Head segments and methods for their determination. Internal obstetric examination. Head on the pelvic floor or pelvic outlet

The large segment of the head is the largest circumference of the head, which it passes through various planes of the small pelvis during the birth process. The very concept of “large segment” is conditional and relative. Its convention is due to the fact that the largest circumference of the head, strictly speaking, is not a segment, but the circumference of a plane that conditionally cuts the head into two segments (large and small). The relativity of the concept lies in the fact that, depending on the presentation of the fetus, the largest circumference of the head passing through the planes of the small pelvis is different. Thus, when the head is in a bent position (occipital presentation), its large segment is a circle passing in the plane of a small oblique size. With moderate extension (anterior cephalic presentation), the circumference of the head passes in the plane of the straight dimension, with maximum extension (facial presentation) - in the plane of the vertical dimension.

Episiotomy or perineotomy

Perineal incisions can be of two types: perineotomy - an incision directed directly towards the rectum, and episiotomy, in which the incision is directed to the side (if you imagine the perineum as a dial, then we can say that perineotomy is performed at 5 or 8 o'clock).

The method of dissection of the perineum during childbirth is chosen taking into account the characteristics and pathological changes of the perineum, the obstetric situation, and the size of the fetus.

Perineotomy carried out during the normal mechanism of labor in case of a threat of rupture of the “high” perineum (increased compared to the norm the distance between the posterior commissure of the labia majora and the anus), as well as in case of premature birth.

Indications for episiotomy are the threat of rupture of the “low” perineum (when the distance between the rectum and the entrance to the vagina is small), acute subpubic angle (the angle at which the bones of the pubic symphysis meet), breech presentation of the fetus, cicatricial changes in the perineum, obstetric operations (application of obstetric forceps, vacuum -extractor).

Lateral episiotomy - an incision strictly to the side - is carried out only in case of pathological changes in the perineum that do not allow the use of another method of dissection (for example, for tumors) - such incisions heal worse.

Perineotomy and episiotomy are performed in the second stage of labor, when the presenting part of the fetus has sank to the pelvic floor and tension in the perineum appears, before its rupture occurs. The operation is performed by a doctor; in emergency cases, in his absence, by a midwife.

The perineotomy operation does not require pain relief, since ischemia (lack of blood supply) of the perineal tissue leads to loss of pain sensitivity. Before dissection, the skin of the perineum is treated with tincture of iodine. The incision is usually made with scissors at the moment the fetal head erupts. Its length is on average 2-3 cm. Blood loss, as a rule, is small. Restoration of the cut perineum is carried out after the birth of the placenta.

The mass screening program involves mandatory ultrasound examinations in pregnant women three times: at 10-12, 20-22 and 30-32 weeks

4.3.13. Hormonal profile study

Biological methods for diagnosing pregnancy. Among the most common biological reactions to pregnancy are the hormonal reaction of Friedman, Aschheim-Tsondek, and the hormonal reaction in frogs (Galli-Mainini reaction).

Friedman's reaction. A woman's urine is injected into the rabbit's ear vein. If the urine contains hCG, then 12 hours after the introduction of urine the rabbit ovulates.

The Galli-Mainini reaction is based on the ability of male frogs to secrete sperm into the ejaculatory ducts under the influence of hCG contained in the urine of pregnant women.

Aschheim-Tsondeka test. After injection of the urine of a pregnant woman, which contains hCG, into infantile female mice weighing 6-8 g, hemorrhages into the follicles and the formation of the corpus luteum are observed in their ovaries.

Currently, biological methods for diagnosing pregnancy have lost their leading role and preference is given to immunological methods.

Immunological methods for diagnosing pregnancy. Immunological methods include various methods for determining human chorionic gonadotropin (CG) or its β-subunit (β-CG) in serum and urine. Preference is given to the radioimmunological method for the quantitative determination of r-CG in blood serum, since it has high specificity and sensitivity. Enzymatic immunoassay methods for detecting hCG in urine, as well as other variants of immunological tests (capillary, plate) have received a positive assessment. Have the right to

the existence of such widely known serological methods for determining hCG in urine, such as the reaction of inhibition of erythrocyte agglutination or sedimentation of latex particles.

