Aggravated obstetric-gynecological history. OAA: history, not a verdict. What does OAA apply to?

State budgetary educational institution of higher professional education

"Bashkir State Medical University"

Ministry of Health of the Russian Federation

Department of Obstetrics and Gynecology No. 1

Head department: professor, doctor of medical sciences U.R. Hamadyanov

Teacher:

HISTORY OF CHILDREN
Last name, first name, patronymic of the mother in labor

FULL NAME.__________________________________________________________________

Curator:

4th year student

Groups________

FULL NAME.______________________

Academic year

Birth history plan

I. Passport part

1. Last name, first name, patronymic

2. Age

3. Profession

4. Date and time of receipt

5. Sanitary treatment of women in labor upon admission to the maternity hospital in accordance with Order No. 808N dated 10/02/2009. Ministry of Health of the SSR of the Russian Federation “On approval of the procedure for providing obstetric and gynecological care.”

II. Complaints upon admission

III. Anamnesis of life(including working and living conditions)

IV. Somatic anamnesis

1. Heredity (including the presence of multiple births in parents and immediate relatives)

2. Previous common diseases, including hepatitis (viral), indicate the year; note previous blood transfusions.

3. Allergy history (indicate factors contributing to allergies)

V. Obstetric and gynecological history

1. Menstrual function: at what age did menstruation begin, when did it become established, how many days it lasts, after what time, the amount of blood lost (heavy, moderate, scanty), pain.

2. Sexual life: at what age did it begin, what kind of marriage was it, is the marriage registered, the husband’s age and information about his health, birth control.

3. Past gynecological diseases (including their consequences).

4. Childbearing function. List all pregnancies in chronological order with outcomes. In relation to childbirth, indicate: normal or pathological, occurred on time, prematurely, late, whether there were obstetric operations, the weight of the newborn, treatment of the postpartum period, whether the child is alive. In relation to abortions, indicate: spontaneous and artificial, at what time it occurred or was performed. In case of spontaneous or out-of-hospital abortion, indicate whether there was subsequent curettage of the uterine cavity. Course after the abortion period. How many children were alive, stillborn, died (cause of death).

5. The course of this pregnancy:

6. Date of last menstruation

7. During the first half of pregnancy

8. Date of first fetal movement

9. The course of the second half of pregnancy, taking into account information from the antenatal clinic (when and at what time did you first go to the consultation, how many times did you visit, data from blood and urine tests over time, blood pressure dynamics, blood type, Rh affiliation and the presence of anti-Rhesus antibodies, Wasserman reaction, HIV, specialist consultation, outpatient treatment, physiopsychoprophylactic preparation for childbirth, date of prenatal leave).

As you know, pregnancy is a difficult period for every woman. After all, it seems that carrying and giving birth to a baby is as easy as shelling pears, but don’t forget about the difficulties that you will face. All this leads to the fact that expectant mothers must take the necessary measures to protect themselves and the baby from various negative environmental factors.

Of course, it often happens that doctors begin to scare a woman in an “interesting” situation with certain diagnoses.

An abbreviation such as “OAGA” is becoming more and more common during pregnancy, but not everyone knows what it is, especially those mothers who are expecting a child for the first time.

What is OAGA?

The abbreviation OAGA means “complicated obstetric and gynecological history.” As for such a term as anamnesis, it is important to understand that this is the history of the disease, from its onset to seeking help from a specialist. But at the same time, expectant mothers must clearly understand that pregnancy is not a disease, because it is a condition.

Thus, it is worth noting that obstetric history represents a certain relationship with other factors of pregnancy and their course. In general, this question implies various risk factors; they, in fact, can negatively affect the process of bearing a baby as a whole, and this also includes a successful delivery.

What does this include?

Many pregnant women cannot fully understand the meaning of this term, since for them it is completely new. Of course, this is especially true for those mothers who are expecting a baby for the first time. The term includes:

• this includes abortion;
• childbirth that occurred prematurely;
• the birth of a baby with various pathologies;
• injuries of the birth canal, etc.

Naturally, these and many other factors can negatively affect the process of bearing a child. As a result, we often have to deal with the fact that many mothers give birth to babies with various pathologies. So, it is important to consult your doctor on this issue in order to reduce possible risks as much as possible.

Thus, it now becomes clear that in general this concept is associated with those factors that affect the health of the expectant mother, but also, of course, the health of her unborn baby.

Moreover, factors that are reflected in the field of gynecology also play a huge role here, for example, the course of menstrual cycles, disruptions in them, certain sexual diseases that the woman has suffered.

The concept of “OGA” (“burdened gynecological history”) is closely related to “OAA” (“burdened obstetric history”), this is explained by the fact that they are often called in common terms. In addition to all that has been said, expectant mothers should clearly understand that this diagnosis is actually given to many women, as practice shows. As for our country, their number is approximately eighty percent.

That is why you should always consult with your doctor, thereby listening to all his recommendations. After all, only then will it be possible to avoid various health problems.

After all, if you regularly undergo various examinations, then there is a risk of not only identifying infections, but also treating them immediately. Moreover, you should definitely examine your hormonal levels, and if the need arises, adjust them.

Conclusion

Only if you follow such valuable advice can you always minimize risks while maintaining the health of the expectant mother and her baby.

General anamnesis
Heredity is not burdened. The age of the parents at the birth of the patient: mother - 21 years old, father - 24 years old. The first child in the family. There were no multiple births in the family. The mother's pregnancy proceeded without complications, the birth occurred on time, her birth weight was 3600 g, her height cannot be determined. Living conditions are normal, the marriage is registered. My husband is 26 years old, healthy. She suffered from Botkin's disease in 1981; she denies blood transfusions and sexually transmitted diseases. No allergic reactions were noted.

