume of amniotic fluid (amniotic fluid), localization of the placenta, and gestational age of the fetus. The contractile function of the uterus and the condition of the cervix (the possibility of premature termination of pregnancy) are assessed.

In thirdtrimester assess the nature of uterine contractions (Braxton-Hicks). With regular contractions, the condition of the cervix is ​​determined (the possibility of premature birth). The frequency of prenatal visits increases from every 2-3 weeks (between 28 and 36 weeks of gestation) to weekly visits after the 36th week of gestational age. Non-immunized patients with Rh-negative blood type should be prescribed 1 dose of anti-Rh gamma globulin at 28 weeks of gestation. After 32-34 weeks of pregnancy, external obstetric examination techniques are used (for Leopold) to identify the position, presentation, position of the fetus, the degree of insertion and descent of the presenting part of the fetus into the pelvis.

Screening tests for high-risk groups

In the third trimester (27-29 weeks), mandatory screening laboratory tests are performed: general blood test, biochemical blood test and coagulogram. With a decrease in hemoglobin<110 г / л диагностируют анемию и назначают препараты железа.

To prevent constipation due to the use of iron supplements, pregnant women are also prescribed laxatives (lactulose). The load glucose test (LOG) is a screening test for gestational diabetes. It consists of taking 50 g of glucose orally followed by measuring serum glucose levels 1 hour later. If the glucose level exceeds 14 mmol/L, a glucose tolerance test (TGT) is ordered. TSH consists of a series of fasting blood glucose measurements and then 100 g of oral glucose is prescribed. Blood glucose levels are measured 1, 2 and 3 hours after oral glucose ingestion. The test is considered positive and indicates gestational diabetes if the fasting glucose level exceeds 105 mmol/L, or any 2 or 3 tests exceed 190, 165 and 145 mmol/L.

In the high-risk group, the examination of vaginal discharge for gonorrhea and PCR for gonorrhea are repeated. At 36 weeks of gestation, screening for group B streptococcus is carried out. If streptococcus is detected, a polymerase chain reaction (PCR) is performed + treatment with intravenous penicillin before birth.

Risk factors for preterm birth

• History of premature birth
• Obstetric complications of pregnancy (twins, isthmic-cervical insufficiency, bleeding)
• Low body weight before pregnancy and inadequate weight gain during pregnancy
• Lower genital tract infections
• Adverse psychosocial factors
• Vaginal bleeding

Threatening symptoms during pregnancy that require special attention

• Abdominal pain or cramps
• Frequent uterine contractions at 20-36 weeks
• Leakage of fluid from the vagina
• Significant reduction in fetal movements
• Severe headache or vision disturbances
• Constant nausea
• Fever or chills
• Swelling of the upper limbs or face

Common pregnancy complications that can be prevented or minimized with adequate prenatal care

• Iron and folate deficiency anemia
• Urinary tract infections, pyelonephritis
• during pregnancy (preeclampsia)
• Premature birth
• Intrauterine growth restriction
• Sexually transmitted diseases and their effect on the newborn
• Rhesus immunization
• Fetal acrosomia
• Breech presentation of the fetus at term
• Hypoxia and fetal death due to delayed labor

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

1. Passport data: Full name, series and passport number.

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

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

5. History, history of general somatic and infectious diseases, diseases of the genital organs, previous pregnancies and childbirths, previous operations, blood transfusion history, epidemiological history, presence of allergies, family history, heredity.

6. Laboratory tests: general blood test - once a month, and from 30 weeks. pregnancy - once every 2 weeks; general urine test - monthly in the first half of pregnancy, and then once every 2 weeks, blood type and Rhesus status for both spouses, RW - three times (if registered at 28-30 weeks and 34-36 weeks), HIV and Australian antigen - upon registration, stool analysis for helminth eggs upon registration: complement fixation reaction with toxoplasma antigen according to indications; coagulogram; the presence of sugar in the daily amount of urine and blood; analysis of vaginal discharge for microflora upon registration and at 36-37 weeks; ECG - at 36-37 weeks.