All laboratory methods for diagnosing pregnancy are highly specific: correct answers are observed in 92-100% of cases already from the 9-12th day after fertilization of the egg. However, these methods make it possible to establish only the fact of the existence of pregnancy without specifying its location, and therefore cannot be used for the differential diagnosis of uterine and ectopic pregnancy.

Agglutination, or latex particle fixation test, is a method for determining the level of hCG in urine. HCG is excreted in the urine already 8 days after fertilization. A few drops of the patient's urine are mixed with AT and hCG, then latex particles coated with hCG are added to this mixture. If hCG is present in urine, it binds to AT; if CG is absent, then AT binds to latex particles. This rapid test is positive in 95% of cases, starting from the 28th day after fertilization.

Radiological and immunological test. The material being tested is blood. The quantitative content of |3-hCG subunits in blood plasma is determined.

Radiological method. Blood is examined. The amount of β-subunits of hCG that competes with labeled hCG for binding to the hCG receptors of the cells of the corpus luteum of the cow is determined. This rapid test is quite sensitive, but not as specific as a radioimmunoassay test.

Methods for assessing the condition of the placenta and fetus. During pregnancy, to assess the function of the placenta and the condition of the fetus, the following hormones are determined: human chorionic gonadotropin (HCG), placental lactogen (PL), progesterone, estrogens, prolactin, dehydro-epiandrosterone sulfate (DHEAS), thyroid hormones and corticosteroids.

The following methods are used to determine hormone levels:

One-time urine test;

Daily urine analysis (compensating for daily fluctuations in hormone secretion);

Blood test of a pregnant woman;

Determination of hormone content in amniotic fluid.

Currently, the content of most hormones in biological fluids is determined by the radioimmunological method. The content of hCG in blood and urine can be determined by biological, immunological and radiological methods. Immunological (including radioimmunological) tests have higher specificity and sensitivity than biological methods.

Knowledge of normal hormone levels (see Physiology of Pregnancy) is necessary to identify the pathology of pregnancy and the degree of risk of complications for the fetus. In this case, it is necessary to take into account daily fluctuations in hormone levels. The deficiency of a number of hormones necessary for the normal course of pregnancy can be corrected by their exogenous administration.

n Maternal mortality is defined (WHO, 1976) as the death of a woman caused by pregnancy, regardless of its duration and location, occurring during pregnancy or within 42 days after its end from any cause associated with pregnancy, aggravated by it, but not from an accident or a random cause.

n Perinatal mortality- a statistical indicator reflecting all cases of death of a fetus or newborn during the period from 22 weeks of pregnancy to 7 days after birth (perinatal period). Calculated per 1000 births. Perinatal mortality includes cases of stillbirth, as well as early infant mortality, that is, up to 7 completed days from birth.

I'm programming a design for a microprocessor with very limited memory, and I have to use "a lot" of memory in different functions. I can't have a big stack segment, a heap segment, a data segment, I have to choose what to make big and what to make small. I have about 32 KB,

I use about 20 KB for the text segment, which gives me 12 KB for the rest. And I need a 4KB buffer to go to various functions (SPI Flash sector size). Where should this large buffer be initialized?

Therefore my picks:

1) If I declare a buffer at the beginning of a function, the stack must be made large

Spiflash_read(...) ( u8 buffer; // allocated on stack syscall_read_spi(buffer,...) )

2) Allocate dynamically, the heap should be made big

Spiflash_read(...) ( u8 *buffer = (u8*) malloc(4096); // allocated in heap syscall_read_spi(buffer,...) )

3) Select statically, a huge down side that cannot be used outside of the "SPI Library".

