Pūkete Waho: pōhiri

e kore e nga wahine hapu mahue anake ki to ratou mau fifi hauora. Hei whakaoti ratou nui ki te tono mo te noho i roto i te whare hauora mua i te whānautanga, ka reira ki te tiki i te āwhina e tika ana, me te mōhiohio. I roto i enei hōhipera, i reira e etahi ture o te wahine hapu, me te tirohanga ki a ia. He he he mea pēnei i te rangahau obstetric waho, e uhinga a te awhina ki te wahine tatari te tamaiti, i roto i te faaineineraa no te whanau. He aha te mea te reira me nga mea i meatia e te ture, kōrero i raro nei.

He aha te rangahau kaiwhakawhänau waho?

mohio tokomaha nga wahine e he tika ki te kia rēhita i roto i te fare ma'i rohe hapūtanga. E kore te mea te haerenga tuatahi ki te rata mātai i muri i te haamauraa o tenei huru ki te reka o te katoa, no te mea e taea te tango i reira ki runga, ki te 40 meneti. e kore te mea taua o te wā he wā roa haere i roto i te noa i roto i te tari o te tākuta. I muri i te katoa, e kore me anake te whakatau i te tohunga ki te wahine hapu, engari ano hoki ki te kohikohi hītori whānui, me te motuhake. whakaritea hoki e whakamātautau taiwhanga, ka whakamana i waho rangahau kaiwhakawhänau.

Ko tā te reira i te whakamātautau tuatahi, e he ona ake hātepe. Pōhiri ki hiahiatia rangahau kaiwhakawhänau waho te ki te kohikohi raraunga e pā ana ki te wahine. He nui te tākuta ki te whakatau i te mana o te wahine uma, i roto i ngā te āhua o te kōmata, no te mea pānga ki te huinga o mehua ki te faaineine no te kai. utu rata mātai whakarongo ki te āhua o kua riro toka te whaea expectant i te kau o te haputanga, me karanga nui auau taimaha mo te wā katoa o tatari pēpi.

Whakahaere rangahau obstetric waho tā kohikohi mōhiohio e pā ana ki hapūtanga o mua, me te scarring o te kōpū. E tika ana ki te whakatū i te mōrea o pathologies hapūtanga enei mahi. I tua atu ki te tirotiro, kua whakamahia tonu tikanga o ine, palpation me auscultation, e tauturu i ki te tiki i te pikitia tino o te whanaketanga tamaiti me te huru o te wahine, poipoia reira. Kei raro, ka kia whakaahuatia enei tikanga i roto i te taipitopito.

He aha ngā momo o taua ako he?

Hei whakatau i te mana tika o te wahine hapu e kore he nui noa ki te ui ia. Ahakoa kahore palpatsionnye nga tinihanga katoa ka waiho kōrero mo te ngaio rangahau obstetric waho. Ki te hanga te pikitia katoa o te wahine tatari te tamaiti, me te hauora o tana tamaiti, Me ki mohio he aha tukanga tango te wahi i roto i te tinana o te hapu. Ka taea te kite i tenei ki tātari te awhina o taiwhanga o toto, mimi, me pera i runga i. Hoki tonu whakarongo te tākuta ki te kongakonga mokowhiti me tautuhi tona tūranga i roto i te kōpū. E whakaaturia enei whawhe katoa i roto i te toru ngā momo matua o te rangahau hapu:

• haumanu;
• taiwhanga;
• motuhake.

whakamātautau haumanu o hapu

Tenei momo o te wahine rangahau i roto i te hapūtanga timata ki te kohinga o hītori hauora me tona ahua reira. Ēnei mahi kore te āwhina anake te tākuta te tiki i te kōrero i runga i te hauora tinana o te wahine, te whakarato hoki ratou he whai wāhi ki te aromatawai i tona mahi neuro-ira.

A haamata whakamātautau haumanu ki te rangahau i roto i nei huri i te reira i roto i ngā mōhiohio e pā ana ki te wahine.

