OB Ngaphandle: reception

Abesifazane abakhulelwe akayekiwe yedwa nezinkinga zabo wezokwelapha. Ukuzixazulula ngokwanele ukuba isicelo yokuhlala e emtholampilo, futhi lapho ukuze uthole usizo oludingekayo kanye nolwazi. Kulezi izibhedlela, zikhona imithetho ethile owesifazane okhulelweyo ukuhlolwa kwakhe. Kukhona into okuthiwa i ucwaningo zangaphandle azoya, okusho usizo kowesifazane ukhulelwe, ilungiselela ebeletha. Kuyini futhi okwenziwa imithetho, zichaziwe ngezansi.

Kuyini ucwaningo Midwifery ngaphandle?

abesifazane abaningi bayazi ukuthi ukukhulelwa kuyadingeka ukuze abhaliswe esibhedlela wesifunda. Ohambeni lwakhe lokuqala ukuya wezifo zabesifazane emva isiqinisekiso kulesi simo akufanele ukunambitheka wonke umuntu, ngoba kungathatha imizuzu efika ku-40. Enjalo isikhathi eside isikhathi sihamba akusilo ize e kwehhovisi likadokotela. Phela, uchwepheshe akumelwe nje bagcine ngokufuna ukuhlangana okhulelweyo, kodwa futhi ukuqoqa umlando jikelele futhi ekhethekile. Futhi aqokwe ukuhlolwa laboratory, futhi kwenziwe ngaphandle ucwaningo Midwifery.

Luhilela luhlolo kokuqala, esesikhundleni algorithm ayo. Reception ucwaningo Midwifery ongaphandle kuyadingeka ukuze iqoqe idatha emayelana owesifazane. Udokotela kubalulekile ukunquma isimo abesifazane webele, ikakhulukazi ukuma ingono, ngoba kuthinta iqoqo izinyathelo ukulungiselela ekunikezeni ukudla. Wabesifazane uyazinaka ukuthi umama okhulelwe iye yazuza Kilos kusukela ngomzuzu wokukhulelwa, futhi uphuphuma isisindo Izinga yonke inkathi ingane ukulinda.

Ukuqhuba ucwaningo zangaphandle azoya kufaka ukubuthelela ulwazi mayelana ukukhulelwa odlule kanye nezibazi kwesibeletho. Lezi zenzo kwadingeka kuvulwe amathuba okukhulelwa pathologies. Ngaphezu ukuhlolwa, zisasetshenziswa izindlela zokulinganisa, palpation futhi auscultation, ezisiza ukuba uthole isithombe esiphelele kwezingane kanye nesimo owesifazane, yasifukamela. Ngezansi, uzobe yalezi zindlela wachaza ngokuningiliziwe.

Yiziphi izinhlobo izifundo ezinjalo kukhona?

Ukuze sithole isimo sokuba semthethweni nokuthumba owesifazane owayezithwele, akwanele ukumane nje ngenjongo yokuphenya wakhe. Nakuba singenayo yonke namaqhinga palpatsionnye ucwaningo zangaphandle azoya zizoba nokwaziswa okuwusizo for the professional. Ukuze wenze wonke isithombe owesifazane ukhulelwe, futhi impilo yomntanakhe, kudingeka wazi ukuthi iyini icubungula zenzeke ngaphakathi isidumbu abakhulelwe. Lokhu kungabonakala ngosizo laboratory ihlaziya kwegazi, umchamo, nokunye. Futhi udokotela njalo ulalela ukushaya kwenhliziyo imvuthu kanye ichaza isikhundla salo kwesibeletho. Zonke lezi manipulations ekuboniswa ayinhloko amathathu izinhlobo ucwaningo okhulelwe:

• emitholampilo;
• laboratory;
• ekhethekile.

luhlolo Clinical of abakhulelwe

Lolu hlobo inhlolovo abesifazane ngesikhathi sokukhulelwa uqale nge ukuqoqwa umlando wezokwelapha kanye esimweni ezikuso manje. Lemisebenti hhayi kuphela ukusiza udokotela uthole ulwazi impilo yowesifazane, futhi kusinike ithuba ukuhlola umsebenzi wayo Neuro-ngemilingo.

