Pregnancy.
The physiological process by which of the fertilized
cells of the developing fetus. In the body there are numerous and complex
changes that create the conditions for fetal development,
prepare the bodies of women and the generic act of breastfeeding
newborn.
Symptoms and treatment.
Recognition of pregnancy in the early stages of base-
but the doubtful and probable signs. Doubtful - it is different
kind of subjective feelings and purely external evidence: the taste and the Obon-
claims more whim, drowsiness, mild fatigue, skin pigmentation on the
face, the white line of the abdomen, nipples, external genitalia. Go to the probability
nym features include: cessation of menstruation, the increase in milk
glands and the appearance of colostrum during extrusion of the nipple, and the loosening of the sys-
nyushnost threshold of the vagina, the vagina and cervix of the uterus, changes
shape and consistency of the uterus, increasing its size, the positive bio-
cal reaction to the pregnancy. Recognition is performed by refuted-
ca, palpation, examination of external genitalia, and mucous membrane
vagina with the help of mirrors and a vaginal examination. Use methods
Au diagnosis based on the determination of the content in the urine of pregnant women,
chorionic gonadotropin and its reaction with the antiserum. In the second
half of pregnancy, there are signs clearly indicating
the presence of the fetus in the womb. These include fetal movements felt by py-
Coy, listening to the heartbeat, palpation of the head, buttocks, legs, py-
check these x-rays, elektrofonokardiografii,
echography. Day of birth can be calculated by adding 280 days to the date of first
date of last menstrual period, or count the first day of the last
menstruation 3 months ago and added to the resulting number of 7 days (form-
mule Naegeli). Determination of fetal movements and listening to his heart
tones are usually possible only at the end of the 18th week of pregnancy re-
Rodia, and primiparous - 20 weeks. Establish the true duration
sequence of a woman's pregnancy is difficult: it is difficult to know the exact time of ovulation
and time of fertilization. However, in most cases, women are nurturing,
UT Child 10 obstetric months (month - 28 days), or 280 days if
come from the first day of last menstrual period. Primary and early turnout
systematic monthly visits to the antenatal clinic significantly
reduce the percentage of errors in determining the gestational age, and conse-
Indeed, the period of prenatal leave.
Ectopic pregnancy.
Subsidence and the development of the ovum outside the matrix
ki. Presents a great danger to the life of the pregnant woman. The fertilized
egg can be grafted on the ovaries, peritoneum, omentum and other organs
abdominal cavity, but more often in the tubes (99%). Causes of disease - Sun-
palitelnye changes in the fallopian tubes, their underdevelopment, various tumor
genital organs, endocrine disorders, alter motility
tubes. Ectopic pregnancies may end in abortion, or tubal,
when the ovum is expelled into the abdominal cavity, or rupture of the pipe
due to its germination chorionic villi (the elements of the ovum).
And in fact, in both cases there is intraperitoneal bleeding,
result of which blood accumulates in the pipe, and okolotrubnom zamatoch-
space. When you break the tube bleeding is particularly
strong.
Symptoms and flow. Progressing tubal pregnancy or first-
nothing makes itself felt. In all the signs of the patient, as in the uterine preg-
multi-temporal (delay menstruation, nausea and vomiting in the morning, cyanosis
vagina and cervix, the uterus). Usually at this stage and it
mistaken for uterine. But already during the first weeks, more often between 4 and 6
weeks, the pregnancy is violated. On the pipe rupture incident evidence-
proof of the characteristic clinical picture of a sudden there is a sharp
rezhushaya pain in lower abdomen radiating up and down in an-
domain of the vulva, or rectum, dizziness, obmo-
rochnoe status, pallor, decreased blood pressure
tion, heart rate - rapid and feeble. Bleeding from the genital pu-
children may not be as decidua has no time-otslo
o.s from the walls of the uterus.
Violation of the type of tubal abortion can occur for a long time and have
most diverse clinic. Typically, the background of a short delay, menstrua-
tion, the patient observed cramping abdominal pain, feeling of-
ing weakness, dizziness, durnotnoe state. A few days later
appear dark spotting spotting from the genital tract. These
Symptoms are intermittent in nature.
Body temperature is usually normal or slightly elevated. For values of
considerably internal bleeding symptoms are similar to those of discontinuities
ve pipe.
