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ЗмістThe pelvic muscles
Early pregnancy diagnostics
Late pregnancy diagnostics
Fetus Attitude in the Uterine Cavity (fetus position, the type of position, presentation)
External obstetric examination maneuvers (the leopold's maneuvers)
Measuring the abdomen circumference and the height of uterine fundus standing
Calculating the foreseeable fetal body weight
V. Organizational structure of lesson
VI. Methodical support
There are no indications for additional pelvic measurements.
One can determine saggital suture
Head of obstetrics and gynaecology department №2
docent, k. m. n. O. V. Bulavenko
Obstetrics and gynaecology department №2
Methodical recommendations for students of 4th year of stomatological faculty for practical lessons in obstetrics
Theme: Parturient canal and fetus as an object of childbirth. The structure of female pelvis, measurements. Mature fetal head structure. Early pregnancy diagnostics. Late pregnancy diagnostics. Fetus position, the type of position, presentation. Auscultation of heartbeats. Additional methods of examination at second part of pregnancy. Self-guided work.
The main theme in obstetrics. It is important for further study of obstetric discipline, particularly about delivery biomechanism of childbirth, clinical correlation of fetus and pelvis.
Il. Scientific and educational goals
To generate skills the student should know:
The student should be able to:
III. The basic knowledge:
IV. Methodical recommendations for practical training:
The structure of female pelvis, measurements
From considerations of obstetrics the female pelvis is divided into two parts: the large and small pelvis. The border between them goes along the innominate line (linea innominata). The large pelvis is bounded by the wings of ilia on either side, by the spine — from behind, and there is no wall from the front. The small pelvis is formed by the pubic bones branches from the front, by parts of the bones forming the femoral fossa — on the sides, and by the sacral and pelvic bones — from behind .
During delivery the small pelvis, as a dense bone tunnel, limits and defines the dimensions, form, and direction of the parturient canal, to which the fetus moves and must conform, changing its own configuration.
Pelvis measuring is the most important method of pelvis examination.
Most internal dimensions of the pelvis are inaccessible for measurement, therefore usually its external dimensions are measured, by which the internal ones are evaluated.
The pelvis is measured with the help of the pelvimeter.
Usually there are measured four main dimensions of the pelvis: three transversal and one straight. Distantia spinarum is the distance between the anterosuperior axes of the ilia. This dimension makes 25 cm. Distantia cristarum is the distance between the most distant points of the iliac crests; it makes 28 cm on average. Distantia trochanterica is the distance between the greater trochanters. This dimension makes 21 cm.
Conjugata externa (external conjugate) is the straight dimension of pelvis. The woman is put on her side; the leg lying below is bent in the hip and knee joints, the other leg is straightened. The end of the pelvimeter is set in the middle of the superior-external border of the symphysis, the other end is pressed to the supersacral fossa, which is situated between the process of the fifth lumbar vertebra and the beginning of the first sacral vertebra. The external conjugate makes 20 cm.
Dimensions of small pelvis are of great importance in obstetric-practice since the course and completion of delivery depend on them. But most dimensions of small pelvis can not be measured directly. The large pelvis is not of big importance for the birth of a child, but it is possible to judge about the form and size of small pelvis by its dimensions. The small pelvis cavity is the space between its walls, limited from above and from below by the area of brim and the area of pelvic outlet. It looks like a cylinder truncated from the front backwards in such a way that the anterior part (directed to the womb) is three times as low as the posterior one (directed to the sacral bone). There are differentiated four planes in the small pelvis cavity: the area of brim, the pelvic plane of greatest dimensions, the third parallel pelvic plane, and the area of pelvic outlet.
The planes of small pelvis and their dimensions:
a) the area of brim is limited from behind with the promontory
of sacral bone, on the sides — with the terminal lines of hip bones,
from the front — with the upper margin of pubic bone and symphysis.
There are differentiated four dimensions.
The straight dimension — the distance from the promontory of sacral bone to the most protrudent point of the superointernal margin of symphysis, it is also called the true or obstetric conjugate (conjugata vera), makes 11 cm. There is also distinguished the anatomic conjugate (conjugata anatomic) — the distance from the promontory of sacral bone to the upper margin of symphysis, it is by 0.3 cm larger than the obstetric one.
