Significant ways of seeing the last. Signs and methods of placental identification (after)

Principles of maintenance after period:

Sporulation of the chaff michura all at once to produce the fruit of the people;

Control of hemodynamic parameters of mothers;

Control of blood loss;

With a normal interruption of the canopy of the fruit, be mechanical injection on the uterus (palpation, grip) until there is a sign of the placenta being seen.

If you see a sign of seeing after you do not see your self-reliant people, then for a change in blood loss you can be victorious and seeing the last time.

Accept the vision of the post.

1. Priyom Abuladze (Fig. 40) To dispose of the chafing dish, press the front cherevnuyuyut stinka with his hands in a fold. The idea is to smell harder. I saw the last time in the presence of a whole population as a result of the advancement of the internal vise.

2. Priyom Genter (Fig. 41) - a vice from the bottom along the ribs of the uterus from the bottom to the middle (in this hour it will not get stuck).

3. Priyom Kredo-Lazarevich (fig. 42) empty sechovy mikhur catheter; bring the bottom of the uterus in the middle position;

viroblyayut lightly stroking (NOT massage!) the uterus with the mark її fast; hunt the bottom of the uterus with a penzel of this hand, like an obstetrician is more beautiful than Volodya, with such a rosary, the valleys of the surface of the chotir fingers grew on the back of the uterus, the dolony - at the very bottom of the uterus, and thumb- on the її front stіntsі; Immediately push on the uterus with the whole hand in two perehresny straight lines (fingers - from the front to the back, the bottom - from the top down) straight to the pubis until quietly, as long as it is not born later.

How Kredo-Lazarevich can be stashed without anesthesia. Anesthesia is a necessary deprivation of that, if it is allowed, it will be seen later in the mother of spastic rapid uterine pharynx. A similar operation is also carried out with an advanced psychoactive period of more than 30 min.

Small. 40. reception of Abuladze

Small. 41. reception of Genter

Small. 42. Priyom of Kredo-Lazarevich

For the development of the fetus, the intrauterine vise grows up to 300 mm Hg, which, in many cases, develops the vise of blood in the vessels, myometry and normal hemostasis. The placenta is clenched, the grip in the umbilical cord vessels moves up to 50-80 mm Hg, and if the umbilical cord is not attached, then a transfusion of 60-80 ml of blood to the fetus is given. To that, the umbilical cord clamping is shown by the pinching of the pulsation. With a stretch of the offensive 2-3 seconds, see the placenta and see the last. After the folklore, the uterus grows thick, rounded, grows in the middle, the bottom is located between the navel and the bosom.

Placenta delivery options

Central (according to Schultz).

Craiova (by Duncan).

One hour change over all surfaces of the attachment (according to Franz).

VEDENNYA III (last) PERIODU POLOGIV

META: Prevent pathological blood loss.

Pislya folk child, vive with a catheter, vidokremiti child from mother. Lower the mother's umbilical cord into a clean tray for the last.

The third period of canopy is carried out actively and up to 20 quills (in the middle 5-10 quills). The midwife spasters behind the camp of the breed, signs of the past and the visions from the nobles.

SIGNS OF VIDDILENNYA placenta:

Schroeder's mark- change of form and position of the fundus of the uterus. When the fetus is born, the uterus has a rounded shape, the bottom is located at the level of the navel, when the placenta grows, the uterus grows into the stomach, the bottom grows in the belly button, and looks to the right through the middle line.

Alfeld's mark- podovzhennya of the name of the umbilical cord. When the placenta emerges from the uterine stems, it descends into the lower segment of the uterus, which leads to the raising of the final umbilical cord. The jam, overlapping on the umbilical cord on the equal position of the slit, goes down by 10-12 cm.

Appearing vipinnya over the symphony- if the placenta has come to descend into the thin lower segment of the uterus, the anterior wall is at once brought in and out of the symphysis.

sign Dovzhenko- retraction and lowering of the umbilical cord in case of a large dichotomy, indicate that the placenta has not grown, and when the umbilical cord is pulled in at the entrance, indicate about the placenta being retracted.

Sign of Küstner - Chukalova- when the edge of the hollow is pressed against the uterus over the pubic joints, the umbilical cord does not retrace.

For the establishment of the placenta, add 2-3 signs.

