Waho OB: eaia

Hapai na wahine ka mea,ʻaʻole koe wale kā lākou 'inikua pilikia me. E hoʻoponopono i ia lawa, e pili ana no ka e noho ai i loko o ka antenatal? Aaieou, a ma laila e loaʻa i ka mea e pono ai kōkua a me ka 'ike. Ma kēia mau Ho 'Oponopono, loaʻa nō kekahi mau rula o ka hapai wahine a me kona nana. Aia no he mea me he mawaho obstetric noiʻi, a hoʻohuʻu he kōkua i ka wahine me ka manao i ke kamaiki, i makaukau no ka hānau. He aha ka mea a me ka mea ua hana ma na rula, kūkā mai ma lalo nei.

He aha mea ma waho midwifery noiʻi?

He nui nā wāhine ike i hāpai keiki mea pono no ka helu ma ka Apana haukapila. Ka mua aku a hiki i ka gynecologist hope e hooiaio ai o keia kulana mea,ʻaʻole i nā kānaka a pau i ka ai, no ka mea, hiki ke lawe i ka 40 minuke. Oia ka lōʻihi wā o ka manawa māʻalo mea,ʻaʻole i loko o make hewa i loko o ke kauka o ka oihana. Ma hope o nā mea a pau, i ke akamai pono ole hālāwai wale me ka wahine hapai, akā, no hoi, e ohi i mau, a me kona mōʻaukala. I kohoia ma ke keʻena hoʻokolohua ho'āʻo ma, a me ka hana ma waho midwifery noiʻi.

Ua komo ai i ka loiloi mua ninaninau, a i kona mau algorithm. ? Eaia foxmike midwifery noiʻi ua pono, e ohi i kaʻikepili e pili ana i ka wahine. Ke kauka mea nui e hooholo aku ai i ke kūlana o ka wahine umauma, ma ka like o ka kinona o ka nipple, no ka mea, e loli ai i ke kaʻina o nā ana, e hoomakaukau no ka ai ana. Gynecologist uku noonoo ana i ana i ka expectant makuahine ua loaa ia i nā kilo, mai ka manawa mai o ka hapai ana, a me ka blurts kaupaona ana no ka holoʻokoʻa wā o ke kali ana keiki.

E mālama nei mawaho obstetric noiʻi komo ai kaʻohiʻana 'ike e pili ana i kekahi palapala pregnancies a me scarring o ka uterus. Mau hana e pono ai e hookupaa aku i ka pilikia o ka hāpai keiki pathologies. Ma waho aʻeo ia nana, e no hoʻohana ki ina hana like o ke ana, a me ka palpation auscultation, a kōkua e kiʻi i ka piha kiʻi o ke keiki? Acaeoey a me ke ano o ka wahine, hā nai ia. Aia ma lalo, i kēia mau kiʻina hana e ia i ho'ākāka 'ia i loko o au mamuli.

He aha 'ano o ia mau haʻawina i?

E hoʻoholo i ka ho'ōia kūlana o ka wahine hapai mea,ʻaʻole lawa wale i ka interrogate ia. E like me nā paena a pau palpatsionnye mawaho obstetric noiʻi e e informative no ka 'oihana. E hana i ka pau kiʻi o ka wahine me ka manao i ke keiki, a me kona pēpē ka ola, pono e ike i keʻano o ka hanaʻana lawe wahi i loko o ke kino o ke hapai. Ua hiki ke ike i ke kōkua o ke keʻena hoʻokolohua kālailai o ke koko, mimi, a no laila, ma luna o. I ke kauka mau, oia ke hoolohe i ka Kal hunahuna a Ho'ākāka 'kona kulana i loko o ka uterus. A pau kēia mau manipulations i hōʻike 'ia i loko o ka papa kuhikuhiEʻekoluʻano o ka noiʻi hapai:

• lapaʻau;
• keʻena hoʻokolohua;
• kūikawā.

