External obstetrical examination ( method of Leopold - Levitsky)
Task for the student:: perform for this pregnant woman, parturient measurement of external sizes of pelvis. Describe, simultaneously, what You are doing.
The time of demonstration is 5 minutes.
Information for the examine:assess, please, the student’s actions, separately, on the every below given item.
| 1 | Explain for pregnant woman, parturient the essence of examination , Wash a hands, dry with disposable towel , Take on a disposable gloves.. | 1 | 0,5 | 0 |
| 2 | The pregnant woman, parturient is lying down on the back side with bent her legs at the cox- femoral and knee joints for relaxation of the abdominal muscles. | 1 | 0,5 | 0 |
| 3 | Stand up with face to patient , to the right side from her. | 1 | 0,5 | 0 |
| 4 | The first method : palms of both hands are situated on the fundus of uterus with fingers ends of arms, directed to each other and find the height standing of uterus fundus., his site,( presence or absence of a big part in the fundus and high of fundus over a pubic. | 1 | 0,5 | 0 |
| 5 | The second method : palms of both hands put on the lateral parts of uterus , from a fundus. Palm surface of arms we are palpate the lateral parts of an uterus changing the action of the left and right arms. Receive the conclusion about situation of a fetus back and small parts , make a conclusion about position and view of fetus . | 0,5 | 0 | |
| 6 | The third method : determine the presenting part of fetus , for that the palms of the right hand we are putting over a pubic and fingers are taken the presenting part . Finding a hard and balloting part we think about cephalic presentation , at finding of the soft and non – balloting part will tell us about pelvic presentation. | 1 | 0,5 | 0 |
| 7 | For performing of the next method , investigator is standing with face to legs of patient , to the right.. | 1 | 0,5 | 0 |
| 8 | The forth method is for the determination of coordination of presenting part with plane of inlet in small pelvis and useful in labor .. | 1 | 0,5 | 0 |
| 9 | Palms of both hands are situated lateral from the middle \line over horizontal branches of pubic bones. Palms are situated lateral from the middle line over horizontal branches of pubic bones . Constantly changing the position of fingers between presenting part and plane of inlet we check the relationship of presenting part to the plane of inlet.. | 1 | 0,5 | 0 |
| 10 | Make a conclusion on the base of receiving da about of fetus sites , position, view presenting part and coordination of presenting part to the plane of inlet in small pelvis.. Take away of gloves, through away its in container for utilization, wash our hands. | 1 | 0,5 | 0 |
Maximum quantity of balls – 10
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Internal obstetrical examination.
Task for the student:perform for this pregnant woman, parturient internal obstetrical examination s. Describe, simultaneously, what You are doing. The time of demonstration is 5 minutes.
Information for the examine:assess, please, the student’s actions, separately, on the every below given item.
| 1 | Explain of pregnant woman, parturient aim of examination. Patient is lying on a backside with flexed legs at the pelvic- femoral and knee’s articulations and situated far from each other.. | 1 | 0,5 | 0 |
| 2 | Performing a cleaning of the external sexual organs of patient. Wash our hands and dry with disposable towel. Take on sterile gloves. | 1 | 0,5 | 0 |
| 3 | Internal examination should be started with examination of the external sexual organs( growing of hair , development, edema of the external sexual organs ( vulva), various veins, perineum( its high, rigidity , presence of scars ) and introits in vagina. | 1 | 0,5 | 0 |
| 4 | At a vagina phalanx of middle and index fingers are introduced and performing its examination( wide of its, length, folding’s, stretching of the vaginal walls , scars presence , tumors, and another pathological conditions ). Palpation of the internal surface of bone’s pelvis is performing.. | 1 | 0,5 | 0 |
| 5 | If there is pregnant woman uterine cervix is found and degree of maturation should be checked : situation of its on the longitudinal axis of small pelvis , size, form, consistence , shortness , permeability of channel by investigated fingers. | 1 | 0,5 | 0 |
| 6 | In labor we determine the condition of cervix ( shorten, smooth), the degree of uterine cervix dilatation in centimeters , condition of edges (soft , hard, thick, thin. Check the condition of fetal bladder ( whole, is disturbed, the degree of tenderness, quantity of anterior amniotic fluid). | 1 | 0,5 | 0 |
| 7 | Determination of the presenting part – buttocks, head, legs, with orientation on the definite points, on the head sutures and fontanels , on the pelvic end – sacrum and coccygeal part. Determine, where is a presenting part :over the plane of inlet, very closed to the plane of inlet, with small segment, the large segment , into the cavity of small pelvis , in the plane of outlet. | 1 | 0,5 | 0 |
| 8 | If presenting part is high and promontories of sacrum is reached , we should measure the diagonal conjugate ( conjugate diagonal ) between the promontories and low part of articulation pubic.( at norm it is 13 sm.) with finger in vagina we try to reach promontories and with end of a middle finger reach its. Index finger of free hand we should touch the low part of pubic articulation that directly contacted with low edge of the pubic arch. | 1 | 0,5 | 0 |
| 9 | Take away fingers from vagina , Measure on the internal hand the distance marked on the arm by tape-measure or pelviometer. Take away fingers from vagina . According to sizes od diagonal conjugate we think about sizes of true conjugate. | 1 | 0,5 | 0 |
| 10 | Make a conclusion on the base of the received date. Take off gloves and through away in container for utilization, wash a hands. | 1 | 0,5 | 0 |
Maximum quantity of balls – 10
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