As soon as the placenta has gone, it will smell harder and later, and if the attempts are ineffective, it will stagnate the way of seeing it afterwards. Pislya vignannya after the uterus is schilna, rounded, the bottom is located on 2 transverse fingers below the navel.

WAYS TO SEE VISION

META: Vidіliti vіddіl last

Shown Positive signs of seeing after and ineffectiveness of attempts

TECHNIKA:

SPOSIB Abuladze:

1. Conduct a dbailivy massage of the uterus, with the note of її fast.

2. With both hands, take a black wall in the fold under the fold and proponate the rocks tugish. Widdil the last one is easy to get people to talk to.

SPOSIB Credo-Lazarevich: (to get stuck in case of ineffectiveness to Abuladze's method).

1. Bring the fundus of the uterus in the middle position, with a light zovnіshnіm massage of the vicious uterus.

2. By the way, evil from the breed (accusations to nig), the bottom of the uterus obhopiti right hand In such a rank, the great toe is on the anterior stance of the uterus, the dolonya is on the bottom, and some fingers are on the back surface of the uterus.

3. Carry out the vitiscana after: squeeze the uterus in the anterior-posterior volume and immediately push it to the bottom right down and forward along the axis of the pelvis. Widdil last, with a whole lot of ways, it's easy to go by name. With the ineffectiveness of the method of Credo-Lazarevich, to carry out manually the vision after the out-of-the-box rules.

Let the baby appear on the light, the curtains are trivial, it’s the third period. The successful completion of the stage is even more important, since all the middle ones have lost unnecessary fabrics, they need to be named. In the norm, the placenta can be traced back, if only on the day of the day there are signs of being seen later, it is necessary to be handled manually. Unsatisfactory production of the placenta with shells, clogging up with development, severe bleeding.

General information

The last is an organ that is supposed to pretend itself for the wedding of the embryo. 40 tyzhnіv vіn will take care the circulatory system mommy. The need and functional significance be completed before the end of the vagina.

placenta;
umbilical cord;
enveloping membranes.

placenta the inviting side creep to the uterus, all the way down to the fruit egg. on internal parties placenta - before the umbilical cord, in the ny rostasovani blood-bearing verdict, as to conduct the mother's plasma, muslin, living elements to the fetus.

The placenta and the umbilical canal are enveloped by a water membrane, there is an amniotic membrane, from the middle of the middle. From the lateral side of the tsei, the microscopes are removed from the uterus with the chorionic villi, which penetrate into the mucus ball of the uterine tissues. In such a rank, a child of the moment for the period of vaginosti, it is locked at the internal state of the woman's system, preventing the germ from developing normal development.

Carrying out acidification, vivedennya in carbon dioxide;
nhohodzhennya kharchuvannya, seeing products in metabolism;
synthesis of hormones;
zakist from infectious diseases.

Formation after the repair in the first days of the egg fixing and ending before the end of the 4th month of vagineness. The size of the body is 20-25 cm. In the circumference, the thickness of the shells is 4-5 cm., Vaga is 400-600 grams.

Vidkhozhennya after means the completion of the final stage of the canopy, the cleansing of the uterus. The woman's behavior is monitored by an obstetrician; It’s self-sufficient that the shells didn’t come out, but manual methods didn’t get stuck.

signs

A large number of obstetricians have a vicarious approach to active HIV tactics after the period. First of all, the placenta has been removed manually, the car is guilty of being overturned in need. Mozhlivo, the woman was simply pushing incorrectly, or physically hanging. For the whole, in obstetrics, the classification is a sign of how to start the camp after 3 stages of the floor.

Visiting method:

Mikulichi - Radetsky;
Schroeder;
Alfeld;
Klein;
Costner-Chukalov;
Dovzhenko;
Strassmann.

For Mikulichi-Radetskiy. The placental tissue was drawn to go down, onslaught on the bottom of the uterus. Z'yavayutsya positive and pushing. The method is working in half of the problems, so don't get the grip of enough for the reaction.

For Schroeder. The technique is based on the unattached placenta by the uterine stump. As the fabrics are crazy, the mother's bottom does not change its position, but the walls to the organ of growth, wide, contours of growth. When the placenta is seen, the uterus is well felt, it’s old, high school, with wide walls. The lower part of the right side.