Qala luhlolo emitholampilo kanye ucwaningo lapho kuvela ulwazi mayelana nowesifazane.

1. Ukuqinisekiswa unina ikusasa lomuntu (igama, iphasipoti - inombolo futhi uchungechunge).
2. Ubudala lapho nulliparous basonta eqenjini elithile (abasha - nesishiyagalombili, engu - emva kweminyaka amathathu).
3. Langempela ikheli lokuhlala kanye nokubhaliswa abesifazane.
4. Kungani ukuya kudokotela-wezifo zabesifazane.
5. lwezimiso eziphilayo (bangaki abantu abaphilayo izilwane egumbini elilodwa nowesifazane, izimo zokuphila), kanye lapho ayesebenzela khona ukubhekana (at eziyingozi kufanele unquma umsebenzi okunengqondo esengeziwe wakhe, futhi izithelo izimo zabasebenzi).
6. Ulwazi mayelana ukumpontshelwa igazi futhi izingxenye zalo (uketshezi olungenambala olusegazini, albumin), komzimba, izifo ukuphathwa kwabathintwayo, Oncology. Ngokuvamile ukuphathwa kwabathintwayo evamile akusho impilo ephelele emzimbeni, ngoba umuntu bangezwa ukuphazamiseka womsebenzi kwengqondo futhi ethukile. duty likadokotela - ukuhlonza izici ezaholela kulokhu kwephula, ngoba abesifazane bavame ukuba abelethe, futhi ukuziphatha ezifanele incike impilo kukamama nengane engakazalwa. Izimbangela nezifo zengqondo nakwezinye iziyaluyalu womsebenzi sezinzwa nangokwengqondo, eziningi:

• izifo ezithwalwa;
• ukucindezeleka;
• ukungazali isikhathi eside;
• isisu;
• ukulimala lapho kuzalwa odlule.

Wabesifazane uthola ukuthi kukhona izimpawu ukwephulwa umsebenzi Neuro-ngemilingo: ngaphambi kokukhulelwa, noma kanyekanye lapho ivela khona. Kuyadingeka ukuthola ukuthi yini owesifazane uxhuma imvelaphi yabo.

7. Umlando Epidemiological.

8. njalo ukudakwa (ukubhema, ukusebenzisa uphuzo ngokweqile, ukusebenzisa kabi izidakamizwa).

9. Kokuya esikhathini nemisebenzi nocansi (lapho eseqala ukuya esikhathini baqala ukugeleza, ukukhulelwa sangaphambilini kanjani ukuzalwa, isisindo futhi isimo sempilo yezingane langaphambilini, izifo zabesifazane kanye izifo ezithathelana ngokocansi nokukhulelwa).

10. Umlando Family (isimo sempilo yombusi bahlanganisa amalungu omkhaya bahlale ndawonye owesifazane, ufuzo, ezempilo, iqembu kanye RH sokusebenzisana uyise esikhathini esizayo).

Okulandelayo, iya ukuhlolisisa umama esizayo:

• Ukwelulekwa owelapha, udokotela wamazinyo, ophthalmologist futhi ENT. Uma kunesidingo, ukhethe ukuhlolwa Ochwepheshe nezinye.
• Kala izinga lokushisa futhi wegazi.
• Hlaziya isimo somzimba walinganisa ubude, isisindo nobukhulu balezi ukhalo.
• Hlola futhi palpate esiswini.
• Hlola igazi, umchamo kanye nezinye uketshezi.
• Hlola pubis symphysis.
• Ingabe i electrocardiogram.
• Ultrasound luhlolo kuyadingeka ukuba kudlule zonke kowesifazane okhulelwe kuze nambili nesishiyagalombili amabili wesibili kanye imizuzu 32 phezu ngesonto 34.
• Feza ucwaningo Midwifery zangaphandle.

