Kunja ob: madyerero

Amayi oyembekezera si ndekha ndi mavuto awo zachipatala. Pofuna kuthana nawo mokwanira ntchito kwa nyumba yogona kuchipatala antenatal, ndipo kumeneko thandizo zofunikira ndi nkhani. Mu zipatala zimenezi, pali malamulo a mayi oyembekezerayo ndi kuyendera ake. Pali chinthu monga kafukufuku kunja obstetric, zomwe zikusonyeza thandizo kwa mkazi woyembekezera, pokonzekera kubereka. Ndichiyani ndi chimene chikuchitika ndi malamulo, kukambirana pansipa.

Kodi kunja uzamba kafukufuku?

akazi ambiri akudziwa kuti mimba n'kofunika kukalembetsa mu chipatala chigawo. Ulendo woyamba gynecologist pambuyo chitsimikiziro cha chikhalidwe ichi si kukoma aliyense, chifukwa zimatenga kwa mphindi 40. Chotero nthawi yaitali angopita pachabe mu ofesi ya dokotala. Ndipotu, katswiri amayenera kukumana ndi mkazi wapakati, komanso kusonkhanitsa onse ndi wapadera mbiri. Komanso akusankhidwa ndi mayesero zasayansi, ndipo anachita kunja kafukufuku uzamba.

Kumafuna kuona koyamba, amene ali aligorivimu yake. Phwando panja kafukufuku uzamba chofunika kusonkhanitsa deta za mkazi. dokotala Nkofunika kudziwa udindo wa akazi chifuwa, makamaka mawonekedwe a nipple, chifukwa kumakhudzanso ya miyeso kukonzekera kudya. Gynecologist amamvetsera mmene mayi woyembekezerayo chapeza pogwiritsa kuchokera pamene mimba, mtima kwambiri n'kunena mokalipa mlingo kulemera kwa nthawi yonse akuyembekezera mwana.

Kuchititsa kunja kafukufuku obstetric kumatanthauza kusonkhanitsa mfundo za mimba yapita ndipo amamuyambitsa timabala la chiberekero. Zimenezi n'zofunika kukhazikitsa chiopsezo pathologies mimba. Kuwonjezera anayendera, amagwiritsa ntchito njira muyeso, palpation ndi auscultation, zomwe zimathandiza kuti kumvetsa kuti akule ndi chikhalidwe cha akazi, malingaliro oipawo kukula. Pansipa, njira zimenezi anafotokoza mwatsatanetsatane.

Kodi ndi mitundu iti ya maphunziro amenewa ndi?

Kudziwa udindo zotuluka pa mkazi wapakati sikokwanira chabe mafunso ake. Ngakhale popanda zidule onse palpatsionnye kunja kafukufuku obstetric adzakhala nkhani kwa akatswiri. Kuti chithunzi chonse cha mkazi woyembekezera, ndi thanzi mwana wake, tiyenera kudziwa zimene njira kutenga malo mkati mtembo wa pakati. Tingaone zimenezi mothandizidwa ndi zasayansi kusanthula magazi, mkodzo, ndi zina zotero. Komanso dokotala nthawi zonse amamva nyenyeswa kugunda ndi kuthandauza pamalo ake chiberekero. mwai onsewa anasonyeza mbali yaikulu mitundu itatu ya kafukufuku pakati:

• matenda;
• zasayansi;
• wapadera.

Matenda Kupenda pakati

Mtundu wa akazi kafukufuku pa mimba kuyamba ndi mndandanda wa mbiri zachipatala ndi uliri pakali pano. zinthu izi osati kuthandiza dokotala wazitenga kuti pa thanzi la mayiyo, iwo mpata kuti aone ntchito zake neuro-zamatsenga.

Yambani Kupenda matenda ndi kafukufuku amene likukhalira zokhudza mkazi.

1. Umboni wa mayi tsogolo la munthu (dzina pasipoti - nambala zino).
2. Age limene nulliparous a gulu lapadera (mnyamata - khumi, m'badwo - patatha zaka makumi atatu).
3. Adiresi enieni okhala ndi kulembetsa kwa akazi.
4. Chifukwa ndipita kwa dokotala-gynecologist.
5. zinthu zakuthupi moyo (angati anthu amoyo ndi nyama m'chipinda chimodzi ndi mkazi, osauka), komanso kumene ntchito kuthana (pa zoipa liyenera kuganizanso za ntchito zambiri zomveka kwa iye, ndipo zipatso za zinthu ntchito).
6. Information za magazi ndi zigawo zake (plasma, albumin), chifuwa, matenda somatic, Oncology. Nthawi zambiri somatic yachibadwa sizikutanthauza wathunthu thanzi, chifukwa munthu akhoza kuona disruptions wa ntchito maganizo ndi mantha. dotoloyo ndi ntchito - kuzindikira zinthu zimene zinachititsa kuti kuyan'anila izi, chifukwa akazi ndiwo amakonda kubereka, ndi pa chikhalidwe zimadalira thanzi la mayi ndi mwana wosabadwa. Zimayambitsa neuroses ndi matenda ena a mantha ndi maganizo ntchito, kwambiri:

• matenda ofalitsidwa;
• nkhawa;
• yaitali osabereka;
• mimba;
• choipa pa kubadwa m'mbuyomu.