The transversal dimension — the distance between the utmost points of the arcuate lines of ilia (linea innominata); it makes 13 cm.
The oblique dimension (left and right) — the distance from the left sacroiliac joint (articulatio sacroiliaca) to the right iliopubic eminence (eminentia iliopubica) and vice versa; it makes 12 cm.
b) the pelvic plane of greatest dimensions is limited from behind
by the junction of the second and third sacral vertebrae, from the
sides — by the middle of femoral fossae, from the front — by the mid
dle of the internal surface of symphysis. In this plane two dimensions
are differentiated — straight and transversal.
The straight dimension — from the projection of the junction of the second and third sacral vertebrae to the middle of the internal surface of symphysis; it makes 12.5 cm.
The transversal dimension — between the middles of femoral fossae; it makes 12.5 cm.
c) the third parallel pelvic plane is limited from the front by the
inferior margin of symphysis, from behind — by the sacrococcygeal
joint, from the sides — by the axes of ischial bones. There are differen
tiated two dimensions of the third parallel pelvic plane — straight and
The straight dimension — from the sacrococcygeal joint to the middle of the inferior margin of pubic symphysis; it makes 11 cm.
The transversal dimension — between the internal surfaces of ischial bones axes; it makes 10.5 cm;
d) the area of pelvic outlet is limited from the front by the infe
rior margin of symphysis, from behind — by the pelvic bone apex,
from the sides — by the internal surfaces of ishial tuberosities. The
dimensions of the area of pelvic outlet are straight and transversal.
The straight dimension — the distance from the middle of the inferior margin of symphysis to the pelvic bone apex; it makes 9.5 cm (during delivery, when the fetal head is being born, the pelvic bone reclines by 1.5 cm and the straight dimension increases to 11 cm).
The transversal dimension — the distance between the internal surfaces of ishial tuberosities; it makes 11 cm.
The dimensions of the pelvic outlet can be measured directly. For this purpose the pregnant is put on her back, the legs are bent in the hip and knee joints, moved sideways and pulled to the stomach. The measurement is conducted with a measuring tape or a special pelvimeter.
The straight dimension is measured between the mentioned above landmarks. To measure the transversal dimension-one should add 1.5 cm to the obtained distance between the internal surfaces of ishial tuberosities (9.5 cm), taking into account the soft tissues thickness.
The line, which goes in the middle of all the straight dimensions of the planes, is called the axis of pelvis (the plane of pelvic canal). The pubic angle makes 90—100°, the angle of pelvic inclination — 55—60°. The height of symphysis is measured during vaginal examination and makes 3.5—4 cm.
The most important dimension for pelvis evaluation is the true conjugate, which can not be measured directly. Therefore it is calculated from the dimensions, which are accessible to measurements — the external and diagonal conjugates.
To find the true conjugate 8 cm are subtracted from the value of the external conjugate if the circumference of the radiocarpal articulation < 14 cm; 9 cm — if the circumference of the radiocarpal articulation makes 14—16 cm; 10 cm — if the circumference of the radiocarpal articulation > 16 cm. For example: 20 cm - 9 cm = 11 cm.
The diagonal conjugate is the distance from the inferior margin of symphysis to the most protrudent point of the sacral bone promontory. The diagonal conjugate is measured by means of vaginal examination.
When introduced into the vagina, the index and long fingers move along the hollow of sacrum to the promontory of sacra, the tip of the long finger is fixed on the promontory apex, and the edge of palm rests against the inferior margin of symphysis. The place, where the doctor's hand touches the inferior margin of symphysis, is marked with a finger of the other hand. After the fingers are taken out of the vagina, the distance from the tip of the long finger to the marked point of the palm edge encounter with the inferior margin of symphysis is measured with a measuring tape or a pelvimeter.
The diagonal conjugate makes 13 cm on average. If it is impossible to reach the sacral bone promontory with a fingertip, the diagonal conjugate dimension is considered close to normal.