Lapaʻau ninaninau o ka hapai

Kēiaʻano o ka anamanaʻo wahine i hāpai keiki hoʻomaka me ka ohi ana o 'inikua mōʻaukala a me kona noho moku'āina. Kēia mau hana i kōkua wale i ke kauka kiʻi i ka 'ike ma luna o ke kino ola o ka wahine, ka mea no hoi i ka manawa e Loiloi i kona neuro-psychic haʻawina.

Hoʻomaka lapaʻau ka ninaninau me ka ana ma a mea, huli mai 'ike e pili ana i ka wahine.

1. E hooiaio ai no ka wā e hiki mai makuwahine o ke kanaka (inoa, palapala holo'āina'ē - helu a me ka moʻo).
2. Makahiki i a nulliparous no i kekahi pūʻulu (opiopio - umikumamawalu, i ka makahiki - ma hope o kanakolu makahiki).
3. Ka helu wahi maoli o ka noho, a kakau ana o na wahine.
4. No ke aha la e hele i ke kauka-gynecologist.
5. Material ka noho (ehia na ola kanaka a me nā holoholona i loko o ka hookahi lumi me ka wahine, ola aku ana), e like me ka pono me kahi ia i hana no ka hoʻoponopono '(ma nā palapala e hoʻoholo ma luna o ka oi ka naauao hana no ia, a me ka hua o ka hana ana).
6. Information e pili ana i ke koko transfusion a me kona eiiiiiaiou (wai koko, albumin), allergies, somatic maʻi, oncology. Pinepine maʻamau somatic 'aʻole i manaʻo piha physical ola, no ka mea, he kanaka i' ike ka hoʻohuikau 'o ka noʻonoʻo' a me ko mākou hopohopo aayoaeuiinoe. ke kauka i ka hana - e kuhikuhi i nā kumumea i alakai aku ai i kēia mau 'aʻe', no ka mea, na wahine i oi paha, e hanau, a ma ka hana kūpono 'ana hilinaʻi nui ma luna o ke ola o ka makuahine, a unborn keiki. Nā kumu o nā neuroses a me nā kāna hana o ko mākou hopohopo a me ka noʻonoʻo haʻawina, he hailona:

• hanau nā mea palahēhē;
• stress;
• hooloihi ae i infertility;
• abortion;
• eha ma ka mua hanau ana.

Gynecologist loaa mai i loaʻa nā hōʻailona o ka 'aʻe' ana o ka neuro-psychic aayoaeuiinoe: mua hāpai keiki, a me ka poʻe me kona hanana. Ua mea i pono e loaʻa mai i ka wahine hoʻohuiʻia kā lākou mau kumu.

7. Epidemiological mōʻaukala.

8. ikaika intoxication (uiki, alcoholism, lāʻau hainā).

9. Menstrual a me ka moe, a reproductive oihana (wā menstruation hoomaka, me he kahe, mamua hāpai keiki me pehea ka hanau ana, ke kaupaonaʻana, a ola kūlana o ka mua na keiki, gynecological a me nā kiʻie hōʻikeʻike pū i hiki maʻi hāpai keiki).

10. Family mōʻaukala (moku'āina o ke ola o ka 'ohana e noho pu me ka wahine, nā kūpuna mai, ola kino, pae a me RH affiliation wā e hiki mai makua).

Next, neʻe i ka Pahuhopu ninaninau o ka wā e hiki mai makuahine:

• Aʻo kino, dentist, ophthalmologist a me ka ENT. Inā pono, e hoonoho i nana hoʻomalu 'ē aʻe.
• Ana i ke anuanu a me ke koko,.
• Loiloi i ka i lawa ke, a ana aʻela kiʻekiʻe, ke kaupaona a me nā Ana o na pelvis.
• Nānā a palpate i ka abdomen.
• Huli koko, mimi a me nā secretions.
• Explore i ka symphysis pubis.
• Hana i electrocardiogram.
• Ultrasound keia hookolokolo ana mea pono i ka kekahi, o kela mea keia hapai wahine a hiki i ka umikumamalua, umikumamawalu i iwakalua-lua, a me ka 32 minuke ma ka hebedoma 34th.
• E lawe mai mawaho midwifery noiʻi.