Obstetric and gynecological history
Menstrual function
Menstruation began at the age of 13, established immediately, after 29 days, 5-6 days each, moderately painful, moderately heavy. The nature of menstruation did not change after the onset of sexual activity. First day of last menstruation - October 7, 1999
Sexual function
He has been sexually active since the age of 18, first marriage, contraception with a condom.
Fertility
Pregnancies - 2, births - 0, medical abortions - 0, spontaneous abortions - 1. The first ended in a spontaneous miscarriage in April 1999 at a period of 5-6 weeks, the second pregnancy is real.
Secretory function
No pathological discharge from the genital tract was noted.
Gynecological diseases
In 1995, cervical erosion was diagnosed, and therefore laser destruction of the erosions was performed.

The course of a real pregnancy by trimester
First trimester: noted periodic vomiting in the morning. II trimester: threat of miscarriage, manifested by nagging pain in the lower abdomen, increased blood pressure to 145/80 mmHg.
Estimated due date
1. According to the first day of the last menstruation (October 7, 1999) - July 15, 2000, gestational age - 18 weeks.
2. By ovulation (20th of October 1999) - mid-July 2000, gestation period - 17-18 weeks.
3. For the first appearance at the antenatal clinic (November 22, 1999, the period was set at 6-7 weeks) - July 14, 2000, pregnancy period - 17-18 weeks.
4. According to ultrasound data from February 3, 2000 - mid-July 2000, the gestational age is 17 weeks. Total weight gain - 2 kg.

Objective examination data
General condition is good. The physique is normosthenic. Height 168 cm, weight 65 kg. Blood pressure 120\70 mmHg. The skin is of normal color. Visible mucous membranes are pale pink. The lung boundaries are normal. A clear pulmonary sound is heard over the entire surface of the chest. Vesicular breathing. The boundaries of the heart are within normal limits. Pulse 76 beats per minute, rhythmic. BP 120\70 Tongue of normal color. Teeth without carious changes. Zev is clean. The abdomen is enlarged due to the pregnant uterus; the enlarged abdomen corresponds to 18 weeks of pregnancy. Regular stool. Pasternatsky's symptom is negative on both sides.

Obstetric examination data
The shape of the abdomen is round, the navel is retracted. Abdominal circumference 82 cm. Height of the uterine fundus 21 cm. Fetal weight according to Jordan - 1722 g, according to Bublichenko - 3250 g, according to Lankowitz - 3360 g.
Distancia spinarum - 26 cm
Distancia cristarum - 29 cm
Distancia troсhanterica - 32 cm
External conjugate - 20cm
True conjugate - 11 cm
Michaelis rhombus - 11 x 11 cm
Frank's size - 11 cm
The position, presentation, position cannot be determined by external techniques due to the short duration of pregnancy at the moment. The uterus is in normal tone, slightly excitable. The fetal heartbeat cannot be heard due to the short duration of pregnancy at the moment.

Vaginal examination
The external genitalia are developed correctly. Female pattern hair growth. Vagina of a nulliparous woman. The cervix is ​​2 cm, dense. The throat is closed. There are no exostoses in the pelvis.

Data from additional research methods
General blood test dated 02/09/2000

Hb – 120 g/l
Red blood cells 4.2 x 1012
Color index 0.90
Leukocytes 8.5 x 109
Segmented 60%
Band 1%
Eosinophils 2%
Lymphocytes 30%
Monocytes 9%
ESR 15 mm per hour

General urine test dated 02/10/2000

Color – straw yellow
Relative density 1018
Full transparency
The reaction is acidic
No protein
Leukocytes 1-2 in the field of view

Diagnosis
Pregnancy 17-18 weeks, threat of miscarriage, vegetative-vascular dystonia of the hypertensive type. Compounded obstetric and gynecological history (miscarriage).

Rationale for diagnosis:
Pregnancy 17-18 weeks - according to methods for determining the timing of pregnancy (by the first day of the last menstruation, by ovulation, by attendance at the antenatal clinic, by ultrasound). Threatened miscarriage - according to the medical history and complaints upon admission: periodic nagging pain in the lower abdomen, a history of miscarriage. Compounded obstetric and gynecological history (miscarriage) - according to the history (miscarriage in April 1999)

Treatment:
Monitoring blood pressure levels and complaints.
1. Motherwort tincture 30 ml 3 times a day - a sedative.
2. Bearberry tincture 30 ml 3 times a day - as a means of reducing uterine excitability.
3. Papaverine 2% 2 ml intramuscularly 2 times a day - an antispasmodic, as a means of reducing the excitability and contractility of the uterus.
In case of increased excitability of the uterus and (or) increased blood pressure, a solution of MgSO4 30 ml IM 3 times a day reduces the tone of smooth muscles (replacing Ca ions in smooth muscles), leads to relaxation of the uterus and a decrease in blood pressure.

Birth management plan:
Childbirth is carried out through the natural birth canal. Prevent bleeding and fetal hypoxia.
Prevention of bleeding in the 3rd period: Administration of uterine contractions (oxytocin, methylergometrine) at the end of the 2nd stage of labor (when the parietal tubercles erupt). Monitoring the process of placenta separation and the amount of blood loss. If the placenta has separated, but:
1. blood loss is 250 ml and continues - manual examination of the walls of the uterus to monitor the integrity of the uterus, complete separation of the placenta, freeing the uterine cavity from blood clots and decidual tissue. Also - massage of the uterus on the fist, without removing the hand from the uterus, and the introduction of uterotonic agents (oxytocin, methylergometrine).
2. blood loss is 400 ml and continues - application of clamps to the cervix according to Baksheev, administration of uterotonic agents (oxytocin, methylergometrine), replenishment of BCC with infusion therapy (reopolyglucin), infusion of fresh frozen plasma, fibrinolysis inhibitors (contrical, gordox - protease inhibitors), tranixamic acid , red blood cells if necessary.
3. blood loss is 1000 ml and continues - hysterectomy.