For Alfeld. The basis of the method is keeping an eye on the umbilical cord. If, after seeing, you are old, you are seeing from the last state organs. Immediately after the birth of the fetus, the umbilical canal is jammed at the moment, the call. As soon as the clamp is about 3 o'clock during the canopy, having descended, you will see it and the statuesque slit (in the norm up to 12 cm), the child will soon appear.

For Klein. The obstetrician pid an hour of attempts of the patient to stitch behind the umbilical cord. In fact, the little guy is guilty of being called, ala, as if it were weakened in the middle, it means that he didn’t come after. A manual method is required.

For Kostner-Chukalov. If there is no tissue, if the edge of the hollow is pressed against the suprapubic part, the umbilical cord will be pulled in in the middle. In any case, you cannot grip the canal with your fingers.

For Dovzhenko. Generated to ask for a deep breath and a vidihnuti. If the legends come back to life, the diaphragm part goes up the hill, behind it goes the uterus, the organ will turn around in the cob. When the umbilical cord collapses up and down, it means that the placenta is attached, it is not rude - it is necessary that it is tighter, soon after we see it.

Behind Strassmann. The obstetrician stood up to the right-handed person, to denounce it to breed. I will put a jam on the umbilical cord, wipe it down with the fingers of my left hand, at once weakly b'є the uterus all over the place. The uterus tissue reacts, the shelter is intensively collapsing along the arteries, as long as it has not been seen, then the post-production plasmas can be felt in the left hand of the car. The umbilical cord is not visible - it means the placenta is visible.

More often for those who, when viznennі signify after the women, the methods of Strassmann and Alfeld, as informative. Ale, at the skin lіkarya, the provincial canopy, є its "pratsyuyut" signs. For example, in another place, for experienced people, I borrowed the Kostner-Chukalov method, which is simple and quick.

methods

With the presence of positive signs of the appearance of the placenta from the uterus, it is necessary, by the way, for the help of the patient's efforts and special technology. Falsely from the growing of shells and physical shape of the breed, the decal is used to stimulate them.

Method of displaying after:

Abuladze;
Lazarevich-Credo;
Heterose.

Abuladze. Recognized reception of the vision of the last one after Abuladze's method black wastes concentration vice. The spatula will descend from the sečovy mikhur, the uterus will be massaged with light pressure, and will be induced in the middle of the rosters. Then, the obstetrician will get the call of the tissue of the belly of the breed, the udovzh tila. For an hour, at the command, hesitate to try 1-2 times. The most effective and simple method. Yakshcho placenta vidokrelena, after it appears immediately.

Lazarevich-Credo. When carrying out the method of seeing the vidokreleny after, following the technique of Credo-Lazarevich, a vise on the uterus is victorious. The production of the slice micurus and the reduction of the uterus in the middle position, spawning spokyno dichaє 1 - 2 chilini. Poten, lykar will love bottom part of the uterus in such a rank, the great toe appeared on the anterior її stintsі, clogged the bottom with a dolon.

The upper phalanges of the four fingers are responsible for embossing on the back wall. In such a girth, the last one is pulled down, and your hand is pressed to press the later arm from the navel to the pubis. Predillya to be in a calm position, not to push.

Heter's method is similar to the forehand technique, so it is also to shy away at an empty slice, on the uterus in the middle. Only the grip is squeezed with fists, smoothly out of the uterine fundus, down to the small pelvis. It's not necessary for mommy, it’s okay.

If it is nasty to see the uterus after seeing the uterus, it is possible to achieve this independent view. The patient pidnima pelvis, zalishayuchis, with the whole on the shoulder blades, with an emphasis on the feet. Vaga of the placenta will stretch the tissue after, the surplus will be pulled out in a vise. Since the method is not simple, it’s just a matter of dropping out before extra calls.

manually viddilennya

Is it possible to get stuck in accelerated situations, otherwise they can add traditional methods or the placenta is attached to the uterus. Prior to the procedure, the confession is shown, the generation of the signed document for the year has been submitted.

show:

There is no sign of the vision after 30 hilin sent by the people of the child;
ryasna bleeding;
promptly accelerated the development;
cervicitis of uterine tissues ·

Manual removal is permissible in cases of severely grown tissues, but in half of them it is ineffective, as the membranes have grown into the uterus afterwards. That organ is seen to rise abo chastkovo.

