Relief Responding to Ticket number 3

1. Fixation points with the front and rear views of the occipital presence.

Answer: With the front of the occipital presence, when the head is extension in the III moment, the point of fixation is formed between the LON-type joint, around which and the head extension occurs - as a result, the forehead and chin of the fetus are born. (In this case, the shoulders in the oblique or transverse size of a wide part of the cavity of the small pelvis). The head is born with a small oblique size \u003d 9.5 cm, circle \u003d 32 cm.

With the rear view of the occipital premium with an additional (maximum) head bending in the III point (when the head reaches the border of the scale of the forehead to the lower edge of the Lonatic articulation), the point of fixation is formed, as a result, dark bugs and the occipital hill are dispersed. When extending the head in the IV moment (after the booty fetal fetus is suitable for the top of the tailbone), the II point of fixation is formed as a result of the head begins to bend and is born from the sex paths with a trapes. The head is broken by a circle \u003d 33 cm, corresponding to the average oblique size, which is 10 cm., The wired point is located between the small and large springs, closer to the large.

Answer:Pelvic prediction is such a prevention when the pelvic end of the fetus is located above the entrance to the cavity of the small pelase. The first position is the back of the fetus facing the left side of the uterus.

I moment - translational movement and inner twist of the buttocks In a wide part of the cavity of the small pelvis. The buttocks of the fetus are inserted with their interstitial size in one of the oblique size of the entrance plane in a small pelvis. Under the influence of the generic expensive forces, the buttocks are lowered and committing an inner turn by installing the frequency line (LIN. INTERTROCHANCERICA) in the direct size of a small pelvis.

II moment - the side flexion of the spine in the lumbar department.The lateral flexion of the spine of the fetus caused by the direction of the generic canal occurs. The front buttock (on which the wired point is located) is cut, but is not born from sex paths, as fixation is formed between the front ileal bone of the fetus and the LONA joint. The rear buttock is born, then the front, and the fruit comes out of the tribute to the umbilical ring.

III moment - the inner turn of the shouldersand associated with the outer turn of the body. Handers, going down to the cavity of the small pelvis, are installed in the direct exit.

IV moment - flexion of the spine in the Shainian and Breast Departmentat the same time, pens and shoulder belt are born.

V moment - the inner turn of the head,which, passing through the generic channel, is lowered and installed by sweep joint in the direct exit size. The podtakenaya fossa is fixed under the lower edge of the Lonatic Jim.

VI moment - flexing the head and her birth. Chin, mouth, forehead and the fetus are born.

The safest location of the baby in the mother's womb is the head preview ̶ head down, a pelvic end up. With the classic location, the larger parts of the kid are advised first. – Head, shoulder belt. The pelvic end goes on the already intended path easily.

In the opposite case, the child is experiencing great difficulties, especially after being born to the abdomen.

• Pullen amniotic fluid ahead of time. Since the pelvic end adjoins not very tightly to the tissues, in contrast to the head, the likelihood of the feet of the child's legs increases or, even more dangerous, cord loops. In the first case, this will lead to the jams of the baby, in the second - to acute hypoxia due to squeezing umbilical cord. The consequences can be the most undesirable, up to the death of the child.
• Weak fights. A pelvic end cannot carry out full pressure on the cervix, its intensity is less, therefore it becomes more likely to be needed in additional stimulation.
• The suffering of a child. After the buttocks and the pelvic belt are shown and born, the cord loops can be somewhat squeezed until the head of the head.
• Throwing the handles. After the birth of the body, the upper limbs may randomly fold the head, which greatly makes it difficult to exit the uterine cavity.
• Infringement of the fruit head. It comes out of the uterus and is born the last. If the uremary zev decreased after the shoulders came out of the uterus, and the head is not yet, then it is like a removal grabbing the baby behind the neck. This is one of the most dangerous complications that leads to high traumatization or fetal death.
• Dangerous for boys. The generic tumor in male fruits can be formed in the scrotum area, which will negatively affect the further reproductive function.

Pelvic presence can also be formed due to Anomalies of the structure of the uterus, multiple pregnancy, in the presence of bone growing in a small pelvis. All this makes it difficult and even makes it impossible natural childbirth.

In general, the course of the generic process passes the following steps:

• fights that are needed to open the cervical channel to 10-12 cm;
• smooth birth of kid.

Observation, the multiplicity of inspections and the main actions of medical personnel are no different. But birth in a pelvic prediction should receive directly doctorNot an obstetric to avoid complications in time and take the necessary actions.

During the cervical disclosure period, it is important that there is no premature influence of the accumulating waters. It is recommended to observe peace and even bedding. After full disclosure the task of a doctor and women - to warn premature felling of legsIf the presence is mixed. In this case, the obster can literally hold them into the vagina.

Due to the fact that the childbirth is often held with complications with complications, in most cases, a cesarean section is carried out after the diagnosis is established.

Cesarean section

To solve the issue of the method of delivery, the following factors are taken into account:

• Age. The older woman, the more doctors lean towards the operational delivery.
• . In the pelvic preservation of the fetus and the upcoming first kinds, a cesarean section is also carried out in most cases.
• There are scar changes in the uterus or not. If earlier the woman was carried out some operations in the uterus (cesarean section, removal of myomatous nodes, etc.), the probability of rupture on the header during independent kinds is much higher.
• Condition of generic paths. If the body is not yet ready for 40 weeks (the cervix is \u200b\u200bclosed and long), the likelihood of complications and the need for additional manipulations, stimulation in childbirth, which increases the risk of women and kid. To avoid this, it is planned to initially perform the operation.

