OB Ngaphandle: namatheko

abafazi abakhulelweyo asishiywa yedwa kunye neengxaki zabo zonyango. Uzisombulule ngokwaneleyo ukuba isicelo yokuhlala kwi kwiklinikhi yabakhulelweyo, yaye apho ukuze ufumane uncedo oluyimfuneko kunye nolwazi. Kwezi izibhedlele, kukho imigaqo ethile umfazi omithiyo kunye nokuhlolwa yakhe. Kukho into enje njenge uphando lwangaphandle yokubelekisa, nto leyo ithetha ukuba uncedo kumfazi owayekhulelwe, ngelokulungiselela zokubeleka. Yintoni na noko kwenziwa kwimigaqo, kuxoxwa ngezantsi.

Yintoni uphando Midwifery ngaphandle?

abafazi abaninzi bayazi ukuba ukhulelwe kuyimfuneko ukuba abhaliswe kwisibhedlele yesithili. Utyelelo lokuqala ukuya ugqirha emva isiqinisekiso yale meko ayikho ekhuhlangubeni wonke, kuba ingathatha imizuzu engama-40. Loo ixesha elide kwexesha akulolize kwi-ofisi kagqirha. Ngapha koko, ingcali kufuneka ihlangane kuphela umfazi omithiyo, kodwa kwakhona ukuqokelela imbali jikelele kunye ezizodwa. Wanyulwa nokunyulwa ngawo iimvavanyo elebhu, yaye zenziwa ngaphandle uphando Midwifery.

Oku kubandakanya uviwo yokuqala, eye indlela yayo. Namatheko uphando Midwifery yangaphandle iyafuneka ukuqokelela ulwazi malunga umfazi. Ugqirha kubalulekile ukumisela ubume abafazi amabele, ingakumbi imilo ingono, kuba kuchaphazela isethi amanyathelo ukulungiselela ukutya. Udokotela byi ingqalelo njani na umama okhulelweyo olufunyenwe kuthunyelwa ukusuka mzuzu kwesisu, endaba izinga ubunzima lonke ixesha lokulinda usana.

Ndiqhuba uphando lwangaphandle yokubelekisa kubandakanya ukuqokelela ulwazi malunga nokukhulelwa zangaphambili nezibhaxu ye isibeleko. Ezi zenzo kuyimfuneko ukuseka umngcipheko ezimbi ukukhulelwa. Ukongeza ukuba sihlolwe, Kusekho kusetyenziswa iindlela yokulinganisa, Ngokucofa kunye auscultation, ezinceda ukufumana umfanekiso opheleleyo wophuhliso komntwana kunye nemeko yomfazi, ku navela loku. Apha ngezantsi, ziza kuchazwa ezi ndlela ngokweenkcukacha.

Ziziphi izifundo ezinjalo?

Ukuze ubone ubume wihi umfazi okhulelweyo Akwanelanga ukuba bayigocagoce kuye. Nokuba ngaphandle zonke amaqhinga palpatsionnye uphando lwangaphandle yokubelekisa iya kumfundisa ngenxa yobungcali. Ukuze wenze yonke umfanekiso womfazi owayekhulelwe, kunye neyomntwana wakhe, kufuneka ukwazi oko iinkqubo kwenzeka ngaphakathi emzimbeni abakhulelweyo. Oku kunokubonwa ngoncedo elabhoratri ahlalutye igazi, umchamo, njalo-njalo. Kwakhona ugqirha rhoqo umamela kwiimvuthuluka nokubetha kwentliziyo uchaza indawo yawo wesibeleko. Zonke ezi zazo zixhonyiwe iintlobo ezintathu eziphambili zophando okhulelweyo:

• lwezonyango;
• elebhu;
• ezizodwa.

kuxilonga abakhulelwe

Olu hlobo saveyi abasetyhini ngexesha lokukhulelwa uqale ukuqokelela imbali yezonyango kunye meko likuyo ngoku. Le misebenzi kuphela kunceda ugqirha ukufumana ulwazi impilo yomzimba lo mfazi, zinika ithuba ukuhlola umsebenzi walo neuro-izangoma.