Treatment. If you suspect an ectopic pregnancy the patient urgently
hospitalized. Once the diagnosis is shown an emergency opera-
tion, both are struggling with anemia and shock. The prognosis for vnema-
accurate pregnancy if it is promptly recognized and held right-
correctly treated, is favorable. Deaths are rare.
Cervical pregnancy.
Is rare. Attachment and development
ovum occurs in the cervical canal, between the inner and outer-
nym throat. The reasons for the anomaly - the frequent induced abortion, re-di-
agnostic scraping and inflammation of the mucous membrane of the uterus, under-
development of cancer, tumors, scars in the internal os and
etc.
Symptoms and over. The main feature - the bleeding that appears in the
first or second half of pregnancy. Arises from the detachment of the plans,
cents, or compromising the integrity of the cervix thinned blood vessels. In the knowledge-
most significantly in the first pregnancy is aborted her polo-
wine, very rarely wore.
Recognition. When the diagnosis account for the absence of menstrua-
tions, the presence of other signs of pregnancy, the results of ASC-vaginal
study, ultrasound is used.
Treatment. Emergency surgery - hysterectomy (removal of
of the uterus). Attempts to remove the fertilized egg through the vagina leads to profuz-
Nome bleeding. In exceptional cases, in the absence of conditions for
surgery as an emergency measure, you can use a tight Tampa
Nadu vaginal clamping on blood vessels of the cervix at the time of trans-
portation patient to a specialized treatment facility. Forecast-
depends on the timeliness of operations.
Drop small pieces of the fruit.
Observed during delivery of the after-
circulation of amniotic fluid in violation of the normal chlenoraspolozheniya
the fetus.
Drop foot is quite often the breech, and
also in oblique and transverse position of the fetus. In the latter cases, it
contributes to the favorable outcome of labor - the commission samopovorota.
Vypadechieruchkch possible at any position of the fetus. Most often observed
given at the cross, when (almost half of the cases), together with otoshed-
Shimi water drops pen, which is a serious oslozhenie birth. You-
drop handles breech of great practical importance is not
has since pen, running down the birth canal with the buttocks, not sam-
Rudnjana flow of labor. In contrast, loss of pens at the head-predlezha
FDI is a dangerous complication of childbirth, as head, advancing to
birth canal with a pen, sometimes encounters such a strong pro-
mation from the past that its further progress, even
with good labor, is very slow, and at half-
Mr. fallout pen and just stops. As a consequence, labor is strongly
tightened, threatening death to the fetus from asphyxia and intracranial injuries.
Loss of the umbilical cord. The reasons for it: irregularly narrowed pelvis, mpogopo-
que, multiple pregnancy, fetal transverse lie, preterm labor,
excessive length of the cord (75 cm or more). Danger pressing precipitated pu-
guilty of the head, resulting in asphyxia can occur, and death
the fetus. Suspicion of umbilical cord prolapse occurs in the case of the resistant-
fetal heart rate changes immediately after the outpouring of water. Should not be
attempt to straighten the cord with your finger. In the absence of conditions for the immediate-
tion of vaginal delivery (with cephalic presentation) in order to
produce fruit cesarean section. If possible, vaginal rodoraz-
solutions to immediate forceps delivery, or (when pelvic proposed
Jania) extraction of the fetus in the leg.
Care of pregnant women. One of the main conditions of the normal course of preg-
multi-temporal - compliance with a number of hygienic and dietary rules. It should be
Avoid sudden movements, heavy lifting and significant fatigue.
Need to sleep at least 8 hours a day, at bedtime walks. Be-
belt should be protected against infectious diseases, carefully
monitor the cleanliness of the skin as the sweat out harmful for the body
metabolic products, is better to wash in the shower. Healthy women can
to take air and sun baths, avoiding overheating of the body. In
osepne-zimpee UFobluchepie time to apply. Pregnant, twice a day,
should wash with warm soapy water vulva, as well as
mammary gland. To prevent cracks in the nipple to wipe a hard
towel. If the nipples are flat or inverted, it is desirable to make their weight-
blacks. It is necessary to check the status of the oral cavity and make the necessary san-
tion. Sexual intercourse should be limited. Prohibited alcohol and Ku-
renie as They have a toxic effect on the body and the negative
respect to affect the fetus. Clothing as a free and easy, not fol-
em to wear tight bras, tightening belts, etc. In the second half
pregnancy is recommended bandage, which should support but not
compress the abdomen. Shoes, especially in the last months of pregnancy - in
low-heeled shoes. In addition to general hygienic measures are useful spe-
Alno gymnastic exercises designed to strengthen the abdominal
press, the deepening of breath in the body and improve blood circulation and limfoobrasche-
of. Pregnant women in a number of cases sent to the specialized
and resorts.
