UtanoMushonga

Kunze Ob: Mabiko

Vakadzi vane pamuviri havana ndoga nezvinetso zvavo kurapwa. Kuagadzirisa zvakakwana kushandisa kuti kugara antenatal kiriniki, uye ikoko kuti rubatsiro zvakakodzera uye ruzivo. Muzvipatara izvi, pane zvimwe mitemo mukadzi pamuviri wake kuongorora. Pane kudaro chinhu somunhu zvokunze obstetric tsvakurudzo, zvinoreva kubatsira mukadzi nepamuviri, kugadzirira yokusununguka. Chii uye chii zvinoitwa mitemo, vakakurukura pazasi.

Chii kunze tsvakurudzo kusununguka?

Vakadzi vakawanda vanoziva kuti pamuviri zvinokosha kunonyoresa muruwa muchipatara. The kekutanga kusvika gayinakorojisiti pashure nokusimbisa ichi hachisi wose kuravira, nokuti anogona kutora kuti maminitsi 40. Akadaro kwenguva yakareba inopfuura hakusi pasina muhofisi yachiremba. Pashure pezvose, nyanzvi havafaniri chete kusangana nomukadzi nepamuviri, asi kuunganidza rwevanhu uye chinokosha munhau. Also akagadzwa Murabhoritari nemiedzo, uye akaita kunze tsvakurudzo kusununguka.

Kunosanganisira kwokutanga kuongororwa, ine yayo algorithm. Mabiko panze tsvakurudzo kusununguka chinodiwa kuunganidza mashoko pamusoro mukadzi. Chiremba kunokosha kuona mamiriro vakadzi zamu, chidimbu Maumbirwe munyatso, nokuti kunokanganisa yakarongwa zviyero kugadzirira dzichifura. Gayinakorojisiti anoteerera sei amai vanepamuviri akawana kilos kubva panguva yokunambwa, uye obva ati uremu mwero kuti nguva yose vakamirira mwana.

Kuitisa kwokunze obstetric tsvakurudzo kunosanganisira kutora ruzivo pamusoro yapfuura pamuviri uye scarring yacho dumbu. Zviito izvi zvakakosha kumisa ngozi pamuviri pathologies. Kuwedzera rokuongorora, dzichiri kushandiswa nzira yakayerwa, palpation uye auscultation, izvo anobatsira kuwana mufananidzo zvakakwana mwana kukura uye ezvinhu mukadzi, nokurerwa izvozvo. Pasi apa, nzira idzi zvichakurukurwa kurondedzerwa zvizere.

Ndezvipi zvidzidzo yakadaro?

Kuona ukoshi mamiriro mukadzi pamuviri hakuna kukwana chete bvunzurudza naye. Kunyange pasina ose anonyengera palpatsionnye kwokunze obstetric tsvakurudzo achava adzidze kuti nyanzvi. Kuti mufananidzo yose mukadzi nepamuviri, uye mwana wake utano, vanofanira kuziva chii kurongedza kutora nzvimbo mukati chitunha ane pamuviri. Izvi zvinogona kuonekwa tichibatsirwa Murabhoritari inoongorora ropa, weti, uye zvichingodaro. Uyewo chiremba nguva anoteerera kwemwoyo mafufu uye rinorondedzera nzvimbo yaro dumbu. manipulations zvose izvi anonyorwa zviri huru nhatu mhando tsvakurudzo pamuviri:

  • zvekuchipatara;
  • rabhoritari;
  • inokosha.

Clinical kuongorora pamuviri

Izvi mhando Ongororo vakadzi panguva yepamuviri kutanga kuunganidzwa kwenhoroondo wezvokurapa uye yaro chipo mamiriro. Zviitwa izvi kwete kubatsira chete chiremba vawane ruzivo pamusoro utano yomukadzi mumuviri, ivo anopa mukana kuongorora ayo neuro-vanoziva remangwana kana zvinofunga basa.

Tanga kunotoda kuongororwa aine Ongororo umo zvinoitika mashoko pamusoro mukadzi.