Kubalulekile ukuthi lo wesifazane bhalisiwe kungakadluli amaviki angu-12 esesibelethweni. I anthropometry okwenzile ngokudlule, ukuhlolwa laboratory kanye nokuhlola umfutho wegazi, ayanda kungenzeka ukuba nengane enempilo noma ukukhomba angahlangani fetus aluhambisani nawo ekuphileni.

Laboratory izifundo abesifazane

Lapho umama okhulelwe Ufika ebhalisiwe, it inikwe kwegazi emitholampilo urinalysis, ukuchaza iqembu futhi RH isici, igazi glucose, hlola Nalia RW, i-hepatitis, i-HIV, futhi wenze scrapings futhi swabs esithweni sangasese futhi wesibeletho ku flora, Cytology, chlamydia, isipatsholo, trichomoniasis.

Uma umlando yembula sokuzalwa kwezingane efile, izisu (ikakhulu uma nisanda kamuva), zokugula extragenital, kubalulekile:

• ukwenza ukufunda egazini lowesifazane ukuze khona hemolysin;
• iqembu igazi esikhathini esizayo kayise ingasetshenziswa ukuhlola kanye RH, ikakhulukazi uma ukhulelwe Rhesus isici angemahle noma iqembu 0 (I);
• ukucacisa khona izifo urogenital;
• ukunquma izinga lama-hormone kudingekile, immunoresistance;
• uma kunesidingo, ukuqhuba ukucwaninga ngofuzo.

Ngaphezu kwalokho ukuhlolwa laboratory wenziwa lafana:

• CBC - ngenyanga ngemva kwesonto wamashumi amathathu - kanye ezinsukwini eziyishumi nane;
• ngesikhathi ngasinye reception ezibekiwe umchamo ukuhlaziywa jikelele;
• ku nesithupha u-ngesonto lamashumi amabili ukunquma hCG futhi ACE;
• uma sebehlanganisa amasonto angu 22-23. futhi amasonto 36-37. ukuhlola izinga likashukela egazini;
• Isifundo ohlelweni coagulation (coagulation) ukukhiqiza 36 kuya kwesonto lika-37;
• at amasonto amathathu, futhi amasonto amabili noma amathathu ngaphambi kokubeletha futhi yini isandulela-ngculaza kanye RW, ukuhlola swabs futhi scrapings.

OB Special

ucwaningo Special azoya kuhlanganisa:

1. Ukuqhuba ucwaningo zangaphandle azoya.
2. ucwaningo Midwifery langaphakathi.
3. Olunye ucwaningo olwengeziwe.

Outdoor uphenyo azoya kuyinto luhlolo, nesilinganiso usayizi ukhalo. Ngemva kwesonto lamashumi amabili kunqunywa ubukhulu selilonke elikhulu esiswini, wenziwa kumba esiswini kanye le symphysis pubic, futhi prolushivaniya inhliziyo yengane. zangaphandle azoya imishini lokucwaninga lingekho elula, it is kwenziwe kuphela ngesikhathi kufika abezimo eziphuthumayo abaqeqeshiwe.

ucwaningo Midwifery langaphakathi. Ngo Midwifery yangaphakathi ucwaningo kuhlanganisa ukuhlola zangasese zangaphandle, cwaningo usebenzisa izibuko emomozini futhi wesibeletho. Kuyinto nje kubaluleke njengokugwema zangaphandle azoya ucwaningo ebeletha. Le nqubo Kwenziwa ngaso wamathumbu and esinyeni. Ukuze lomhlangano owesifazane othile ukuba alale ngomhlane, izinyawo ukuncibilikisa esandleni futhi bend emadolweni. Ukhalo kumele isuswe. Investigation ngempela eyenziwa ngaphansi kwezimo aseptic.

• Lolu cwaningo kuqala ngokuhlola we zangasese zangaphandle. Linganisa ubunjalo umzimba izinwele, ukuxhuma. Thola izinqubo sokugembula, uma: izibazi kusuka uyadabuka ekuzalweni langaphambilini, izimila, inflammations, fistulas, amaqhubu hemorrhoids kule ingquza. Hlaziya isimo labia vulvar baphokophelele ngeminwe yakho, futhi ukunquma isimo nezindlala urethral.