In order to find the true conjugate one has to subtract 1.5—2 cm from the diagonal conjugate depending on the circumference of the radiocarpal articulation: if the circumference makes 15 cm — 1.5 cm, if it makes 16 cm and more — 2 cm.
The main external pelvis dimensions and diagonal conjugate are measured in all pregnant and parturient women without exception.
If examination shows that the main dimensions are irregular and narrow pelvis is suspected, additional measurements are conducted.
The perineum forms the pelvic floor, closing its outlet. In obstetrics the notion of perineum is narrower than in anatomy, where perineum is the space between the posterior commissure of pudendal lips and the anterior margin of anus.
The floor of small pelvis is formed by two diaphragms — pelvic and urogenital.
The pelvic floor muscles consist of three layers.
The superficial (external) layer is formed by such muscles: ischiocavernous (m. ischicavernosus) — begins from the ishial tuberosity and interweaves with the clitoris tissues; bulbocavernous (m. bul-bospongiosus) — begins from the tendinous center of the perineum and attaches to the vaginal walls; the external sphincter muscle of anus (m. sphincter ani externus) — begins in the region of the pelvic bone apex, envelops the anus, and interweaves into the tendinous centre of the perineum; the superficial transverse muscle of perineum (m. transversum perinei superficialis) — begins from the ishial tuberosity and ends in the tendinous centre of the perineum.
The middle layer of the pelvic floor muscles consists of the urogenital diaphragm, which is located between the symphysis pubis, pubic and ischial bones in the form of a triangle. It is formed by the sphincter muscle of urethra (m. sphincter urethrae internum) and the deep transverse muscle of perineum (m. transversus perinei profundus).
The internal layer of the pelvic floor muscles is named the pelvic diaphragm. This is the strong binate elevator muscle of anus (m. levator ani), which consists of muscle bundles: pubococcygeal (m. pubo-coccygeus) and iliococcygeal (m. iliococcygeus). The coccygeal muscle (m. coccygeus) is rudimentary and attaches to the lower vertebrae of sacral and pelvic bones.
Morphologic features of the fetal head and body
Mature fetal head structure. On the fetal head there are sutures (frontal, sagittal, coronal, lambda) and fontanels (large, small, and two lateral on each side).
The frontal suture is situated between the frontal bones, the sagittal suture — between the parietal bones, the coronal suture — between both frontal and both parietal bones, the lambda suture — between two parietal and the occipital bone.
The large fontanel (anterior) is located between the posterior parts of both frontal and anterior parts of both parietal bones; it is a rhomboid connective tissue plate. The small fontanel (posterior) is triangular and is located between the posterior parts of both parietal bones and the occipital one.
The large and small fontanels are joined with the sagittal suture.
The lateral fontanels are situated: anterior — between the frontal, temporal and cuneiform bones, posterior — between the temporal, parietal and occipital bones. They are closed in a mature fetus.
The fetal head has the following dimensions and corresponding circumferences:
---the middle oblique dimension (d. suboccipito-frontalis) is measured from the occipital fossa to the margin of the pilar part of forehead, makes 10 cm. The corresponding circumference makes 33 cm;
---the vertical dimension (d. sublinguabregmaticus) is measured from the middle of large fontanel to the hyoid bone, makes 9.5 cm; The corresponding circumference makes 33 cm;
Mature and full-term fetus signs
Fetal maturity signs:
1. mature fetus' height is more than 47 cm;
2. mature fetus' weight is more than 2,500 g;
3. the umbilical ring is located in the middle between the uterus and the xiphoid process;
4. the skin is pink, healthy, developed. Vernix caseosa is found only in the inguinal and axillary folds;
5. the fingernails cover the ends of finger bones;
6. the hair on the head is 2 cm long;
7. the cartilages of nose and ears are tight;
8. in boys the testicles are in the scrotum; in girls the large lips of pudendum cover the clitoris and small lips of pudendum.
The fetus is considered full-term if it is born in the period from the 37th to the 41st week of pregnancy inclusive. Most often there is perfect coincidence between fetal maturity and its being full-term. Still, sometimes a child is born before the term being absolutely mature by its development. At unfavorable conditions of intrauterine development a full-term child may have signs of immaturity.