  1. Nokusimbisa mai remangwana munhu (zita, pasipoti - nhamba uye series).
  2. Age nulliparous nhengo yakananga boka iro (vaduku - gumi, zera - pashure makumi matatu).
  3. Kero chaiyo dzokugara uye kunyoresa vakadzi.
  4. Sei kuenda chiremba-gayinakorojisiti.
  5. Material Magariro (sei vanhu vakawanda mupenyu uye mhuka imwe kamuri nomukadzi, Magariro), uyewo kwaaishanda kugadzirisa (pa hunokuvadza vanofanira kusarudza kuva zviine musoro basa rake, uye zvibereko zvebasa mamiriro).
  6. Information pamusoro ropa uye yenhengo dzayo (plasma, sealbumin), nezvimwe zvinhu, somatic zvirwere, oncology. Kazhinji zvinoitika somatic hazvirevi rakazara utano, nekuti munhu anogona kuona disruptions chepfungwa uye huta basa. chiremba basa - kuziva zvinoita kuti kwakaita kuti kutyorwa izvi, nekuti vakadzi vangangoramba asununguke, uye zvakakodzera maitiro kunoenderana utano paamai nomwana asati aberekwa. The zvinokonzera netsinga uye zvimwe zvirwere zviri huta uye pfungwa basa, zvizhinji:
  • takatakura noutachiona;
  • kushushikana;
  • refu kushaya mbereko;
  • kupfupfudzika;
  • kukuvadzwa mune yapfuura pakuberekwa.

Gayinakorojisiti anowana kuti pane zviratidzo kutyorwa kuri neuro-vanoziva remangwana kana zvinofunga basa: pamberi pamuviri, kana panguva imwe chete parinowanika. Zvinokoshawo kuziva chii mukadzi richibatanidza mavambo yavo.

7. Epidemiological kare.

8. Constant kudhaka (kusvuta, udhakwa, zvinodhaka).

9. kumwedzi uye zvepabonde uye dzokubereka mabasa (kana kumwedzi atanga, sezvo aibuda, rapfuura pamuviri sei pakuzvarwa, uremu uye utano mamiriro vana zvapfuura, gynecological uye zvirwere zvinotapuriranwa pabonde pamuviri).

10. Nhoroondo Family (state eutano vemumhuri kugara pamwe mukadzi, nhodzera, utano, kusawirirana kweropa raamai chavanopinda baba ramangwana boka uye).

Next, kune chimwe kuongorora mai nezveramangwana:

  • Zano chiremba, chiremba wemazino, ophthalmologist uye pfava. Kana zvakakodzera, gadzai rokuongorora nyanzvi vamwe.
  • Ayere tembiricha uye BP.
  • Kuongorora nomuviri uye akayera kureba, uremu uye kukura chiuno.
  • Rokuongorora uye palpate mudumbu.
  • Ongorora ropa, weti nezvimwe secretions.
  • Wekudzidza symphysis pubis.
  • Ita kwemwoyo unonzi, electrocardiograph.
  • Ultrassom ongororo zvinokosha kupfuura mukadzi ose pamuviri kusvikira wegumi, navasere-maviri wechipiri uye maminitsi 32 pazuva 34th vhiki.
  • Kuita tsvakurudzo kwokunze kusununguka.

Zvakakosha kuti mukadzi vakanyorwa kwete paya pane mavhiki 12 gestation. The kare akaita anthropometry, rabhoritari miedzo uye kunyatsoongorora BP, dzakanga mukana kuva nemwana ane utano kana kuziva fetus abnormality haawirirani upenyu.

Laboratory zvidzidzo vakadzi

Kana amai vanepamuviri chinozadzwa vakanyorwa, zviri basa chiremba bvunzo ropa uye urinalysis, havatsananguri uye kusapindirana kweropa chinhu ropa shuga boka, tarisa kuti Nalia RW, hepatitis, HIV, uye kuitawo scrapings uye swabs kubva nepanhengo uye cervix pamusoro kasvisto, cytology, chlamydia, mwandabvu, trichomoniasis.

Kana nhoroondo akaratidza kuberekwa kwevana vakafa, kupfupfudzika (kunyanya paya matanho), extragenital zvokurwara, zvakakodzera:

  • kuti kudzidza ropa mukadzi kuti kuvapo hemolysin;
  • boka ramangwana ropa yababa anogona kushandiswa kuongorora uye kusapindirana kweropa, kunyanya kana pamuviri rhesus chinhu kunaka kana boka 0 (I);
  • kuona pamberi urogenital zvirwere;
  • kuona pachiyero zvakafanira mahormone, immunoresistance;
  • kana zvakakodzera, kuti kuitisa magene tsvakurudzo.

Uyezve rabhoritari kunovhenekwa rinoitwa mu akadai:

  • CBC - mwedzi pashure rechimakumi matatu svondo - kamwe pamazuva gumi nemana;
  • panguva imwe vaenzi taurira weti iri hombe ongororo;
  • pamusoro navatanhatu ramakumi maviri vhiki kuona hCG uye ACE;
  • panguva mavhiki 22-23. uye 36-37 mavhiki. ongorora ropa shuga;
  • Kudzidza ari coagulation hurongwa (coagulation) kubereka 36 vhiki rechi37;
  • pane mavhiki matatu, uye maviri kana matatu mavhiki kusununguka zvakare firimu HIV uye RW, ongorora swabs uye scrapings.