Static u8 buffer; // allocated in data section. spiflash_read(...) ( syscall_read_spi(buffer,...) )

My question is what is the best way to implement this project? Can someone explain the explanations?

4 answers

Static allocation is always safe at runtime, since if you run out of memory, your linker will tell you the buid time rather than crashing the code at runtime. However, if the memory is not needed constantly at runtime, it can be wasteful since the allocated memory cannot be reused for multiple purposes unless you explicitly code it that way.

Dynamic memory allocation is checked by runtime - if you run out of heap, malloc() returns a null pointer. However, you need to check the return value and free the memory as needed. Dynamic memory blocks are typically 4- or 8-byte aligned and carry heap management data overhead that makes them ineffective for very small allocations. Also, frequent allocation and deallocation of widely varying block sizes can lead to heap fragmentation and wasted memory - this can be disastrous for "always on" applications. If you're never going to release memory and it will always be allocated and you know how much you need, then you might be better off with static allocation. If you have the library source, you can modify malloc to immediately stop memory allocation failures to avoid having to check each allocation. If the sizes of the allocations tend to have several common sizes, a fixed block allocator may be preferable rather than the standard malloc(). This would be more deterministic and you could implement usage monitoring to optimize block sizes and numbers of each size.

Stack allocation is the most efficient because it automatically acquires and reclaims memory as needed. However, it also has little or no support for runtime checking. Typically, when a stack overflow occurs, the code will not be deterministic - and not necessarily anywhere near the root cause. Some linkers can generate stack analysis results that will calculate the worst-case stack usage in the call tree; you should use this if you have this facility, but remember that if you have a multi-threaded system, there will be a lot of stacks and you need to check the worst case for each entry point. Additionally, lonker will not analyze interrupt stack usage, and your system may have a separate interrupt stack or share the system stack.

The way I would go about this is of course not by placing large arrays or objects on the stack, but by following the process:

Use linker stack analysis to calculate worst-case stack usage, adding additional stack for ISR if necessary. Allocate that much stack.

Select all objects needed to be static.

Use a link map to determine how much memory is left, allocate almost all of it to the heap (your linker or linker script may do this automatically, but if you need to explicitly specify the heap size, leave a little unused, otherwise every time you add a new one static object or extend the stack, you will have to change the heap size). Allocate all large temporary objects from the heap and be vigilant in freeing allocated memory.

If your library includes heap diagnostic functions, you can use them in your code to monitor heap usage to check how close you are to exhaustion.

A "worst case" linker analysis means it will be larger than what you see in practice - worst case paths that never get executed. You can pre-populate the stack with a specific byte (eg 0xEE) or pattern, and then after careful testing and work, check the tide mark and optimize the stack that way. Use this method with caution; your testing may not cover all contingencies.

it depends on whether you need to constantly buffer. If 90% of your work will be spent working with this buffer, I would put it in the data segment

If it's just needed temporarily for a given function, then put it on the stack. It's cheap and you can reuse the space. This means you must have a large stack tho

Otherwise, put it in a pile.

Indeed, if you are limited by this memory, you should analyze in detail what memory consumption is. Once you get that small, you can't treat it as "normal", throw it into OS/runtime, development. I've seen built-in development stores that are not allowed to do dynamic memory allocation; all things are pre-computed and allocated statically. Although they can have multi-purpose memory areas (for example, a regular I/O buffer). Back in my COBOL days, it was the only way you could work (young people today..., grumble, grumble...)

15228 0

A vaginal examination of a pregnant woman is carried out on a couch or on a gynecological chair, observing asepsis and antisepsis. The pregnant woman's legs are bent at the hip and knee joints and spread apart.

It is mandatory to perform upon admission to the maternity hospital and when amniotic fluid breaks. In addition, according to indications.

The external genitalia are treated with a solution of manganese or furacillin or a 5% iodine solution. Hands are washed with soap and water with a brush, then with a 0.5% solution of chlorhexidine or another antiseptic solution.

