93
Internal obstetrical examination.
Task for the student:
perform for this pregnant woman, parturient internal
obstetrical examination s. Describe, simultaneously, what You are doing.
The time of demonstration is 5 minutes.
Information for the examine:
assess, please, the student’s actions,
separately, on the every below given item.
1
Explain of pregnant woman, parturient aim of examination.
Patient is lying on a backside with flexed legs at the pelvic-
femoral and knee’s articulations and situated far from each
other..
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2
Performing a cleaning of the external sexual organs of patient.
Wash our hands and dry with disposable towel. Take on
sterile gloves.
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3
Internal examination should be started with examination of
the external sexual organs( growing of hair , development,
edema of the external sexual organs ( vulva), various veins,
perineum( its high, rigidity , presence of scars ) and introits in
vagina.
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4
At a vagina phalanx of middle and index fingers are
introduced and performing its examination( wide of its,
length, folding’s, stretching of the vaginal walls , scars
presence , tumors, and another pathological conditions ).
Palpation of the internal surface of bone’s pelvis is
performing.
.
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5
If there is pregnant woman uterine cervix is found and degree
of maturation should be checked : situation of its on the
longitudinal axis of small pelvis , size, form, consistence ,
shortness , permeability of channel by investigated fingers.
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6
In labor we determine
the condition of cervix ( shorten,
smooth), the degree of uterine cervix dilatation in
centimeters , condition of edges (soft , hard, thick, thin.
Check the condition of fetal bladder ( whole, is disturbed, the
degree of tenderness, quantity of anterior amniotic fluid).
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7
Determination of the presenting part – buttocks, head, legs,
with orientation on the definite points, on the head sutures
and fontanels , on the pelvic end – sacrum and coccygeal part.
Determine, where is a presenting part :over the plane of inlet,
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94
very closed to the plane of inlet, with small segment, the large
segment , into the cavity of small pelvis , in the plane of
outlet.
8
If presenting part is high and promontories of sacrum is
reached , we should measure the diagonal conjugate (
conjugate diagonal ) between the promontories and low part
of articulation pubic.( at norm it is 13 sm.) with finger in
vagina we try to reach promontories and with end of a middle
finger reach its. Index finger of free hand we should touch the
low part of pubic articulation that directly contacted with low
edge of the pubic arch.
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9
Take away fingers from vagina , Measure on the internal
hand the distance marked on the arm by tape-measure or
pelviometer. Take away fingers from vagina . According to
sizes od diagonal conjugate we think about sizes of true
conjugate.
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10 Make a conclusion on the base of the received date. Take off
gloves and through away in container for utilization, wash a
hands.
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Maximum quantity of balls – 10
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