Indications for Cesarean section:

• If women have reasons for the pathological flow of the generic process in the past: miscarriages, fetal death, child injury at previous birth.
• Complications of the second half of the hatching, for example, gestosis, multi-way.
• Previously operated on Moma, or Caesarean section was performed.
• Anomalous location of the placenta or its dysfunction, in which the kid constantly experiencing a deficiency of oxygen.
• Women pelvis parameters are less than permissible or expected large fruit.

Biomechanism of childbirth with a pelvic preservation of the fetus:

• There is a fixation and lowering of the body of the baby at the level of the pelvic bottom.
• Then the buttocks are born: first front, then the back (the baby lies on the side). At the same time, the body is significantly flexed that the lower buttock can come out.
• Birth kid to the corner of the blade. At the same time, not only the promotion is forward, but also the inner turn of the baby. In no case can not pull and force the stepsOtherwise, you can provoke the folding of the handles and serious difficulties in further promotion of the crumbs. But also weakening battles, and tightening the time between the fights more than 5 minutes lead to acute hypoxia of the fetus.
• Then two stages appear shoulders and handles. If necessary, assistance is provided for their elimination.
• The last stage is the turn of the baby's head inside the tribal pathways and her birth face to the sacrum.

The head of a newborn, unlike birth according to the classical option, has no configuration and round. A small edema of fabrics, which is formed by compression, is located in the front of the front buttock.

Conducting birth to the moment of teething does not have significant features. A woman can move, although some experts for the prevention of early strengthening of amniotic fluid recommend sticking to beddown. Anesthesia is carried out according to sensations, if necessary - stimulation of generic activities.

Main features begin with the date of lowering the presenter part of the kid on the pelvic bottom. Depending on the locality, it is carried out:

• Manual in Tsovyanov (When the feet are at the top with the stretched legs). The task of the technique is to save the location of the legs of the fruit at the top near the chest, they are elongated. For this, the doctor who takes childbirth puts his hands on the buttocks and slightly presses the legs to the body. As the bodies of the body appear, the hands of the midwife are moving towards the back.

• (If, except for the buttocks, the feet are below). Performing begins after the birth of the baby to the level of the blades. Next, the legs of the child are captured by one hand of the doctor. The second obster passes to the elbow fetus fold and the special "washing" movements frees and displays a handle. They very gently turn the baby to 180 degrees.

In the event of complications, traction may be carried out (releasing the fetus) per legs. At the same time, the doctor accelerates all stages of promotion, which is fraught with complications, but non-fulfillment of these events threatens even the death of the baby.

Immediately after the appearance of the baby, he is transmitted to neonatologists. If there were changes in heartbeat in the process of birth, there are assumptions that the child will be born in the state of asphyxia, the resuscitation team is called.

Read more in our article about childbirth at pelvic preview.

Read in this article

Probable danger of the situation of the fetus

The most safe location of the baby in the mother's womb, in which the likelihood of complications in childbirth is minimal, is the head presence ̶ head down and the pelvic end up. All other are fraught with serious consequences for both. It is determined by the fact that during the classic location, the larger parts of the baby ̶ head, the shoulder belt, are progressing.

The pelvic end goes on the already scheduled path easily. In the opposite case, the child is experiencing great difficulties, especially after being born to the abdomen.

Options for fetal positions in a pelvic preview

Childbirth With this position, the kid may complicate as follows:

• Pullen amniotic fluid ahead of time. Since the pelvic end adjoins not very tightly to the tissues, in contrast to the head, the likelihood of the feet fell drops is increasing or, which is even more dangerous, cord loops. In the first case, this will lead to the jams of the baby, in the second ̶ to acute hypoxia due to the squeezing of umbilical cords, according to which oxygen comes to the kid. The consequences can be the most undesirable until the death of the child.
• Weak fights. An important point in the development of the cuts of the uterus and the opening of the generic paths is the pressure from the head of the child in normal childbirth. A pelvic end cannot accomplish such an impact, its intensity is less, therefore it becomes more likely to be needed in additional stimulation.
• Suffering child. It may come both to the full phase and already during the direct birth of the kid. After the buttocks and the pelvic belt are shown and born, the cord loops can be somewhat squeezed until the head of the head. This is a very important and responsible moment.
• Throwing the handles. After the birth of the body, the upper limbs may randomly fold the head, which greatly makes it difficult to exit the uterine cavity.

Throwing the handles: a - i degree; b - II degree; B - III degree.

• Infringement of the fruit head. It comes out of the uterus and is born the last. If the dairy zev is reduced after the shoulders come out of the uterine cavity, and there is no head, then it is like a remover grabs the baby behind the neck. This is one of the most dangerous complications that practically leads to high traumatization or fetal death.
• Dangerous for boys. The generic tumor in male fruits can be formed in the scrotum area, this can adversely affect the further reproductive function of the boy.

In addition, pelvic prediction can be formed due to the abnormal structure of the uterus, multiple pregnancy, with a short umbilical umbilical cord, the presence of bone growths in a small pelvis. All this makes it difficult and even makes it impossible natural childbirth.

How do natural labor under the pelvic preview

In general, the course of the generic process, with this location, the baby in the pelvis does not differ from the usual and the following steps take place:

• fights that are needed to open the cervical channel to 10-12 cm;
• gradual lowering the child to the outlet of the pelvis cavity;
• smooth birth of kid.

Observation, the multiplicity of inspections and the main actions of medical personnel are no different. However, the genus in the pelvic preview should be directly the doctor, and not an obstetric in order to avoid complications in time and take the necessary actions.

During the cervical disclosure period, it is important that there is no premature influence of the accumulating waters. However, this process cannot be controlled. The only thing is that it is recommended to observe peace and even bedding. After full disclosure, the task of the doctor and women ̶ warn premature feet of the legs, if the presence is mixed. In this case, the obster can literally hold them into the vagina.

During the female, a woman needs to be carefully listened to staff recommendations and fulfill all instructions, especially after the birth of the pelvic belt.