Qala kuxilonga kunye uphando apho kuvela ulwazi malunga umfazi.

1. Ukungqinwa unina elizayo yomntu (igama, yokundwendwela - inani kunye series).
2. Age apho nulliparous lilungu iqela elithile (abaselula - elinesibhozo, iminyaka - emva kweminyaka engamashumi amathathu).
3. Idilesi kanye yokuhlala kunye nokubhalisa kwamabhinqa.
4. Kutheni uye kugqirha-ugqirha.
5. iimeko Material zokuphila (bangaphi abantu abahlala kunye nezilwanyana gumbi elifanayo nomfazi, iimeko zokuphila), kwakunye apho wayesebenza ukujongana (kwi eziyingozi ekufuneka senze isigqibo malunga umsebenzi kakhulu- ngenxa yakhe, yaye iziqhamo iimeko zomsebenzi).
6. Ulwazi malunga igazi kwanangamacandelo alo (plasma, albumin), aleji, izifo somatic, Oncology. Amaxesha amaninzi somatic eqhelekileyo akuthethi impilo emzimbeni, ngenxa yokuba umntu bangafumana ukuphazamiseka komsebenzi kwengqondo ethukile. umsebenzi kagqirha - ukuchonga izinto ezabangela ukuba ezi daba, ngokuba abafazi baba lula kuzala, yaye yokuziphatha efanelekileyo ixhomekeke impilo kamama nomntwana engekazalwa. Ubangelwa nezifo kunye nezinye izifo yomsebenzi luvo nangokwasengqondweni, a lot:

• izifo ukuyinyamezela;
• uxinzelelo;
• nenzalo elide;
• isisu;
• yokwenzakala kwi ekuzalweni odlulileyo.

Udokotela ifumanisa ukuba kukho iimpawu ukunyhashwa umsebenzi neuro-izangoma: phambi ukukhulelwa, okanye ngaxeshanye kunye ukwenzeka kwayo. Kuyimfuneko ukuba ufumanise ukuba yintoni na umfazi kanga imvelaphi yabo.

7. imbali Epidemiological.

8. ukunxila rhoqo (ukutshaya, ukusela utywala, gwenxa kweziyobisi).

9. sexesheni kunye nemisebenzi zezesondo nezenzala (xa saqalisa esexesheni, njengokuba flow, ukukhulelwa yangaphambili nendlela ngokuzalwa, ubunzima kunye nesimo sempilo yabantwana zangaphambili, izifo ezosulela ngokwabelana ngesondo zizifo ukukhulelwa).

10. imbali Family (nobume bempilo lamalungu osapho abahlala kunye umfazi, ufuzo, ezempilo, iqela kunye RH aliphi ubawo elizayo).

Okulandelayo, yiya uviwo kwinjongo umama elizayo:

• Ufumane Iingcebiso therapist, wamazinyo, zamehlo kunye ENT. Ukuba kuyimfuneko, iqeshe iingcali zohlolo enye.
• Linganisa iqondo lobushushu kunye noxinzelelo lwegazi.
• Kuhlolwe Imizimba Wayilinganisa ubude, ubunzima kunye nemilinganiselo isinqe.
• Hlola kwaye palpate esiswini.
• Hlola igazi, umchamo kunye nezinye netuwa.
• Hlola pubis symphysis.
• Yenza i electrocardiogram.
• uviwo ultrasound kuyimfuneko Kwathi wonke umfazi omithiyo de elinesibini, elinesibhozo yesibini-mabini kunye nemizuzu 32 kwi kwiveki yama-34.
• Ukwenza uphando Midwifery lwangaphandle.