He mea nui i i kakau ole ma hope o ka wahine ma mua o 12 pule o ka gestation. Ka mua i hana 'anthropometry, keʻena hoʻokolohua ho'āʻo a me ka loiloi' ia 'ana o ke koko,, ke kiekie o ka manawa kūpono o ka ke ola i ke kamaiki a kuhikuhi fetal abnormality incompatible me ke ola.

Keʻena hoʻokolohua haʻawina o na wahine

I ka wā o ka expectant makuahineʻia kakau, ka mea, ua häʻawi mai i ka lapaʻau koko ho'āʻo a me ka urinalysis, hoakaka i ka pae a me RH ololi, ke koko monakō koko, kaha no Nalia RW, hepatitis, HIV, a me e scrapings a me swabs mai ka vagina a me ka cervix ma flora, cytology, chlamydia, gonorrhea, trichomoniasis.

Inā mōʻaukala hoike i ka hanau ana o ke keiki make, miscarriages (oi loa i loko o ka hope kahua o ka hoʻonaʻauao), extragenital pathology, ia mea e pono ai:

• e hoʻopaʻa haʻawina koko no ke alo aku o ka hemolysin i ka wahine o;
• wā e hiki mai ke koko makua kāne pae hiki ke hoʻohana i ka makaikai a me RH, pakahi aku la ia ina hapai rhesus ololi io pūʻulu 'ole 0 (I);
• e hooholo i ka alo o urogenital nā mea palahēhē;
• hoʻoholo i ka nui o ke kupono hormones, immunoresistance;
• ina e pono ai, e hoʻomaka aaiaoe noiʻi.

E möakäka hou keʻena hoʻokolohua ikea ai ua lawe mai i loko o ia mau hua'ōlelo:

• CBC - mahina ma hope o ka hebedoma kanakolu - hookahi iʻumikumamāhā mau lā;
• ma kēlā me kēia? eaia i hoakaka ia mimi ma luna o ka nohona ma Ka Ikepili;
• ma ka umikumamaono a hiki i ka hebedoma iwakālua ho oholo i ka hCG a me ka ACE;
• ma 22-23 pule. a me 36-37 pule. ninaninau koko kōpaʻa;
• Study ma ka coagulation'ōnaehana (coagulation) paka 36 i 37th pule;
• ma kanakolu pule, a no elua a ekolu pule ma mua ka hānau keiki hou loiloi no HIV a me RW, ninaninau swabs a me scrapings.

Special OB

Special obstetric noiʻi kikowaena:

1. E mālama nei mawaho obstetric noiʻi.
2. Kūloko midwifery noiʻi.
3. Other nā haʻawina.

Foxmike obstetric hoʻokolokolo 'ka hookolokolo ana, ana o ka nui o na pelvis. Ma hope o ka hebedoma iwakalua hoʻoholo ka nui o ka nui anapuni o ka abdomen, hoʻokō probing ka abdomen, a me ka pubic symphysis, a me prolushivaniya fetal naau. mawaho obstetric noiʻi lako a pan mea,ʻaʻole mea, ka mea, ua lawe mai wale ma pela i hoomakaukauia ka paramedics.

Kūloko midwifery noiʻi. Ma na midwifery noiʻi kikowaena hookolokolo ana o ka mea mawaho wahine, vagina a me ka cervix study ka hoʻohana 'ana aniani keleawe. He like me nui me mawaho obstetric noiʻi ka nahunahu hanau. Kēia ke kaʻina hana no ua lawe mai i na naau oʻu me ka bladder. No ka mea ke anaina kanaka i ka wahine noi, e moe ana ma kou kua, na wawae, e hoike mai ma ka lima, a lena ma na kuli. Nā pelvis E e hoʻokiʻekiʻeʻia. pono lawe mai hoʻokolokolo 'ana ma lalo o aseptic ana.

• Ka like hoʻomaka me ka hookolokolo ana o ka mea mawaho genitalia. Loiloi i ke ano o ke kino lauoho, crotch. Huai ae pathological keʻano o ka hanaʻana, ina ka mea, e: scars mai ruptures i loko o ka mua hanau ana, hikoko, aku aat, fistulas, warts, hemorrhoids ma ka anus. Loiloi i ka moku'āina o vulvar labia e hookuke me kou mau manamana lima, i hooholo i ka moku'āina o ka urethral glands.

