Methods for isolating the placenta. Management of the III stage of labor by a midwife

Management principles subsequent period:

Emptying the bladder immediately after the birth of the fetus;

Control of hemodynamic parameters of the mother;

Control of blood loss;

At normal course childbirth after the birth of the fetus, any mechanical effect on the uterus (palpation, pressure) until signs of placental separation appear is prohibited.

If, after the appearance of signs of separation of the placenta, its independent birth does not occur, then techniques for isolating the placenta can be used to reduce blood loss.

Techniques for isolating the separated placenta.

1. Reception Abuladze (Fig. 40) After emptying the bladder, the anterior abdominal wall is grasped with both hands in a fold. After that, the woman in labor is offered to push. The separated placenta is born as a result of an increase in intra-abdominal pressure.

2. Genter's maneuver (Fig. 41) - pressure from the bottom along the ribs of the uterus downwards and inward (currently not used).

3. Reception Crede-Lazarevich (Fig. 42) is emptied bladder catheter; bring the bottom of the uterus to the middle position;

make a light stroking (not massage!) of the uterus in order to reduce it; clasp the bottom of the uterus with the hand of the hand that the obstetrician is better at, so that the palmar surfaces of her four fingers are located on back wall uterus, the palm is at the very bottom of the uterus, and thumb- on its front wall; at the same time, they press on the uterus with the whole brush in two intersecting directions (fingers - from front to back, palm - from top to bottom) towards the pubis until the afterbirth is born.

The Krede-Lazarevich method is used without anesthesia. Anesthesia is necessary only when it is assumed that the separated placenta is retained in the uterus due to spastic contraction of the uterine os. In the absence of signs of separation of the placenta, apply manual separation placenta and excretion of the placenta. A similar operation is also performed when the postpartum period lasts more than 30 minutes, even in the absence of bleeding.

Rice. 40. Abuladze's reception

Rice. 41. Genter's reception

Rice. 42. Reception Krede-Lazarevich

After the birth of the fetus, intrauterine pressure increases to 300 mm Hg, which is many times higher than the blood pressure in the vessels of the myometrium and contributes to normal hemostasis. The placenta contracts, the pressure in the vessels of the umbilical cord rises to 50-80 mm Hg, and if the umbilical cord is not clamped, then 60-80 ml of blood is transfused to the fetus. Therefore, the clamping of the umbilical cord is shown after the cessation of its pulsation. During the next 2-3 contractions, the placenta separates and the placenta is released. After the birth of the placenta, the uterus becomes dense, rounded, located in the middle, its bottom is located between the navel and the womb.

If the next check reveals positive signs of placental separation, the woman in labor is offered to push, and the placenta is born on its own. If the placenta is not born on its own, then they resort to its allocation by manual methods.

Methods for manual selection of the placenta.

Abuladze method. After emptying the bladder, the anterior abdominal wall grasp with both hands in a longitudinal fold so that both rectus abdominis muscles are tightly grasped by the fingers. The woman in labor is offered to push. The separated placenta is easily born due to the elimination of the divergence of the rectus abdominis muscles and a significant decrease in the volume of the abdominal cavity.

Genter's method . The doctor stands on the side of the woman in labor, facing her feet. The uterus is also transferred to the middle position. Hands, clenched into a fist, with the back surface of the main phalanges are placed on the bottom of the uterus in the area of the tube corners. Then proceed to the actual squeezing of the placenta. At first, weakly, and then, gradually increasing the pressure, they press on the uterus in the downward and inward direction. The afterbirth is born from the genital gap.