Modern obstetrics are aimed primarily on preserving the health of the mother and the kid. Due to the fact that the childbirth is often held with complications with complications, in most cases, a cesarean section is carried out after the diagnosis is established.

To solve the issue of whether, you can or not a woman give birth through natural labor pathways, the following factors are taken into account:

• Age. It matters if it is the first pregnancy and childbirth, especially in a woman with a burdened obstetric history, for example, when infertility, after eco, etc. The older woman, the more doctors lean towards the operational delivery.
• What are the birth of childbirth. With the pelvic prelation of the fetus and the upcoming first kinds, in most cases a cesarean section is carried out, since the probability of complications is higher than in a situation if it would be repeated childbirth.
• Compliance with pelvic sizes in a woman and the weight of the fetus. If there are essentials or a major kid, the likelihood of threading the handles, the infringement of the head and other similar dangerous complications is higher, so the cesarean cross section is performed more often.

• There are scar changes in the uterus or not. If earlier a woman was held any operations in the uterus (Cesarean section, removal of myomatous nodes, etc.), the probability of breaking over the header during independent births is much higher if it were childbirth without preceding interventions.
• Condition of generic paths. If, by 40 weeks, a woman with a baby is a toddler, the body is not yet ready (the cervix is \u200b\u200bclosed and long), the probability of complications and the need for additional manipulations, stimulation in childbirth, which increases the risk of groom and baby injuries. To avoid this, the operation is planned.

Indications for Cesarean section

Pelvic presence ̶ is a relative reading for operational delivery. Usually the operation is planned when combining factors. The main predisposing moments include the following:

• If women have reasons for the pathological flow of the generic process in the past: miscarriages, the death of the fetus, the injuries of the child at the previous birth.
• Complications of the second half of the hatching, for example, gestosis, multi-way, infection and others.
• The lack of the readiness of the tributes on the period of docking pregnancy.
• If the legs of the kid are located below its buttocks.
• Previously operated on Moma or Caesarean section was performed.
• Anomalous location of the placenta or its dysfunction, in which the kid constantly experiencing a deficiency of oxygen.
• Location of umbilical cord or fruit midges immediately at the inner zev.
• Women pelvic parameters are less than permissible for the norm or precipitate large fruit (more than 3500 g).

See this video about the reasons and types of the pelvic prevention of the fetus, the testimony for Cesarean section, the peculiarities of the maintenance of natural labor:

Biomechanism of childbirth in the pelvic prelation of the fetus

The birth of a kid, which is located a pelvic end at the entrance to a small pelvis, has a number of differences. Biomechanism of childbirth consists of six consecutive stages:

• There is a fixation and lowering of the body kid at the level of the pelvic bottom.
• Further, buttocks are born: first front, then the rear (the baby lies as if on the side). At the same time, the body is significantly flexed that the lower buttock can come out.
• Birth kid to the corner of the blade. At the same time, not only the promotion is forward, but also the inner turn of the baby. In no case can not pull and force the steps, otherwise you can provoke the folding of the handles and serious difficulties in further promotion of the crumbs. On the other hand, the weakening of the fights during this period and tightening the time between the fights of more than 5 minutes lead to acute hypoxia of the fetus, as the umbilical cord is squeezed.
Biomechanism of childbirth in the pelvic prelation of the fetus

The head of a newborn, unlike birth in classic childbirth, has no configuration, it is round. A small edema of fabrics, which is formed at the expense of squeezing, is located in the field of the front buttock.

Knowledge of birth

Conducting childbirth until the discharge does not have significant features. A woman can move, although some experts for the prevention of early strengthening of amniotic fluid recommend sticking to beddown. Anesthesia is carried out according to the sensations of a woman, if necessary, ̶ stimulation of generic activity.

Main features begin with the date of lowering the presenter part of the kid on the pelvic bottom. Depending on the members of the position, the Tsovyanov allowance is carried out (when the feet are at the top of the extended legs) or manual manual (if except the buttocks at the bottom are the feet).

Manual manual

His execution begins after the baby was born to the level of the blades. Next, the legs of the child are captured by one hand of the doctor. The second obster passes to the elbow fetus fold and the special "washing" movements free and displays a handle. Then, very neatly turn the baby to 180 degrees and the same is done with the other handle.

It remains only to bring the fetus head. For this, we are somewhat pressed on the adapter, as a result, the podgetying fossa is fixed under Lona. In the event of difficulties with the appearance of the head in the mouth of the child, a finger is injected and the movements of the crumbs are sent.

In the event of complications, traction may be carried out (releasing the fetus) behind the legs of the child. At the same time, the doctor accelerates all the stages of the advance of the child, which, of course, is fraught with complications, but non-fulfillment of these events threatens even the death of the baby.

Manual in Tsovyanov

The task of this technique ̶ Save the location of the legs of the fruit at the top near the chest, they are elongated. For this, the doctor who takes childbirth puts his hands on the buttocks and slightly presses the legs to the body. As the bodies of the body appear, the hands of the midwife are moving towards the back.

When the baby is born to the corner of the blades, insignificant guides are exempting the front, then the back shoulder. At this time there is an independent turn of the head, it is installed with a population to Lon. She gradually excluded.

See this video about a classic manual manual with a pelvic preview:

Help doctors after birth

Immediately after the appearance of the baby, it is transmitted to neonatologists. If in the process of childbirth there were changes in heartbeat and there are assumptions that the child will be born in the state of asphyxia, the resuscitation team is called.

Main events with well-being kid standard: hardening the eye with an albacid solution for preventing inflammatory complications, nasal sanitation and respiratory tract, umbilical treatment.

And more about how the gaps are invented after delivery.