1. Te haamauraa o te whaea o te tangata i mua nei (ingoa, uruwhenua - tau me te raupapa).
2. Age i nei no nulliparous ki te rōpū motuhake (taitamariki - waru, te tau - e toru tekau nga tau i muri i).
3. Ko te wāhitau tūturu o te noho me te rēhita o te wahine.
4. He aha haere ki te tākuta-rata mātai.
5. āhuatanga Material ora (te tini o te tangata ora, me kararehe i roto i te ruma kotahi ki te wahine, tikanga ora), me te wahi mahi ia ki te whakatutuki (i kino kia whakatau i runga i te mahi atu kouma hoki ia, me nga hua o ngā āhuatanga mahi).
6. Mōhiohio e pā ana te toto huhu me ona wāhanga (wē, albumin), mate pāwera, mate somatic, matepukupuku. E mea pinepine e kore e somatic noa tikanga hauora tinana oti, no te mea kia wheako i te tangata feia faahuehue o mahi hinengaro, me te io. fatongia o te tākuta - ki te tautuhi i te āhuatanga i arahina ki enei maumaui, no te mea he nui ake pea ki te hoatu whanau wahine, a ki runga ki te whanonga e tika ana tei runga i te hauora o te whaea me te tamaiti e parauhia te. Ko te take o neuroses me ētahi atu disorders o mahi io, me te hinengaro, he rota:

• mate whanau;
• ahotea;
• pākoko auroa;
• materoto;
• whara i roto i te whanau o mua.

kitea e rata mātai i roto i taua i reira he tohu o maumaui o te mahi neuro-Piripīni: i mua i te hapū, te wā kotahi ranei me tona takanga. Ko reira tika hoki ki te kitea i roto i te mea hono i te wahine ratou takenga.

7. hītori tahumaero.

8. haurangi tamau (paowa, waipiro, tarukino).

9. mate wahine me mahi fakasekisualé, me te whakaputa uri (ka timata paheke, rite te rere, te hapūtanga o mua ki te āhua o te whanautanga, taimaha, me te mana hauora o ngā tamariki o mua, gynecological me paipai mate hapūtanga).

10. aamu utuafare (āhua o te hauora o te mau melo o te utuafare e noho tahi ki te wahine, whakapapa, hauora, rōpū, me te rH hononga papa heke mai).

Next, neke ki te whakamātautau whāinga o te whaea i mua nei:

• Tohutohu kaihaumanu, TEETH, ophthalmologist me Ent. Ki te tika, whakarite tohunga tirohanga atu.
• Whanganga i te pāmahana me te pēhanga toto.
• Arotake i te Force, ka whanganga teitei, te taimaha me te āhuatanga o te papatoiake.
• Tirohia a palpate te puku.
• Te ārohi i te toto, mimi, me te tahi atu secretions.
• Te tūhura i te puke hononga.
• Meatia te hiko-.
• he tika Ultrasound whakamātautau ki te tika katoa wahine hapu noa te tekau ma rua, tekau ma waru ki te rua tekau-rua, me te ki 32 meneti i runga i te wiki 34raa.
• Kawe i roto i te rangahau kaiwhakawhänau waho.

He mea nui kia rēhita te wahine i kore i muri atu i te 12 wiki o te hapūtanga. Ko te anthropometry whakamana i mua, whakamātautau taiwhanga me te aro mātai o te pēhanga toto, te teitei te pea o he tamaiti hauora ranei te tāutu pīari fetal hohotahi ki te ora.

rangahau Taiwhanga o te wahine

A, no te tangata rēhita te whaea expectant, kua whakaritea he whakamātautau toto haumanu me te urinalysis, tautuhi i te rōpū, me te tauwehe rH, toto kūhuka, tirohia hoki Nalia RW, kakā, HIV, ka hanga hoki scrapings me swabs i te tenetene me cervix runga otaota, cytology, chlamydia, gonorrhea, trichomoniasis.

Ki te whakakitea mai hītori te whanautanga o tamariki mate, whakatahe (rawa i roto i te wāhanga i muri mai), māuiuitanga extragenital, he mea e tika ana:

• kia ako toto o te wahine mo te aroaro o te hemolysin;
• Ka taea te whakamahi rōpū toto o papa i mua nei ki te tūhura me te rH, ngā ki te āhuatanga Rhesus hapu kino rōpū ranei 0 (ahau);
• ki te whakatau i te aroaro o te mate urogenital;
• whakatau i te taumata o hormones tika, immunoresistance;
• ki te tika, ki te whakahaere rangahau iranga.

kawea whakamātautau taiwhanga atu te roto i roto i taua ngā:

• CBC - marama i muri i te wiki toru tekau - kotahi i roto i nga ra e wha;
• i roto i ia mimi fariiraa whakahau i runga i te tātari whānui;
• i runga i te tekau ma ono ki te wiki rua tekau whakatau te hCG me ACE;
• i 22-23 wiki. me 36-37 wiki. titiro huka toto;
• Ako i runga i te pūnaha coagulation (coagulation) hua 36 ki te wiki 37th;
• i toru wiki, me mo te rua ranei e toru wiki i mua i te hoatu whanau hipoki ano hoki HIV ko RW, tirohia swabs me scrapings.

