The degree of insertion of the fetal head into the small pelvis. Determination of the degree of insertion of the fetal head. Insertion of the fetal head Type of insertion

The degree of insertion of the fetal head into the pelvis it is recommended to define as follows. Penetrating at the fourth external obstetric examination with the fingers of both hands as deep as possible into the pelvis and pressing on the head, they make a sliding movement along it towards themselves.

With a high standing of the fetal head, when it is movable above the entrance, you can, with an external examination, bring the fingers of both hands under it and even move it away from the entrance (Fig. 4.21).

If at the same time the fingers diverge, the head is at the entrance to the small pelvis by a small segment m (Fig. 4.22).

If the hands sliding on the head converge, then the head either located in a large segment at the entrance, or went through the entrance and went down into deeper sections (planes) of the pelvis (Fig. 4.23).

If the fetal head penetrates so deeply into the pelvic cavity that it completely fulfills it, then usually palpate the head with external methods is no longer possible.

A - head above the entrance to the small pelvis

B - head with a small segment at the entrance to the pelvis

B - head with a large segment at the entrance to the pelvis

G - head in the widest part of the pelvic cavity

D - head in the narrow part of the pelvic cavity

E - head in the outlet of the pelvis

The head is movable over the entrance.

By the fourth method of obstetric research, it is determined by the whole (between the head and the upper edge of the horizontal branches of the pubic bones, you can freely bring the fingers of both hands), including its lower pole. The head ballots, i.e., it easily moves to the sides when it is repelled during external examination. With vaginal examination, it is not achieved, the pelvic cavity is free (you can palpate the border lines of the pelvis, cape, the inner surface of the sacrum and symphysis), it is difficult to reach the lower pole of the head if it is fixed or shifted downward with an externally located hand. As a rule, the sagittal suture corresponds to the transverse size of the pelvis, the distances from the promontory to the suture and from the symphysis to the suture are approximately the same. Large and small fontanelles are located on the same level.

If the head is above the plane of the entrance to the small pelvis, its insertion is absent.

The head is a small segment at the entrance to the small pelvis (pressed against the entrance to the small pelvis). By the fourth reception, it is palpated all over the entrance to the pelvis, with the exception of the lower pole, which has passed the plane of the entrance to the small pelvis and which the examining fingers cannot cover. The head is fixed. It can be shifted up and to the sides with the application of a certain effort (it is better not to try to do this). During external examination of the head (both during flexion and extensor insertions), the palms of the hands fixed on the head will diverge, their projection in the cavity of the small pelvis is the top of an acute angle or wedge. With occipital insertion, the region of the occiput, accessible to palpation, is 2.5-3.5 transverse fingers above the ring line and 4-5 transverse fingers from the side of the front part. During vaginal examination, the pelvic cavity is free, the inner surface of the symphysis is palpated, the promontorium is difficult to reach with a bent finger or unattainable. The sacral cavity is free. The lower pole of the head may be accessible for palpation; when pressing on the head, it moves up outside the contraction. The large fontanel is located above the small one (due to the flexion of the head). The sagittal suture is located in a transverse dimension (may make a small angle with it).

The head is a large segment at the entrance to the small pelvis.

The fourth method determines only a small part of it above the entrance to the pelvis. In an external study, the palms tightly attached to the surface of the head converge at the top, forming an acute angle with their projection outside the large pelvis. The part of the occiput is determined by 1-2 transverse fingers, and the front part - by 2.5-3.5 transverse fingers. During vaginal examination, the upper part of the sacral cavity is filled with the head (the cape, the upper third of the symphysis and the sacrum are not palpable). The sagittal suture is located in a transverse dimension, but sometimes, with small sizes of the head, its beginning rotation can also be noted. The cape is unreachable.

Head in a wide part of the pelvic cavity.

During external examination, the head is not determined (the occipital part of the head is not determined), the front part is determined by 1-2 transverse fingers. During vaginal examination, the sacral cavity is filled in most of it (the lower third of the inner surface of the pubic joint, the lower half of the sacral cavity, IV and V sacral vertebrae and ischial spines are palpated). The belt of contact of the head is formed at the level of the upper half of the pubic articulation and the body of the first sacral vertebra. The lower pole of the head (skull) may be at the level of the apex of the sacrum or somewhat lower. The swept seam can be in one of the oblique sizes.

