 Definition of a duration of gestation and childbirth  External obstetric examination  Determination of mass of a fruit

Definition of a duration of gestation and childbirth Purpose: definition of a duration of gestation and childbirth Indication: method of inspection of all pregnant women Equipment: calendar, prenatal record On the last menses: Ask the woman start date of the last menses: Negel's formula – of the first day of the last menses minus 3 months plus 7 days = of date of childbirth read back before defined date. On an ovulation: day of an ovulation (conception) in 14 days after the beginning of the last menses. On the first stir of a fruit: At primapara in 20 weeks, at multipara in 18 weeks. On ultrasonography of a fruit: calculation on weeks from the date of ultrasonography before defined date. On the I appearance in policlinic: By the uterus sizes at per vaginum (at an early appearance till 12 weeks)

Determination of estimated mass of a fetus Purpose: a fetation assessment in dynamics of pregnancy Indication: method of inspection of all pregnant women and women in labor Equipment: couch, centimetric tape To lay the pregnant woman on a couch in a dorsal decubitus To rise facing the woman on the right To surround with a centimetric tape the woman's trunk at the level of a navel and on the middle of lumbar area – defining the stomach circle (SC) To determine height of standing of an uterine fundus (VDM), putting the beginning of a centimetric tape the right hand to the middle of the upper edge of a pubic joint. An edge of a palm of the left-hand hand to note an upper bound of an uterine fundus on a tape. To increase a stomach circle by height of standing of an uterine fundus. On the received figure it is possible to judge the mass of a fruit expressed in grams

External obstetric examination Purpose: to define a chlenoraspolozheniye, situation, a position, a type of a position and a presentation, the relation of the prelying part of a fruit to the planes of a basin of mother Indications: method of inspection of all pregnant women, women in labor Equipment: couch The pregnant woman is stacked on a couch on a back with the extended feet. The doctor sits down to the right of the woman nearby. 1 reception - palmar surfaces of both hands have densely on an uterine fundus so that nail phalanxes were turned to each other. Determine by this reception height of standing of an uterine fundus. 2 reception - hands lower from an uterine fundus on right and left-hand its parties to navel level below. In turn carefully press palms and fingers of both hands on uterus sidewalls, define the back and shallow parts of a fruit are turned into what party. I.e. position and type of a fruit. At 1 position the back is turned into a left-hand side of a uterus, at 2 positions – in right. At a forward look – the back is turned kpered, at a rear view – to a back wall of a uterus. 3 reception - the right hand cover the prelying part of a fruit then carefully make the movements by this hand to the right and to the left. Allows to define this reception what part predlezhit to an entrance to a small pelvis and its relation to a basin. 4 reception - investigating becomes facing feet of the pregnant woman and puts palms on the prelying part of a fruit on both sides of a uterus. Fingers of both hands, versed to an entrance to a basin, carefully and sluggishly get between the prelying part and lateral departments of an entrance to a basin and palpate available sites of the prelying part. Determine by this reception the prelying part and its relation to a basin.