pūkete motuhake

rangahau obstetric Motuhake ngā:

1. Whakahaere rangahau obstetric waho.
2. rangahau kaiwhakawhänau ā-.
3. Ētahi atu rangahau atu.

Outdoor tūhuratanga obstetric he whakamātautau, inenga o te rahi o te papatoiake. I muri i te wiki rua tekau whakaritea rahi o te paenga nui o te puku, i mahi pūkenga te puku, me te hononga tore, me prolushivaniya ngakau fetal. e kore te mea ohie taputapu rangahau obstetric waho, kua kawea te reira i roto i anake e paramedics rawa whakangungua.

rangahau kaiwhakawhänau ā-. I roto i te kaiwhakawhänau ā-rangahau ngā whakamātautau o te kikokiko o waho, ako te whakamahi i whakaata tenetene, me te waha. Ko reira tika rite nui rite waho whanau rangahau obstetric. kawea ana tēnei tukanga i roto i te whēkau, me te tōngāmimi. Hoki te hui ka ui tetahi wahine ki te takoto i runga i tou hoki, ki waewae tareka ia i roto i te ringa, me te whakapiko i te turi. kia ara nga papatoiake. Investigation tika kawea atu i raro i ngā āhuatanga iroiti.

• haamata te ako ki te whakamātautau o te taihemahema waho. Te arotake i te āhua o te makawe tinana, crotch. Rapu tukanga pathological, ki te he e ratou: tohu i ruptures i roto i te whanau o mua, te pukupuku, inflammations, fistulas, ngä kiritona, te pukupuku i roto i te nono. Arotake i te āhua o te labia vulvar e aki ki o koutou maihao, whakatau hoki te āhua o te repe urethral.

• tirohia te waha ki te awhina o whakaata. Kia whai whakaaro ki te mea ngaro, te rahi korokoro waha, me te uterine mucous. I roto i te huatū ahau-st kawea te whakamātautau e rua-ringa o te tenetene, i roto i te tuarua, me te tuatoru anake e hāngai ana kotahi-ringa.

Tuatahi whakatau tata i te crotch (ranei rigidity, scarring) me te puta tenetene (rahi, taiepa kotuituitanga wātea).

4 te fariiraa i rangahau obstetric waho

Pōhiri ki rangahau kaiwhakawhänau waho (tikanga Leopold) whakamahia e palpation o te puku o te wahine hapu. Ēnei tikanga e wha:

• whakatau tata i te tiketike o te kōpū e tu ana, a ka faaite te hua, i te mea te reira;
• te whakatau i te wāhi o te kukune, e hanga whakatau e pā ana te kimi i te hoki me ona ringa, me waewae;
• faaotiraa o te hua, whakatakotoria nei i mua, tona wāhi i roto i te pā ana ki papatoiake iti;
• whakaritea rite foaki fetal wahi tūnga te whanaunga ki te tomokanga ki te papatoiake.

Ko te whakaaro o te tirohanga o te waha

I mua i whanau whakaritea te waha paari, mai tohu reira pehea te tinana he rite ki te waiho. He kanorau Methods mō te whakatau i te paari o te whare tangata, engari aromatawaitia enei tawhā i roto i te katoa o ratou:

• ōritetanga;
• he aha te mea te roa o te wahi tara o te awa;
• patency o te awa te waha;
• Kei a pehea tawhiti whakahaua te tuaka kaki te i roto i te papatoiake;
• te matotoru taiepa o te wahi kaki, whakaritea nei i roto i te tara;
• whakatau i te huru o te wahi o raro o te kōpū.

Te arotake i te waha mo te tauine motuhake. Ko cervix teeki i 0 ki te 5 ngā. Ki te mea kua puta ke te tirohanga atu i te 10, ka taea te wahine te faaineine no te whanau ana.

Studies o papatoiake wahine

Hei mohio taha papatoiake, te whakamahi i te pūkete waho hapu rite pelviometriya. Tikanga āhuatanga papatoiake waho e whai ake nei:

• tawhiti spinarum, i te mea e rite ana ki te 25-26 henimita;
• kristarum tawhiti - i 28 ki te 29 henimita;
• tawhiti trohanterika - i 31 ki te 32 henimita;
• Haumi waho - i te 20 ki te 21 henimita;
• diagonalis haumi, i meinga nei hei i roto i te whānuitanga 12.5 - 13 henimita.