Gynecologist wapeza kuti pali zizindikiro za kuyan'anila za ntchito neuro-zamatsenga: pamaso mimba, kapena imodzi pakuwonekera kwake. M'pofunikanso kupeza zimene mkazi zikugwirizana anachokera.

7. AIDS mbiri.

8. zonse kuledzera (kusuta, kumwa mowa mwauchidakwa, mankhwala ozunguza bongo).

9. kusamba ndi zokhudza kugonana ndi ubereki wabwino (pamene kusamba anayamba, monga otaya, ndi mimba kale kubadwa, kulemera ndi udindo thanzi la ana yapita, matenda opatsirana pogonana ndi matenda mimba).

10. mbiri Banja (ukupeza a m'banja limodzi ndi mkazi, chibadwa, thanzi, gulu ndi RH amayanjana bambo mtsogolo).

Kenako, kusuntha kwa cholinga mosamala mayi tsogolo:

• Uphungu madokotala, mano, maso ndi ENT. Ngati ndi kotheka, kusankha akatswiri kuyendera ena.
• Kuyeza kutentha ndi kuthamanga kwa magazi.
• Unikani ndi kukula kwa thupi ndi kuyeza kutalika, kulemera ndi miyeso ya mafupa a chiuno ndi.
• Kuyendera ndi palpate pamimba.
• Pendani magazi, mkodzo ndi secretions ena.
• Kufufuza symphysis pubis.
• Kodi ndi electrocardiogram.
• Ultrasound tione zofunika pochitika mkazi aliyense pakati mpaka akhumi ndi, chakhumi ndi chisanu ndi chitatu makumi awiri chachiwiri ndi mphindi 32 pa mlungu 34.
• Agwire kunja uzamba kafukufuku.

Nkofunika kuti mkazi mayina pasanafike masabata 12 a gestation. Kale anachita anthropometry mayesero zasayansi ndi kufufuza magazi, ndi apamwamba n'zotheka kukhala ndi mwana wathanzi kapena kuzindikira yoopsa chosayenerera atakwatirana ndi moyo.

Laboratory maphunziro a akazi

Pamene mayi woyembekezera kamakhala anawawerenga, iwo anatuma matenda magazi mayesero urinalysis umakhala gulu ndi RH chinthu, magazi shuga, Yang'anani Nalia RW, matenda a chiwindi, HIV, ndiponso scrapings ndi swabs ku nyini ndi khomo pachibelekeropo pa zomera, cytology, chlamydia, chinzonono, trichomoniasis.

Ngati yasonyeza kubadwa kwa ana akufa, padera (makamaka magawo Patapita), extragenital kudwala, m'pofunika:

• kupanga kuphunzira magazi mkazi pamaso pa hemolysin;
• gulu magazi tsogolo bambo angagwiritsidwe ntchito pofufuza ndi uchembere wabwino, makamaka ngati mimba rhesus chinthu zoipa kapena gulu 0 (I);
• kudziwa pamaso pa matenda urogenital;
• kudziwa mlingo wa mahomoni zofunika, immunoresistance;
• ngati n'koyenera kafukufuku chibadwa.

Komanso zasayansi kuyezetsa ikuchitika mawu akuti:

• Ndondomekoyi - mwezi ndi sabata thirtieth - kamodzi pa masiku khumi ndi inayi;
• panthawi iliyonse mkodzo phwando mankhwala pa kusanthula chonse;
• pa chakhumi ndi chisanu ndi chimodzi sabata la makumi awiri kudziwa hCG ndi Ace;
• pa masabata 22-23. ndipo masabata 36-37. tione shuga;
• Phunziro pa dongosolo coagulation (coagulation) kubala 36 sabata 37;
• pa masabata makumi atatu, ndi masabata awiri kapena atatu pamaso akubereka kachiwiri ndisanabadwe kwa HIV ndi RW, tione swabs ndi scrapings.

ob Special

Special kafukufuku obstetric zikuphatikizapo:

1. Kuchititsa kunja kafukufuku obstetric.
2. Internal uzamba kafukufuku.
3. Other zina maphunziro.

Panja kufufuza obstetric ndi bwinobwino muyeso wa kukula kwa mafupa a chiuno ndi. Pambuyo pa sabata la makumi awiri anatsimikiza kukula kwa circumference waukulu wa pamimba, anachita akufufuza mpata pamimba ndi a symphysis obisika, ndi prolushivaniya mtima yoopsa. kunja obstetric zida kafukufuku si kwapafupi, izo ikuchitika yekha ndi azachipatala ophunzitsidwa mwapadera.