Early pregnancy is diagnosed by a combination of signs, data of gynecologic examination, instrument and laboratory methods of investigation.
Pregnancy signs are divided into three groups.
1. Doubtful signs are various subjective sensations and objec
tively detected changes in the organism except for the changes in the
internal genital organs:
2. Probable signs are objective signs detected in the genital or
gans, mammary glands, and also with the help of immune response to
pregnancy. These are characteristic of pregnancy, though sometimes
may arise because of other reasons. The signs include cessation of
menstruation at the childbearing age, mammary glands enlargement,
and nipple discharge of milk or colostrum.
Probable signs also include gynecological examination data: inspection of the external genital organs, examination of the neck of uterus with the help of specula, bimanual gynecological examination. Softening and cyanosis of the vestibule of vagina, vagina itself, and the neck of uterus may be observed; enlargement and softening of the uterus, change in its form; increase of the contractile capacity of uterus (short-term hardening of the softened uterus).
During the examination of the gravid uterus the most important signs are the following:
a) the Genter's sign: vaginal examination during early pregnancy shows a cristate protuberance on the anterior surface of uterus, directly on its midline; the protuberance does not spread either to the fundus, or its posterior surface, or the neck;
Probable signs include immune responses to pregnancy, which are based on HCG detection in the urine or blood plasma. HCG is produced by the trophoblast, then by the chorion, placenta. This hormone consists of alpha- and beta-subunits. Production begins from the 7th—8th day after fertilization, therefore laboratory diagnostics is possible after this term. Since the method has a threshold of sensitivity, one should take morning urine for the investigation — it has the highest concentration of the hormone. Detection of beta-HCG in the plasma is more reliable. It should be emphasized that though HCG is produced by trophoblast, the reaction is referred to probable signs, because at such pathological state as chorioepithelioma positive reactions to HCG are also observed. Besides, after abortion reactions remain positive during 7—10 days, and at pathological states (trophoblast diseases) — during 2—4 months. The lower threshold of sensitivity of the method is 5 IU/L.
3. True signs of pregnancy are conclusive proofs of pregnancy in the examined woman. All the signs of this group are objective and originate from the fetus. They include the signs shown by intravagi-nal ultrasound investigation. Other true signs reveal beginning from the 20th week of pregnancy and do not belong to the signs of early pregnancy; they are: fetal movement detected manually or during auscultation (not the movement felt by the pregnant woman); auscultation of fetal heart tones; palpation of fetal parts (the head, legs, buttocks, arms); detecting fetal heartbeats by means of cardiotoco-graphy. It should be noted that application of the color impulsive Doppler is forbidden till the end of the crucial period of organogenesis. This is connected with the fact that the usage of modern Doppler technologies at transvaginal echographies if pregnancy term is less than 10 weeks has a potential threat of teratogenic thermal effect as a result of embryo heating.
Currently the standard of early pregnancy diagnostics is the combination of two methods:
a). detecting beta-HCG in the urine or blood plasma;
b). transvaginal ultrasound investigation.
The uterus dimensions during the first 3 months of pregnancy, when it is still in the small pelvis cavity, are detected by means of bimanual gynecological examination, further at abdominal palpation — by the height of uterine fundus standing.
The accuracy of pregnancy term determination depends on the early visit of the woman to the antenatal clinic. It is recommended to conduct the primary examination of the woman by two specialists-obstetricians. Taking into account the difficulty of detecting the term of fertilization, pregnancy is diagnosed with a week interval (for example: pregnancy of 8—9 weeks). Pregnancy term is detected more reliably on the basis of measuring the parameters of the embryo and fetus by the method of ultrasound investigation.
The methods of late pregnancy investigation include: general examination of the pregnant or parturient woman, external measuring of the uterus and pelvis of the woman, external and internal obstetric examination; auscultation of fetal heartbeats, auxiliary instrument and apparatus methods of investigating the fetal condition (see the chapter Fetal Condition Imaging and Assessment).
Anamnestic data — pregnancy term calculation in weeks with the help of the pregnancy table from the date of the last menstruation and from the date of the first fetal movement (in para I the first fetal movement is usually felt beginning from 20 weeks of pregnancy, in para II — from 18 weeks). To calculate the term of delivery by the date of the last menstruation one has to count 3 months off it and add 7 days to the obtained date.