Carrying out technique:

evaluate the show;
for additional dribblers (internally, strumenevo), electrical breakdown is introduced;
put internal anesthesia;
obstetrician pidtyaguє umbilical cord for tightening;
a hand is inserted into the uterus;
the edge of the placenta appears;
gently with a dimple to see the tissue from the surface of the uterus (sawing with a ruff);
how long it gets to be in the middle of the body;
with the other hand, the placenta fights;
to be carried out manually, until the uterus is sighted for the canopy for the integrity, during the daytime of the surplus of fruit sheaths;
if necessary, massage, induce tone;
drugs are injected that will freeze for release after the canopy (antibacterial, oxytocin);
the hand is safe.

In case of bleeding occurring afterwards, the amount of plasma is monitored. I will pour in 800 ml. promptly involved, Viklyuchatsya DIC-syndrome, hemorrhagic shock and іn. In 10% vipad uterine bleeding in the third period of the canopy, the visible organ will end.

Manually clearing the emptying of the uterus is carried out only in sterile drains, with clean pads under the stegna formation, under anesthesia. Vikoristovutsya one hand, the friend is at the bottom of the organ.

Review and acceleration

Technique I will look after the last one, so as the integrity of the shells in the norm is guilty of 90%. Zalishki go out with suckers for a stretch of 2 months per day of flat.

Algorithm for conducting a look after:

if a child is forcibly placed on a sterile area;
the mother's side of the organ marvel at the mountain;
to be afraid to look back at the consistency;
it is necessary to move into the visibility of the blood-bearing vessels on the shells;
as the appearance of a piece of the placenta, it means that the placenta part of the placenta has been lost.

Often the reason for the acceleration in the third period of the growth is the true growth of the placenta. The villi of the sheaths grow gliboko in the tissue of the uterus;

Particles get stuck on the walls, blocking the development of important infections, decompensated blood loss, death of breeds. Tom, for a unique lethal result of the patient, the uterus is seen. The shyka, uterine tubes, yachniki are overcrowded. For the operation, the quality of the life of a woman does not change, there is only one vagomiy minus.

Visible traces:

waste of second function;
hormonal background does not collapse;
to cringe menstruation;
to protect yourself from pulling.

The woman, for the quicker slopes, was rewound at the stress mill, especially when she saw a second organ. It is important to be smart, but it is a cardinal decision to get used to drugs, for the sake of life.

It is often the case that the placenta is independent of the condition of obstetric assistance and adequate behavior of the breed. Decrease in the size of the uterus is seen in 0.01% of the growth rate. Incorrect placement of the placenta appears to start more in the period of vaginosity, in advance to prepare tactics for successful canopies, and to quickly develop important inheritances.

As soon as when Chergov is inverted, positive signs of a placenta emerge, it will give rise to a more pronounced sense of the placenta, and later will emerge independently. As soon as you do not pop up on your own, then you will be able to see it by hand.

Ways to manually see the last.

Sposib Abuladze. When spraying the slash, press the front cherevnya wall with your hands into the fold, then hurt the straight mucous membrane of the abdomen with your fingers. Generate to smell tighter. It’s easy to get back to life afterwards because of the loss of abdominal mutilation, and a significant change in the loss of empty stomachs.

Genter's way . Likar stood up from the side of the breed, denounced to її ніг. The uterus can also be folded in mid-position. Hands, clenched into a fist, put the strong surface of the main phalanges on the bottom of the uterus in the area of the trumpets. Then we proceed until the next day. The spatula is weak, and then, step by step, a grip, pushing the uterus straight from the bottom to the middle. The last one at the time of the whole population is from the statues of the school.

Sposib Kredo-Lazarevich a. Iakshcho after not having been born, to go to the Abuladze way, to go up to the Credo-Lazarevich way. Tsey is able to achieve a traumatic, and viconuvati it is necessary for great protection. For the correct execution of the following rules, we have distributed all the manipulation for 5 moments:

1st moment- spraying the chaff (it is virobbed all at once when the fruit is born);

2nd moment- vidhilenu to the right of the uterus to vindicate until the middle line;

3rd moment- viroblyayut circular massage of the bottom of the uterus, schob viclikati її fast, so how to fix a grip on a mlyav, a weakened uterus is not possible through a moss її;

4th moment- hunt the uterus with the hand so that the great finger is lying on the anterior surface of the uterus, the dolon is on the bottom of the uterus, and 4 fingers are on the posterior surface;

5th moment- at once, pushing on the uterus with the whole hand in two, cross each other straight (with fingers from front to back and downward from top to bottom, straight to the pubis), the people are expected afterwards. Behind the last one, the shells are pulled, they turn into jgut. The vise on the uterus is pinned and piled up against those who have removed the shells.