Special Ob

Special obstetric tsvakurudzo zvinosanganisira:

  1. Kuitisa kwokunze obstetric tsvakurudzo.
  2. Internal kusununguka tsvakurudzo.
  3. Other okuwedzera zveBhaibheri.

Outdoor obstetric kutsvakurudza iri kuongororwa, nokuyerwa ukuru chiuno. Mushure vhiki rechimakumi maviri akasarudza ukuru guru sekamufarenzi ari mudumbu, akaita inoda kufunga mudumbu uye ari pubic symphysis, uye prolushivaniya fetus mwoyo. zvekunze obstetric tsvakurudzo michina hakusi nyore, voitakura kunze chete nokuda zvikuru vakadzidziswa vakashinga.

Internal kusununguka tsvakurudzo. In munyika kusununguka tsvakurudzo inosanganisira kuongorora chokunze sikarudzi, nyinyo uye cervix kudzidza kushandisa magirazi. Zvakangoita sezvazvakanga kukosha sezvo zvokunze obstetric tsvakurudzo yokusununguka. nzira iyi rinoitwa panguva bowel uye dundira. Nokuti musangano mukadzi akakumbira kuti nhema kumusana kwako, tsoka kukurumidza muruoko uye vanokunga pamabvi. The chiuno anofanira kusimudzwawo. Investigation hazvo kuitwa pasi aseptic ezvinhu.

  • Kudzidza rinotanga uongorore kwokunze nhengo dzokubereka nadzo. Ongorora hunhu muviri bvudzi, crotch. Wanikidza pathological urongwa, kana vari: nezvaiitika ruptures muzvirevo pakuberekwa, namamota, inflammations, fistulas, warts, Mamota ari horo. Kuongorora mamiriro vulvar labia rokufurira neminwe yenyu, uyewo kuona mamiriro urethral mumasero.
  • kuongorora cervix nokubatsirwa nezvionioni. Nyatsoteerera kuti mucous chakavanzika, remuromo uye uterine huro saizi. Muna I-Saint trimester vakatakura maviri chinhu kuzviongorora nyinyo, mune wechipiri uye chetatu chete akakodzera chete chinhu.

First kufungidzira crotch (kana Rigidity, scarring) uye nyinyo (size, rusvingo Kumbofungatira Kuwanikwa).

4 kugamuchira zvekunze obstetric zveBhaibheri

Mabiko panze tsvakurudzo kusununguka (Leopold unyanzvi) anoshandiswa palpation pakati mudumbu romukadzi ane pamuviri. Nzira ina idzi:

  • anofungidzira kukwirira yakamira dumbu, uye kuudza muchero, izvo zviri;
  • Pakusarudza nzvimbo mudumbu, dzinoita mhedziso maererano kuwana musana uye maoko nemakumbo;
  • kutsunga muchero, iri pamberi, nzvimbo yaro pachinhu chiuno diki;
  • akatsunga fetus kupa chikamu papi hama kuti nomukova chiuno.

Chinangwa rokuongorora of cervix

kuti cervix kuberekwa vasati kwatemwa kukura, sezvo zvinoratidza sei muviri akagadzirira kusiya. Nzira dzekufambisa Pakusarudza kukura ari cervix vari siyana, asi parameters aya kuongororwa mune vose:

  • kusachinja-chinja;
  • chii kureba kusangana nekutsi kwemukadzi mugove mugero;
  • patency of remuromo Canal;
  • chiri uye sei kure mutsipa akabatana chinotungamirwa muna chiuno;
  • rusvingo pakukora mugove mutsipa, riri yakarongwa nyinyo;
  • kuona mamiriro rezasi chikamu dumbu.

Nezvemabatiro cervix rinokosha pezvose. Saibva cervix anobva 0 kusvika 5 points. Kana rokuongorora rwauya anopfuura 10, ipapo mukadzi anogona kugadzirira yokusununguka.