Prevention of bleeding in the postpartum period:
1. Catheterization of the bladder (so as not to compress the uterus and thereby weaken its contraction)
2. Ice on the stomach - improving vascular contraction
3. Uterine contracting agents - oxytocin (for better contraction of the uterus and vascular tamponade), methylergometrine - 1 ml IV at the end of the 2nd stage of labor (when the parietal tubercles erupt).
4. External massage of the uterus.

Prevention of fetal hypoxia during childbirth:
1. Stimulation of labor in the 2nd period in case of insufficient intensity.
2. Oxygen therapy for the mother during labor.
3. Monitoring the condition of the fetus (listening to the heart rate) to identify fetal hypoxia and timely take measures for rapid delivery if hypoxia occurs and increases.
4. Administration of drugs that improve uteroplacental blood flow - sigetin (iv 2 ml of 2% solution), administration of glucose with ascorbic acid (iv 50 ml of 40% glucose with 30 mg of ascorbic acid), corazol (iv m 1 ml of 10% corazole solution).

Federal Agency for Health and Social Development of the Russian Federation

GOU VPO IGMA

Department Obstetrics and gynecology

Izhevsk 2013

Passport details:

1.FULL NAME.:

.Age: 25 years old

.Marital status: Married

.Profession, position: accountant, Positive LLC

.Date of admission: 03/11/13

.Pregnancy, Childbirth: 1 pregnancy, 1 childbirth

.Blood type, Rh factor: AB(IV) Rh+

.Diagnosis on admission: Pregnancy 39-40 weeks. Mild preeclampsia. Bronchial asthma, long-term remission.

.Concomitant diseases: bronchial asthma

Pregnancy history:

The course of this pregnancy:

2nd trimester - denies general diseases, noted nausea, vomited several times, blood pressure - 120/80 mm Hg. Art.

2nd trimester - denies general diseases, heartburn appears, weight gain is 8 kg, blood pressure is 120/80 mm Hg. Art. First fetal movement at 16 weeks.

2nd trimester - total weight gain during pregnancy is 10 kg, uniform. Blood pressure - 120/80 mm Hg. Art. Reason for hospitalization: preeclampsia, childbirth.

Obstetric history:

1.Menstrual function: Menarche at 13 years old, the cycle was established immediately, 5-6 days after 28 days, heavy, painless. . The date of the last menstruation is 06/11/12.

.Secretory function: vaginal discharge is mucous, moderate, transparent, odorless.

.Sexual function: Beginning of sexual activity at age 21, first marriage. My husband is 27 years old, healthy, without bad habits.

.Fertility:

1st pregnancy - real

Contraception before pregnancy: condoms.

1. The function of the digestive and urinary organs is unremarkable.
2. Allergy history - without any peculiarities.
3. Heredity is not burdened.
4. There are no bad habits.
5. Prof. No harm
6. My husband is healthy.

Objective examination data:

1.Complaints of pain during contractions, no headache, clear vision, slight swelling in the lower extremities, general condition is satisfactory.

.The physique is correct, proportional, normosthenic type, height - 155 cm, weight - 70.8 kg, t - 36.6.

.Nervous system: pupillary reflexes are preserved, sleep is restful.

.State of mind: good mood, slight fear of childbirth.

.Cardiovascular system: heart sounds are clear, rhythmic, there is no accent of the second tone, blood pressure in both arms is 120/80 mm Hg. Art., pulse 76 beats per minute.

.Respiratory organs: vesicular breathing, no wheezing, respiratory rate - 16 per minute.

.Genitourinary system: no dysuric disorders.

External obstetric examination data at the time of admission:

1.Pelvis dimensions:

d. spinarum - 22 cm, d. cristarum - 26 cm, d. trochanterica - 32 cm, c. externa - 23 cm.

2.The height of the uterine fundus is 37 cm, the abdominal circumference is 101 cm, the estimated size of the fetus is 3737

.Lumbosacral diamond - 11cm x 11cm

.Wrist joint index - 15cm

.The state of contractile activity of the uterus - the uterus contracts upon palpation.

.The position of the fetus is longitudinal, presentation is occipital, position is first, view is anterior, the fetal heartbeat is clear, the listening location is below the navel on the left, frequency is 130 per minute, rhythmic, sonorous.

Data from internal obstetric research 03/16/2013 at 7:40

a) The external genitalia are developed correctly, the vagina has not given birth.

b) the cervix is ​​centered, up to 0.5 cm long, soft, thin, opening 3 cm.

c) the amniotic sac is intact

d) presenting part - head, pressed to the entrance to the pelvis

e) there are no exostoses, the cape is not reachable, the size of the diagonal conjugate is > 12 cm.

f) diagnosis based on the study: 1st period of 1st term labor, cephalic presentation.

Laboratory research.