1. Examination of the external genitalia. The height of the perineum, the absence or presence of ulcers, vascular or other tumors, disfiguring scars or other pathological conditions that could complicate childbirth or the postpartum period are determined.

2. Vaginal examination. It is performed with two fingers inserted into the vagina after spreading the labia with the fingers of the other hand (Fig. 1). Define the following:

Rice. 1. Bimanual examination of a pregnant woman

a) the state of the muscles that lift the anus - the degree of their development, whether they tense during contractions or pushing, the reaction to their irritation;

b) the condition of the vagina - wide, narrow, short, is there a septum or any formation, etc.;

c) condition of the cervix - the shape of the cervix is preserved, shortened, smoothed; opening of the uterine pharynx - no, yes; the pharynx is passable for one, two or more fingers; the edges of the pharynx are thick, thin, extensible, not extensible; whether an umbilical cord loop, placental tissue, small parts of the fetus, etc. will be detected within the pharynx;

d) condition of the amniotic sac - intact, absent (opened); if the amniotic sac is intact, its state outside and during contractions: well expressed, fills only during contractions, remains full outside of contractions, is overly tense, weak or does not fill at all during contractions (flat bladder), etc.;

e) the state of the presenting part: what the head is presenting, buttocks, where the presenting part is located, fontanelles, sutures, their location in relation to the sacrum or womb (Fig. 2, a-f);

Rice. 2. The relationship of the fetal head with the small pelvis of the woman in labor as she moves through the birth canal.

a - above the entrance to the pelvis;

b - pressed to the entrance to the pelvis;

c - small segment at the entrance to the small pelvis;

d - large segment at the entrance to the pelvis;

d - in the pelvic cavity;

e - at the pelvic outlet

1. The head is above the entrance to the pelvis. The pelvis is free, the head stands high, it does not interfere with palpation of the innominate line of the pelvis, the cape; the sagittal suture is located in transverse size at the same distance from the symphysis and promontory, the large and small fontanelles are at the same level.

2. The head is at the entrance to the pelvis with a small segment. The sacral cavity is free; you can approach the promontory with a bent finger (if it is reachable). The inner surface of the symphysis is accessible to research, the small fontanel is lower than the large one. The arrow-shaped seam stands in a slightly oblique size

3. The head at the inlet and the small pelvis with a large segment. The head occupies the upper third of the symphysis and sacrum. The cape is unreachable, the ischial spines can be easily palpated. The head is bent, the small fontanel is lower than the large one, the sagittal suture is in one of the oblique sizes.

4. The head is in the wide part of the small pelvis. The largest circumference of the head passed the plane of the widest part of the small pelvis. Two-thirds of the inner surface of the symphysis pubis and the upper half of the sacral cavity are occupied by the head. The IV and V sacral vertebrae and ischial spines can be easily palpated. The sagittal suture is in one of the oblique sizes, the small fontanel is lower than the large one.

5. The head is in the narrow part of the small pelvis. The upper two thirds of the sacral cavity and the entire inner surface of the symphysis pubis are occupied by the head. The ischial spines are difficult to reach. The head is close to the bottom of the pelvis, its internal rotation has not yet been completed, the sagittal suture is in one of the oblique sizes, close to straight. The small fontanel near the womb is lower than the large one.

6. Head at the pelvic outlet. The sacral cavity is completely filled with the head, the ischial spines are not defined, the sagittal suture is located in the direct size of the exit from the small gas. The small fontanel near the womb is lower than the large one.

f) the state of the relief of the bony pelvis - is there any pathological protrusion of the bones (exostoses); characterize the condition of the inner surface of the pubis and sacral cavity, measure the diagonal conjugate.

g) the nature of vaginal discharge - quantity, color, smell, etc.

h) before removing the hand, the vagina is treated with 30-50 ml of a warm solution of rivanol or furatsilin (1:5000).