7. An objective examination is carried out by an obstetrician, therapist, dentist, otolaryngologist, ophthalmologist, and, if necessary, an 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 you deviate from the specified dimensions, it is necessary to take additional measurements of the pelvis 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 joint to the posterior superior spine of the wings of both iliac bones - 17.5 cm,
• 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 suprasacral fossa and the apex of the sacrum - 11 cm,
• horizontal - between the posterior superior spines of the wings of both iliac bones - 10 cm;

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

e) dimensions of the pelvic outlet:

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

f) determine the values ​​of the true conjugate:

• on the outer conjugate - subtract 9 cm from the size of the outer conjugate,
• along the diagonal conjugate - 1.5-2 cm is subtracted from the value of the diagonal conjugate (the figure that needs to be subtracted is determined by the circumference in the area of ​​the wrist joint - for a circumference of up to 14 cm, 1.5 cm is subtracted, over - 2 cm),
• according to UZS data (most accurate).

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

After the size of the uterus increases, when external palpation becomes possible, the tone of the uterus, the size of the fetus, the amount of amniotic fluid, the presenting part, the articulation of the fetus, its position, position and appearance should be determined using four classical 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 proposed the following rules for listening to the fetal heartbeat:

1. In case of occipital presentation - near the head below the navel on the side where the back is facing. In posterior views - from the side of the abdomen along the anterior axillary line.

2 In case of facial presentation - below the navel on the side where the breast was 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 presented with the pelvic end - above the navel, near the head on the side where the back is facing.

In recent years, the “Malysh” apparatus and ultrasound devices and cardiac monitors have been widely used, which make it possible to clarify auscultatory data in difficult cases.

Ed. K.V. Voronina

All pregnant women should be regularly examined by an obstetrician-gynecologist. This will allow you to detect incipient complications in time and prevent their consequences for mother and baby.

To get an appointment with a doctor, it is best to register with a antenatal clinic or sign a contract for pregnancy management. We do not recommend that you go occasionally to a private center, because the doctors there usually do not bear any responsibility for you.

Frequency of visits

From the moment of registration or conclusion of a contract until 12 weeks of pregnancy, a doctor’s examination is required once a month.
From 13 to 28 weeks - once every three weeks.
From 29 to 36 weeks - once every two weeks.
From 36 weeks until delivery - weekly examination.

Before each visit to the doctor, you must take a urine test.

What does the doctor do during an examination?

• Height measurement– carried out on the first visit. Necessary for calculating body mass index.
• Weighing– carried out at each inspection. Based on weight gain, the doctor determines whether the pregnancy is proceeding normally and whether there is hidden edema.
• Blood pressure measurement(BP) and pulse - at every appointment. Allows you to detect severe dehydration (drop in blood pressure) or the onset of late toxicosis (increase in blood pressure more than 140/90 mm Hg)
• Pelvis measurement– carried out at the first examination. Indirectly shows the width of the pelvis, since the thickness of the bones also affects the width of the birth canal. If in doubt, use the Solovyov index: wrist circumference in centimeters. If it is more than 14, then the thickness of the bones is considered large, and the birth canal with the same external dimensions of the pelvis will be narrower.
• Palpation(palpation) belly– carried out at every appointment. With its help, the doctor can find out whether the tone of the uterus is increased (threat of miscarriage), how the fetus is positioned, and what its presentation is.
• Internal inspection– carried out at the first appointment, subsequently according to indications (for example, for pain and bleeding). The doctor inserts his hand into the vagina and determines the condition of the uterus and cervix. In some cases, a slight dilation is detected by 28 weeks and can cause.
• Vaginal smear– taken at the first visit and at 36–37 weeks. Using it, you can identify infectious diseases and determine the “smear cytotype” - a sign of the stage of readiness for childbirth.
• Abdominal circumference measurement– starting from 14–15 weeks and further at each examination.
• Measuring the height of the uterine fundus– from the womb to the upper edge of the uterus, measured at each examination after 14–15 weeks.
• Listening to the fetal heartbeat– usually performed starting from 14–15 weeks, when it can be heard through a regular obstetric stethoscope. With a Doppler stethoscope (electronic), you can hear the heartbeat earlier. This provides very important information about the child's condition.
• – done from 30–32 weeks and further according to indications. In other words, the doctor can refer you for a CTG at any time as soon as he suspects something is wrong with the child.