1. complete blood test:

Hemoglobin ---100 g\l

Red blood cells---3.4*10 12\l

Leukocytes---4.5*10 9\l

Eosinophils ---2%

Basophils --- 0%

Sticks.--- 1%

Segments.--- 49%

Lymphocytes--- 39%

Monocytes--- 9%

ESR--- 37mm/h

platelets 320*10 9\l

Clotting time: 6min20sec

bleeding time: 5min35sec

1. Analysis of urine.

Yellow color

Transparency - slightly cloudy

Specific gravity - 1011

Protein - not detected

Leukocytes - 1-2 in the area.

Flat epithelium 1-3 in n/z.

total protein 69.8.2 g\l

fibrinogen 5.2 g/l

1. Smear microscopy:

leukocytes 12-15 in the field

epithelium: 4-7

flora: unit. cocci

Trichomonas - negative

Conclusion: 1st degree of vaginal cleanliness.

1. ECG: sinus rhythm, heart rate 85-57 per minute, respiratory arrhythmia, vertical EO.

Summary of pathological findings:

1. Bronchial asthma.
2. Cervical erosion.
3. Ureaplasma.
4. Varicose veins.

Diagnosis and its rationale:

First pregnancy, 39-40 weeks, occipital presentation, first position, anterior view, large fetus. Complicated obstetric history. 1st period of 1st term birth.

The following signs of pregnancy are present: cessation of menstruation (last menstruation 06/11/11), the uterus is enlarged, its standing height is 37 cm, abdominal circumference is 101 cm, palpation of the abdomen reveals parts of the fetus and its movement; The fetal heartbeat can be heard well (especially on the left, below the navel).

From the obstetric history it is known that this is the first pregnancy.

Justification for the duration of pregnancy: the date of the first day of the last menstruation is 06/11/12, 279 days have passed from this day to the present, which corresponds to 39 weeks of pregnancy.

Based on data from external obstetric examination and vaginal examination, the longitudinal position of the fetus was determined in the anterior view of the occipital presentation, the first position.

Estimated weight of the fetus: multiply the circumference of the abdomen (101 cm) by the height of the uterus (37 cm), it turns out approximately 3737 g, therefore the fetus is large.

From the obstetric anamnesis it is known that the woman has cervical erosion, which is an aggravation of the obstetric anamnesis.

The onset of the first stage of labor is indicated by the appearance of contractions and vaginal examination data: effacement of the cervix and opening of the uterine pharynx, formation of the fetal bladder.

From the obstetric history it is known that these births are the first. pregnancy obstetric birth

Estimated due date:

Urgent birth: due date at the last menstrual period is 06/18/13.

Birth management plan, rationale, birth prognosis:

Childbirth is managed conservatively with the use of antispasmodics and analgesics. To prevent intrauterine fetal hypoxia and bleeding during childbirth. Delivery should be carried out with a functional assessment of the pelvis.

Considering that the fetus is in an anterior occipital presentation and the size of the mother's pelvis corresponds to the size of the fetus, we can predict a normal course of labor.

Progress of labor (16.03.13)

1.1st stage of labor (dilation period)

Management tactics: Active monitoring of the condition of the woman in labor (color of the skin and visible mucous membranes, pulse, blood pressure, bladder and bowel function; when amniotic fluid is released, their quantity, color, transparency, smell are determined, and a vaginal examination is performed) and the fetus (listened to fetal heartbeat every 15 minutes, observe the pattern of insertion of the fetal head - this can be determined by external palpation techniques, vaginal examination, listening to the fetal heartbeat, ultrasound examination).

The bladder must be emptied, since its overflow can interfere with the normal course of labor.

Pain relief for childbirth: Sol. Promedoli 1% 1-2 ml subcutaneously.

Prevention of vomiting: Seduxen 5-10 mg.

:40 - the amniotic fluid was opened, the amniotic fluid was clear. The general condition is satisfactory, the head does not hurt, the vision is clear. Pulse - 76 per minute, blood pressure - 120/80 mm Hg. Art. Contractions in 4-5 minutes for 35 seconds. The fetal head is pressed against the entrance to the pelvis. The fetal heartbeat is clear, rhythmic, up to 136 beats per minute. Dilation 4cm.

Vaginal examination:

Indication: rupture of amniotic fluid.

Data: the cervix is ​​smoothed, the edges are of medium thickness, soft, the opening of the pharynx is 4-5 cm. There is no amniotic sac. The head is pressed against the entrance to the pelvis.

Diagnosis: 1st stage of 1st term labor, cephalic presentation, large fetus, rupture of amniotic fluid. Complicated obstetric history.

Conclusion: continue conservative management of labor.

:40 - General condition is satisfactory, headache does not hurt, vision is clear. Pulse - 76 per minute, blood pressure - 120/80 mm Hg. Art. Contractions every 3 minutes, 40 seconds. The fetal head is pressed against the entrance to the pelvis. The fetal heartbeat is clear, rhythmic, up to 136 beats per minute. Cervical dilatation is 7cm.

2.II stage of labor (period of expulsion)

Tactics: Enhanced monitoring of the condition of the mother in labor and the birth canal. After each attempt, the fetal heartbeat must be listened to, since during this period acute fetal hypoxia often occurs and intrauterine death may occur.

The advancement of the fetal head during the expulsion period should occur gradually, constantly, and it should not stand in the same plane in a large segment for more than an hour. During the eruption of the head, they begin to provide manual assistance. When extending, the fetal head puts strong pressure on the pelvic floor, and it is greatly stretched, and a rupture of the perineum may occur. On the other hand, the fetal head is subjected to strong compression from the walls of the birth canal, the fetus is exposed to the threat of injury - impaired blood circulation to the brain. Providing manual assistance during cephalic presentation reduces the possibility of these complications.

Manual aid for cephalic presentation is aimed at protecting the perineum. It consists of several moments performed in a certain sequence.