Ed. K.V. Voronina

In obstetrics, it is customary to distinguish between segments of the head - large and small

The largest segment of the head is the largest circumference of which it passes through various planes of the small pelvis during childbirth. The concept of “large segment” itself is conditional and relative. Its convention is due to the fact that the largest circumference of the head, strictly speaking, is not a segment, but a circumference of a plane, conditionally cutting the head into two segments (large and small). The relativity of the concept lies in the fact that, depending on the presentation of the fetus, the largest circumference of the head passing through the planes of the small pelvis is different. Thus, when the head is in a bent position (occipital presentation), its large segment is a circle passing in the plane of a small oblique size. With moderate extension (anterior cephalic presentation), the circumference of the head passes in the plane of the straight dimension, with maximum extension (facial presentation) - in the plane of the vertical dimension.

Any head segment that is smaller in volume than the major one is a minor head segment.

Incorrect positions of the fetus include oblique and transverse. In an oblique position, the axis of the fetus intersects with the axis of the uterus at an acute angle and one of the large parts of the fetus is located below the iliac crest.
The transverse position of the fetus is characterized by the intersection of the axis of the fetus and the uterus at an angle approaching 90°; in this case, large parts of the fetus are located above the iliac crest.
Recognition of the transverse and oblique position of the fetus is usually based on examination of the woman in labor, palpation, and vaginal examination. Examination of the abdomen reveals its unusual shape - stretched across. During palpation, the presenting part of the fetus is not determined: the head is palpated to the left or right of the midline.
During vaginal examination, the large part of the fetus above the pelvic inlet cannot be felt. Sometimes small parts of the fetus can be palpated. In the case of a pen falling out of the genital tract after the discharge of amniotic fluid, the diagnosis is beyond doubt.
With the onset of labor, the oblique position of the fetus can turn into longitudinal. If the transverse or oblique position remains, childbirth (in the absence of medical care) is accompanied by a number of very life-threatening complications for the woman in labor and the fetus [early rupture of water, prolapse of small parts of the fetus, umbilical cord, handle, the occurrence of advanced transverse position of the fetus].
When the transverse position is neglected, the fetus loses mobility due to the outpouring of water and its tight coverage by the uterine wall; it is extremely dangerous for a woman in labor due to the possibility of uterine rupture, as well as fetal hypoxia. It is extremely rare that childbirth with a transverse position of the fetus ends spontaneously, by self-rotation, self-inversion, or the birth of the fetus with a double body.
If the fetus is in an oblique position, you can try to correct it by external maneuver or by placing the woman in labor on the side towards which the underlying large part of the fetus is deviated. The most reasonable option for transverse or persistent oblique position of the fetus is cesarean section.