If you are late

What to do if you are late or cannot make it to your appointment? You should definitely call the antenatal clinic and inform your doctor about this. The doctor places patient cards on shelves for the corresponding appearance dates; if you are late or cancel your appearance, you will be transferred to another date.
If you cannot come because you feel unwell, then call an ambulance, a doctor will examine you and, if necessary, take you to the hospital.

SURVEY OF PREGNANT AND WOMEN IN LABOR

A survey of a pregnant woman and a woman in labor is carried out according to a specific plan. The survey consists of a general and a special part. All data obtained is entered into the pregnant woman’s chart or birth history.

General anamnesis

-Passport details : last name, first name, patronymic, age, place of work and profession, place of birth and residence.

-Reasons that forced a woman to seek medical help (complaints).

-Working and living conditions.

-Heredity and past diseases. Hereditary diseases (tuberculosis, syphilis, mental and oncological diseases, multiple pregnancies, etc.) are of interest because they can have an adverse effect on the development of the fetus, as well as intoxication, in particular, alcoholism and drug addiction in parents. It is important to obtain information about all infectious and non-infectious diseases and operations undergone in early childhood, during puberty and adulthood, their course and methods and timing of treatment. Allergy history. Previous blood transfusions.

Special anamnesis

-Menstrual function: the time of the onset of menarche and the establishment of menstruation, the type and nature of menstruation (3 or 4 week cycle, duration, amount of blood lost, presence of pain, etc.); did menstruation change after the onset of sexual activity, childbirth, abortion; date of the last normal menstruation.

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

-Sexual function: at what age did you begin sexual activity, what type of marriage, duration of marriage, period from the beginning of sexual activity to the onset of the first pregnancy, time of last sexual intercourse.

- Age and health of the husband.

-Childbearing (generative) function. In this part of the anamnesis, detailed information is collected about previous pregnancies in chronological order, what the current pregnancy is, the course of previous pregnancies (were there any toxicoses, gestosis, diseases of the cardiovascular system, kidneys, liver and other organs), their complications and outcome. The presence of these diseases in the past prompts a woman to be especially closely monitored during a current pregnancy. It is necessary to obtain detailed information about the course of the abortions, each birth (duration of labor, surgical interventions, gender, weight, growth of the fetus, its condition at birth, length of stay in the maternity hospital) and postpartum periods, complications, methods and timing of their treatment.

-Past gynecological diseases :time of onset, duration of disease, treatment and outcome

-The course of this pregnancy (by trimester):

- 1st trimester (up to 12 weeks) – general diseases, complications of pregnancy (toxicosis, threat of miscarriage, etc.), the date of the first appearance at the antenatal clinic and the gestational age established at the first visit.

2nd trimester (13-28 weeks) - general diseases and complications during pregnancy, weight gain, blood pressure numbers, test results, date of first fetal movement.

3 trimester (29 – 40 weeks) – overall weight gain during pregnancy, its uniformity, results of blood pressure measurements and blood and urine tests, diseases and complications of pregnancy. Reasons for hospitalization.

Determining due date or gestational age

GENERAL OBJECTIVE EXAMINATION

A general objective study is carried out to identify diseases of the most important organs and systems that can complicate the course of pregnancy and childbirth. In turn, pregnancy can cause 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 of the skin and visible mucous membranes. Then the circulatory, respiratory, digestive, urinary, nervous and endocrine systems are examined.

SPECIAL OBSTETRIC EXAMINATION

Special obstetric examination includes three main sections: external obstetric examination, internal obstetric examination and additional research methods .

EXTERNAL OBSTETRIC EXAMINATION

External obstetric examination is carried out by inspection, measurement, palpation and auscultation.

Inspection allows us 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. Particular attention is paid to the size and shape of the abdomen, the presence of pregnancy scars (striae gravidarum), and skin elasticity.