The location of the child is a pelvic end to the exit of the pelvis does not apply to pathological, however, childbirth should always behave as dangerous at risk of developing serious complications. Increasingly, doctors are resorted to the execution of cesarean section, so the skill is lost, which further increases the likelihood of unfavorable outcome primarily for the fetus. Before carrying out natural genera, we should weigh all the "for" and "against".

Biomechanism of childbirth for pelvic previews

Moving on the generic paths with the pelvic end of the Kepent, the fruit, as with head premises, makes a number of progressive and rotational movements.

The main benchmark for pelvic preview is the Linea Intertrochanterica, as a sword-shaped seam with head previews. A number of moments of biomechanism are distinguished.

1. The holding of the buttocks into a small pelvis and the promotion of the generic channel begins with that. What is a fodder line of fruit in one of the oblique sizes of a woman's pelvis enters into a small pelvis. Next, the pelvic end passes into the cavity of the small pelvis with a brown line in the left braid size of the pelvis of a woman at the first position and in the right braid at the second position, the back is greater than the kepened when the front form or the back form. When the back, reversed by the back, is usually rotated by the shock, and the front appearance is formed. In the process, the bouts of the buttock are lowered all lower and deeper inserted into a small pelvis, and the front buttock is lowered below the rear and is a leading point, like small spring in the occlusion. It subsequently formed a generic tumor.

2. The inner turn of the buttocks takes place in the cavity of the pelvis in such a way that at the bottom of the pelvis, the bridge is already located in direct size, the front buttock approaches Lona, and the back goes to the sacrum.

3. Creaming and teething of the buttocks occurs after fixing the front buttocks with an area of \u200b\u200bthe iliac bone (the fixation point between the trochanter and the edge of the iliac bone) under the lane arc. Around this point of fixing the first, the front buttock is broken, then the rear, and thus the pelvic end is born. In the course of this, the fetal spine makes a strong side bending, respectively, the wired axis of the woman's pelvis. With a mixed buttock preview, together with the teething buttocks, legs are born, with a purely buttock, they go later, after the birth of the body from the navel and above. Following the buttocks, a torso is rapidly born to the navel, turning the back of the kleon. At the same time, the buttocks, born in the direct size of the engineer line, rotate into the oblique position (at the first position in the left, with the second - right) and are set in transverse size. Then the fruit is born to the lower angle of the front blade, once again turning at the first position in the left, and with the second - in the right oblique size. Together with the breast a pen is born.

4. The birth of the shoulder belt, the inner turn and flexing of the heads are performed almost simultaneously. The shoulder belt makes the same movements as under head previews, passing by its transverse size of the same sizes of a woman's pelvis, for which the buttocks took place - inserting this size into the transverse size of the entrance into a small pelvis, turning into its cavity through one of the oblique sizes And installing in the direct exit. The symbol is shown the front shoulder and fixed from the Lonaya Arc, then the first is born above the crotch back shoulder. At this point, the head is at the bottom of the pelvis in one of its oblique sizes, the opposite of the insertion of the buttocks (at the first position in the right braid, with the second - in the left). Then, remaining in a state of bending and making an internal rotation, is installed in the direct size of the pelvis from the pelvis with its sweatshop.

5. The head of the head occurs in the bent position. Podtotilkaya fossa (point of fixation) It is fixed under the Lona Arc, after which the chin, face, forehead, theme and head of the head are gradually born. Thus, with pelvic predictions, the head is broken by a circle corresponding to its small oblique size

Due to the rapid passage of the head through the bone pelvis ring, it retains a rounded shape, and the generic tumor does not form on it, the generic tumor at pelvic premises is formed on one of the buttocks (left - at the first position and right - with the second) and genitals, and With foot - on the front leg (which is born first).

Biomechanism of childbirth with foot predictions is similar to that with berium. Often the preemptive leg is lowered and falls into the vagina (after influencing the oily water) with an incomplete disclosure of the cervix. It delays and complicates the further flow of labor. With complete disclosure of the cervix, buttocks are born after the leg, and then biomechanism is performed on the outlined option.

how often meet pelvic supplement fetal?

The pelvic prelations of the fetus are found in 2-3.5% of the female in the timely childbirth. With premature birth, the frequency of gas presence of the fetus increases 1.5-2 times.

What kind factors promote appearance pelvic prelation?

The predisposing factors of the occurrence of pelvic 11 loops can be excessive feturization of the fetus with premature pregnancy, multi-way, limited fetal mobility with multiple pregnancy, lowers, pre-lying placenta, obstacles to the head of the head in a small pelvis with a narrow basin, uterine tumors and its appendages, vices Its development, when there is a mismatch of the form of the fetus and the form of the uterus.

What kind options distribution fruit meet for

pelvic prelations?

With pelvic previews there may be the following options:

1) purely berium preview (legs bent in hip joints, broken into the knee and press knobs);

2) mixed berium Prelation (the buttocks and foot of the fetus will be pretended, the legs are bent in hip and knee joints - the fruit "sits in Turkish");

3) shoot The presence is complete (both legs will be pretended) or incomplete (one leg will be pretended) (Fig. 11.1).

Rarely meet knee The presence, which can also be complete or incomplete (one or both legs bent IS knee and dispel in the hip joints).

Fig. 11.1. Pelvic preview options:

a - purely berium; b - mixed berium;

in - full foot; g - incomplete foot

What are the options for the fetal location when pelvic pre-lying are most favorable for mother and fetus and why?

The most favorable options for pelvic prerequisites should be considered butodic - clean and mixed. With these pre-lying, the pelvic end has the greatest circle and best prepares the generic paths for the next birth of the head.

In addition, with purely buttaging prevails, the legs stretched along the body hold knobs from the thread.

What kind layers used for vaginal research

for recognition options pelvic prelations?