Crede-Lazarevich method a. If the placenta was not born after applying the Abuladze method, they resort to the Krede-Lazarevich method. This method is quite traumatic, and it must be performed with great care. For his correct execution the following rules should be followed, dividing the entire manipulation into 5 points:

1st moment- emptying of the bladder (it was performed immediately after the birth of the fetus);

2nd moment- the uterus deviated to the right is shifted to the midline;

3rd moment- produce a circular massage of the bottom of the uterus to cause its contraction, since it is impossible to put pressure on a flaccid relaxed uterus due to its possible eversion;

4th moment- the uterus is clasped with a hand so that the thumb lies on the front surface of the uterus, the palm is on the bottom of the uterus, and 4 fingers are on its back surface;

5th moment- simultaneously pressing on the uterus with the whole brush in two mutually intersecting directions (fingers from front to back and palm from top to bottom, in the direction towards the pubis), they achieve the birth of the placenta. After the placenta, shells are stretched, folded into a tourniquet. The pressure on the uterus is stopped and care is taken that the membranes come out completely.

To do this, Yakobe suggested, taking the placenta in his hands, rotate it clockwise so that the shells curl up into a “cord” and come out unexploded.

If, when observing a woman in labor, it is not possible to detect signs of separation of the placenta, then the expectant management of the III period should not exceed 30 minutes, despite the absence of bleeding and the good condition of the woman in labor. To avoid possible complications leading to a large loss of blood, one has to resort to manual separation of the placenta and removal of the placenta.

Active management of the afterbirth period is also started in cases where bleeding has begun, blood loss has reached 250-300 ml, and there are no signs of placental separation. Active measures (manual separation of the placenta) are also necessary with a small external blood loss, but with a deterioration in the condition of the woman in labor.

Attempts to speed up the process of expulsion of the placenta by massaging the uterus, pulling the umbilical cord are unacceptable, as they violate physiological process placental abruption from the uterine wall, change the rhythm of its contractions and only contribute to increased bleeding.

Since the duration of the afterbirth period is normally 15-20 minutes, after this time, if the afterbirth has not yet been born, it is necessary, after making sure that the placenta is separated, to accelerate its birth. First of all, the woman in labor is offered to push. If the afterbirth is not born by force of an attempt, one of the methods for isolating the separated afterbirth is resorted to. Abuladze method: the abdominal wall is captured along the midline into the fold with both hands and rises, after which the woman in labor should push (Fig. 29). In this case, the afterbirth is easily born. This simple technique is almost always effective.

29. Isolation of placenta according to Abuladze. 30. Isolation of the placenta according to Genter. 31. Isolation of the placenta according to Lazarevich - Crede. 32. Reception, facilitating the separation of shells.

Geter method also technically simple and effective. With an empty bladder, the uterus is positioned in the midline. A light massage of the uterus through the abdominal wall should cause its contraction. Then, standing on the side of the woman in labor facing her legs, you need to put your hands clenched into fists on the bottom of the uterus in the area of the tubal corners and gradually increase the pressure on the uterus downwards, towards the exit from the small pelvis. During this procedure, the woman in labor must completely relax (Fig. 30).

Method of Lazarevich - Crede, like both previous ones, is applicable only with a separated placenta. At first, it is similar to the Genter method. After emptying the bladder, the uterus is brought to the midline and its contraction is caused by a light massage. This moment, as in the application of the Genter method, is very important, since pressure on the relaxed wall of the uterus can easily injure it, and the injured Muscle is not able to contract. As a result of an incorrectly applied method for isolating a separated placenta, serious postpartum hemorrhage can occur. Besides, strong pressure to the bottom of a relaxed hypotonic uterus easily leads to its eversion. After achieving contraction of the uterus, standing on the side of the woman in labor, the fundus of the uterus is captured by the strongest hand, in most cases the right one. In this case, the thumb lies on the front surface of the uterus, the palm is on the bottom of it, and the remaining four fingers are located on the back surface of the uterus. Having captured in this way a well-reduced dense uterus, it is compressed and at the same time pressed down on the bottom (Fig. 31). At the same time, the woman in labor should not push. The separated placenta is easily born.

Sometimes after the birth of the placenta, it turns out that the membranes have not yet separated from the wall of the uterus. In such cases, it is necessary to ask the woman in labor to raise the pelvis, leaning on the lower limbs bent at the knees (Fig. 32). The placenta, with its weight, stretches the membranes and contributes to their separation and birth.