Head in the narrow part of the pelvic cavity.

With vaginal examination, the head is easily reached, the swept suture is in an oblique or direct size. The inner surface of the pubic articulation is unreachable. The hard work began.

Head on the pelvic floor or in the exit of the small pelvis.

With external examination, it is not possible to determine the head. The sacral cavity is completely filled. The lower pole of contact of the head passes at the level of the apex of the sacrum and the lower half of the pubic symphysis. The head is determined immediately behind the genital slit. Arrow seam in direct size. With an attempt, the anus begins to open and the perineum protrudes. The head, located in the narrow part of the cavity and at the exit of the pelvis, can also be felt by palpation through the tissues of the perineum.

According to external and internal studies, a match is observed in 75-80% of the examined women in labor. Different degrees of flexion of the head and displacement of the bones of the skull (configuration) can change the data of an external study and serve as an error in determining the insertion segment. The higher the experience of the obstetrician, the less errors are allowed in determining the segments of the insertion of the head. More accurate is the method of vaginal examination.

At the beginning of normal labor, the head is installed above the entrance to the pelvis or inserted into the entrance in such a way that the swept seam, coinciding with the wire line of the pelvis, is located in the entrance at the same distance from the womb and cape, which favors its passage through the birth canal. In most cases, the head is inserted into the entrance in such a way that the anterior parietal bone is deeper than the posterior one (the sagittal suture is closer to the promontory) - asynclic insertion. Weak and moderately pronounced anterior asynclitism favors the passage of the head through the birth canal, which is not spacious enough for it.

Sometimes asynclitism is so pronounced that it prevents the head from moving further along the birth canal - pathological asynclitism.

Distinguish two types of asynclitism:

a) anterior (Negele's asynclitism)- the sagittal suture is close to the sacrum, and the anterior parietal bone descends first into the plane of the entrance of the small pelvis, the leading point is located on it

b) posterior (Litzmann's asynclitism)- the posterior parietal bone descends first into the pelvis, the sagittal suture is rejected anteriorly to the bosom

Causes: a relaxed state of the abdominal wall, a relaxed state of the lower segment of the uterus, the size of the fetal head and the state of the pelvis of the woman in labor (its narrowing and especially flattening - a flat pelvis, as well as the degree of the angle of inclination of the pelvis).

Diagnostics: the sagittal suture deviates from the axis of the pelvis towards the symphysis or sacrum and steadily maintains this position.

Childbirth prognosis with anterior asynclitism favorable in case of a mild discrepancy between the size of the pelvis of the woman in labor and the head of the fetus. The head undergoes a strong configuration, acquiring an oblique shape with depressions in the bones of the skull. Under the influence of strong labor activity, the presenting parietal bone penetrates deeper into the pelvis, and only after that another parietal bone, which lingered at the cape, descends.

Posterior asynclitism more often it is a consequence of childbirth with a generally narrowed flat and flat rachitic pelvis. The posterior parietal bone is inserted first in a transverse size. With lateral flexion of the fetal head, the sagittal suture deviates towards the symphysis. The head is inserted in a state of slight extension.

A pronounced degree of anterior and especially posterior asynclitism is indication for caesarean section.

Incorrect standing of the head (deviations from the normal biomechanism of labor with occipital presentation)

1. High straight standing swept seam - condition, the fetus at the beginning of labor is turned with its back straight anteriorly (anterior view) or backwards (posterior view), and its head stands with an arrow-shaped seam above the direct size of the entrance to the small pelvis.

Etiology: violation of the relationship between the head and the pelvis (narrow pelvis, wide pelvis), prematurity of the fetus (small size of its head), changes in the shape of its head (wide flat skull) and the shape of the pelvis (round shape of the entrance of the small pelvis with its transverse narrowing).

Childbirth possible under certain conditions: the fetus should not be large, its head should be well configured, the mother's pelvis is of normal size, labor activity is of sufficient strength. The fetal head moves along the birth canal in the direct size of all planes of the small pelvis, without making an internal turn. Childbirth is protracted.

Complications: weakness of labor, difficulty in advancing the head, compression of the soft tissues of the birth canal, fetal hypoxia, intracranial trauma to the fetus.