For the whole Jacob, having proponuvav, having taken the placenta in his hands, wrapped it behind the year's arrow, the shells burnt into a "rope" and did not break out.

Even if, while being careful of the breed, it is not a sign of the placenta being born, then the vicious tactics of the third period is not guilty of overhauling 30 minutes, without regard for the appearance of bleeding and a good stage of the formation. It’s possible to unicuti the youngsters fast, to produce them to the great loss of blood, to be brought to the manual removal of the placenta and to be seen afterwards.

Prior to active maintenance, the last period is also started in quiet drops, if bleeding is felt, blood loss has reached 250-300 ml, and the placenta is not visible. Actively come in (manually collecting the placenta) is necessary when there is a small amount of blood loss, or when there is a death in the breed.

Try to speed up the process of shaking the placenta after going through the massage of the uterus, pulling on the umbilical cord is inadmissible, this will destroy the physiological process of shaving the placenta from the uterine wall, changing the rhythm and faster and less bleeding.

plan:

Lead to the III period of the canopy
Signs of placenta identification
Look after.

Lead to the III period of the canopy

Memories about the concept of practical obstetrics krylatoy phrase: "Get out of your hands after the uterus." Tse, zychayno, does not mean that to the uterus in the last period it is not possible to hitch. Clarify the signs as soon as possible and necessary. Ale robiti tsereba carefully, do not timidly grip the uterus, do not wicked in any unfortunate speed, which can lead to a disquiet, not without bleeding.

The main rule when conducting the period of the slopes of the field in the retreat is:

for breeding (zalny camp, scoring of skirts, visible mucous, pulse, vice, inquire about self-esteem),

for blood loss (for a pelvis of rocks, for a kidney-shaped tray or for a vessel),

for the last days (they support the shape of the uterus, the height of the standing of the bottom)

behind the camp of the slash mikhur (not to allow the re-raising of the slice mikhur reflexively, the re-raising of the slice mikhur reflexively, the re-raising of the uterus and the population afterwards)

With a good breed of birth, as there is no bleeding, it is required to check the independent retrieval and population of the placenta with a stretch of 30 quills. Actively come in to see what is needed in case of pathological blood loss and death of a woman, as well as in case of trivial placenta in the mother of 30 hilines.

Diy medical personnel in such cases begin to appear, or when the placenta is visible:

with positive signs of seeing the placenta, it will become tighter. As soon as it is born to push, and after not to populate, to begin to see the way of seeing it afterwards;

when there is a sign of the placenta being seen, when the placenta is visible, it is a sign of internal bleeding, an operation is performed manually, the placenta is seen after. I think it’s the last time I’ve started to think about it, but I’m seeing the same terms, but I don’t think of the meanings of the term.

Signs of placenta identification

Mark of Schroeder. Zmіna form and vizoti standing of the fundus of the uterus. Immediately after the development of the fetus, the uterus takes a rounded shape and grows along the middle line. The fundus of the uterus is located at the level of the navel. When the placenta is seen, the uterus grows (grows bigger), the bottom of the uterus grows in the navel, it does not look to the right

Sign Dovzhenko. Generate to smell glyboko dihati. If, when inhaled, the umbilical cord does not retract into the snout, then the placenta is drawn out of the wall of the uterus; if the umbilical cord is retracted, the placenta is not seen

Sign of Alfeld. The placenta descended into the lower segment of the uterus, or else, as soon as the placenta descended. At the junction of the zym, the Kocher lock, overlaps on the umbilical cord with the її ligation, go down by 8-10 cm and more.

Sign of Klein. Generate to smell tighter. When the placenta was seen from the wall of the uterus, when the umbilical cord was pressed to the wall. If the placenta is not seen, then the umbilical cord will be drawn into the tree.