Another technique that contributes to the birth of delayed membranes is that the born placenta must be taken with both hands and the membranes must be twisted, turning the placenta in one direction (Fig. 33).

33. Twisting shells. 34. Examination of the placenta. 35. Inspection of shells. a - inspection of the place of rupture of the shells; b - examination of the membranes at the edge of the placenta.

It often happens that immediately after the birth of the placenta, the contracted body of the uterus sharply leans anteriorly, forming an inflection in the region of the lower segment, which prevents the separation and birth of the membranes. In these cases, it is necessary to shift the body of the uterus up and somewhat backwards, pressing on it with your hand. The born placenta must be carefully examined, measured and weighed. The placenta should be subjected to a particularly thorough examination, for which it is laid with the mother's surface up on a flat plane, most often on an enameled tray, on a sheet or on one's hands (Fig. 34). The placenta has a lobular structure, the lobules are separated by grooves. When the placenta is located on a horizontal plane, the lobules are closely adjacent to each other. The maternal surface of the placenta has a grayish color, as it is covered with a thin surface layer of the decidua, which exfoliates along with the placenta.

The purpose of examining the placenta is to make sure that not the slightest lobule of the placenta remains in the uterine cavity, since the retained part of the placenta can cause postpartum hemorrhage immediately after delivery or in the long term. In addition, placental tissue is an excellent nutrient medium for pathogenic microbes and, consequently, the placental lobule remaining in the uterine cavity can be a source of postpartum endomyometritis and even sepsis. When examining the placenta, it is necessary to pay attention to any changes in its tissue (rebirths, heart attacks, depressions, etc.) and describe them in the history of childbirth. After making sure that the placenta is intact, it is necessary to carefully examine the edge of the placenta and the membranes extending from it (Fig. 35). In addition to the main placenta, there are often one or more additional lobules associated with the placenta by vessels that pass between the aqueous and fleecy membranes. If during examination it turns out that a vessel has moved from the placenta to the membranes, it is necessary to trace its course. The rupture of the vessel on the membranes indicates that the placental lobule, to which the vessel went, remained in the uterus.