The first point is to prevent premature extension of the head. The head, erupting through the genital slit, should pass its smallest circumference (32 cm), drawn along a small oblique dimension (9.5 cm) in a state of flexion.

The person delivering the baby stands to the right of the woman in labor, places the palm of his left hand on the pubis, and places the palmar surfaces of four fingers on the head, covering its entire surface emerging from the genital slit. Light pressure delays the extension of the head and prevents its rapid movement along the birth canal.

The second point is to reduce perineal tension. To do this, the right hand is placed on the perineum so that four fingers are pressed tightly to the left side of the pelvic floor in the area of ​​the labia majora, and the thumb is pressed to the right side. The soft tissues are carefully pulled with all fingers and moved towards the perineum, thereby reducing the tension of the perineum. The palm of the same hand is used to support the perineum, pressing it against the erupting head. The excess soft tissue reduces perineal tension, restores blood circulation and prevents rupture.

The third point is the removal of the head from the genital slit without pushing. At the end of the attempt, use the thumb and forefinger of the right hand to carefully stretch the vulvar ring over the erupting head. The head is gradually removed from the genital slit. At the beginning of the next attempt, the stretching of the vulvar ring is stopped and the extension of the head is again prevented. This is repeated until the head approaches the genital slit with its parietal tubercles. During this period, the perineum sharply stretches, and there is a danger of its rupture.

The fourth point is the regulation of pushing. The greatest stretching and the threat of rupture of the perineum occurs when the head in the genital fissure is located by the parietal tubercles. At the same moment, the head experiences maximum pressure, creating a threat of intracranial injury. To avoid injury to the mother and fetus, it is necessary to regulate pushing, i.e. turning them off and weakening or, conversely, lengthening and strengthening them. This is done as follows: when the fetal head is positioned by the parietal tubercles in the genital fissure, and the suboccipital fossa is located under the pubic symphysis, when pushing occurs, the woman in labor is forced to breathe deeply in order to reduce the force of pushing, since pushing is impossible during deep breathing. At this time, both hands delay the advancement of the head until the contraction ends. Outside the attempt, with the right hand they squeeze the perineum above the fetal face in such a way that it slides off the face, with the left hand they slowly lift the head up and straighten it. At this time, the woman is asked to push so that the birth of the head occurs with low tension. Thus, the person leading the labor with the commands “push” and “don’t push” achieves optimal tension of the perineal tissues and the successful birth of the densest and largest part of the fetus - the head.

The fifth moment is the release of the shoulder girdle and the birth of the fetal body. After the birth of the head, the woman in labor must push. In this case, an external rotation of the head occurs, an internal rotation of the shoulders (in the first position, the head turns towards the opposite position - towards the mother’s right thigh, in the second position - towards the left thigh). Usually the birth of the shoulders occurs spontaneously. If this does not happen, then the head is grabbed with the palms in the area of ​​the right and left temporal bones and cheeks. The head is easily and carefully pulled downwards and backwards until the anterior shoulder fits under the symphysis pubis. Then with the left hand, the palm of which is on the lower cheek, they grab the head and lift its top, and with the right hand they carefully remove the back shoulder, moving the perineal tissue from it. The shoulder girdle was born. The midwife inserts the index fingers from the back of the fetus into the armpits, and the torso is lifted anteriorly (up onto the mother's stomach). The child was born.

To prevent bleeding, administration of methylergotomine is indicated before the appearance of the parietal tubercles of the fetal head (causes contraction of the uterus, which helps stop bleeding).

Depending on the condition of the perineum and the size of the fetal head, it is not always possible to preserve the perineum and it ruptures. Considering that an incised wound heals better than a lacerated one, in cases where there is a threat of rupture, a perineotomy or episiotomy is performed.

:30 - General condition is satisfactory, headache does not hurt, vision is clear. Pulse - 76 per minute, blood pressure - 120/80 mm Hg. Art. Push every 1-2 minutes for 50 seconds. The fetal head in the pelvic cavity. The fetal heartbeat is clear, rhythmic, up to 130 beats per minute.

:55 - A live, full-term boy was born without visible malformations. Weight - 3680 g, height - 52 cm, head circumference - 34 cm, chest circumference - 32 cm. Apgar score at the 1st minute - 7 points, at the 5th minute - 8 points. The integrity of the soft birth canal is not compromised.

3.III stage of labor (afterbirth period)

Management tactics: Wait and see. Active monitoring of the woman in labor: the skin should not be pale, the pulse should not exceed 100 beats per minute, blood pressure should not decrease by more than 15-20 mm Hg. Art. compared to the original one. Monitor the condition of the bladder; it must be emptied, because... an overfilled bladder prevents uterine contraction and disrupts the normal course of placental abruption.

Signs of placental separation:

1.The placenta has separated and descended into the lower part of the uterus, the fundus of the uterus rises above the navel, deviates to the right, the lower segment protrudes above the womb (Schroeder's sign).

.A ligature placed on the umbilical cord stump at the genital fissure, when the placenta is separated, lowers by 10 cm or more (Alfeld sign).

.When pressing with the edge of the hand above the womb, the uterus rises up, the umbilical cord does not retract into the vagina if the placenta has separated, the umbilical cord is retracted into the vagina if the placenta has not separated (Kustner-Chukalov sign).

.The woman in labor takes a deep breath and exhales if, when inhaling, the umbilical cord does not retract into the vagina, therefore, the placenta has separated (Dovzhenko’s sign).

.The woman in labor is asked to push: with a detached placenta, the umbilical cord remains in place; and if the placenta has not separated, the umbilical cord is retracted into the vagina after pushing (Klein's sign).