With a vaginal study, the role of the sweep-shaped seam is played by the conductor line (LIN. INTERTROCHANTERICA), and the role of small springs - the crushes and the cuxentiary of the fetus.

Additional landmarks are: sedable bumps, inter-fodded grooves, posterior hole, outdoor genitals and fetal feet (with mixed berries). However, it should be remembered that the careless finger study of the region of the external genital organs of the fetus can

i | Rovest to defloration (gap of virgin splas) in girls, i) in the fruit of male irritation of the reflexogenic zone of the scrotum - to the emergence of respiratory movements and aspiration of eye-pop-water water.

how call first moment biomechanism rodov for purely

"Obstetrics in matters and answers"

berry prelations?

The first moment of biomechanism of childbirth - internal turn buttocks.

what occurs in first moment biomechanism rodov for

purely berry prelations?

The buttocks of the fetus are inserted with their interstitial size in one of the oblique size of the entrance plane in a small pelvis. Under the influence of the generic expensive forces, the buttocks are lowered and co-nerve the inner rotation when switching from a wide part to a narrow, mounted in the intersecting line in the direct size of a small pelvic.

how call second moment biomechanism rodov for purely

berry prelations?

The second moment of the biomechanism of labor is called the side SGI-Ping in the lumbar spine of the fetus.

What kind movement performs fetus in second moment biomechanism childbirth?

The lateral flexion of the spine of the fetus caused by the direction of the generic canal occurs. The front buttock (on which the wired point is located) is cut, but is not born from sex paths, as fixation is formed between the front ileal bone of the fetus and the lane battle. The rear buttock is born, then the front, and the fruit comes out of the root paths to the umbilical ring (Fig. 11.2).

how call the third moment biomechanism rodov for purely

berry prelations?

The third point of the biomechanism of labor is the inner turn of the shoulders and the external turn of the fetal body.

what presents by himself the third moment biomechanism childbirth?

The third moment is internally turning the shores and the associated outer turning of the body - occurs in a narrow part of the cavity of the small pelvis and is completed by installing the shoulders in the 11-dimensional exit size. At the same time, the back turns into

Fig. 11.2. The second moment of biomechanism

(lateral bending lumbar

spinal Department)

Fig. 11.3. Completed the third moment

biomechanism of childbirth under the berry

preview (internal turn

holders and Outdoor Tool)

ron, the fetal front shoulder passes under the walled arc, and the rear is installed ahead of the tailbone above the crotch (Fig. 11.3). how call fourth moment biomechanism childbirth?

The fourth moment is the side flexion of the cerzya-thoracic portion of the spine. At the same time, pens and shoulder belt are born from the genital paths. how occurs fourth moment biomechanism childbirth?

Thanks to the translational movement of the fetus, the second point of fixation is formed on the front shoulder of the fetus at the site attachment of the deltoid muscle (the top one third of the shoulder bone). Point of support is the bottom edge of the womb. Under the influence of the generic forces, the body bending occurs in the cervical spine and the birth from the generic canal of the shoulder belt and the handles. At this time, the head comes with its small oblique size in the oblique size of the entrance to the pelvis, the opposite of which the fruit was held.

"Obstetrics in matters and answers"

what occurs in fifth moment biomechanism childbirth?

When moving from the plane of a wide part of the cavity of the small pelvis into a narrow head

Fig. 11.4. Sixth moment of biomechanism

bodies with a berry prelimination

(Birth of the head in extension)

verses the inner turn, as a result of which the sweat-shaped seams turns out to be in the direct exit, and under-occipital fossa (the third point of fixation) is fixed under the Lonny Jim.

how call and in than

concludes sixth

moment biomechanism childbirth?

The sixth moment is called flexion of the head and her birth. Chin, mouth, nose, forehead and fetus are born (Fig. 11.4).

how easier remember order moments biomechanism rodov

for tazov prelation?

With a careful study of the biomechanism of labor in a pelvic preview, you can see a clear pattern: the alternation of three turns and three flexions. The first moment is the turn, the second moment - the fibration, the third moment is the turn, the fourth - flexion, etc.

Where located generic tumor for rodah in pelvic pre-lying?

The generic tumor with berium previews is located on the front buttock, with foot - on the front leg.

What size occurs digging heads?

The head is breaking with a small oblique size of 9.5 cm, and a circle of 32 cm, it appropriate.

Biomechanism and clinic

Delivery at pelvic

PREFERENCE PREVA

Biomechanism rodov for pelvic prelations

how often meet pelvic supplement fruit?

The pelvic prelations of the fetus are found in 2-3.5% of the female in the timely childbirth. With premature birth, the frequency of gas presence of the fetus increases 1.5-2 times.

What kind factors promote appearance pelvic prelation?

The predisposing factors of the occurrence of pelvic 11 loops can be excessive feturization of the fetus with premature pregnancy, multi-way, limited fetal mobility with multiple pregnancy, lowers, pre-lying placenta, obstacles to the head of the head in a small pelvis with a narrow basin, uterine tumors and its appendages, vices Its development, when there is a mismatch of the form of the fetus and the form of the uterus.

What kind options distribution fruit meet for

pelvic prelations?

With pelvic previews there may be the following options:

1) purely berium preview (legs bent in hip joints, broken into the knee and press knobs);

2) mixed berium Prelation (the buttocks and foot of the fetus will be pretended, the legs are bent in hip and knee joints - the fruit "sits in Turkish");

3) shoot The presence is complete (both legs will be pretended) or incomplete (one leg will be pretended) (Fig. 11.1).

Rarely meet knee The presence, which can also be complete or incomplete (one or both legs bent IS knee and dispel in the hip joints).

Fig. 11.1. Pelvic preview options:

a - purely berium; b - mixed berium;

in - full foot; g - incomplete foot

What are the options for the fetal location when pelvic pre-lying are most favorable for mother and fetus and why?