The measurement of the placenta makes it possible to imagine what the conditions were for the intrauterine development of the fetus and what size the placental area in the uterus was. The usual average dimensions of the placenta are as follows: diameter -18-20 cm, thickness 2-3 cm, weight of the entire placenta - 500-600 g. With a large area of the placenta, more blood loss from the uterus can be expected. When examining the shells, it is necessary to pay attention to the place of their rupture. The length of the membranes from the edge of the placenta to the place of their rupture can, to a certain extent, judge the location of the placenta in the uterus. If the rupture of the membranes occurred along the edge of the placenta or at a distance of less than 8 cm from its edge, then there was a low attachment of the placenta, which requires increased attention to the condition of the uterus after childbirth and to blood loss. Considering the fact that the postpartum period in every woman is accompanied by blood loss, the task of the midwife leading the birth is to prevent pathological blood loss. Meanwhile, it is bleeding that is the most common complication of the afterbirth period. In order to be able to foresee and prevent pathological blood loss, it is necessary to know the causes that cause them. The amount of blood loss depends primarily on the intensity of uterine contraction in the afterbirth period. The stronger and longer the contractions, the faster the separation of the placenta. Blood loss is small if the placenta is separated in one contraction and can reach pathological dimensions in those births when the process of separation of the placenta occurs over three, four or more contractions of weak strength. ) in childbirth that proceeded for a long time due to primary weakness labor activity ; 2) due to overstretching of the uterus at the birth of a large fetus (more than 4 kg), with multiple pregnancies and polyhydramnios; 3) with a pathologically altered uterine wall, especially in the presence of fibromyoma nodes; 4) after violent labor activity, observed in the first two periods of labor, and rapid labor; 5) with the development of endometritis in childbirth; 6) with an overfilled bladder. The size of the child's place affects the rate of separation of the placenta and the amount of blood loss. The larger the placenta, the longer its separation proceeds and the larger the area of the placental site with bleeding vessels. The place of attachment of the placenta in the uterus is essential. If it was located in the lower segment, where the myometrium is poorly expressed, the separation of the placenta occurs slowly and is accompanied by large blood loss. Also unfavorable for the course of the afterbirth period is the attachment of the placenta in the bottom of the uterus with the capture of one of the tubal corners. The cause of pathological blood loss may be improper management of the afterbirth period. Attempts to accelerate the separation of the placenta by pulling on the umbilical cord, premature (before separation of the placenta) using the methods of Genter and Lazarevich - Crede lead to a violation of the process of separation of the placenta and to an increase in blood loss. The course of the afterbirth period, of course, depends on the nature of the attachment of the placenta. Normally, chorionic villi do not penetrate deeper than the compact layer of the uterine mucosa, therefore, in the third stage of labor, the placenta is easily separated at the level of the loose spongy mucosal layer. In cases where the lining of the uterus is changed and there is no decidual reaction in it, a more intimate attachment of the placenta to the wall of the uterus, called placenta accreta, may occur. In this case, there can be no independent separation of the placenta. Placenta accreta is observed more often in women who have had abortions in the past, especially if the abortion operation was accompanied by repeated curettage of the uterus, as well as in women who have undergone inflammatory diseases of the uterus and operations on it in the past. There is a true and false accreta of the placenta. With a false increment (placenta adhaerens), which occurs much more often than a true one, chorionic villi can grow through the entire thickness of the mucous membrane, but do not reach the muscle layer. In such cases, the placenta can be separated from the uterine wall by hand. True placenta accreta (placenta accreta) is characterized by the penetration of villi into the muscular layer of the uterus, sometimes even the germination of the entire wall of the uterus (placenta percreta). With a true increment of the placenta, it is impossible to separate it from the uterine wall. In these cases, supravaginal amputation of the uterus is performed. Placenta accreta, both false and true, can be observed throughout, but partial is more common. Then part of the placenta is separated from the uterus, after which bleeding from the vessels of the placental site begins. To stop bleeding in case of false placenta increment, it is necessary to manually separate its attached part and remove the placenta. If during the operation it turns out that the villi are deeply embedded in the wall of the uterus, i.e. there is a true accretion of the placenta, you should immediately stop trying to separate the placenta, as this will lead to increased bleeding, immediately call a doctor and prepare for the operation of supravaginal amputation or extirpation of the uterus . In very rare cases, a true increment develops throughout the placenta. In this case, there is no bleeding in the afterbirth period - there is no separation of the placenta. Uterine contractions, clearly visible to the eye, follow one after another for a long time, and placental separation does not occur. Under these conditions, first of all, it is necessary to call a doctor and about an hour after the birth of the child, having prepared everything for the operation of supravaginal amputation of the uterus, to attempt a manual separation of the placenta. After making sure of the full true increment of the placenta, you should immediately proceed to the operation of the abdominal surgery. Even at the first meeting with a woman in labor, collecting her anamnesis and making a detailed examination of the woman, it is necessary, on the basis of the data obtained, to make a forecast of possible complications of the afterbirth period and reflect it in the plan of childbirth. To the group increased risk according to the occurrence of bleeding in the afterbirth period, the following women should be classified: 1) multiparous, especially with short intervals between births; 2) multiparous with burdened during the past childbirth during the afterbirth and postpartum period; 3) who had abortions before the onset of this pregnancy with a aggravated post-abortion course (repeated curettage of the uterus, edomiometritis); 4) who have undergone uterine surgery in the past; 5) with overstretched uterus ( large fruit, multiple pregnancy, polyhydramnios); 6) with uterine fibroids; 7) with anomalies of labor activity in the first two periods of labor (weakness of contractions, excessively strong contractions, discoordinated labor activity); 8) with the development of endometritis in childbirth. For women who are expected to have a complicated course of the third stage of labor, for a prophylactic purpose, in addition to passing urine, you can use uterine contracting agents. Per last years the use of methylergometrine or ergotamine has proven itself very well. Intravenous administration of these drugs reduced the frequency of pathological blood loss by 3-4 times. The drug should be administered slowly, over 3-4 minutes. To do this, 1 ml of methylergometrine is drawn into a syringe along with 20 ml of 40% glucose. At the moment when the extension of the head begins and the woman in labor does not push, the second midwife or nurse begins the slow introduction of the solution into the cubital vein. The introduction ends shortly after the birth of the baby. The purpose of intravenous use of methylergometrine is that it intensifies and prolongs the contraction that expels the fetus, and the placenta separates during the same prolonged contraction. 3-5 minutes after the birth of the baby, the placenta is already separated and it is only necessary to accelerate the birth of the placenta. The negative quality of ergot preparations, including methylergometrine, is their reducing effect not only on the body of the uterus, but also on the cervix. Therefore, if the separated afterbirth is not removed from the uterus within 5-7 minutes after the introduction of methylergometrine into the vein of the woman in labor, it may be infringed in a spastically reduced pharynx. In this case, you must either wait until the spasm of the pharynx passes, or apply 0.5 ml of atropine intravenously or subcutaneously. The strangulated placenta is already for the uterus foreign body, preventing its contraction, and can cause bleeding, so it must be removed. After the birth of the placenta, the uterus under the influence of methylergometrine remains well reduced for another 2-3 hours. This property of methylergometrine also helps to reduce blood loss during childbirth. Of the other uterine contracting agents, oxytocin or pituitrin M are widely used. However, the latter, when administered internally, violates the physiology of placental separation, since, unlike methylergometrine, it does not increase muscle retraction, but causes contractions of small amplitude at a high uterine tone. Oxytocin is destroyed in the body within 5-7 minutes, in connection with which relaxation of the uterine muscle may occur again. Therefore, instead of oxytocin and pituitrin "M" in the afterbirth period with preventive purpose it is better to use methylergometrine. In cases where blood loss in the afterbirth period exceeded the physiological one (0.5% relative to the body weight of the woman in labor), and there are no signs of placental separation, it is necessary to proceed with the operation of manual separation of the placenta. Every self-employed midwife should be able to perform this operation.