Internal uzamba kafukufuku. Mu uzamba mkati kafukufuku zikuphatikizapo mosamala kumaliseche zakunja nyini ndi khomo pachibelekeropo kuphunzira ntchito kalirole. Ndi lofunika kwambiri monganso mmene kunja obstetric kafukufuku pobereka. Ndondomeko ikuchitika pa matumbo ndi chikhodzodzo. Msonkhano mkazi anafunsa kugona nsana wanu, mapazi kupasuka mu dzanja ndi maondo pa mawondo. Mafupa a chiuno ayenera kukwezedwa. Investigation kwenikweni ikuchitika pansi pa zikhalidwe aseptic.

• phunziro akuyamba ndi mosamala maliseche kunja. Amayang'anitsitsa chikhalidwe cha tsitsi thupi, crotch. Kudziwa njira pathological, ngati iwo: zipsera utaphulika mu kubadwa yapita, zotupa, inflammations, fistulas, njerewere, zotupa mu chotulukira lapansi. Unikani boma la labia vulvar akukankha ndi zala zanu, komanso kudziwa boma la zopangitsa za urethral.

• kufufuza khomo pachibelekeropo mothandizidwa ndi kalirole. Samalani mucous chinsinsi, khomo lachiberekero ndi uterine kukula pakhosi. Mu I-St trimester anagwira kudzifufuza awiri chimanjamanja ku nyini, lachiwiri ndi lachitatu yekha zogwirizana wina chimanjamanja.

Choyamba amati ndi crotch (ngati chinthu chimodzimodzi, amamuyambitsa timabala) ndi nyini (kukula, khoma kungomanga kupezeka).

4 kulandira kunja maphunziro obstetric

Phwando panja uzamba kafukufuku (Leopold njira) ntchito ndi palpation wa pamimba za mkazi wa pakati. Njirazi anayi:

• amanena kutalika woyima chiberekero, ndi kugawana zipatso, zomwe ndi;
• kudziŵa malo mwana wosabadwayo, amene amapanga mfundo zokhudza kupeza kumbuyo ndi manja ake ndi miyendo;
• mtima wa zipatso, amene ali ndi, malo ake poyerekezera ndi mafupa a chiuno yaing'ono;
• mtima yoopsa kupereka gawo pabwino wachibale khomo mafupa a chiuno ndi.

Cholinga cha anayendera khomo pachibelekeropo

Asanabadwe khomo pachibelekeropo anatsimikiza kukhwima, chifukwa limasonyeza bwanji thupi ndi wokonzeka kusiya. Njira kudziwa kukhwima wa khomo pachibelekeropo ndi osiyanasiyana, koma magawo amenewa imawunikidwa mu onsewo:

• kugwirizana;
• zimene kutalika kwa gawo ukazi wa njira ndi;
• patency wa ngalande khomo lachiberekero;
• ili ndi momwe khosi olamulira imatsogoleredwa mu mafupa a chiuno ndi;
• khoma makulidwe a khosi gawo, yomwe ili ndi nyini;
• kudziwa mmene mmunsi mwa chiberekero.

Amayang'anitsitsa chiberekero cha sikelo wapadera. Mwana khomo pachibelekeropo ndi mfundo 0 5. Ngati kuyenderako chasanduka zoposa 10, ndiye mkazi angathe kukonzekera pobereka.