The most favorable options for pelvic prerequisites should be considered butodic - clean and mixed. With these pre-lying, the pelvic end has the greatest circle and best prepares the generic paths for the next birth of the head.

In addition, with purely buttaging prevails, the legs stretched along the body hold knobs from the thread.

What kind layers used for vaginal research

for recognition options pelvic preclient?

With a vaginal study, the role of the sweep-shaped seam is played by the conductor line (LIN. INTERTROCHANTERICA), and the role of small springs - the crushes and the cuxentiary of the fetus.

Additional landmarks are: sedable bumps, inter-fodded grooves, posterior hole, outdoor genitals and fetal feet (with mixed berries). However, it should be remembered that the careless finger study of the region of the external genital organs of the fetus can

i | Rovest to defloration (gap of virgin splas) in girls, i) in the fruit of male irritation of the reflexogenic zone of the scrotum - to the emergence of respiratory movements and aspiration of eye-pop-water water.

how call first moment biomechanism rodov for purely

berry preclient?

The first moment of biomechanism of childbirth - internal turn yagoditz.

what occurs in first moment biomechanism rodov for

purely berry preclient?

The buttocks of the fetus are inserted with their interstitial size in one of the oblique size of the entrance plane in a small pelvis. Under the influence of the generic expensive forces, the buttocks are lowered and co-nerve the inner rotation when switching from a wide part to a narrow, mounted in the intersecting line in the direct size of a small pelvic.

how call second moment biomechanism rodov for purely

berry preclient?

The second moment of the biomechanism of labor is called the side SGI-Ping in the lumbar spine of the fetus.

What kind movement performs fetus in second moment biomechanism rodov?

The lateral flexion of the spine of the fetus caused by the direction of the generic canal occurs. The front buttock (on which the wired point is located) is cut, but is not born from sex paths, as fixation is formed between the front ileal bone of the fetus and the lane battle. The rear buttock is born, then the front, and the fruit comes out of the root paths to the umbilical ring (Fig. 11.2).

how call the third moment biomechanism rodov for purely

berry preclient?

The third point of the biomechanism of labor is the inner turn of the shoulders and the external turn of the fetal body.

what presents by himself the third moment biomechanism rodov?

The third moment is internally turning the shores and the associated outer turning of the body - occurs in a narrow part of the cavity of the small pelvis and is completed by installing the shoulders in the 11-dimensional exit size. At the same time, the back turns into

Fig. 11.2. The second moment of biomechanism

(lateral bending lumbar

spinal Department)

Fig. 11.3. Completed the third moment

biomechanism of childbirth under the berry

preview (internal turn

holders and Outdoor Tool)

ron, the fetal front shoulder passes under the walled arc, and the rear is installed ahead of the tailbone above the crotch (Fig. 11.3). how call fourth moment biomechanism rodov?

The fourth moment is the side flexion of the cerzya-thoracic portion of the spine. At the same time, pens and shoulder belt are born from the genital paths. how occurs fourth moment biomechanism rodov?

Thanks to the translational movement of the fetus, the second point of fixation is formed on the front shoulder of the fetus at the site attachment of the deltoid muscle (the top one third of the shoulder bone). Point of support is the bottom edge of the womb. Under the influence of the generic forces, the body bending occurs in the cervical spine and the birth from the generic canal of the shoulder belt and the handles. At this time, the head comes with its small oblique size in the oblique size of the entrance to the pelvis, the opposite of which the fruit was held.

what occurs in fifth moment biomechanism rodov?

When moving from the plane of a wide part of the cavity of the small pelvis into a narrow head

Fig. 11.4. Sixth moment of biomechanism

bodies with a berry prelimination

(Birth of the head in extension)

verses the inner turn, as a result of which the sweat-shaped seams turns out to be in the direct exit, and under-occipital fossa (the third point of fixation) is fixed under the Lonny Jim.

how call and in than

concludes sixth

moment biomechanism rodov?

The sixth moment is called flexion of the head and her birth. Chin, mouth, nose, forehead and fetus are born (Fig. 11.4).

how easier remember order moments biomechanism rodov

for tazov prelation?

With a careful study of the biomechanism of labor in a pelvic preview, you can see a clear pattern: the alternation of three turns and three flexions. The first moment is the turn, the second moment - the fibration, the third moment is the turn, the fourth - flexion, etc.

Where located generic tumor for rodah in pelvic fore- lying?

The generic tumor with berium previews is located on the front buttock, with foot - on the front leg.

What size occurs digging heads?

The head is breaking with a small oblique size of 9.5 cm, and a circle of 32 cm, it appropriate.

Clinic and modern principles keeping childbirth as pelvic prelations

there is lie features in flow pregnancy?

Pregnancy during pelvic previews

it differs from that with head premises. But, given the possibility of developing complications in childbirth, all pregnant women with pelvic previews should be hospitalized into the maternity hospital two weeks before the intended date of birth.

During this time, the pregnant woman needs to be fully examined: ultrasound diagnostics and test definition of the status of the fetus and the readiness of the uterus for childbirth should be made, if necessary, ultrasound or X-ray viometry. During the survey, all pregnant women are divided into three groups of the risk of upcoming genera for the fetus.

To the I group referred to pregnant high-risk (large size of the fetus - more than 3,600 g, the escape of the pelvis, hypoxia of the fetus, extragenital diseases that affect the state of the fetus and generic activities, primordinaries over 30 years old, etc.). This pregnant women, as a rule, is produced by the delivery by the operation of cesarean section in a planned manner.

In II, the risk group includes pregnant women who have the development of complications in childbirth, but these complications are not complicated. Pregnant women should give birth with mandatory intensive observation (monitor control) for the state of generic activity and the palpitation of the fetus. When complications occur, the cesarean section is performed.