Results of objective examination — the height of uterine fundus standing over the womb at measuring with a measuring tape in relation to a standard gravidogram, external obstetric examination (the Leopold's maneuver), auscultation of fetal heartbeats (beginning from 20 weeks), the data of ultrasound fetometry.
Attitude of fetus is the relation of small fetal parts and head to the body. At normal attitude the spine is bent to the abdominal surface, the head is pulled to the chest, the arms are bent in the elbow joints and folded on the chest, the legs are bent in the knee and hip joints, pulled to the stomach.
Fetal lie is the relation of the longitudinal axis of fetus to the longitudinal axis of uterus. There are differentiated the following fetal lies:
--- longitudinal — the longitudinal axis of fetus and the longitudinal axis of uterus coincide;
--- transversal — the longitudinal axis of fetus crosses the longitudinal axis of uterus;
Fetus position is the relation of the fetal back to the right and left sides of uterus. Two positions are differentiated:
At transversal and oblique lie the position is detected by head location: the head is on the left of the maternal stomach midline — the first position, on the right — the second.
The type of position — relation of the fetal back to the anterior or posterior uterine wall. There are two types:
--- anterior — the fetal back is turned to the front;
--- posterior — the fetal back is turned backwards.
Presentation is the relation of a big fetal part (the head or pelvis) to the inlet of small pelvis. There are differentiated cephalic and pelvic presentations.
A presenting part is the part of fetus, which is located closer to the inlet and is the first to go through the maternal passages. At the bent fetal head the most low located part is the occiput. Such presentation is called vertex and is observed most often.
Considerably less frequently the head is unbent. Depending on the level of unbending the presenting part may be the crown (sincipital presentation), forehead (brow presentation), or face (face presentation).
At pelvic presentation the most low located part might be the buttocks (breech presentation) or feet (foot presentation).
The major segment of fetal head is understood as the largest circumference of the head, with which it goes through the planes of small pelvis depending on its fitting. At vertex presentation, when the head is fitted into the pelvis in bent position, the largest circumference is the one corresponding to the circumference of the small oblique size. At extended fitting of the head the major segment will be different (depending on the degree of deflexion).
The minor segment of fetal head is considered by convention the part of the head smaller than the major segment, with which the head goes through the smaller pelvis planes.
The first maneuver. The purpose is to detect the standing of the fundus of uterus and the part of fetus located close to the fundus of uterus. To do this, the doctor stands on the right of the pregnant woman, facing her, puts both palms on the fundus of uterus, detects the height of its standing over the womb and the part of fetus located close to the fundus of uterus.
The second maneuver. The purpose is to detect the position and position type of the fetus. Both palms are removed from the fundus of uterus and in turn palpate the parts of fetus directed to the lateral uterine walls. The back and small parts of fetus are found. At irregular position the head is adjacent to one of the lateral uterine walls.
The third maneuver. The purpose is to detect the character of the presenting part of fetus (presentation). With one hand, usually the right one, which is lying slightly above the pubis, the presenting part of fetus is covered, after what cautious movements are made with this hand to the right and to the left. At cephalic presentation a dense, spheric part is detected, which has well-defined contours. If the fetal head is not yet fitted into the area of brim, it easily moves between the thumb and the rest of fingers. At pelvic presentation a voluminous soft part is detected, it is not spheric and can not move.
The fourth maneuver. The purpose is to detect the level of presenting part standing (of the head in particular) relative to the area of brim and to the degree of its fitting. The doctor stands on the left, with the face to the lower extremities of the pregnant woman, puts both hands with palms down on the lateral parts of the lower uterine segment and palpates accessible parts of the presenting part of fetus, trying to get with the fingertips between the presenting part and lateral parts of the area of brim.
Abdomen circumference (AC) is measured with ameasuring tape, which goes through the navel in front and through the middle of lumbar area from behind.