Delivery: in the anterior view - independent childbirth; at the back - independent childbirth is rare, more often caesarean section, obstetric forceps, craniotomy.

2. Low transverse swept seam - pathology of childbirth, characterized by the standing of the head with an arrow-shaped suture in the transverse dimension of the pelvic outlet, in which there is no internal rotation of the head.

Etiology: narrowing of the pelvis (flat pelvises, especially flat rachitic ones), small sizes of the fetal head, decreased tone of the pelvic floor muscles.

Complications: compression and necrosis of the soft tissues of the birth canal and bladder, ascending infection, uterine rupture, fetal hypoxia.

Delivery: with active labor activity, childbirth ends spontaneously, otherwise they resort to caesarean section, the imposition of obstetric forceps, craniotomy.

Extension presentation and insertion of the fetal head. Features of the biomechanism of childbirth. The course and management of childbirth.

The extensor presentation of the fetal head: anterior head, frontal, facial.

Insertion of the fetal head

the position of the fetal head in the birth canal during childbirth, in which it crosses (by a large or small segment) the plane of the entrance of the small pelvis.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what "Insertion of the fetal head" is in other dictionaries:

The position of the fetal head in the birth canal during childbirth, in which it crosses (by a large or small segment) the plane of the entrance of the small pelvis ... Big Medical Dictionary

See Asynclitism posterior ... Big Medical Dictionary

See Asynclitism anterior... Big Medical Dictionary

ASYNCLITIC INSERT- ASYNCLITIC INSERT, or asynclitism. A. in. is called the incorrect insertion of the fetal head during childbirth. By inserting, it is customary to designate the relationship of the swept seam to the entrance to the pelvis, or rather, to its two main identification points to ... ... Big Medical Encyclopedia

BIRTH PHYSIOLOGICAL- honey. Childbirth is a complex physiological process of expulsion of the contents of the uterine cavity (fetus, amniotic fluid, fetal membranes and placenta) through the natural birth canal. Reasons for the onset of labor The placental clock is a hypothetical mechanism ... Disease Handbook

I Childbirth Childbirth (partus) is the physiological process of expulsion from the uterus of the fetus, amniotic fluid and placenta (placenta, membranes, umbilical cord) after the fetus has reached viability. The fetus, as a rule, becomes viable after 28 weeks ... ... Medical Encyclopedia

In obstetrics, anatomically and clinically (functionally) a narrow female pelvis is distinguished. Anatomically narrow is a pelvis in which at least one of the main dimensions, i.e. interosseous size, the distance between the most distant points of the iliac ... ... Medical Encyclopedia

Examination of pregnant women, women in labor and puerperas; is carried out using generally accepted clinical, incl. laboratory, and special research methods to monitor the course of pregnancy, childbirth and the postpartum period. Allows you to identify... Medical Encyclopedia

- (asynclitismus; A + Greek synklinō tilt) insertion of the fetal head into the upper aperture of the small pelvis, in which the sagittal suture is deflected towards the promontory or pubic symphysis. Back asynclitism (a. posterior; synonym: insertion of the fetal head ... ... Medical Encyclopedia

NEGELE ASYNCLITISM- (described in 1825 by the German obstetrician F. K. Naegele, 1778–1851; synonyms - anterior pathological asynclitism, anterior parietal insertion of the fetal head) - due to various reasons (narrow pelvis, flabby abdominal wall, prolapse of the handle next to ... ... Encyclopedic Dictionary of Psychology and Pedagogy

Birth of a dead fetus born after 28 weeks of pregnancy and not having taken a single breath after birth; the length of the fetus is not less than 35 cm and the weight is not less than 1000 g. As a statistical indicator of M., the ratio of the number of stillborns to ... ... Great Soviet Encyclopedia

I moment - insertion and flexion of the fetal head. Under the action of expelling forces, the head with its swept seam is inserted into the transverse or into one of the oblique dimensions of the plane of entry into the small pelvis. The occiput and small fontanel are turned anteriorly. In the first position, the head is inserted with an arrow-shaped suture into the right oblique dimension, and in the second position, into the left oblique dimension of the plane of entry into the small pelvis.