53. Manual separation and removal of the placenta

What is afterbirth or baby place? This is the placenta, the membrane and the umbilical cord, that is, the placenta with all its membranes and the umbilical cord. The afterbirth plays very important role in the development of the embryo. It performs the following functions:

Protective. Protects the fetus from maternal blood antibodies and at the same time prevents fetal antibodies from entering the mother's blood. In fact, it does not allow the immunological conflict between the body of the mother and the child. In addition, he does not miss some medicines, which the mother may take, or bacteria during colds women.
Endocrine. Produces biologically active substances, as well as hormones that are necessary for the development of the embryo.
gas exchange. transports oxygen from the mother's blood while carbon dioxide brings out.
Nutritious. Provides nutrition to the embryo with the substances necessary for development.

The placenta is an embryonic organ that is formed and exists only during pregnancy. After childbirth, it should separate with the help of uterine contractions and abdominals and then exit naturally. But sometimes this doesn't happen. It depends on many reasons, such as weak muscles press or various pathologies.

After the birth of the baby, the placenta separates, which during the entire pregnancy was attached to the wall of the uterus. This natural physiological process should proceed independently and begin immediately after childbirth.

The genera themselves are divided into three main parts. These are contractions, the birth of a baby and the birth children's place. This process should take no more than 30 minutes, at which time several painless contractions occur and the uterus is completely emptied due to the release of the placenta. This is where the name of this embryonic organ comes from, because it is the last to leave the uterus. After the exit, the placenta is examined for the presence of pathologies and torn vessels. Sometimes it can be given for histological analysis.

signs

There are several main signs of the separation of the child's place:

Schroeder sign. It lies in the fact that the state, height and shape of the uterus changes. It becomes flatter, its bottom rises, and the organ itself deviates to the right side.
Sign of Alfred. It lies in the fact that the free end of the umbilical cord is noticeably lengthened. After childbirth, the cut umbilical cord is grasped with a clamp, and after separation occurs, and, accordingly, the placenta descends, the rope itself lengthens.
Sign of Mikulich. It lies in the fact that the woman in labor feels contractions, that is, the urge to push. But this symptom is not manifested in all women.
Klein sign. It lies in the fact that during attempts the length of the umbilical cord does not change, respectively, the child's place is not attached to the wall of the uterus, but has already separated and lies freely without any attachment.
Sign of Klyuchter-Chukalov. It lies in the fact that when you press on the suprapubic area, the visible part of the umbilical cord lengthens, and after pressing the umbilical cord remains motionless.

Separation methods

There are several methods of external stimulation of the child's place:

Abuladze method. Manipulations should begin with the emptying of the bladder. Then you need to do a gentle massage of the uterus. Then grab the abdominal wall by the longitudinal fold. In this case, the discrepancy between the muscles should be eliminated, and the size of the abdomen should decrease. Next, the woman in labor should push hard. This method is quite effective and painless.

Genter's method. In this case, the afterbirth, as it were, is squeezed out. First you need to empty your bladder. Then the gynecologist presses his hands, folded into fists, on the stomach of the woman in labor, thereby surviving the placenta. This method is quite traumatic, so the experience of the doctor and great care during this manipulation are very important.
Krede-Lazarevich Method. As a rule, it is used if other methods have been ineffective. First, the bladder is emptied, and then the uterus is massaged. Next, the doctor puts his hand on the bottom of this organ so that one finger rests on the front wall, and four fingers on the back wall. During these manipulations, the doctor compresses the uterus, presses on it and thus pushes the placenta out.

If the previous methods did not help, manual separation of the placenta is performed.

It is practiced only when it is impossible to perform it in another way and with heavy bleeding when every minute counts. This procedure must be carried out in compliance with all safety measures and antiseptics. The gynecologist should treat the hands up to the elbow and put on sterile gloves. Then process antiseptic solution labia, womb and inner surface the patient's thighs. Cover the woman's stomach with a sterile diaper and only then proceed with the procedure.

It is performed either under anesthesia or with the help of painkillers. The doctor inserts one hand into the uterine cavity, with the other hand he presses on the abdominal wall from above. When a place of attachment of the embryonic organ to the uterus is found, the doctor separates it with sawtooth movements. The separated embryonic organ must be taken out with the left hand, while the right hand must remain in the uterus so that the doctor can examine it for pathologies and injuries. And also in order to make sure that there are no parts of the placenta left in it.

Do not confuse manual removal of the placenta and manual removal of the placenta. These are different manipulations. In addition, separation is a rather complicated process, while the removal of an already separated placenta does not pose a big threat to the health of the mother.

Pathologies

Now we will try to figure out why the process of separation of such an organ as a child's place does not occur in time and what pathologies contribute to this delay.

The hypotonic state of the uterine muscles can cause a delay in the placenta.
Sometimes the cause may be an abnormal location, that is, a low attachment of the placenta.
Presentation is the process in which the placenta descends into the lower segment of the uterus.
Accretion is the process of too much attachment of the placenta.
The dense attachment of such an organ as a child's place differs from the increment only in that the intensity of attachment is slightly weaker.
Detachment is a pathology in which there is a premature discharge of the placenta. In this case, bleeding can occur, which is dangerous not only for the mother, but also for the child.
Premature maturation or aging of the placenta may indicate serious problems and possible interruption pregnancy.
Late maturation is most often seen in women with diabetes and smoking pregnant women. This indicates the need to healthy lifestyle life.

Video: how the placenta separates

For primiparous women, it is very important to know how or what to do if they have begun.
In addition, many expectant mothers are tormented by the question of whether.
The question of anesthesia of contractions, in general, and in particular, remains very important.

I would like to ask women who faced the problem of separation of a child's place to describe in their comments how midwives helped you. Did you know before giving birth that some problems might arise and whether you had the pathologies described in the article.

General information: for the management of the afterbirth period, it is important to know the signs indicating that the placenta has separated from the walls of the uterus, and then apply external techniques for isolating the placenta.