Kubalulekile ukuba lo mfazi yabhaliswa zingadlulanga iiveki ezili-12 yokumitha. Le anthropometry lwenziwa ngaphambili, iimvavanyo elebhu kunye novavanyo uxinzelelo lwegazi, ayanda amathuba okuba nosana olunempilo okanye ukuchonga ukungaqheleki ezingekazalwa akuvumelani ebomini.

izifundo Laboratory kwabafazi

kokuba Xa umama okhulelweyo ebhaliswe, unikwe uvavanyo lwegazi lwezonyango kunye urinalysis, ukuchaza iqela kunye RH factor, iswekile yegazi, khangela ukuba Nalia RW, hepatitis, i-HIV, kwaye wenze scrapings kunye namalaphu okusula evela kwilungu lobufazi kwaye wesibeleko kwizityalo, cytology, chlamydia, ukuvuza ngaphantsi, itrichomoniasisi.

Ukuba imbali kutyhilwa ukuzalwa abantwana kwabafileyo, kwezisu (ingakumbi kwi zigaba kamva), ngezifo extragenital, kuyimfuneko:

• ukwenza isifundo igazi yomfazi ubukho hemolysin;
• iqela elizayo uyise igazi xa zingasetyenziswa ukuba baphonononge kwaye RH, ingakumbi xa ukhulelwe rhesus factor kakubi okanye iqela 0 (I);
• ukufumanisa ubukho izifo enzala;
• ukuqinisekisa inqanaba iihomoni eziyimfuneko, immunoresistance;
• xa kukho imfuneko, ukuqhuba uphando yemfuza.

kokuhlolwa laboratory yenziwa ngokubhekiselele ezinjalo:

• ICBC - kwenyanga emva kwiveki wamashumi amathathu - kanye ngeentsuku ezilishumi elinesine;
• ngexesha ngalinye umchamo yokwamkela kwenkcazo kucazululo ngokubanzi;
• kwi eleshumi elinesithandathu kwiveki wamashumi amabini ukuqinisekisa hCG kunye ACE;
• e kwiiveki 22-23. kunye neeveki 36-37. ukuhlola iswekile yegazi;
• Study kwindlela le coagulation (coagulation) zivelisa 36 ukuya kwiveki yama-37;
• e kweeveki ezimashumi mathathu, kunye iiveki ezimbini okanye ezintathu ngaphambi kokuba kuzalwe kwakhona isandulela HIV kunye RW, sihlolisise ilaphu kunye scrapings.

OB Special

Uphando Special angama ibandakanya:

1. Ndiqhuba uphando lwangaphandle yokubelekisa.
2. uphando Midwifery yangaphakathi.
3. Ezinye izifundo ezongezelelweyo.

uphando zangaphandle yokubelekisa mviwo, lomlinganiselo ubukhulu isinqe. Emva kweveki amabini kumiselwa ubungakanani achazwe apha inkulu esiswini, wenza zokuhlola esisu kunye lo symphysis zikawonke wonke, yaye prolushivaniya intliziyo ezingekazalwa. izixhobo lwangaphandle uphando yokubelekisa asinto ilula, kuliwa kuphela paramedics oqeqeshiwe.

uphando Midwifery yangaphakathi. Xa Midwifery lwangaphakathi uphando kuquka ukuhlolwa zangasese yangaphandle, ukufunda usebenzisa izibuko ikuku kunye wesizalo. Kunjengokuba kanye kubaluleke zangaphandle ekubelekeni uphando yokubelekisa. Le nkqubo yenziwa kwi kwesisu kunye isinye. Kuba intlanganiso umfazi wacela ukuba alale ngomqolo, iinyawo inganyityilikiswa ngesandla, bagobe emadolweni. Isinqe kumele isuswe. Uphando ukuba kwenziwe phantsi kweemeko aseptic.

• Uphononongo luqala uviwo kwezi esini yangaphandle. Ukuvavanya uhlobo noboya obuninzi emzimbeni, uhanjiso. Ukubona iinkqubo yezifo, ukuba ngaba: amanxeba ukusuka ugqabhuka ngokuzalwa odlulileyo, nangezilonda, inflammations, fistulas, intsumpa, hemorrhoids kwi empundwini. Vavanya imo kwiLibia vulvar ukutyhala ngeminwe yakho, ukuqikelela imeko kwamadlala urethral.