Twins.
Multiple pregnancy occurs when the fertilization of two
or more eggs (fraternal twins), or the development of embryo-
electrons from a single fertilized egg (identical twins).
Symptoms and flow. Multiple pregnancy occurs more frequently,
What starshezhenschina. Can proceed normally, but often there are
spontaneous abortion, premature delivery, toxemia of pregnancy. But
Even in uncomplicated pregnancy, a woman may feel tired,
there are shortness of breath, frequent urination, constipation due to significant
relatively larger size of the uterus. Developing fetuses are generally more
or less the same, the difference in their weight is small, sometimes there
pronounced irregularity until the second death of the fetus. Decay
decomposition in the uterus may be different: most of the fruit, both are pro-
longitudinal position and cephalic presentation.
Recognition. Based on the dynamic observation. Ultrasonic
Wai diagnosis helps to clarify the diagnosis in the earliest periods (from 2-3
weeks).
Ditokia often occur normally. There are complications: untimely
mennoe rupture of membranes and loss of small parts of the first fetus
weakness of the tribal forces from overdistension of the uterus, fetal hypoxia (see
Asphyxia), abruptio placenta second fetus after birth
of the first (see Premature detachment of placenta), a late break
second shell of the fruit, hypotonic bleeding in early poslerodo-
PTO period (see bleeding during labor and after birth). If you have any
complications during the first expulsion of the fetus to accelerate the extraction of the one-
gas shut-end or operational methods - forceps,
necessarily tie up the ends of the fruit, and the mother's umbilical cord to
second fetus died from blood loss, as twins have a common circulatory-
schenie. After 10-20 minutes of the resumption of clashes reveal a bag of pu-
zyr second fetus (amniotic fluid released slowly!) and the provision
lyayut the natural flow of labor.
In the second transverse position of the fetus is carried out at the turn of foot.
This manipulation and immediate extraction of produce also for the occurrence of
venii fetal hypoxia, or bleeding from the birth canal at the location
head over the entrance to the pelvis, and if it is in the pelvic cavity, place
forceps. Breech fetus is extracted by the stem or
inguinal fold. Particular attention should be given post-partum period. Necessary
carefully monitor the status of women in travail, the number of blood-vyde
representations of the genital tract, uterine tone, as due to its expansion ve-
ably hypotonic bleeding.
Fraternal twins can be a same-sex and opposite-sex, a DAR-
tical or different blood group, as a rule, they do not like each other-
hectares. Identical twins are always unisexual, apparently at times indistinguishable.
Blood type is the same.
Full-term (maturity) of the fetus. Donoshen post - the normal development
fetus occurring during gestation in the 39-40 weeks of pregnancy.
The concept of "full term" and "maturity" are not identical. Is a mature fruit,
well adapted to extrauterine existence. The extent of his zrelos-
ty depends on the individual duration of pregnancy in each
women and the environment in which it occurred in utero develop-
ment. There are cases when the fetus is born a few weeks earlier,
is mature and, conversely, multiple pregnancies complicated by
pregnancy and diseases of the mother, born in a timely manner, it
turns out to be functionally immature.
However, as a rule, full-term fetus is mature.
Weight at term maturity of the fruit varies from 2500 to 6000 g or more.
More often than 3400-3500 g for males and 3200-3400 g for girls. Growth
varies from 47 to 56 cm (average 50-52 cm). Newborns with
length of less than 45 cm are considered as premature. Full-term baby
increased from 45 to 47 cm is determined individually, based on an analysis
all the features that characterize the maturity of the fetus. These features are-
Xia: the development of adequate fat, pink skin, kept down
only on the shoulder girdle, hair length not less than 2-3 cm, cartilage
Ear nose and thick, hard nails and the fingers extend beyond
the tips of the past, place of origin of the umbilical cord is located midway between
vagina and the xiphoid process, or slightly below, the testes in males (for
a few pathological exceptions) fell into the scrotum, the girls
clitoris and labia minora are covered with large labia. Mature
the fetus is very active: moving limbs, a loud
cry. These figures are averages. Deviations from these in that
or another occur frequently and are dependent on many factors: the WHO-
Rasta parents and their physical condition (health, height, weight), if-
tional to the preceding birth mother (with subsequent birth weight and length
to grow normally), etc.