A violation of the blood coagulation process or the so-called thrombohemorrhagic syndrome can develop with some complications of pregnancy and childbirth, and therefore every paramedic and every midwife should have an idea of this formidable pathology, be able to diagnose it in a timely manner and treat it correctly.
Most often, thrombohemorrhagic syndrome develops with amniotic fluid embolism, with partial premature abruption of a normally located placenta, with hemorrhagic shock due to hypotonic bleeding.
In order to understand the mechanism of blood coagulation disorders in obstetric pathology, it is necessary to have at least a schematic idea of the process of hemostasis in general.
Stopping bleeding, or hemostasis, occurs due to the complex interaction of a number of physiological processes, one of which is blood clotting. The hemostatic, or coagulation, blood system consists of many links of various origins.
The blood clotting process is a kind of chain reaction, which is divided into three phases. During the first phase, tissue and blood thromboplastins are activated. All tissues of the human body contain up to a certain point inactive thromboplastin in varying quantities. For its transition to an active state, the presence of calcium ions and many other blood and tissue factors is necessary. Any soft tissue injury leads to tissue thromboplastin activation. This process takes only 8-10 seconds. Activation of blood thromboplastin is much slower and takes from 3 to 5 minutes.
Active thromboplastin, of both tissue and blood origin, then converts prothrombin into thrombin. The second phase of hemostasis, which consists in the formation of thrombin, occurs in 2-5 s. The appearance of thrombin in the blood entails the conversion of liquid fibrinogen in the blood plasma into fibrin. This process, which belongs to the third phase of hemostasis, also occurs within 2-5 s and requires the mandatory presence of calcium ions.
Thus, only the first phase of the blood coagulation process can normally take 3-5 minutes, while the second and third occur in the form of short bursts lasting 2-5 seconds each. All links of this chain reaction interact with the obligatory presence of calcium ions.
As a result of blood clotting, a certain amount of fibrinogen is consumed to form blood clots. The more fibrinogen consumed for the process of thrombus formation, the more significantly its concentration in the blood decreases. During a normal pregnancy, the content of this protein, necessary for blood clotting, gradually increases in the woman’s blood and reaches a maximum at the onset of labor. During pregnancy, the concentration of fibrinogen in the blood increases 1.5-2 times. In addition to the increase in fibrinogen content, an increase in thromboplastic activity is noted in the blood of a pregnant woman and, especially, in the blood of a woman in labor. As a result of these changes, every woman giving birth experiences an acceleration of the blood clotting process, due to which, after the separation of the placenta, rapid thrombus formation occurs in the vessels of the placental site.

Question 39

The fetus as an object of birth is considered mainly taking into account the size of the head. The head is the most voluminous and dense part, experiencing the greatest difficulties when moving along the birth canal. It is a guideline by which the dynamics and effectiveness of labor are assessed.

A full-term fetus on average has a mass of 3000 - 3500 g, length - 50 cm. The brain part of the skull is formed by 7 bones: two frontal, two temporal, two parietal and one occipital. The individual bones of the skull are connected by sutures and fontanelles. The fetal head is elastic and can shrink in one direction and expand in another.

Sutures and fontanelles have diagnostic significance in childbirth: the frontal suture (sutura frontalis), separating both frontal bones in the sagittal direction; sagittal (s.sagitahs) separates the parietal bones from each other; coronary (s.coronaria) - frontal bone from parietal; lambdoid (s.lambdoidea) - parietal bones from the occipital; temporal fs.temporalis) - temporal bones from the parietals.

The large fontanel, or anterior one (fonticulus magnus), has a diamond shape. In the center between four bones (two frontal and two parietal), four sutures converge to it - the frontal, sagittal and two branches of the coronoid)

The small fontanel (f.parvus), or posterior, is a small depression in which three sutures converge - the sagittal suture and both legs of the lambdoid.

To understand the biomechanism of childbirth, it is important to know the following head sizes:

large oblique (diameter mento-occipitalis) - from the chin to the most distant point on the back of the head - 13.5 cm, with a corresponding circumference of 40 cm;

small oblique (d.suboccipito-bregmatika) - from the suboccipital fossa to the anterior angle of the large fontanel -9.5 cm, with a circumference of 32 cm;

middle oblique (d.suboccipito-frontalis) - from the suboccipital fossa to the border of the scalp of the forehead - 9.5 - 10.5 cm, with a circumference of 33 cm;

straight (d.fronto-occipitalis) - from the bridge of the nose to the occipital protuberance - 12 cm, with a circumference of 34 cm; vertical, or vertical (d.tracheo-bregmatica), - from the top of the crown to the hyoid bone - 9.5 cm, with a circumference of 33 cm; large transverse (d.biparietalis) - the greatest distance between the parietal tubercles - 9.25 cm; small transverse (d.bitemporalis) - the distance between the most distant points of the coronal suture is 8 cm.

Body dimensions: shoulder girdle - circumference at the level of the shoulders - 35 cm, shoulder size - diameter of the shoulder girdle (distantia biacromialis) - 22 cm. Transverse size of the buttocks (distantia biiliacalis) - 9.0 - 9.5 cm, pelvic girdle - circumference at the level of the trochanters of the femur is -27-28 cm. These dimensions are also important during childbirth.