The height of uterine fundus standing (HUFS) is measured with a measuring tape from the upper margin of symphysis to the most protruding point of the fundus of uterus. The results of HUFS measuring are compared with a standard gravidogram (normally by the 30lh week of pregnancy HUFS increase makes 0.7—1.9 cm a week; at 30—36 weeks — 0.6—1.2 cm a week; at 36 and more — 0.1—0.4 cm. If case monitoring shows lagging of dimensions by 2 cm or absence of increase during 2—3 weeks, it gives ground to suspect fetal growth inhibition).
The foreseeable fetal body weight (FBW) is approximately calculated by the following formula:
FBW = AC x HUFS. More reliably fetal body weight is estimated by ultrasonic fetometry.
Auscultation of heartbeats
CTG structure and analysis:
Record width (amplitude) is measured between the absolute maximum and minimum of all oscillations nonregistering accelerations and decelerations, i.e. the amount of deflection from the basal rhythm (Fig. 32).
In the given example the amplitude will make 150-135 = = 15(bpm).
There are differentiated 4 variants of amplitude:
— pulsating (saltatory rhythm) — more than 25 bpm.
Oscillations frequency is their quantity per minute.
By frequency there are differentiated low (less than 3 per min), medium (3—6 per min), and high frequency (more than 6 per min) oscillations.
By the character of origination accelerations and decelerations may be sporadic, periodical, and regular, by duration — typical and prolonged.
Sporadic — appear in response to fetal movements, are not regular.
Regular — are registered in approximately equal intervals of time and are connected with fetal movements.
Periodical — are connected with fetal vital activity, e.g. accelerations and decelerations arising after a labor pain or caused by umbilical cord compression.
Typical accelerations and decelerations last more than 15 sec, but not longer than 2 min.
Accelerations and decelerations are prolonged if basal rhythm change lasts more than 2 min.
4.1. Spontaneous decelerations (dip 0). Short-term decelerations, last not more than 30 sec, the amplitude of 30—40 beats from the basal level. These changes have no practical meaning. Decelerations of this type may be sporadic, regular, and periodical.
4.2. Early decelerations (dip I) are periodical, i.e. are detected only if the uterus is active. Deceleration duration and amplitude correspond to the duration and intensity of parodynia.
4.3. Late decelerations (dip II) are periodical, i.e. also connected with parodynia, but arise later (up to 30 sec after beginning) and reach their high after the maximum uterine tension.
4.4. Variable decelerations (dip III) are also referred to periodical. This is a stable form of HR reduction, a combination of dip I and dip II. They are characterised by unsteady time of emergence relative to labor pains, different duration and form. During delivery fetal condition is assessed by the W. Fisher's scale (1976).
At normal fetal condition CTG is characterized by: BHR within 110—170 bpm (normocardia), variability (record width) — 10— 25 bpm with oscillation frequency of 3—6 cycles per min (undulating type), presence of HR accelerations and no decelerations.
Non-stress test (NST) is assessment of fetal cardiac function reactivity with the help of CTG during pregnancy in response to spontaneous movements. The pregnant woman is in comfortable position during CTG.
NST may be reactive (norm) when during 20 min there are 2 or more accelerations of fetal heartbeats by. more than 15 bpm and lasting not less than 15 sec connected with fetal movements. The test is areactive if there are less than 2 accelerations of fetal heartbeats by less than 15 bpm, lasting less than 15 sec, connected with fetal movements during 40 min of monitoring.
Stress test is assessment of fetal cardiac function reactivity by means of CTG during pregnancy in response to functional tests: oxytocin introduction, breath-holding, physical load of the mother, nipples stimulation, thermal irritation of the belly skin, or acoustic stimulation. This method has low predictive value concerning the fetus and a very high frequency of error-positive results.
Biophysical fetal profile (BFP) is a change of biophysical indices controlled by the central nervous system at fetal hypoxia.
Biophysical indices include: frequency of fetal respiratory movements, fetal motion activity, fetal tone, fetal cardiac function reactivity and NST, amniotic fluid volume, placenta maturity (Table 3).
Modified BFP combines NST with amniotic fluid index.
Amniotic fluid index is a total of maximal recesses with fluid in 4 quadrants of the uterine cavity: 0—5 cm — evident oligohydramnios, 5.1—8 cm — moderate oligohydramnios, 8.1 — 18 cm — normal index, more than 18 cm — hydramnion.