Te nuinga o tākuta kē i te haerenga tuatahi, tamata wahine ki te ine i te whakapono haumi (pono), e whakatau te rahi o te tomokanga ki te peihana iti. Tikanga, kia waiho ai 11 ki te 12 cm. Ka taea te kitea te haumi pono, te kore nga conjugates waho (waho) tango 9 henimita. tutaki ano tōna rahi te rhomb Michaelis me Frank rahi (whakaritea e te pekehoe waha te whitu ki te waenganui o te fossa jugular). Ko te hauroki o te haumi kei nei i waenganui i te mata o raro o te hononga tore ki mātārae nga wahi tino salient krestsovogo, rite ano ki te conjugates pono uara.

Ki te afe nga rahi papatoiake i te täkupu, he mea tika ki te whakahaere waho tikanga rangahau obstetric e te hunga anō taha: whanganga taha haumi, kei nei i waenganui i te tuarā mua o te Illium me te tuaiwi muri i tetahi taha. Ko tōna uara noa o 14 ki te 15 henimita te. Ki te he te reira henimita iti iho i te 12 me te hawhe, whanau ana whaiaroaro taea. whanganga hoki te rahi o te matahao. E toru o ratou, me te mea te rerekētanga i waenganui i a ratou ake atu i te 1.5 henimita, te kaiwhakawa matahao whāiti, i te mea mōrearea i roto i te whanau hoki.

Te whakatau hoki te koki papatoiake o tokonga ake, e kore nei e peka ke i 45-55 nekehanga. E rite nui koki tore kia e kia rite ki te 90-100 nekehanga.

Ko te hātepe o te rangahau obstetric waho ngā te uara o te putanga o te peihana iti:

• rahi raina, e te mea rite ki te iwa henimita. Kei waenganui i te mutunga o raro o te wahapū tore me te wāhi o runga o te iwi timu. Mai i te raraunga whiwhi pahuatia e rua henimita runga i te kopa ngohengohe;
• tazometrom whanganga taha hake i te 11 henimita me kei waenganui i te tuberosity ischial (ratou papa i roto).

Pōhiri ki Leopold-Levitsky

Hoki whakauru o tetahi rata o te wahine puta noa i te wā o te hapūtanga te tika pau waho rangahau kaiwhakawhänau. Pōhiri ki Leopold-Levitsky te takaro wāhi nui i roto i reira. Ko te ingoa o enei tikanga ki runga ki te mau parau tumu o, a kua oti whakahuatia i runga ake, poluchli mo o te tangata e whakawhanakehia ratou i roto i te mutunga o te rautau tekau mā iwa. Tenei tangata ko te tākuta Tiamana Karaitiana Leopold. Kua faatiti'aifarohia ēnei whanaketanga maha ngā raruraru obstetric e he hāngai ana ki te ra nei.

te tauturu ia ratou te whakatau i te rahi me te tūranga o te kukune i roto i te mutunga o te hapū. Ko te tuatahi o enei tikanga hanga i mua i ia ultrasound. tohu ia ki te tiketike o te tu raro whaea, me te tata tonu hāngai ki te wā o te hapūtanga. Tika ona e pā ana ki te matotoru taiepa puku. Ki te i roto i te feaa, inaianei atu tika e hoatu i te hua ultrasound.

E whakaatu ana te tuatoru o nga fariiraa whakaaturanga fetal: kōaro, hake upoko ranei. A hoki, pehea hohonu kua te hua i roto i te papatoiake. Ko te tuawha fariiraa haapapu te toru o mua.

ako hātepe

He maha ngā hātepe waho tikanga rangahau obstetric. inenga papatoiake tuatahi hanga hapu. I muri i te mutunga o tenei whawhe o te tākuta puta ki palpation o te puku o te wahine. Ko te wā o te tono Leopold pōhiri ki tenei. Next, haere ki te auscultation, ranei whakarongo ki te ngakau fetal. He auau nui o ngā patu ngakau (ko te tikanga i 120 ki te 160 kapakapa ki te meneti.), Ratou te maramarama, me te manawataki. whakamana Auscultation te whakamahi i te pūoko whakaroto te aroturuki fetal ranei.

Ko te tino nui i roto i hapūtanga me muri tuku rangahau kaiwhakawhänau waho, me te ā-. kia matau te wahine reira, ki te tikanga tika me te i roto i tetahi take e kore e nunumi atu i a ratou. te tauturu ia ratou i te tākuta kitea i roto i ranei he hauora nga rerenga hapūtanga noa ki te te whaea expectant me tona tamaiti.