Studies vakadzi chiuno

Kuziva pelvic kukura, kushandisa zvokunze Ob pamuviri sezvo pelviometriya. Dzemunharaunda kwokunze pelvic kukura ndeinotevera:

  • spinarum kure, izvo zvakaenzana 25-26 masendimita;
  • kristarum kure - kubva 28 kusvika 29 masendimita;
  • trohanterika kure - kubva 31 kusvika 32 masendimita;
  • Conjugate externa - kubva 20 kusvika 21 masendimita;
  • diagonalis Conjugate, izvo zvinofanira kuva kuwanda 12,5 - 13 masendimita.

vanachiremba Most kare pakutanga kushanya, vakadzi vanoedza kuyera Conjugate kutenda (kwechokwadi), izvo anosarudza kukura pamukova mumwe wokushambidzira duku. Kazhinji, unofanira kuva 11 kusvika 12 cm. The Conjugate yechokwadi inogona kuwanikwa, kana dzokunze verlauf (externa) bvisa 9 masendimita. saizi wayo remhosva rhomb Michaelis naFrank kukura (pakutsvaga wechinomwe remuromo vertebrae kusvika pakati jugular fossa). The diagonal munhu Conjugate riri pakati yepazasi kumucheto wenyika pubic symphysis kune Wekumusoro salient zvikamu krestsovogo Cape, uyewo akaenzana kukosha kwechokwadi verlauf.

Kana chiuno hukuru tsaukai ndozvakajairwa, zvinokurudzirwa kuti kuitisa kwokunze obstetric tsvakurudzo mitoo kuti vari mamwe kukura: kuyera divi Conjugate, riri pakati pamberi nomuzongoza pamusoro ilium uye rwemberi nomuzongoza rimwe divi. Zvarakanga tsika 14 kusvika 15 masendimita. Kana masendimita asingasviki 12 nehafu, vasiri kuzvara hazviiti. Uyewo kuyera kukura oblique. Vatatu vavo, uye kana musiyano pakati pavo anopfuura 1.5 masendimita, mutongi oblique aienda, riri ngozi yokusununguka.

Sarudza Uyewo pelvic kwekona kuti mafungiro, chisingazivi tsaukai 45-55 inegumi. Zvinokoshawo ndezvokuti pubic angled iyo inofanira kuva akaenzana 90-100 inegumi.

The algorithm nechitarisiko obstetric tsvakurudzo dzinosanganisira kukosha goho ane bheseni diki:

  • mutsetse saizi, izvo zvakaenzana pfumbamwe masendimita. Riri pakati yepazasi kuguma pubic nekunyatsotsanangura uye yokumusoro pfungwa yacho coccyx. Kubva Data vakawana angabira masendimita maviri pamusoro nyoro munyama;
  • tazometrom akayera transverse divi riri 11 masendimita uye iri pakati ischial tuberosity (kwavo kwomukati hukawanika).

Mabiko Leopold-Levitsky

Nokuti chero chiremba wacho kubvuma vakadzi munyika nguva pamuviri zvinenge aipedza kunze kusununguka tsvakurudzo. Mabiko Leopold-Levitsky airidza basa guru mariri. Zita unyanzvi izvi mazano iyo kare pamusoro apa, poluchli achimiririra munhu yakatanga navo mukupera namapfumbamwe remakore. Murume uyu chiremba wokuGermany Christian Leopold. Zviitiko izvi zvinetso obstetric zvizhinji inoshandawo nhasi.

Vanobatsira kuona kukura uye chinzvimbo fetus mukupera pamuviri. Chokutanga izvi unyanzvi kunoita pamberi mumwe Ultrasound. Iye anotaura kukwirira mai vakamira pasi uye zvinenge nguva unoenderana nguva pamuviri. Kururama yayo chokuita abdominal rusvingo ukobvu. Kana mubvunzo zvino neyakarurama migumisiro vachapa Ultrasound.

The wechitatu rinoratidza mabiko fetus mharidzo: breech, transverse kana musoro. Uyewo, sei chaizvo muchero kare muna chiuno. Mabiko wechina rinosimbisa yapfuura matatu.

Algorithm kudzidza

Vazhinji dzinonakidza algorithm zvokunze obstetric tsvakurudzo unyanzvi. pakutanga pelvic kuyerwa akaita pamuviri. Yapera bata chino chiremba mberi palpation ari mudumbu wevakadzi. Ndiwo padariro chikumbiro Leopold yemichato. Next, enda auscultation, kana kuteerera fetus mwoyo. Pane zvinokosha kakawanda mwoyo anorova (dzinowanzoona kubva 120 kusvika 160 anorova paminiti.), Avo zvakajeka uye mutinhimira. Auscultation rinoitwa uchishandisa stethoscope kana fetus Monitor.

External uye munyika tsvakurudzo kusununguka kunokosha chaizvo panguva yepamuviri uye pashure pakusununguka. Mukadzi anofanira kunzwisisa izvozvo, kuzvibata zvakakodzera uye chero zvazvingava hariregi kure navo. Vanobatsira chiremba kuwana kana kuipa Rwako pamuviri akanaka kana amai vanepamuviri uye mwana wake.

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