Each index is assessed in points from 0 (pathology) to 2 (norm), then the total of points of all biophysical parameters is analyzed. Thus, BFP is found.
BFP is detected beginning from 30 weeks of pregnancy.
Indications to BFP:
1. Areactive NST of the fetus at CTG recording.
2. Syndrome of fetal development delay.
3. Chronic fetoplacental insufficiency.
4. A high degree of risk in the pregnant woman at some extragenital pathology.
Topic motivation -3%;
Checking the initial level of knowledge -20%;
Independent work of students under supervision of a lecturer -35%;
Checking the final level of knowledge -20%;
The rating of students` knowledge -15%;
Lecturer`s summary/conclusion, home task-5%.
The place of practical training: department of pathology pregnant, gynecology department, intensive care department, low operating, classroom.
Visual aids: tables, slides, results of laboratory examinations, case histories of pregnant women with early and late gestosis, a set of tools for abortion.
Checking questions for the assessment of the final level of knowledge
Case studies for the assessment of the final level of knowledge
On pelvimetry there is noted that the diagonal conjugate equals 12.5 cm and carpus circumference is 15 cm.
Which suture can be determined on the presenting part during internal examination if under the pubic it is conjugated with a triangular shape fontanel and at sacrum – with rhomb-shaped fontanel? Reproduce this situation on the phantom.
Which suture can be determined on the presenting part if in front under the pubic it is conjugated with a hornlike fontanel and at sacrum – with a triangular shape fontanel? Reproduce this situation on the phantom.
The newborn boy weighs 2, 500 grams, 45 cm long.
On measuring the main pelvis dimensions there was noted that the interspinal distance Distantia spinarum equals 26 cm, intercrista one Distantia cristarum equals 28 cm, intertrochanteric Distantia trochanterica one is equal 31 cm, external conjugate is 20 cm. On internal examination the promontory was not approached.
On pelvimetry there is noted that the diagonal conjugate equals 12 cm. The circumference of the radiocarpal articulation is 14 cm.
On pelvimetry there is noted that the diagonal conjugate equals 12.5 cm and carpus circumference is 15 cm.
True conjugate equals 10.5 cm
On measuring the main pelvis dimensions there is noted that the interspinal distance Distantia spinarum equals 24 cm, intercrista one Distantia cristarum equals 25 cm, intertrochanteric one Distantia tro-chanterica is equal 29 cm. External conjugate is 20 cm. On internal examination there is noted that the diagonal conjugate equals 12 cm.
On measuring the main pelvis dimensions there is noted that the interspinal distance^ m equals 26 cm, intercrista one Distantia cristarum equals 28 cm, intertrochanteric one Distantia tro-chanterica is equal 31 cm, external conjugate is 20 cm. On internal examination the promontory was not approached.
Which suture can be determined on the presenting part on internal examination if in front it is conjugated with a triangular shape fontanel and at the back – with a rhomb-shaped fontanel? Reproduce this situation on the phantom, when the small fontanel is under the pubic and the big one is at the sacrum bone.
The newborn boy weighs 2, 500 grams, 45 cm long.
The infant is immature. For diagnostic adjustments one should consider the following signs: the position of umbilical ring, skin coloration, presence and amount of lubricant, length of nails, hair, and consistency of nose and ear cartilage, the condition of external genitals.
Test questions for the assessment of final level of knowledge
On pelvimetry it is found out that the diagonal conjugate equals 12 cm. The circumference of the radio carpal articulation is 14 cm.
C. 11 cm
D. 9.5 cm
On the presenting head one can palpate the triangular shape conjunctive tissue plate where three sutures come together.
A. Big fontanel
B. Side front fontanel
C. Small fontanel
D. Side back fontanel
The place of practical training: classroom, delivery room, compartment of pregnant pathology, children’s compartment.
Visual aids: tables, model of pelvis, centimeter tape, pelviometr, case studies and test questios.
Appoved at the chair meeting from “___” _____________________ 200__ year,
minutes № ___ .
Revised at the chair meeting from “___” _____________________ 200__year,
minutes № ___
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