Pelvic examination is important in obstetrics because its structure and size have a decisive influence on the course and outcome of childbirth. A normal pelvis is one of the main conditions for the correct course of labor. Deviations in the structure of the pelvis, especially a decrease in its size, complicate the course of labor or present insurmountable obstacles to it. The pelvis is examined by inspection, palpation and measurement of its size. When examining, pay attention to the entire pelvic area, but give special importance to the lumbosacral rhombus (Michaelis diamond). The Michaelis rhombus is a shape in the sacral area that has the contours of a diamond-shaped area. The upper corner of the rhombus corresponds to the spinous process of the V lumbar vertebra, the lower - to the apex of the sacrum (the origin of the gluteus maximus muscles), the lateral angles - to the superoposterior spine of the iliac bones. Based on the shape and size of the rhombus, you can evaluate the structure of the bony pelvis and detect its narrowing or deformation, which is of great importance in the management of childbirth. With a normal pelvis, the rhombus corresponds to the shape of a square. Its dimensions: horizontal diagonal rhombus is 10-11 cm, vertical- 11 cm. With different narrowings of the pelvis, the horizontal and vertical diagonals will be of different sizes, as a result of which the shape of the rhombus will be changed.

During an external obstetric examination, measurements are made with a centimeter tape (circumference of the wrist joint, dimensions of the Michaelis rhombus, abdominal circumference and height of the uterine fundus above the womb) and an obstetric compass (pelvis gauge) in order to determine the size of the pelvis and its shape.

Using 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 uterine fundus - the distance between the upper edge of the pubic symphysis 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 uterine fundus above the womb allows the obstetrician to determine the duration of pregnancy, the expected weight of the fetus, and identify disorders of fat metabolism, polyhydramnios, and multiple births.

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

Distantia spinarum - the distance between the most distant points of the anterior superior iliac spines (spina iliaca anterior superior) is 25-26 cm.

Distantia cristarum - the distance between the most distant points of the iliac crests (crista ossis ilei) is 28-29 cm.

Distantia trochanterica - the distance between the greater trochanters of the femurs (trochanter major) is 31-32 cm.

Conjugata externa (outer conjugate) - the distance between the spinous process of the V lumbar vertebra and the upper edge of the symphysis pubis is 20-21 cm. To measure the external conjugate, the subject turns on her side, bends the underlying leg at the hip and knee joints, and extends the overlying leg. The pelvic meter button is placed between the spinous process of the V lumbar and I sacral vertebrae (suprasacral fossa) at the back and in the middle of the upper edge of the symphysis pubis at the front. By the size of the outer conjugate one can judge the size of the true conjugate. The difference between the external and true conjugate depends on the thickness of the sacrum, symphysis and soft tissues. The thickness of bones and soft tissues in women is different, so the difference between the size of the external and true conjugate does not always exactly correspond to 9 cm. To characterize the thickness of the bones, they use the measurement of the circumference of the wrist joint and the Solovyov index (1/10 of the circumference of the wrist joint). Bones are considered thin if the circumference of the wrist joint is up to 14 cm and thick if the circumference of the wrist joint is more than 14 cm. Depending on the thickness of the bones, with the same external dimensions of the pelvis, its internal dimensions may be different. For example, with an external conjugate of 20 cm and a Solovyov circumference of 12 cm (Solovyov index - 1.2), we need to subtract 8 cm from 20 cm and get the value of the true conjugate - 12 cm. With a Solovyov circumference of 14 cm, we need to subtract 9 cm from 20 cm, and at 16 cm, subtract 10 cm, - the true conjugate will be equal to 9 and 10 cm, respectively.

The size of the true conjugate can be judged according to the vertical size of the sacral rhombus And Franc size. The true conjugate can be more accurately determined along the diagonal conjugate .

Diagonal conjugate (conjugata diagonalis) they call the distance from the lower edge of the symphysis to the most prominent point of the sacral promontory (13 cm). The diagonal conjugate is determined during a vaginal examination of a woman, which is performed with one hand.

Straight pelvic outlet size - this is the distance between the middle of the lower edge of the symphysis pubis and the tip of the coccyx. During the examination, the pregnant woman lies on her back with her legs apart and half-bent at the hip and knee joints. The measurement is carried out with a pelvis meter. 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, and we obtain the direct size of the exit from the pelvic cavity, which is equal to 9.5 cm.