The Group III includes pregnantly low risk. They have children with common observation, although the use of mono-mono control is justified in this group.

What are difference clinic rodov for pelvic prelations from the clinic rodov for head prelations and than they are explained?

1) The period of expulsion of the fetus during pelvic previews may begin with the incomplete opening of the uterine zoom. This is explained by smaller sizes of the pelvic end of the fetus (especially with foot previews) compared with the head. When the fetal shoulder belt and heads through the generic canal with incomplete disclosure may occur or spastic cutting of the cervix, delaying the birth of the head and leading to the asphyxia of the fetus.

2) It is often observed to throw the handles, which requires certain medical manipulations (eliminating the trapped knobs).

3) When the head passes through the generic channel, there is always a pressing of umbilical cord to the walls of a small pelvic. When the head is delayed, this can lead to asphyxia and fetal death.

how proceed roda for pelvic prelations

fruit?

The leader's leader must remember that in labor in pelvic previews of the fetus there may be complications with unfavorable consequences as for the fetus (intranatal hypoxia, brain-brain injury with blood hemorrhage), and for mother (protracted delivery, tribal injuries, postpartum septic Diseases).

Currently, the method proposed by N. A. Tovyanov should be considered the most appropriate when conducting birth through natural generics. However, even when this method is applied, the fulbirth remains high - reaches 3-6% or more.

What kind complications there are in first period rodov?

In the first period of birth, more often than with the head of the preservation, there is a premature oral influence, weakness of generic activities, the fallout of the umbilical cord, hypoxia of the fetus.

Than explained big frequency premature sley-

tiya okoloplodnyy water?

The high frequency of premature oral influence is explained by the fact that the pelvic end in cross section is less than the head, and therefore, inserting into the entrance to a small pelvis, it I IE fills the lower segment of the uterus. The absence of hermetic coverage of the predatory part leads to overflow and overvoltage of the lower part of the fetal bubble and, as a result, the premature bursting of the bubble and the expulsion of water.

With an early breakdown of the fruit bubble and the lack of water separation for the rear and the front is connected and another complication -

fallet of cord and small parts of the fetus. Moreover, the deposition of umbilical cords occurs in pelvic premises five times more often than with head premises.

Than explained frequent development weakness generic activities?

Frequent development of the weakness of generic activity in some cases is due to the same reasons that the pelvic preview has led (defects of development, fragrant of the uterus, etc.).

It is also impossible to exclude the impact on the nature of the generic activity and the most pelvic preview: the pelvic end of the fetus is softer than the fetus head, and, apparently, has a smaller effect on the bottom segment receptor and cervical apparatus.

how conducted first period rodov for pelvic prelations

fruit?

One of the main tasks of conducting the first period of childbirth in pelvic previews is to preserve the faith of the fetus bubble before the onset of the complete or almost complete opening of the cervix. To do this, it is necessary to put the female in the bed. Urination and defecation should be made on a lining ship.

In the first period of birth, it is necessary to conduct monitor observation of the state of the fetus and generic activities.

If after 3-4 hours after untimely (prenatal or early), the influence of the oily water is good generic activity does not develop, childbirth must be completed by the cesarean section.

In the occurrence of generic weakness, the relaxulation should be carried out only when opening a 5 cm and more uterine ode; With a smaller opening, childbirth in the interests of the fetus should be completed by the cesarean operation.

What cause premature exile fruit for insufficient disclosure shays matties?

Most often, this complication is observed with foot

lowering when the size of the prepaying pelvic end of the fetus is the smallest. In addition, the leg of the fetus after the deposition of water is lowered into the vagina and irritates its walls, reinforcing this generic activity. As a result of the legs, and then the buttocks and the torso begin to move forward with an insufficiently open uterine zea.

The large and dense part of the fetus - the head is not in the state of the passage through the insufficiently open neck of the uterus, which leads to asphyxia and the death of the fetus, and when trying to extract the delayed head - and to the rupture of the neck and even the lower segment of the uterus, as well as to generic fetal injury .

In some cases, during the passage of the head, a spasm of the uterine zoom occurs, and the head promotion becomes impossible.

how follow news second period rodov for pelvic prelations fruit?

In the period of expulsion, the doctor's tactics should be expectant.

With pelvic previews, the four stages of expulsion of the fetus are clinically distinguished: the birth of the fruit to the navel, from the navel to the lower corner of the blades, the birth of the shoulder belt and the birth of the head.

As soon as the fruit is born to the navel, the head begins to insert into the entrance to a small pelvis and presses the umbilical cord to the pelvis wall. If from the moment of birth of the fetus to the navel, childbirth will not end over the next 5 minutes, then the fruit is born in asphyxia. If this time is 10 minutes and more, the fruit usually dies.

In the absence of monitor control, the palpulation of the fetus during pelvic previews in the expulsion period must be heard after each sweep.

It should be remembered that in the period of expulsion, during pelvic previews, there is often a noticeable acceleration of the fetal heartbeat due to irritation of P. Splanchnicus as a result of the crown of the fetus tummy with legs, but this should not be a testimony to operational delivery.

Physiologically, the release of mixonia during pelvic previews.

To prevent the spasm of the uterine sewage, after the rubberization of the buttocks, it is necessary to introduce an intravenous solution of spa

litics (2 ml of 2% reduction of but-sleeves or 4 ml of 2% solution of hydrochloride papaverine).

After the teething, the buttocks begin to provide a manual obstetric manual according to the Tsovyanov method.