• hoike i ka cervix me ke kōkua o ke aniani. E lohe i ka mucous huna, cervical a me ka uterine puʻu nui. Ma ka trimester I-ke ala kūpono lawe i kekahi mau-hema ninaninau o ka vagina, i loko o ka lua a me ke kolu wale pili hoʻokahi-hema.

Mua manaʻo i ka crotch (ina rigidity, scarring) a me ka vagina (nui, pa pelu loaʻa nui).

4 loaa ana mawaho obstetric haʻawina

? Eaia foxmike midwifery noiʻi (Leopold i kūpono) hoʻohana ma palpation o ka abdomen o ka wahine hapai. Hanau keia poe eha epekema:

• manaʻo i ke kiʻekiʻe o ke ku ana uterus, a kaʻana like i ka hua, a ia mea;
• hoomaopopo ana i ka wahi o ka fetus, a e hopena a e pili ana i ka loaa ole o ke kua a me kona mau lima a me nā wāwae;
• hoʻoholo 'ana o ka hua, a ua kau mua, kona wahi i pili i ka poe liilii, pelvis;
• manao like fetal hooku iho la ia wahi ua hoʻonoho i pili i ka mea e komo ai i ka pelvis.

Ke kumu o ka nana ana o ka cervix

Ma mua o ka hānauʻana o ka cervix hoʻoholo waiwai nui, no ka mea, i ka 'ana i ke kino o makaukau e haʻalele. Epekema ka 'ike i ka waiwai nui o ka cervix e like, akā, i kēia mau mea kiko'î i auhau i loko o nā mea a pau o ia mau mea:

• hana mau;
• ka mea i ka lōʻihi o ka hapa vaginal o ka moana;
• patency o ka cervical Canal;
• ke aupuni 'a i ka mamao o ka'ā'ī (axis) ua kuhikuhi ma na pelvis;
• ka paia mānoanoa o ka'ā'ī hapa, a ua hoʻonohonoho i loko o ka vagina;
• kau i ke ano o ka malalo o ka uterus.

Loiloi i ka cervix no ka kūikawā pālākiō. ʻiliahi cervix mea mai 0 a hiki i 5 puan. Inā i ka nana i huli hou aku 10, laila i kekahi wahine e hoomakaukau ai no ka nahunahu hanau.

Haʻawina o na wahine pelvis

E ike pelvic Ana, hoʻohana i kekahi mawaho OB hapai like pelviometriya. Kūmau mawaho pelvic Ana e like penei:

• spinarum loihi, i mea like me 25-26 kenimika;
• kristarum loihi - mai ka 28 a hiki i 29 mau kenimika;
• trohanterika loihi - mai ka 31 a hiki i 32 mau kenimika;
• Conjugate externa - mai ka 20 a hiki i 21 mau kenimika;
• diagonalis conjugate, a e ia i loko o ka laulā 12,5 - 13 kenimika.

Ka hapanui o kauka mua i ke kipa mua, na wahine ho'āʻo e ana i ka conjugate manaoio (oiaio), a hoʻoholo i ka nui o ka puka e komo ai a hiki i ka poe liilii, pa holoi. Maʻamau, ka mea, e ia 11 i 12 knm, ka oiaio conjugate hiki ke loaʻa, ke ole ka mea ma waho conjugates (externa) unuhi i 9 mau kenimika. Kona nui no hoi me ka rhomb Michaelis a me Frank nui (nānā 'ana i ka hiku o ka cervical vertebrae i ka waena o ka jugular fossa). Ka diagonal o ka conjugate i ua aia ma waena o ka haahaa kae o ka pubic symphysis i ka loa salient māhele krestsovogo lae, i like i ka waiwai oiaio conjugates.