Transverse size of the pelvic outlet - this is the distance between the inner surfaces of the ischial tuberosities. The measurement is carried out with a special pelvis or measuring tape, which is applied not directly to the ischial tuberosities, but to the tissues covering them; therefore, to the resulting dimensions of 9-9.5 cm, it is necessary to add 1.5-2 cm (thickness of soft tissues). Normally, the transverse size is 11 cm. It is determined in the position of the pregnant woman on her back, with her legs pressed as close as possible to her stomach.

Oblique pelvic dimensions have to be measured with oblique pelvises. To identify pelvic asymmetry, the following oblique dimensions are measured: the distance from the anterosuperior spine of one side to the posterosuperior spine of the other side (21 cm); from the middle of the upper edge of the symphysis to the right and left posterosuperior spines (17.5 cm) and from the supracruciate fossa to the right and left anterosuperior spines (18 cm). The oblique dimensions of one side are compared with the corresponding oblique dimensions of the other. With a normal pelvic structure, the paired oblique dimensions are the same. A difference greater than 1 cm indicates pelvic asymmetry.

Lateral dimensions of the pelvis – the distance between the anterosuperior and posterosuperior iliac spines of the same side (14 cm), measured with a pelvis. The lateral dimensions must be symmetrical and at least 14 cm. With a lateral conjugate of 12.5 cm, childbirth is impossible.

Pelvic angle - this is the angle between the plane of the entrance to the pelvis and the horizontal plane. In the standing position of a pregnant woman, it is 45-50° . Determined using a special device - a pelvis angle meter.

In the second half of pregnancy and during childbirth, the head, back and small parts (limbs) of the fetus are determined by palpation. The longer the pregnancy, the clearer the palpation of parts of the fetus. External obstetric examination techniques (Leopold-Levitsky) are sequential palpation of the uterus, consisting of a number of specific techniques. The subject is in a supine position. The doctor sits to her right, facing her.

First appointment of external obstetric examination. The first step is to determine 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.

Second appointment of external obstetric examination. The second step 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 and, carefully pressing with his palms and fingers on the lateral surfaces of the uterus, determines the back of the fetus along its wide surface on one side, and the small parts of the fetus (arms, legs) on the other. This technique allows you to determine the tone of the uterus and its excitability, palpate the round ligaments of the uterus, their thickness, pain and location.

Third appointment of external obstetric examination. The third technique is used to determine the presenting part of the fetus. The third technique can determine the mobility of the head. To do this, cover the presenting part with one hand and determine whether it is the head or the pelvic end, a symptom of voting of the fetal head.

Fourth appointment of external obstetric examination. This technique, which is a complement and continuation of the third, makes it possible to determine not only the nature of the presenting part, but also the location of the head in relation to the entrance to the pelvis. To perform this technique, the obstetrician stands facing the legs of the examinee, places 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 pelvis, and palpates the presenting part. When examined at the end of pregnancy and during childbirth, this technique determines the relationship of the presenting part to the planes of the pelvis. During childbirth, it is important to find out in which plane of the pelvis the head is located with its largest circumference or major segment. The large segment of the head is its largest the part that passes through the entrance to the pelvis in a given presentation. With an occipital presentation of the head, the border of its large segment will pass along the line of the small oblique size, with an anterior cephalic presentation - along the line of its direct size, with a frontal presentation - along the line of the large oblique size, with a facial presentation - along the line of the vertical size. The small segment of the head is any part of the head located below the large segment.

The degree of insertion of the head by a large or small segment is judged by palpation data. During the fourth external technique, the fingers are moved deeper and slide upward along the head. If the hands come together, the head is a large segment at the entrance to the pelvis or has sunk deeper; if the fingers diverge, the head is a small segment at the entrance. If the head is in the pelvic cavity, it cannot be determined by external methods.

Fetal heart sounds are listened to with a stethoscope, starting from the second half of pregnancy, in the form of rhythmic, clear beats repeated 120-160 times per minute. With cephalic presentations, the heartbeat is best heard below the navel. In case of breech presentation - above the navel.

M.S. Malinowski proposed the following rules for listening to the fetal heartbeat:

In case of occipital presentation - near the head below the navel on the side where the back is facing, in posterior views - on the side of the abdomen along the anterior axillary line,

In case of 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),

In a transverse position - near the navel, closer to the head,

When presented with the pelvic end - above the navel, near the head, on the side where the back of the fetus is facing.

