1 HISTORY TAKING IN OBSTETRICS & GYNECOLOGY COLLEGE OF MEDICINE DEPT. OF OBSTETRICS AND GYNECOLOGY.
Department of Obstetrics and Gynecology MEDICAL AND OF HEALTH PREVENTIVE FACULTY OBSTETRICS IV...
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Transcript of Department of Obstetrics and Gynecology MEDICAL AND OF HEALTH PREVENTIVE FACULTY OBSTETRICS IV...
Department of Obstetrics and GynecologyMEDICAL AND OF HEALTH PREVENTIVE
FACULTY
OBSTETRICSIV course
Anomalies of patrimonial activity
WOMB
prostaglandins myoglobinOXYTOCIN ATPkinins actomyosinserotonin CALCIUMacetylcholine RNAcatecholamines GLYCOGENoestradiol
Downward TRIPLE GRADIENT
- PEYSMEKER- pacemaker
- DOMINANT BOTTOM
- TOP-DOWN WITH FORCE Descending
momentary MAXIMUM REDUCTION AND PAUSE
Downward TRIPLE GRADIENT
SCRUM
• contraction
retraction
distraction
contractions are characterized
* Regular * Certain duration * Force
Action uterine contractions
Phase 1 stage of labor
* Латентная: открытие зева до 4 см * Активная: открытие зева от 4 до 8-10см
during childbirth• The rate of cervical dilatation
- Nulliparous least 1 cm / hour, - Multiparous - 1.5-2 cm / hour
• The average duration of labor - The first birth - 8 hours, rarely 18chas - Repeated births - 5:00 seldom 12:00
Anomalies of patrimonial activity
Pathological preliminary periodWeak labor FORCES - PRIMARY - SECONDARY - WEAKNESS attempts
• EXCESSIVE Stormy generic activities - Prompt delivery, FAST DELIVERYIncoordination of labor - incoordination - Dystocia CERVICAL - Hypertonicity of the lower segment - Uterine tetany
Pathological preliminary period
• Irregular contractions, sometimes sharp pain that lasts more 6-8hoursThese contractions disrupt the rhythm of sleep and bodrostvovaniyaFatigue mothersDo not lead to the disclosure of the cervixLead to the appearance of fetal hypoxia
Clinical management is defined* * Severity of clinical manifestations
* The status of the cervix* The status of the fetus* Is there a premature discharge of water or not.
Treatment of pathological preliminary period:
medication sleepanesthesia
Amniotomy - the presence of defective membranes (flat) may be the
cause of pathological preliminary period. Amnitomiya promising in the
presence of mature or maturing of the birth canal.
The main criterion for the flow of labor
• The characteristics of contractions (regular, strong enough)
* The dynamics of disclosure uterine os, nulliparous disclosure uterine os 1 cm per hour in multiparous 2 cm per hour.* Promotion of the head through the birth canal
Prolonged labor: Due to the weakness of labor
PRIMARY• preeclampsia
extragenital diseasesABORTIONinfantilismBIRTH AFTER 30 YEARS
• Uterine malformationsperenashivaniePelvic E previa
• Scar on the uterus gynecologic diseases MYOMAENDOMETRITIS Prenatal outpouring of waterHyperextension of the uterus (multiple pregnancy, polyhydramnios
• Large fruit, multiparous) !
Because of the weakness of labor
ЭГЗ ЭГЗ УСТАЛОСТЬ, ГОЛОДУСТАЛОСТЬ, ГОЛОД
ГИПЕРСТИМУЛЯЦИЯ МАТКИГИПЕРСТИМУЛЯЦИЯ МАТКИ
НЕСООТВЕТСТВИЕ НЕСООТВЕТСТВИЕ РАЗМЕРОВ РАЗМЕРОВ ПЛОДА ПЛОДА РАЗМЕРАМ РАЗМЕРАМ ТАЗА ТАЗА МАТЕРИМАТЕРИ
SECONDARY 1. Women aged and young age 2. Women with overstretching of the uterus (large
fetus, multiple pregnancy, polyhydramnios). 3. Multiparous, mnogoberemennye, numerous
abortions with curettage, ie in the presence of degenerative and inflammatory changes in the myometrium.
4. In women with menstrual dysfunction and hormonal balance
5. Hypertrichosis, obesity
DIAGNOSIS Prolonged labor 1. Characteristics of contractions: the weak,
short 2. Insufficient dynamics of cervical
uterus (normally 1 cm per hour) - 0.5 cm per hour.
3. To clarify the dynamics of the used methods for determining the external data and vaginal
examination -Partogramma4. Diagnosis should be delivered within 3-4
hours.
Treatment: amniotomy
Rodostimulyatsiyacesarean
OVERTORQUE labor.The clinical picture of the turbulent
labor
Vaginal examination fast speed disclosure of uterine os.
treatment:antispasmodics
sedation
DISKOORDINIROVANNAYA of laborContractions -Different strength, duration, and
intervals, sharply painful, mosaicism.Increased uterine tone especially in the lower
segment, rigid edges of uterine os.Slowing promotion fetus through the birth canal
difficulty urinating
DISKOORDINIROVANNAYA of laborCAUSES OF
Uterine malformations
· Anatomical changes of the cervix (after diathermocoagulation)· Women with unstable nervous system, increased sensitivity to pain reaction
Осложнения
• complications: Premature rupture of membranes prolonged labor Increased percentage of septic infections fetal hypoxia A high percentage of operational delivery
TACTICSamniotomy
Oxytocic
Caesarian
I WAS born YOURSELF!