• ukuhlola wesibeleko ngoncedo yezibuko. Nikelani ingqalelo le mfihlakalo, ubungakanani uxakaxa umqala wesibeleko kunye zesibeleko. Kwi I-tsh ezintathu wathwala kweemviwo umgadi-ezimbini kwinxenye yelungu lobufazi, kwi yesibini neyesithathu efanelekileyo kuphela omnye olinxele.

Okokuqala ukuqikelela uhanjiso (nokuba ngqongqo, loloyiko) kunye lobufazi (ubukhulu, udonga yokusonga zokufumaneka).

4 ukufumana izifundo yokubelekisa zangaphandle

Namatheko uphando Midwifery yangaphandle (Leopold techniques) ezisetyenziswa yi Ngokucofa esiswini yomfazi okhulelweyo. Ezi ndlela ezine:

• ukuqikelela ukuphakama bemi wesibeleko, kunye nokwabelana iziqhamo, ngalo;
• kumiselwa indawo ndingekazalwa, nto leyo yenza izigqibo malunga ekufumaneni ngasemva iingalo kunye nemilenze yakhe;
• nokuzimisela iziqhamo, nto leyo into ebekwa phambi, indawo yayo ngokunxulumene isinqe amancinci;
• ezimisele nokunikezela foetal ngenxenye ikwindawo ngokunxulumene emnyango isinqe.

Injongo uhlolo wesibeleko

Ngaphambi kokuba azalwe wesibeleko wagqiba ukukhula, kuba ibonisa indlela umzimba ukulungele ukuhamba. Iindlela zokubona bokudlala wesibeleko zahlukahlukene, kodwa ezi parameters zavavanywa bonke bephela;

• efanayo;
• yintoni na ubude wesahlulo langasese umjelo;
• patency lomsele wesibeleko;
• osendaweni kwaye esqwini intamo ngqo kwi isinqe kude kangakanani;
• udonga ububanzi isabelo entanyeni, nto leyo zicwangciswe ikuku;
• ukufumanisa imeko kumazantsi isibeleko.

Phonononga wesibeleko ukuba isikali okhethekileyo. cervix ubuntwana uvela amanqaku-0 ukuya ku-5. Ukuba uhlolo lwaba ngaphezulu kwe-10, ngoko ke umfazi bazilungiselela ekubelekeni.

Studies abafazi isinqe

Ukuze ukwazi dimensions zangasese, sebenzisa i OB lwangaphandle abakhulelweyo pelviometriya. IMIMISELO imilinganiso zangaphandle zangasese zezi zilandelayo:

• Umgama spinarum, nto leyo ilingana ngokweesentimitha 25-26;
• kristarum Umgama - ukusuka iisentimitha 28 ukuya 29;
• trohanterika Umgama - ukusuka iisentimitha 31 ukuya 32;
• Udibaniso ongaphandle - ukusuka iisentimitha-20 ukuya kwi-21;
• diagonalis udibaniso, ekufuneka zibe kuluhlu 12.5 - 13 cm.

Oogqirha abaninzi sele kutyelelo lokuqala, abafazi zama umlinganiselo ukholo udibaniso (oyinyaniso), nto leyo kugqiba ubungakanani somnyango isitya esincinane. Ngokuqhelekileyo, kufuneka ibe zisentimita 11 ukuya ku-12. I-udibaniso lokwenyaniso, ngaphandle kokuba conjugates langaphandle (angaphandle) uthabathe iisentimitha 9. ubukhulu zaso uyahlangabezana rhomb Michaelis kunye nobukhulu uFrank (emiselwe yi amathambo yesixhenxe wesibeleko ukuya embindini fossa jugular). I idiagonal a udibaniso apho ibekwe phakathi ungqameko olungezantsi le symphysis zikawonke wonke ukuya ekapa kwezona kakhulu eqalise krestsovogo, nayo elingana nexabiso conjugates oyinyaniso.