IN what cases apply method Tsovyanova and in than is he concludes? The Tsovyanov method is used in childbirth in a purely buttaging preview. The method is based on the conservation of the normal location of the fetus, which prevents the development of such serious complications, as the threading of the handles and the extension of the head. Normal locality is achieved by the fact that the legs at the birth of the fetus pressed to the body, without giving them to be born ahead of time. In addition, the legs of the fetus pressed crossed handles to the breast, which is warned by the folding of the handles. And finally, because at the level of the chest, the volume of the body together with crossed handles and legs is greater than the volume of the head, the latter is usually born without difficulty.

What technics manual benefits for pure berry prelation by method. Tsovyanova?

In the teething of the buttocks, they are captured by both hands so that the thumbs are located on the fruit pressed to the belly, and the remaining fingers on the sacrum's surface. Due to this arrangement of hands, it is convenient to contribute to the physiological flow of biomechanism of genera - the movement of a born torso up, to continue the axis of the generic channel (Fig. 11.5, a).

As the fetus body is born, the doctor holding his hands at the boulevard ring, gradually misses the fetal body through them, at the same time cautiously pressing the elongated legs to the belly, and the remaining fingers of the hands move along the back of the fetus. At the same time, it is necessary to strive to ensure that the legs of the fetal fell earlier than the shoulder belt born (Fig. 11.5, b).

The nearest sweat usually leads to the rapid birth of the fetus to the umbilical ring, and then to the lower corners of the blades. At this time, the lamp of the fetus goes into one of the oblique sizes, and by the time of the birth of the shoulder belt - in direct

Fig. 11.5. Manual allowance for Tsovyanov with a purely buttock preview:

a - capturing the fetal body; B - As the body is born, they skip between their hands

exit measures. The fetal buttocks need to be sent at this moment somewhat on themselves to facilitate the birth of the front handle. For the birth of the back handle, the fruit is raised, and the back handle is born. Simultaneously with the birth of the back handle, the legs of the fetus fall out and the chin of the fetus is broken from the germ. For the next birth of the head according to the Tsovyanov method, the born torso of the fetus raise up and gradually laid on the belly of the guinea (Fig. 11.6).

what that benefit by

Brahtu?

Bracht head is identical to the Tsovyanov method, except that the assistant

Fig. 11.6. Birth of the head according to the Tsovyanov method

it comes a moderate pressure on the fetus head to eliminate its extension.

What method can be released head?

With a difficulty birth, the fetus head can be removed according to the Moriso-Leispel method (Fig. 11.7).

Fig. 11.7. Birth of the head according to Moriso-Levera-Leshapel

how lead roda for mixed berry prelation?

With a mixed butt-made preview, manual allowance is beginning to have the appearance of the bottom corners of the blades from the germ. Further remote classical manual benefit for pelvic prelations (Exemption of the brachial belt and the development of the subsequent fetus head).

What is the difference between childbirth during foot predets from childbirth at clean and mixed buttocking previews?

The difference lies in the fact that born legs cannot expand the generic paths so that the shoulder belt and the head of the fetus are hosted. Therefore, with foot predictions, such complications often occur as the threads of the handles, the extension of the head and its infringement in the uterine zea.

how can prevent development these complications?

The only way to prevent these complications is to achieve the full opening of the cervix to the moment of expulsion of the shoulder belt and head.

what necessary for of this to do?

To do this, it is necessary to delay the birth of the legs to the complete opening of the cervix. For this purpose, the method proposed by Tsovyanov is used.

how perform manual benefit by method. Tsovyanova for foot prelations?

This allowance is performed by the following way. Covered with a sterile napkin The outer genitals of the manufacture and the palm surface of the right hand counteract the premature falling out of the legs of the vagina. As a result, the fruit, as it were, "squatting" in the vagina and the foot preview goes into a mixed berium prevention. There is a strong irritation of pelvic plexus, as a result of which the contractions and sweat (Fig. 11.8) are enhanced.

Fig. 11.8. Manual manual according to the Tsovyanov method with foot previews

The opposition to the born legs should be supplied to the full opening of the uterine zoom.

What are signs full discoveries music seva?

The full discovery is evidenced by severe crotch protrusion, the gaping of the posterior hole, frequent and strong swelling and the high standing contract rings. Under the pressure of the buttocks, the floor slot is gradually revealed, and the legs of the fetus, despite the opposition of the doctor's hands, are shown from under the palm.

how lead roda after full discoveries music seva?

After the complete opening of the uterine zoom ceases to provide a manual for the Tsovyanov (the hand is released) and the childbirth leads as with a purely buttaging preservation.

After the birth of the body to the lower corners of the blades in violation of the physiological location of the fetus provide classical manual benefit for pelvic preparation- jeans (Liberation of the brachial belt and the release of the subsequent head of the fetus). ____________________

Of what moments consists liberation shoulder belt?

Liberation shoulder belt Complied from two points.

First moment- reference rear shoulder and pens. To do this, the fruit is captured by hand for both legs, and the torso is lifted up and removed to the side, until the legs occur the position parallel to the inguinal column, the opposite side of the handle freed. After that, two or four fingers are introduced into the generic paths from the half of the sacral depression, to which the back of the fetus is addressed until they reach the fruit's shore, and, having converted it to the elbow joint. Flex a hand in this joint and remove it from the generic pathways along the front surface of the fruit of the fetus with a washing movement.

Simultaneously with the removal of the back handle, the front is often born herself. If this did not happen, proceed to Second Moment Liberation of the shoulder belt - front release shoulder and pens. To do this, it is necessary to pre-translate the front handle for the post. To this end, they capture the body with the born handle in the chest area and rotate it in the oblique the pelvis size opposite to the one in which it is located. At the same time you need to follow

by the back of the back, and therefore, the heads were addressed to the lane.

Of what moments consists liberation subsequent heads?

The release of the subsequent head is composed of two points: flexing the head and its removal from the sex harness (according to the Moriso-Leura-le Chapel method).