Indications: 3rd stage of childbirth. The presence of signs of separation of the placenta.

Equipment: bladder catheter, tray, umbilical cord clamp.

Performing a manipulation

Preparatory stage:

1. Empty the bladder with a catheter

2. Invite the woman to push. If the placenta is not born, the following external methods are used to remove the separated placenta.

Main stage:

1. Abuladze method. The anterior abdominal wall is grasped with both hands in a fold so that both rectus abdominis muscles are tightly clasped with the fingers. After that, they offer the woman to push. the separated afterbirth is easily born, due to the elimination of the divergence of the rectus abdominis muscles and a significant decrease in the volume of the abdominal cavity.

2. Crede-Lazarevich method. It is performed in a certain sequence:

a/ empty the bladder with a catheter

b/ bring the bottom of the uterus to the middle position

c/ make light stroking /not massage!/ of the uterus in order to reduce it

d/ grasp the bottom of the uterus with the hand of the hand that the obstetrician has a better command of, so that the palmar surfaces of its four fingers are located on the back wall of the uterus, the palm is on the very bottom of the uterus, and the thumb is on its front wall e/ simultaneously press on uterus with the whole brush in two intersecting directions (fingers - from front to back, palm from bottom to top towards the pubis until the last is born from the vagina

3. Genter's method.

a) the bladder is emptied with a catheter

b/ the bottom of the uterus leads to the midline

c / the midwife stands on the side of the woman in labor, facing her legs, hands clenched into a fist, put the back surface of the main phalanges on the bottom of the uterus (in the area of the tube angles) and gradually press down and inward

d/ the woman in labor should not push

Genter's method is used relatively rarely.

The final stage:

1. Sometimes, after the birth of the placenta, it is found that the membranes are retained in the uterus. In such cases, the born placenta is taken in the palms of both hands and slowly rotated in one direction. In this case, the membranes are twisted, contributing to their gradual detachment from the walls of the uterus and removal to the outside without breakage.

2. Method for isolating shells according to Genter. After the birth of the placenta, the woman in labor is offered to lean on her feet and raise her pelvis; at the same time, the placenta hangs down and, with its weight, contributes to the exfoliation of the membranes

3. After the placenta is isolated, it is carried out outdoor massage uterus.

4. Put cold on the lower abdomen

5. Inspect the last.

Filling in the passport part individual card pregnant and puerperal No.

General information: Primary documentation is filled out for each pregnant woman when registering with antenatal clinic.

Indications:When taking a pregnant woman for dispensary registration in the antenatal clinic

Equipment: an individual card of a pregnant woman and a puerperal, form 111 / U.

Filling sequence:

1. Date of registration

2. Passport data in the history of childbirth are entered from the passport indicating the number of surname, name, patronymic

3. Age - date, month, year of birth. Age matters for pregnant women (the first pregnancy before the age of 18 is "young" primigravida, over 30 years old "age" - accompanied by a number of complications during pregnancy and childbirth). The most favorable age for the first pregnancy is 18-25 years

4. Marital status: marriage registered, not registered, single (underline)

5. Address, phone, registered, lives. Place of residence, especially living in areas contaminated with radionuclides, can adversely affect both the woman's body and the fetus

6. Place of work, telephone, profession, position. Profession or position, working conditions have great importance for the health of the pregnant woman and the development of the fetus. Education: primary secondary, higher (underline)

7. Surname and place of work of the husband, phone.

Survey of a pregnant woman:

General.

Special.

Examination at the 1st turnout: height, weight, blood pressure in both arms, special obstetric research external (pelvic examination), internal (examination of the external genitalia, cervix in the mirrors, bimanual examination), taking smears for gonorrhea, for oncocytology, laboratory examination(an. blood general, biochemical, glucose, protombin index, RW, Rhesus and group, an. urine, an. feces for eggs of the worm), referrals to a general practitioner, dentist, ENT doctor, ophthalmologist, endocrinologist, ultrasound.