Inā ka pelvis nui like 'ole deviate mai ke kūmau, ia mea kupono e hoʻomaka mawaho obstetric noiʻi' ana i kūpono i ka mea keu Ana: anaʻaoʻao conjugate, i ua aia ma waena o ka mua spine o ka ilium , a me ka hope spine ma kekahiʻaoʻao. Kona maʻamau aiee o 14 a hiki i 15 mau kenimika. Inā ka mea, ua emi o 12 a me ka hapalua kenimika, physiological ka nahunahu hanau ole i ke Akua. No hoi ana i ka nui o ka kēlā. Ekolu o lakou, a ina i ka likeʻole ma waena o ia oi ma mua o 1.5 kenimika, ka lunakanawai kēlā hou, i ka i pilikia ma ka hānau.

Ho oholo i ka pelvic huina o inclination, a 'aʻole i deviate mai ka 45-55 degere. Like nui pubic huina a e e like me 90-100 degere.

Ke algorithm o mawaho obstetric noiʻi pū i ka waiwai o ka auoiaea o ka uuku pa holoi:

• laina nui, i mea like i eiwa mau kenimika. Ua Ua ma waena o ka hopena malalo o ka pubic articulation, a me ka hoaka oʻoi o ka coccyx ke aupuni '. Mai kaʻikepili loaa hao mau kenimika ma ka pahee nā'aʻaʻa;
• tazometrom ana transverse Ana i ka 11 mau kenimika, a aia ma waena o ka ischial tuberosity (lākou loko surfaces).

? Eaia Leopold-Levitsky

No kekahi kahuna lapaau e pono ka noi komo 'ana o nā wāhine, ma ka wā o ka hāpai keiki ua pono kana a mawaho midwifery noiʻi. pâʻani 'o ia i? eaia Leopold-Levitsky nui kūlana i loko o laila. Ka inoa o kēia mau 'ana i kūpono ma nā loina o i i mua hōʻikeʻia aʻela ma luna, poluchli ma ka aoao o ke kanaka nana i hoʻomohala ia i loko o ka hopena o umikumamaiwa kenekulia. Kēia kanaka o ka German kauka Christian Leopold. Mau Aey? Acaeoey Ua Wehewehe i nā hāʻina i mea i pili i ka keia lā he nui obstetric pilikia.

Ka mea, kōkua e hoʻoholo i ka nui a me kaʻoihana o ka fetus ma ka hopena o hāpai keiki. Ka mua o kēia mau 'ana i kūpono i ke alo o kēlā me kēia ultrasound. He kuhikuhi mai la lakou i ke kiekie o ka makuahine e kū ana lalo, a kokoke mau hoʻopili like me ka wā o ka hāpai keiki. Pololei kona pili me ka abdominal paia mānoanoa. Inā ma ka kanalua, e oi pololei i nā hualoaʻa e haawi ultrasound.

Ke kolu o ka hōʻike i ka? Eaia fetal hōʻike: breech, transverse a me ke poo. A no hoi, pehea nui o ka hua mua i loko o ka pelvis. Ke ha? Eaia keʻae i ka mea mua ekolu.

Algorithm like

He nui na hana hoihoi algorithm mawaho obstetric noiʻi 'ana i kūpono. pelvic ana initially i hapai. Ma hope iho o ka pau ana o keia manipulation o ke kauka puka mai a hiki i palpation o ka abdomen o na wahine. 'O kēia ke kahua o ka palapala noi Leopold? Eaia. A malaila, e hele i ka auscultation, a hoʻolohe i ka fetal naau. Aia i nui alapine (frequency) o ka naau kui iho oe a (mea maʻamau mai ka 120 a hiki i 160 kui iho oe a no minuke.), Ko lakou mōakaaka a me ka pāpana. Auscultation ua hana ka hoʻohana 'ana i kekahi stethoscope a me ka fetal kanaka hoʻoponopono.

Mawaho a me na midwifery noiʻi mea nui loa i hāpai keiki, a ma hope o haawi. E ike A wahine ia, e hele kūponoʻia, a ma kekahi hihia, aole ia i hilahila aku, mai o lakou. Ka mea kōkua i ke kauka loaʻa mai paha ka mea maʻamau i pele hāpai keiki mea ola ina ka expectant makuahine a me kona bebe.