• ukuhlola wesibeletho ngosizo izibuko. Nakani imfihlo lwamafinyila, wesibeletho lesizalo usayizi emphinjeni. Esikhathini mina-st senyanga eyenziwa ukuhlolisisa amabili ngilambatha sangasese, e eyesibili neyesithathu efanele kuphela ngumuntfu loyedvwa.

Okokuqala ukulinganisa ukuxhuma (kungakhathaliseki rigidity, nezibazi) kanye emomozini (usayizi, udonga ukusonga ukutholakala).

4 ethola izifundo azoya yangaphandle

Reception ucwaningo ongaphandle Midwifery (Leopold amasu) esetshenziswa palpation esiswini nokuthumba owesifazane owayezithwele. Lezi izindlela ezine:

• ukulinganisa ukuphakama emi kwesibeletho, bese wabelana izithelo, okuyinto;
• ekutholeni indawo ezingenzeka embungwini, ezivuma iziphetho ngokuthi lokuthola emuva izingalo zakhe imilenze;
• ukuzimisela izithelo, okuyinto okubekwa phambi, indawo yayo maqondana ukhalo elincane;
• wazimisela kwetfula fetus ingxenye ibekwe isihlobo emnyango ukuze ukhalo.

Injongo ukuhlolwa wesibeletho

Ngaphambi kokuzalwa wesibeletho kunqunywa ukuvuthwa, njengoba kubonisa indlela umzimba isikulungele ukushiya. Izindlela sokunquma ukuvuthwa wesibeletho zahlukahlukene, kodwa lezi nemingcele ezihloliwe kuzo zonke zazo:

• ukungaguquguquki;
• yini ubude ingxenye lwesitho sangasese sowesifazane isiteshi;
• patency we-canal wesibeletho;
• elise futhi eksisi entanyeni iqondiswa e ukhalo kude kangakanani;
• udonga ukushuba ingxenye entanyeni, okuyinto ahlelwe sangasese;
• sithole isimo Ezansi kwesibeletho.

Linganisa wesibeletho ukuze esikalini esikhethekile. wesibeletho beya ivela amaphuzu 0 kuya 5. Uma ukuhlolwa buphendukile baba ngaphezu kuka 10, ngaleso sikhathi owesifazane angase alungiselele lokho ebeletha.

Izifundo abesifazane ukhalo

Ukuze ukwazi Ubukhulu okhalo, sebenzisa OB zangaphandle abakhulelwa pelviometriya. Kwezinkambiso zangaphandle Ubukhulu okhalo zimi kanje:

• spinarum ibanga, okuyinto ilingana 25-26 amasentimitha;
• kristarum ibanga - kusukela ngamasentimitha 28 kuya ku-29;
• trohanterika ibanga - kusukela ngamasentimitha angu-31 kuya 32;
• Conjugate ongaphandle - kusukela ngamasentimitha 20 kuya 21;
• Diagonalis conjugate, okuyinto kufanele sibe ububanzi 12.5 - 13 amasentimitha.

Odokotela abaningi kakade ngesikhathi nokuhambela kokuqala, abesifazane bezama ulinganise ukholo conjugate (yeqiniso), okuyinto inquma usayizi umnyango indishi encane. Ngokuvamile, kufanele kube 11 kuya 12 cm. I conjugate kweqiniso kukhona futhi kungatholakala, ngaphandle uma conjugates yangaphandle (ongaphandle) ukhupha 9 amasentimitha. Ubukhulu bayo futhi uhlangabezana rhomb Michaelis noFrank usayizi (kunqunywa lwesikhombisa amathambo wesibeletho ukuze phakathi fossa jugular). I idayagonali we conjugate esemgwaqweni phakathi onqenqemeni engezansi we symphysis pubic ukuze izimpawulo izingxenye ezimangalisayo kakhulu krestsovogo, futhi elingana nenani conjugates kweqiniso.