Ukuba ubukhulu isinqe zitenxe kwisiqhelo, uyacebiswa ukuba baqhube iindlela uphando lwangaphandle yokubelekisa ukuba imilinganiselo extra: umlinganiselo udibaniso icala, nto leyo ifumaneka phakathi emqolo phambi kwe ilium kunye umnqonqo abasemva kwicala elinye. imilinganiselo yawo eqhelekileyo ngeesentimitha eziyi-14 ukuya kwi-15. Ukuba iisentimitha ngaphantsi kwe-12 kunye enesiqingatha, ekubelekeni nokomzimba akunakwenzeka. Kwakhona ukulinganisa ubungakanani elibhalwe ngokumileyo. Ezintathu kuzo, kwaye ukuba umahluko phakathi kwabo ngaphezulu kwe-1.5 iisentimitha, ijaji elibhalwe ngokumileyo exineneyo, apho kwakhona eyingozi zokubeleka.

Ukumisela kwakhona engile zangasese of utyekelo, nayo baphambuke degrees 45-55. angle Enye into ebalulekileyo zikawonke wonke apho kufuneka alingane degrees 90-100.

I algorithm yophando lwangaphandle yokubelekisa ziquka ixabiso zikhutshwa isitya amancinci:

• ubungakanani line, nto leyo ilingana ngokweesentimitha ezisithoba. Le ibekwe phakathi osezantsi kuhambisana zikawonke wonke kunye kwinqanaba eliphezulu coccyx. Ukususela lwazi ezithathwe rob iisentimitha mabini izicwili athambileyo;
• tazometrom kulinganiswa Ubukhulu ezinqamlezayo leyo iisentimitha 11 ephakathi tuberosity ischial (kuyenze ngaphakathi).

Namatheko Leopold-Levitsky

Sokwamkelwa nayiphi lukagqirha amabhinqa lonke ixesha ukukhulelwa ibithethwa babebuchithela ngaphandle uphando Midwifery. Namatheko Leopold-Levitsky wadlala indima enkulu kulo. Igama zezi kwimigaqo apho sele ikhankanyiwe apha ngasentla, poluchli egameni umntu kuphuhliswa kubo kwinkulungwane yeshumi elinesithoba emva kwexesha. Le ndoda ugqirha waseJamani Christian Leopold. Ezi zinto ziye zisonjululwe iingxaki ezininzi yokubelekisa ezifanelekileyo ukuya namhlanje.

Banceda ukuqinisekisa ubungakanani kunye nendawo osadaleka ukukhulelwa emva kwexesha. Eyokuqala kwezi ndlela yenza phambi ultrasound nganye. Ukhomba le indawo ephakamileyo, unina emi ezantsi kwaye phantse lonke ekwafanekisa ngexesha lokukhulelwa. Ukuchaneka kwayo ezinxulumene esiswini udonga ubukhulu. Ukuba uyathandabuza, ngoku ngakumbi echanekileyo iziphumo ziya kunika ultrasound.

I yesithathu ibonisa ulwamkelo ntetho ezingekazalwa: breech, ezinqamlezayo okanye intloko. Kananjalo, indlela iziqhamo sele isinqe. Ukwamkelwa yesine ingqina ezintathu ezidlulileyo.

algorithm isifundo

ubuchule abaninzi algorithm umdla lwangaphandle yokubelekisa uphando. imilinganiselo zangasese ekuqaleni amithiswe. Emva kokuphela kwale manipulation ugqirha uyemka Ngokucofa esiswini yabafazi. Eli nqanaba isicelo Leopold imisitho. Okulandelayo, yiya auscultation, okanye ukuphulaphula entliziyweni Palsy. Kukho esasidla obalulekileyo ibetha intliziyo (ngokwesiqhelo kwi ibetha 120 ukuya 160 ngomzuzu.), Ingcaciso yabo isingqisho. Auscultation lwenziwa usebenzisa yeSkrini okanye esweni Palsy.

uphando lwangaphandle kunye lwangaphakathi Midwifery kubaluleke kakhulu ngexesha lokukhulelwa emva kokubeleka. Umfazi kufuneka aqonde ukuba, ukuba aziphathe ngokufanelekileyo yaye nayiphi na etyaleni abawaphephi kuzo. Banceda ugqirha ufumanise ukuba ingaba eziqhelekileyo lokusetyenziswa ukukhulelwa uphilile ukuba umama okhulelweyo kunye nosana lwakhe.