The correct diagnosis of placental separation is made based on the combination of these signs. The woman in labor is asked to push, and the placenta is born. If this does not happen, then external methods of removing the placenta from the uterus are used:

1.Abuladze's method (strengthening the abdominals). The anterior abdominal wall is grasped with both hands in a fold so that the rectus abdominis muscles are tightly grasped with the fingers, the discrepancy of the abdominal muscles is eliminated, and the volume of the abdominal cavity is reduced. The woman in labor is asked to push. The separated afterbirth is born.

.Genter's method (imitation of generic forces). The hands of both hands, clenched into fists, are placed with the back surfaces on the fundus of the uterus. Gradually, with downward pressure, the placenta is slowly born.

.The Crede-Lazarevich method (imitation of a contraction) may be less gentle if the basic conditions for performing this manipulation are not met. The conditions are as follows: emptying the bladder, bringing the uterus to the midline position, lightly stroking the uterus in order to contract it. Technique of the method: the fundus of the uterus is grasped with the right hand, the palmar surfaces of four fingers are located on the back wall of the uterus, the palm is on the bottom of it, and the thumb is on the front wall of the uterus; at the same time, use the whole hand to press the uterus towards the pubic symphysis until the placenta is born.

It is necessary to examine the afterbirth and soft birth canal. To do this, place the placenta on a smooth surface with the mother side up and carefully examine the placenta; the surface of the lobules is smooth and shiny. If there is any doubt about the integrity of the placenta or a defect in the placenta is detected, then a manual examination of the uterine cavity is immediately performed and the remnants of the placenta are removed.

When examining the membranes, their integrity is determined, whether blood vessels pass through the membranes, as happens with an additional lobe of the placenta. If there are vessels on the membranes, they break off, therefore, the additional lobule remains in the uterus. In this case, manual separation and removal of the retained additional lobe are also performed. If torn membranes are found, it means that their fragments lingered in the uterus. The closer to the placenta the rupture of the membranes, the lower the placenta was attached, the greater the risk of bleeding in the early postpartum period. In the absence of bleeding, the membranes are not artificially removed. After a few days they will come out on their own.

Women in labor in the afterbirth period are not transportable.

Examination of the external genitalia is carried out on the delivery bed. Then, in a small operating room, all primiparous and multiparous women are examined using vaginal speculums to examine the vaginal walls and cervix. Detected tears are sutured.

:10 - The general condition is satisfactory, the head does not hurt, vision is clear, the skin and visible mucous membranes are of normal color and moisture. Pulse - 76 per minute, blood pressure - 110/70 mm Hg. Art. The afterbirth separated and was born on its own after 15 minutes, intact, all membranes, umbilical cord 60 cm, total blood loss 150 ml. The integrity of the soft birth canal is not compromised. The uterus is dense, painless, moderate bleeding, urine is light.

Duration of labor by period and in general:

The duration of labor is 6 hours 10 minutes, which corresponds to the normal period. The second period is 5 hours (fast). The second period is 25 minutes (normal). The second period is 15 minutes (normally up to 40 minutes).

The mechanism of these births, described point by point:

The first moment is flexion of the head. At the end of the opening period, the head stands at the entrance of the pelvis so that the sagittal suture is located in the transverse or slightly oblique dimension of the pelvis. During the period of expulsion, the pressure of the uterus and abdominal press is transmitted from above to the pelvic end, and through it to the spine and head of the fetus. The back of the head drops, the chin approaches the chest, the small fontanel (wire point) is located below the large one.

As a result of flexion, the head enters the pelvis in the smallest size, namely small oblique (9.5 cm) instead of the direct size (12 cm) with which it was previously installed.

The second point is the internal rotation of the head with the back of the head anterior, or correct rotation. The head makes translational movements forward (lowers) and simultaneously rotates around the longitudinal axis. In this case, the back of the head (and the small fontanel) turns anteriorly, and the forehead (and the large fontanel) turns posteriorly. The sagittal suture, located in the transverse (or slightly oblique) size of the entrance to the pelvis, gradually changes position. When the head descends into the pelvic cavity, the sagittal suture becomes oblique (the first position is the right oblique). At the outlet of the pelvis, the sagittal suture is installed in its direct size.

The third point is extension of the head. When the flexed head reaches the pelvic outlet, it encounters resistance from the pelvic floor muscles. Contractions of the uterus and abdominal press direct the fetus downwards. The pelvic floor muscles resist the movement of the head in this direction and contribute to its deflection anteriorly (upward). Under the influence of these two forces, the head extends, which is facilitated by the shape of the birth canal. Extension of the head occurs after the area of ​​the suboccipital fossa comes close to the pubic arch. The head extends around this fulcrum. During extension, the parietal region, forehead, face and chin appear successively from the genital fissure, i.e. the entire head is born (with a plane passing through the small oblique size, the circumference of which is 32 cm).

The fourth point is the internal rotation of the body and external rotation of the head. The shoulders, with their transverse size, fit into the transverse or slightly oblique size of the pelvis; in the pelvic cavity the rotation of the shoulders begins and they become oblique. At the bottom of the pelvis they are installed in the direct size of the pelvic outlet (one shoulder - to the symphysis, the other - to the sacrum). The rotation of the shoulders is transmitted to the head, when they are installed in the direct size of the pelvic outlet, the face turns towards the mother’s hip. After the birth of the shoulder girdle, the remaining parts of the fetus are expelled. This happens quickly and without obstacles, since the fetal body, less voluminous compared to the head and shoulder girdle, passes through the birth canal, maximally expanded by the head in front.