Uma osayizi ukhalo bachezuke kuyinsakavukela khona, kungcono ukuqhuba amasu azoya zangaphandle ucwaningo ukuthi kukhona Ubukhulu extra: yokulinganisa ohlangothini conjugate, esemgwaqweni phakathi yomgogodla phambi kwe-ilium kanye nomgogodla ezingemuva ngakolunye uhlangothi. amagugu alo avamile ngamasentimitha 14 kuya ku-15. Uma kuwukuthi ngamasentimitha esingaphansi 12 nesigamu, lapho ebeletha ngoba engalutholanga bokuphila engenakwenzeka. Futhi ukukala usayizi etshekile. Ezintathu kuzo, futhi uma umehluko phakathi kwabo kuka 1.5 amasentimitha, ijaji etshekile ukuvaleka, okuyilona elisebenzayo futhi kuyingozi ebeletha.

Nquma futhi engela okhalo ukuthambekela, okungadingi bachezuke 45-55 degrees. engela Okubaluleke pubic okuyinto ungakwazi ukukwenza kufanele kulingane 90-100 degrees.

I-algorithm zocwaningo zangaphandle azoya zihlanganisa ukubaluleka ekhishwa indishi esincane:

• usayizi umugqa, okuyinto ilingana ayisishiyagalolunye ngamasentimitha. Itholakala phakathi nesikhathi sokuphela engezansi ukuhambisana pubic kanye iphuzu elingenhla coccyx. Kusukela idatha etholwe rob ngamasentimitha amabili kwezicubu ezithambile;
• tazometrom kulinganiswa ubukhulu transverse okuyinto 11 amasentimitha futhi uhlala phakathi tuberosity ischial (evele kwawo kwangaphakathi).

Reception Leopold-Levitsky

Ukulaliswa esibhedlela iyiphi dokotela abesifazane phakathi naso sonke isikhathi sokukhulelwa is ngempela wachitha ngaphandle ucwaningo Midwifery. Reception Leopold-Levitsky abadlala indima enkulu kuwo. Igama la namasu izimiso zazo kakade okukhulunywe ngaye ngenhla, poluchli egameni umuntu athuthukile kubo ngasekupheleni kwekhulu nesishiyagalolunye. Lo muntu udokotela German Christian Leopold. Lezi zenzakalo sele bararulule imiraro engaba eziningi azoya lekungiko namuhla.

Asiza ukucacisa nendzawo umbungu ekukhulelweni sekwephuzile. Eyokuqala yalezi amasu okwenza phambi ultrasound ngamunye. Ubhekisela ukuphakama umama emi phansi futhi cishe ngaso sonke isikhathi sifana inkathi yokukhulelwa. Ukunemba ahlotshaniswa ne besisu odongeni ukujiya. Uma ungabaza, manje enembile nakakhulu imiphumela uyonika ultrasound.

Wesithathu ibonisa ukwamukela isethulo fetus: breech, transverse noma ikhanda. Futhi, indlela ngokujulile izithelo kakade ukhalo. I reception wesine qinisekisa dlule ezintathu.

algorithm cwaningo

zangaphandle amasu algorithm ezithakazelisayo eziningi azoya ucwaningo. izilinganiso okhalo ekuqaleni wenza abakhulelwe. Ngemva kokuphela kwalesi manipulation udokotela wabe palpation esiswini abesifazane. Lona isigaba kwesicelo Leopold reception. Okulandelayo, iya le auscultation, noma ukulalela inhliziyo yengane. Kukhona imvamisa ezibalulekile beats inhliziyo (ngokuvamile kusukela ngomzuzu 120 160.), Ukuzwakala yabo nesigci. Auscultation wenziwa usebenzisa IselulekoSesihenqo noma qapha fetus.

Zangaphakathi nezangaphandle ucwaningo Midwifery kubaluleke kakhulu phakathi nesikhathi sokukhulelwa futhi emva kokubeletha. Umuntu wesifazane kufanele baqonde ke, ngokuziphatha kahle futhi noma kunjalo asisho anqikaze kubo. Basiza udokotela ukuthola ukuthi le evamile notshwala sokukhulelwa siphilile uma umama okhulelwe nengane yakhe.