Sign of Kyustner-Chukalov. Even when the edge of the valley is pressed against the uterus over the pubic joints, the umbilical cord does not get drawn into the labor of the way - it means that the placenta has drifted; how to get involved - it means that she did not seek

Sign of Mikulichi-Radetsky. The placenta was prompted to descend into pichva, to appear (do not expect) posing for a push.

Sign of Strassmann. In case of placenta, the palpitations along the bottom of the uterus are transmitted by the umbilical vein, filled with blood. Qiu hvilyu can be seen with the fingers of the hand, loosening on the umbilical cord, a lull. When the placenta is seen from the wall of the uterus, the symptom is visible.

Signs of Hohenbichler. With the placenta before the hour of the fasting of the uterus, the umbilical cord can be wrapped around its axis with blood.

Note: to judge about the placenta not by one acquaintance, but by two or three signs. The signs of Schroeder, Alfeld, Küstner-Chukalov are most reliable.

Ways to see the adrift after

With positive signs of the appearance of the placenta and the appearance of an independent people after being seen manually. For the people afterwards, it is necessary to open enough internal vise. For all kinds of breeds to be tighter. It’s just a piece of effort not to bring to the people the last time, but when the belly muscles are overtightened, after the abdominal muscles are overtightened, then the front cherewny stink should be folded into a fold (change the empty thread) following the Abuladze method. Writing for one - two attempts to populate the last.

sposib Abuladze

Disposal of chaff mikhura.

Dbayliviy massage of the uterus through the anterior abdominal wall.

By the way, on the right, sideways from the breed.

Zahopiti with both hands the front cherevnu stinka in the sub-fold.

Proponuvati zhіntsі tugіshe.

Genter's way

Disposal of chaff mikhura.

By the way, from the side of the breed, to the denunciations to її ніг.

Clench both hands into fists.

Lay the curly surface on the bottom of the uterus in the area of the pipe root.

Bury the rocks.

Press down on the uterus with your fists straight down until it is crooked.

Sposib Kredo-Lazarevich

Disposal of chaff mikhura.

Dbayliviy massage of the uterus through the anterior cervical wall.

The uterus is in the middle.

By the way, evil from the breed, to the denunciations to її ніг.

The bottom of the uterus is hunted with the right hand so that the great finger is on the anterior stance of the uterus, the dolon is on the bottom, and 4 fingers are on the posterior surface of the uterus.

One hour, pushing on the uterus with the whole hand in two, cross each other straight (with fingers from front to back and downward from top to bottom straight to the pubis), to seek the people after.

A vise on the uterus, pinch and podbati about those, which have come out of the shells.

When the placenta is populated, the midwife will use her hands and arms and twist the sheaths around the cord (Jacobs way) with her hands and arms. The whole process is simple and simple when you see the shells.

Jacobs's way - to take the placenta in hand, to wrap it behind the year's arrow, the shells burnt into a cord and did not break out

Predillya entered into the canopy of the room for the original sanitary treatment. The appearance of the pubic hair is obov'yazkovim.

As soon as the canopy does not end in the near future, if the breed is built up to a gentle appearance, then the toilet of the new organs will be carried out.

When there is a positive delay, it is possible to disinfect the school of the new organs and internal surface the upper third of the stegon.

The hands of the obstetrician, who are to carry out the vaginal follow-up, become clogged like that for an empty operation.

In the process of leading the paths and in the mental period, it is necessary to be educated in order to increase the penetration of the paths of the infectious process. For vaginal follow-up, it is recommended that obstetricians add 3-4 tablets of tetracycline or antibiotics in the upper form.

With an increasing amount of antibiotics in the middle, the middle line appears, as I can get an antibacterial effect on the microflora, as if the bullet was brought by hand up to the lower end of the uterus. Accumulation of material for vaginal antibiotics storage with a prophylactic method, when internal reports, inform about those who may use a method that may increase the risk of the possibility of information about the childbirth of the childbirth. Tsei zahid is even more significant in the early and early vidhozhennya waters.

When antibiotic family nobles are infected, the antibiotics have been fixed until the infectious disease is sensitive to them. modern methods give the opportunity to correct the price of the dan in 18-24 years.

ESSAY

On the topic: Canopy, paramedic lining for the introduction of a 3-period canopy.

Vikonala: Salakhova Diana

Perevirila: Zakirova I.A