In the period of exile, the pressure of the uterus and abdominal pressure is transmitted from above to the spine of the fetus and through it to the head. The spine is connected to the head not in the center, but closer to the back of the head (eccentric). A two-arm lever is formed, at the short end of which the back of the head is placed, at the long end - the forehead. The pressure force of the expelling forces is transmitted through the spine primarily to the back of the head - the short arm of the lever. The back of the head drops, the chin approaches the chest. The small fontanel is located below the large one and becomes the leading point. As a result of flexion, the head enters the pelvis in the smallest size - a small oblique (9.5 cm). With this reduced circle (32 cm), the head passes through all the planes of the pelvis and the genital gap.

I.I. Yakovlev suggested dividing the first moment into two (separately consider inserting the head and bending the head). He also noted that even with normal childbirth, the swept suture may deviate from the axis of the pelvis anteriorly or posteriorly, i.e. asynclitpic insertion (see: "Basic obstetric concepts"). True, during normal childbirth, this physiological asynclitism with a deviation in each direction by about 1 cm. As another point, I.I. Yakovlev singled out sacral rotation, i.e. pendulum-like advancement of the fetal head with alternating deviation of the sagittal suture: either towards the promontory (anterior asynclitism), then towards the pubis (posterior asynclitism). One of the parietal ossicles drops forward while the other lingers and then slides off. The alignment of the head relative to the axis of the pelvis is due to the configuration of the bones. Due to the pendulum movement, the head descends into the cavity of the small pelvis.

II moment - internal rotation of the fetal head. The internal rotation begins when it passes from the wide part of the small pelvis to the narrow one and ends at the pelvic floor. The head performs translational movement forward (lowers) and simultaneously rotates around the longitudinal axis. In this case, the back of the head turns anteriorly, and the forehead - backwards. When the head descends into the pelvic cavity, the sagittal suture changes into an oblique size: in the first position, to the right oblique, and in the second position, to the left. At the exit of the pelvis, the swept seam is set in its direct size. In the process of rotation, the occiput moves along the arc by 90 ° or 45 °.

With the internal rotation of the head, the swept suture passes from the transverse to the oblique and on the pelvic floor - to the direct size of the exit plane from the small pelvis. Internal rotation of the head is associated with various reasons. It is possible that this is facilitated by the adaptation of the advancing head to the dimensions of the pelvis: the head, with its smallest circumference, passes through the largest dimensions of the pelvis. At the entrance, the largest size is transverse, at the cavity - oblique, at the exit - straight. Accordingly, the head rotates from the transverse dimension to the oblique and then to the straight line. I.I. Yakovlev associated the rotation of the head with the contraction of the muscles of the pelvic floor.

III moment - extension of the head. Contraction of the uterus and abdominals expel the fetus towards the top of the sacrum and coccyx. The muscles of the pelvic floor resist the movement of the head in this direction and contribute to its deviation anteriorly, towards the genital gap. Extension occurs after the region of the suboccipital fossa fits under the pubic arch. Around this point of fixation, the head unbends. When unbending, the forehead, face and chin erupt - the whole head is born. Extension of the head occurs during cutting and cutting through the vulva with a circle (32 cm) passing through a small oblique size.

IV moment - internal rotation of the shoulders and external rotation of the fetal head. During the extension of the head, the shoulders with their largest size (biacromial) are inserted into the transverse dimension or into one of the oblique dimensions of the pelvis - opposite to where the sagittal suture of the head was inserted.

When moving from the wide part of the small pelvis to the narrow one, the shoulders, moving in a helical manner, begin an internal turn and due to this they pass into an oblique, and on the pelvic floor - into a straight size of the exit from the small pelvis. The internal rotation of the shoulders through the neck is transmitted to the born head. In this case, the face of the fetus turns to the right (in the first position) or to the left (in the second position) thigh of the mother. The back of the child's head turns to the mother's thigh, which corresponds to the position of the fetus (in the first position, to the left, in the second, to the right).

The posterior shoulder is located in the sacral recess, and the anterior shoulder cuts through to the upper third (to the point of attachment of the deltoid muscle to the humerus) and rests against the lower edge of the symphysis. A second fixation point is formed, around which the lateral flexion of the fetal body in the cervicothoracic region occurs in accordance with the direction of the deepening of the birth canal. In this case, the back shoulder is born above the perineum, and then the front shoulder is completely released. After the birth of the shoulder girdle, the child's body is born quickly and without obstacles, less voluminous compared to the head and shoulder girdle.