The dynamics of the fetal heartbeat is studied using monitoring and ultrasound.

INTERNAL (VAGINAL) EXAMINATION

Internal obstetric examination is performed with one hand (two fingers, index and middle, four - half-hand, whole hand). Internal examination makes it possible to determine the presenting part, the state of the birth canal, observe the dynamics of cervical dilation during childbirth, the mechanism of insertion and advancement of the presenting part, etc. In women in labor, a vaginal examination is performed upon admission to the obstetric institution, and after the rupture of amniotic fluid. In the future, vaginal examination is performed only when indicated. This procedure allows for timely identification of complications during labor and provision of assistance. Vaginal examination of pregnant women and women in labor is a serious intervention that must be performed in compliance with all rules of asepsis and antiseptics.

Internal examination begins with examination of the external genitalia (hair growth, development, swelling of the vulva, varicose veins), the perineum (its height, rigidity, presence of scars) and the vestibule of the vagina. The phalanges of the middle and index fingers are inserted into the vagina and examined (lumen width and length, folding and extensibility of the vaginal walls, the presence of scars, tumors, septa and other pathological conditions). Then the cervix is ​​found and its shape, size, consistency, degree of maturity, shortening, softening, location along the longitudinal axis of the pelvis, and patency of the pharynx for the finger are determined. During the examination during labor, the degree of smoothness of the cervix is ​​determined (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). In women in labor, a vaginal examination determines the condition of the fetal bladder (integrity, loss of integrity, degree of tension, amount of anterior water). Determine the presenting part (buttocks, head, legs), where they are located (above the entrance to the small pelvis, at the entrance with a small or large segment, in the cavity, at the pelvic outlet). Identification points on the head are sutures, fontanelles, and at the pelvic end - the sacrum and coccyx. Palpation of the inner surface of the pelvic walls makes it possible to identify 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 conjugata (conjugata diagonalis), the distance between the promontory and the lower edge of the symphysis (normally 13 cm). To do this, with the fingers inserted into the vagina, they try to reach the promontory and touch it with the end of the middle finger; the index finger of the free hand is brought under the lower edge of the symphysis and the place on the hand that directly contacts the lower edge of the pubic arch. Then remove the fingers from the vagina and wash them. The assistant measures the marked distance on the hand with a centimeter tape or a hip meter. By the size of the diagonal conjugate one can judge the size of the true conjugate. If Solovyov index(0.1 from Solovyov’s circumference) to 1.4 cm, then subtract 1.5 cm from the size of the diagonal conjugate, and if more than 1.4 cm, then subtract 2 cm.

Determining the position of the fetal head during labor

At first degree of head extension (anterocephalic insertion) the circumference of which the head will pass through the pelvic cavity corresponds to its direct size. This circle is the large segment when inserted anteriorly.

At second degree of extension (frontal insertion) the largest circumference of the head corresponds to the large oblique size. This circle is a large segment of the head when it is inserted frontally.

At third degree of head extension (facial insertion) the largest circle is the one corresponding to the “vertical” size. This circle corresponds to the large segment of the head when it is inserted face-on.

Determining the degree of insertion of the fetal head during labor

The basis for determining the height of the head during vaginal examination is the ability to determine the relationship of the lower pole of the head to the linea interspinalis.

Head above the pelvic inlet: When you gently press upward with your finger, the head moves away and returns to its original position. The entire anterior surface of the sacrum and the posterior surface of the pubic symphysis are accessible to palpation.

The head is a small segment at the entrance to the pelvis: the lower pole of the head is determined 3-4 cm above the linea interspinalis or at its level, the sacral cavity is 2/3 free. The posterior surface of the pubic symphysis is palpable in the lower and middle sections.

Head in the pelvic cavity: the lower pole of the head is 4-6 cm below the linea interspinalis, the ischial spines are not defined, almost the entire sacral cavity is filled with the head. The posterior surface of the pubic symphysis is not accessible to palpation.

Head on the pelvic floor: the head fills the entire sacral cavity, including the coccyx area, only soft tissues can be palpated; the internal surfaces of bone identification points are difficult to access for research.