When a woman is infected in the first week of pregnancy, fetal damage occurs in 80% of cases, in 2-4 weeks - in 60%, in 5-8 weeks - in 30% and in 9-12 weeks - in 10% . When infected at a later stage, the likelihood of developing birth defects decreases, but even at 5 months this danger still exists for 1 in 10 children.

The danger of the rubella virus is that it is almost always transmitted from the mother to the fetus and damages it. Congenital rubella can damage any organ of the child, but the most common triad is cataracts, deafness and heart disease. There may also be consequences in the form of blood disorders (hemolytic anemia, thrombocytopenia), pneumonia, low body weight and short stature at birth.

The adverse effect of rubella on the fetus is also manifested by spontaneous abortions (30%), stillbirth (20%), and death in the neonatal period (20%). The rate of stillbirth is about 10% when a woman becomes ill in the first trimester, 5% when ill in the second and 2% when ill in the third trimester. Congenital rubella is the cause of death in 20% of all deaths from intrauterine infections; it also often leads to the need to choose between abortion and maintaining the infection if the mother becomes infected during pregnancy.

How to recognize?

A woman who had rubella as a child or was vaccinated against rubella does not have to worry that her child will become infected, because she has immunity. If a pregnant woman does not know whether she has had rubella or not, and has not been vaccinated, then she needs to take a blood test for rubella antibodies.

syphlis At any stage of pregnancy, the disease can be transmitted to the baby through the bloodstream. Infection can also occur during childbirth. If syphilis is quickly identified and treated, then in most cases the health of the mother and child is not in danger.
If this disease is not treated, the likelihood of infection of the fetus is very high, especially in the early stages of the disease. In 40 percent of cases, untreated primary syphilis leads to miscarriage, stillbirth, or death shortly after birth. Syphilis also increases the risk of premature birth and intrauterine growth restriction.
In some cases, intrauterine lesions occur that can be seen with ultrasound. Such pathologies include enlarged placenta, accumulation of fluid in the child’s abdominal cavity and its swelling, enlargement of the liver and spleen. After birth, an affected baby may have other manifestations of congenital syphilis, such as rash and skin lesions around the mouth, genitals and anus, nasal discharge, swollen lymph nodes, pneumonia and anemia.
Most babies do not have these symptoms at birth, but without treatment they appear within one to two months. Even in the absence of external signs of syphilis, if this disease is not treated, it will manifest itself years later and lead to serious consequences, such as deformation of bones and teeth, deafness, blindness and neurological diseases. That is why it is so important to identify syphilis during pregnancy and carry out appropriate treatment, and for a child infected during childbirth to undergo the necessary examination and therapy.

Abortion

For a long time it was performed only for indications that threatened the life of the mother. Today, in most countries, including ours, it is legal to terminate an unwanted pregnancy up to 12 weeks. At longer stages of pregnancy, termination is permissible only for medical reasons. Unfortunately, despite the development of medicine and society as a whole, the problem of criminal abortions, as well as incorrectly performed medical terminations of pregnancy, remains not fully resolved. Even at the end of the 19th century, it was said that this procedure must be performed by a highly qualified specialist and only within the walls of a medical institution. To this day, there is an opinion about the “absolute safety” of the method, no matter where and how it is carried out. The latter is not always true.

Among the main ways termination of unwanted pregnancy There are medicinal and instrumental methods. Among the instrumental methods in Russia, the most common is curettage of the uterine cavity, although in periods up to 5-6 weeks of pregnancy, termination of pregnancy by vacuum aspiration of the fetal egg is more preferable. Unfortunately, this method is not used often and depends on the qualifications of the personnel and the equipment of the medical institution.