Maphunziro a akazi mafupa a chiuno

Kudziwa miyeso m'chiuno, ntchito ob kunja pakati pelviometriya. Mchikhalidwe kunja miyeso m'chiuno ali motere:

• spinarum mtunda, umene uli wofanana 25-26 masentimita;
• kristarum mtunda - kuchokera masentimita 28 mpaka 29;
• trohanterika mtunda - kuchokera masentimita 31 32;
• Conjugate externa - kuchokera masentimita 20 mpaka 21;
• diagonalis conjugate, amene ayenera kukhala mu osiyanasiyana 12,5 - 13 masentimita.

madokotala ambiri kale pa ulendo woyamba, akazi kuyesera kuyeza conjugate chikhulupiriro (oona), amene amasankha kukula kwa pakhomo kuti beseni yaing'ono. Mwachibadwa, zikhale 11 12 cm. The conjugate woona angapezeke, ngati conjugates akunja (externa) kuchotsera 9 masentimita. kukula kwake komanso likukwaniritsa rhomb Michaelis ndi Frank kukula (anatsimikiza ndi chiwiri vertebrae khomo lachiberekero kuti pakati pa fossa jugular). The opendekera wa conjugate limene lili pakati m'mphepete m'munsi mwa symphysis obisika kwa m'madera ambiri zazikulu krestsovogo Cape, komanso wofanana ndi conjugates phindu lenileni.

Ngati makulidwe a mafupa a chiuno kamo mwakale, izo m'pofunika kuchita maluso kunja obstetric kafukufuku amene miyeso owonjezera: kuyeza mbali conjugate, limene lili pakati pa msana kutsogolo kwa ilium ndi ndi msana kumbuyo mbali imodzi. zake za masiku onse masentimita 14 mpaka 15. Ngati ndi zosakwana 12 ndi theka masentimita, thupi pobereka zosatheka. Komanso kuyeza kukula kwa oblique lapansi. Atatu a iwo, ndipo ngati kusiyana pakati pawo kuposa 1.5 masentimita, woweruza oblique kuchepetsa, amene ndi oopsa pobereka komanso.

Kudziwa komanso mbali m'chiuno ya ndingaliro, zomwe sasiya madigiri 45-55. Ofunika obisika ngodya zomwe ayenera kukhala wolingana ndi madigiri 90-100.

The aligorivimu kafukufuku kunja obstetric monga mtengo wa linanena bungwe la beseni towerengeka;

• mzere kukula, umene uli wofanana ndi masentimita naini. Malowa ali pamtunda pakati pa mapeto m'munsi mwa articulation obisika ndi mfundo chapamwamba coccyx lapansi. Kuchokera deta analandira kulanda masentimita awiri pa zimakhala zofewa;
• tazometrom anayeza yopingasa gawo lomwe ndi 11 masentimita ndi ili pakati pa tuberosity ischial (kali wamumtima).

Phwando Leopold-Levitsky

Yopemphera aliyense dokotala wa akazi mu nthawi ya mimba ndi kwenikweni anakhala kunja kafukufuku uzamba. Phwando Leopold-Levitsky pogwiritsa ntchito zikuluzikulu izo. Dzina njira izi pa mfundo za kale tatchulazi, poluchli m'malo mwa munthu amene anayamba iwo m'zaka za m'ma chakhumi ndi chisanu ndi chinayi mochedwa. Munthu ameneyu ndi German dokotala Mkhristu Leopold. Zimenezi ndi mavuto ambiri obstetric omwe ndi ofunika kwambiri masiku ano.

Iwo kudziwa kukula ndi malo a mwana wosabadwayo mimba mochedwa. Woyamba njira izi zimapangitsa musanadye ultrasound. Ananena kuti kutalika kwa mayi atayima pansi ndi nthawi limafanana ndi nthawi ya mimba. Zowona zake kugwirizana ndi m'mimba khoma makulidwe. Ngati mukukayika, tsopano molondola zotsatira idzakupatsani ultrasound.

Wachitatu limasonyeza phwando yoopsa ulaliki: breech, yopingasa kapena mutu. Ndiponso, mmene chipatso kale mu mafupa a chiuno ndi. Phwando chachinayi chinatsimikizira yapita atatu.

phunziro aligorivimu

Ambiri chidwi aligorivimu kunja njira kafukufuku obstetric. miyezo m'chiuno poyamba ndi pakati. Pakutha pa mpheto ili la dokotala akupitiriza palpation wa pamimba akazi. Izi siteji ya ntchito Leopold madyerero. Kenako pitani auscultation, kapena kumvetsera kwa mtima yoopsa. Pali zofunika pafupipafupi kumenyedwa mtima (ndi zambiri kuchokera kumenyedwa 120 mpaka 160 pa mphindi imodzi.), Momveka chawo ndi mungoli. Auscultation imagwiridwa ntchito stethoscope kapena polojekiti yoopsa.

Kunja ndi mkati uzamba kafukufuku ndi zofunika kwambiri pa mimba ndipo pambuyo pobereka. Mkazi ayenera kumvetsa izo, kuchita zinthu moyenera ndi Mulimonsemo sikuti manyazi iwo. Iwo asapasana dokotala kupeza ngati munthu wamba utuluke mimba ndi wathanzi ngati mayi woyembekezera ndi mwana wake.