Newborn:

Gender - boy, weight - 3680 g, head circumference - 34 cm, head shape - dolichocephalic, chest circumference - 32 cm, which corresponds to the mechanism of childbirth.

primary toilet of the newborn and primary treatment of the umbilical cord:

The umbilical cord is wiped with a sterile swab soaked in 96% alcohol and crossed between two clamps at a distance of 10-15 cm from the umbilical ring. The end of the newborn's umbilical cord together with the clamp is wrapped in a sterile napkin. The eyelids are wiped with sterile swabs. Blenorrhea is prevented: the lower eyelid of each eye is pulled back and 1-2 drops of a 30% solution of albucid or a freshly prepared 2% solution of silver nitrate are instilled onto the everted eyelids with a sterile pipette. Areas of skin densely covered with cheese-like lubricant are treated with a cotton swab soaked in sterile petroleum jelly or sunflower oil.

Condition of the postpartum woman in the first two hours after birth:

The general condition is satisfactory, the head is not dizzy or painful, vision is clear, the skin and visible mucous membranes are of normal color and moisture. Pulse - 76 per minute, blood pressure - 110/70 mm Hg. Art., heart sounds are clear, rhythmic. The integrity of the tissues of the soft birth canal is preserved, there is no bleeding.

Forecast of the postpartum period:

Considering the normal course of labor and the early postpartum period (in the first 2 hours), the absence of complications in these periods, and the birth of a healthy child, the postpartum woman should be considered practically healthy, but she needs a special regime that will create conditions for the correct involution of the genital organs and the healing of microtraumas and normalization of the function of all organs and systems. The main points of this regime are the prevention of infectious diseases (compliance with asepsis, antiseptics, toilet of the external genitalia, antibiotic therapy), constant monitoring of the condition of vital organs and body systems, proper nutrition, care for the mother in labor, etc. Only if all these points are observed, is it possible to restoration of the mother’s body and preservation of her health. Destination:

1.Table No. 15

.Toilet external genitalia

.Tab. Analgini 0.5 for pain

.Oxytocini 1.0 ml x 2 times a day

.Blood and urine tests

Based on the data obtained during childbirth and the early postpartum period, I make a final diagnosis: 1st pregnancy, 40 weeks, occipital presentation, first position, anterior view, large fetus. Complicated obstetric history.

Expanded epicrisis:

Full name, born in 1986, was admitted to maternity hospital No. 5 on March 11, 2013 at 9:10 a.m. with complaints of periodic pain in the lower abdomen and swelling in the lower extremities. Based on complaints, medical history, general examination, external obstetric examination, vaginal examination, a preliminary diagnosis was made: 1st pregnancy, 40 weeks, occipital presentation, first position, anterior view, large fetus. Complicated obstetric history.

Based on the diagnosis, conservative labor management tactics were chosen.

In the first stage of labor, in the conditions of the prenatal room, active monitoring of the condition of the woman in labor and the fetus was carried out, anesthesia was performed as indicated, and a vaginal examination was performed as indicated (rupture of amniotic fluid).

In the second period, monitoring of the condition of the mother and fetus was intensified, obstetric care was provided to protect the perineum, and prevention of bleeding and intrauterine fetal hypoxia. A live boy was born without visible malformations, weighing 3737 g, height - 52 cm. The soft tissues of the birth canal were examined.

In the third period, active expectant monitoring of the woman in labor continued in order to timely identify signs of bleeding, delayed separation of the placenta and birth of the placenta, and provide appropriate obstetric care. The soft tissues of the birth canal were examined.

During the first two hours of the postpartum period, the postpartum woman was under close medical supervision in order to timely identify complications and provide appropriate preventive and therapeutic measures. The soft tissues of the birth canal were examined.

OGA is a term that accompanies pregnancy with any deviation from the norm. According to statistics, in Russia about 80% of women have OGA, and their number does not decrease from year to year. When compiling an anamnesis, all previous pregnancies are taken into account, regardless of their outcome, as well as gynecological diseases and operations.

OAS: the essence of the problem

The abbreviation OAGA stands for burdened obstetric and gynecological history. This is the presence in each individual patient of factors associated with past pregnancies, as well as with gynecological health, which can complicate the current condition and have a negative impact on the fetus. In medical practice, this diagnosis is made when a woman has premature birth, miscarriages, stillbirths, abortions, the birth of children with developmental defects, and the death of a child within 28 days after birth. The medical history is also complicated by pathologies of the uterus and ovaries, infertility of any origin, hormonal imbalance, and Rh conflict.

What can a woman do

If a woman has already had unsuccessful pregnancies or has gynecological diseases in her medical history, then each new conception plan should be approached very seriously. Accidental pregnancies should not be allowed, especially if the timing recommended by the gynecologist is not followed after miscarriages, childbirth and induced abortions. It is important for a woman with OGA to register with a antenatal clinic or private clinic as early as possible, since, for example, the first screening to detect genetic pathologies in the fetus must be carried out strictly before 12 weeks of gestation. The patient should inform the gynecologist about each episode associated with previous pregnancies, abortions, surgical treatment of the uterus and appendages, and chronic gynecological diseases. Only with the woman’s complete frankness will the doctor be able to minimize the factors that complicate the course of pregnancy and lead to pathology or death of the fetus.

Fight infections!