Methods

Before carrying out any methods, you should finally make sure that the patient has a intrauterine pregnancy. For this purpose, a diagnostic ultrasound of the uterine cavity is necessary. In our clinic, this procedure is performed by all specialists using the most modern ultrasound machines.

Along with the dimensions of the pelvic planes, for a correct understanding of the mechanism of labor and the proportionality of the pelvis and fetus, it is necessary to know the dimensions of the head and torso of the full-term fetus, as well as the topographical features of the fetal head. During a vaginal examination during childbirth, the doctor must focus on certain identifying points (sutures and fontanelles).

The fetal skull consists of two frontal, two parietal, two temporal bones, occipital, sphenoid, and ethmoid bones.

In obstetric practice, the following sutures are important:

sagittal (sagittal); connects the right and left parietal bones, in front passes into the large (anterior) fontanel, in the back into the small (posterior);

frontal suture; connects the frontal bones (in the fetus and newborn, the frontal bones have not yet fused together);

coronal suture; connects the frontal bones with the parietal bones, located perpendicular to the sagittal and frontal sutures;

occipital (lambdoid) suture; connects the occipital bone with the parietal bones.

At the junction of the sutures there are fontanelles, of which the large and small ones are of practical importance.

Large (anterior) fontanelle located at the junction of the sagittal, frontal and coronal sutures. The fontanelle has a diamond shape. Small (posterior) fontanel represents a small depression at the junction of the sagittal and occipital sutures. The fontanelle has a triangular shape. Unlike the large fontanel, the small fontanelle is covered with a fibrous plate; in a mature fetus, it is already filled with bone.

From an obstetric point of view, it is very important to distinguish between the large (anterior) and small (posterior) fontanelles during palpation. In the large fontanel four sutures meet, in the small fontanel there are three sutures, and the sagittal suture ends in the smallest fontanel.

Thanks to sutures and fontanelles, the fetal skull bones can shift and overlap each other. The plasticity of the fetal head plays an important role in various spatial difficulties for movement in the pelvis.

The dimensions of the fetal head are of greatest importance in obstetric practice: each variant of presentation and moment of the mechanism of labor corresponds to a certain size of the fetal head with which it passes through the birth canal.

Small oblique size - from the suboccipital fossa to the anterior corner of the large fontanel; equal to 9.5 cm. The head circumference corresponding to this size is the smallest and is 32 cm.

Average oblique size - from the suboccipital fossa to the scalp of the forehead; equal to 10.5 cm. The head circumference according to this size is 33 cm.

Large oblique size - from the chin to the most distant point of the back of the head; equal to 13.5 cm. The circumference of the head along the large oblique dimension is the largest of all circles and is 40 cm.

Straight size - from the bridge of the nose to the occipital protuberance; equal to 12 cm. The circumference of the head in straight size is 34 cm.

Vertical size - from the top of the crown (crown) to the hyoid bone; equal to 9.5 cm. The circumference corresponding to this size is 32 cm.

Large transverse size - the largest distance between the parietal tubercles - 9.5 cm.

Small transverse size - the distance between the most distant points of the coronal suture - 8 cm.

In obstetrics, it is also common to conventionally divide the head into large and small segments.

Large segment of the fetal head its largest circumference is called, with which it passes through the planes of the small pelvis. Depending on the type of cephalic presentation of the fetus, the largest circumference of the head, with which the fetus passes through the planes of the small pelvis, is different. With an occipital presentation (bent position of the head), its large segment is a circle in the plane of a small oblique size; with anterior cephalic presentation (moderate extension of the head) - circumference in the plane of direct size; with frontal presentation (pronounced extension of the head) - in the plane of a large oblique size; with facial presentation (maximum extension of the head) - in the plane of the vertical dimension.

Small head segment Any diameter that is smaller than the larger one is called.

The following dimensions are distinguished on the fetal body:

transverse size of the hanger; equal to 12 cm, circumference 35 cm;

transverse size of the buttocks; equal to 9-9.5 cm, 27-28 cm in circumference.