A mandatory test before conception is a test for TORCH infections - determination of antibodies to rubella, cytomegalovirus, herpes and toxoplasmosis, as well as sexually transmitted diseases. Remember: infection with rubella during pregnancy is almost always an indication for its artificial termination at any stage, since it entails pathologies of the fetus - deafness, blindness, and other developmental defects. As gestation continues, intrauterine fetal death occurs in 20 percent of cases. If there are no antibodies to the rubella virus, you should get vaccinated against it no later than two months before the planned conception.
Rubella infection during pregnancy is an indication for abortion

With toxoplasmosis, the severity of the prognosis directly depends on the time of infection. When Toxoplasma is introduced into the fetus in the first trimester, spontaneous abortions and severe developmental pathologies are possible. Late congenital toxoplasmosis is characterized by intracranial calcification, chorioretinitis, convulsions, and edema of the brain. Fixed. CMV infection during pregnancy also provokes the onset of perinatal pathology - prematurity, stillbirth, defects of organs and systems. Infection with herpes is most dangerous in the first 20 weeks of pregnancy; vertical infection of the fetus is possible with subsequent development of pathologies.

What is important to remember regarding infection? You can become infected at any time, even a few days before conception, which means that the absence of certain pathogens in your body does not guarantee a positive outcome of your pregnancy. Therefore, most doctors argue that carriage of a number of infectious pathogens (not all, of course) is much better than their absence in the body. Why? Because if you come into contact with a sick person, you are not in danger of being reinfected - you already have protection against this type of pathogen. This does not apply to bacteria and fungi, where the mechanism of defense against these microorganisms is different, so you can become infected with many bacterial and fungal infections more than once.

Elena Berezovskaya

http://lib.komarovskiy.net/mify-ob-infekciyax.html

Hormonal swing

During pregnancy planning, it is important for a woman to have her hormonal levels examined and normalized. A good place to start is with thyroid hormones. This organ produces triiodothyronine (T3) and tetraiodothyronine (T4, thyroxine). Thyroid-stimulating hormone (TSH) is produced in the pituitary gland. Thyroid dysfunction can cause menstrual irregularities, miscarriage, and fetal pathology.

Table of thyroid hormone norms

By gender

Sex hormones should be checked in case of menstrual irregularities, male-pattern body hair growth, a history of missed pregnancies, excess weight, and PCOS.

Video about hormone tests before a planned pregnancy

Ultrasound will show the exit

The release of an egg from the ovary, which will help a woman determine the period of possible conception, and also give an objective picture of the condition of the uterus and appendages. The procedure is prescribed on days 9–10 of a 28-day cycle (to control ovulation) or on days 5–7 to detect possible pathological changes.

OAGA: medical tactics

Whether the expectant mother belongs to a certain risk group, taking into account the OGA, is determined by an obstetrician-gynecologist after clinical and laboratory tests. An individual observation plan is entered into the patient’s chart with the appointment of modern methods of examining the mother and fetus. It also contains information about recommended preventive hospitalizations, as well as an indication of where the birth will take place - in a regular or specialized maternity hospital.

At-risk groups

In Russia, obstetricians and gynecologists use a systematic approach to determine the degree of perinatal risk. The first - low - includes repeat pregnant women with a maximum of three quiet births in the anamnesis. This group also includes primary pregnant women who have no obstetric complications or non-gynecological pathologies; one uncomplicated abortion is allowed in their medical history.
The second degree of risk is childbirth in women with compensated pathological conditions of the cardiovascular system, mild diabetes mellitus, kidney disease, hepatitis, and blood diseases.

Also complicating the medical history:

• pregnancy after 30 years;
• placenta previa;
• clinically narrow pelvis;
• large fruit;
• its wrong position;
• perinatal mortality recorded in previous pregnancies;
• gestosis;
• operations on the uterus.

The third degree of risk includes women with severe pathologies of the heart and blood vessels, exacerbation of systemic diseases of connective tissue, blood, placental abruption, shock during childbirth, and complications during anesthesia.

Just what the doctor ordered

Pregnant women of high risk groups may be prescribed a consultation with a geneticist with a possible chorionic villus biopsy, amnio-, cordo-, placentocentesis to determine abnormalities in the development of the unborn child. The most accessible of all these studies is amniocentesis. With it, by micropuncture of the amniotic membrane, a portion of amniotic fluid is obtained, which contains embryonic cells. They are examined for the presence or absence of genetic damage.
Examination of amniotic fluid will help determine fetal pathologies

All pregnant women with OGA, according to indications, are referred for consultation to specialists to resolve the issue of prolonging pregnancy. In cases where it is necessary to conduct examinations in a hospital setting, the patient is placed in the gynecological department of the hospital or maternity hospital.

Important attitude

Women with OGA often experience pessimism during pregnancy. The need to visit the doctor more often and stay in the hospital worsens their mood. Constant thoughts about the upcoming birth and the health of the unborn child also add to the problems. Soft psychological relaxation techniques, which are used by specialist psychologists who conduct courses for expectant mothers in maternity hospitals and antenatal clinics, can come to the rescue. Physical activity is also indicated, of course, with the permission of the gynecologist observing the woman: walking, swimming in the pool, yoga. It must be remembered that the OAGA is not a sentence, but an instruction to the doctor in choosing the optimal way to manage the pregnancy.
Yoga is good for you during pregnancy

Forecast for the future

It is worth knowing that childbirth with a burdened obstetric and gynecological history, as a rule, ends in the birth of a healthy child. Only in some cases, the mother’s simple medical history can affect the health of the newborn. For example, if a woman has sexually transmitted infections, the fetus may become infected during childbirth. A predisposition to certain diseases is also inherited - hypertension, diabetes. They can complicate future pregnancies for the girl born. But OAGA itself is by no means a hereditary phenomenon, but the medical history of a particular person.