Jaundice during pregnancy. Acute degeneration of the liver. Disorders of function of ne-
Cheney - the body that takes an active part in metabolic processes,
most notably manifested in the form of jaundice that develops when
all forms of toxicity far come of pregnancy. However, sometimes yellow-
ha during pregnancy has an independent significance and is one-
Noah form of toxicity.
Symptoms and flow. Jaundice may occur at any time pregnancies,
ty, but most often develops in the first half. First, icteric
color can be seen on the sclera eyes, in the future - throughout the body.
Accompanied by itching, especially facial skin, enlarged liver or
soreness. Jaundice can be kept for weeks or even
months, not only breaking the general condition of the patient. If you do not pass during the
pregnancy, it is stored in the first few days postpartum.
Recognition. Pregnant woman who has found at least one of the symp-
volumes, indicating liver damage should be immediately hospitalizations
lysed, as These phenomena may indicate a hidden while proceeding
more severe forms of toxemia of pregnancy. When the diagnosis -
jaundice pregnant women - should be excluded afebrile period of illness
Hepatitis, which is characterized by acute onset of disease, weakness,
disturbance of bowel function (constipation, diarrhea), and vomiting. Botkin's disease
and jaundice, complicate pregnancy may go into acute dystrophy
the liver.
Acute degeneration of the liver - one of the most rare and severe diseases,
occur at any stage of pregnancy.
Symptoms and flow. A slight icteric coloration of the skin in 2-3 days
becomes shafrannozheltoy. Liver first increases and becomes bo-
leznennoy, and then rapidly decreases until it is wrinkling. State
tion the patient is rapidly deteriorating: itching, vomiting, agitation, ship-
goad seizures, coma, and then developed with a fatal outcome. Simul-
simultaneously with the increase in the severity of the disease usually occur premature
nye spontaneous labor.
Treatment. Immediate termination of pregnancy, but it rarely saves
sick.
Delay lohny. Blood, mucus, degenerated and disintegrated organic
Kia elements form etc. postpartum discharge - lochia. In the first 2-3
the day they have a blood character. Then before the end of the first week after the ro-
Dov become dark red color with a brown tint, then yellowish-
is due to the impurity-and-white large number of leukocytes. With 10 days you will-
division of watery light, they were mixed with ever-increasing if-
tional to the mucus, thus becoming sero-mucous-konsisten
tion. By the number-scarce, by the end of the third week of almost ceased,
will soon disappear completely. From the first days postpartum in the lochia
revealed a diverse microbial flora, among which the pathogenic
species, most often Streptococcus.
Symptoms and flow. Lochia has a kind of rotten smell, similar to a
healthy women with menstrual odor. If they delay,
Xia in the uterus or the vagina and the bacteria multiply in them, then when-
acquire an unpleasant odor may become even malodorous.
Occasionally, due to spasm of the internal os of the uterus or blockage sheech-
tion channels are dropping pieces of shell, blood clots, etc.
allocation at all stops. The temperature rises to 38 39shS, but on-
schee feel sick quite satisfactory. Such a state of na-
lohiomegroy turns out that, with rare exceptions, is not a samosa-
toyatelnym disease - but only one manifestation of metroendometrita
(See Postpartum infectious diseases).
Treatment. Is the appointment of ice on the lower abdomen, antibiotics,
sulfonamides, as well as tools that reduce the uterus.
It is advisable to put the patient on his stomach, which contributes to the free
outflow discharge.
The physiological process by which of the fertilized
cells of the developing fetus. In the body there are numerous and complex
changes that create the conditions for fetal development,
prepare the bodies of women and the generic act of breastfeeding
newborn.
Symptoms and treatment.
Recognition of pregnancy in the early stages of base-
but the doubtful and probable signs. Doubtful - it is different
kind of subjective feelings and purely external evidence: the taste and the Obon-
claims more whim, drowsiness, mild fatigue, skin pigmentation on the
face, the white line of the abdomen, nipples, external genitalia. Go to the probability
nym features include: cessation of menstruation, the increase in milk
glands and the appearance of colostrum during extrusion of the nipple, and the loosening of the sys-
nyushnost threshold of the vagina, the vagina and cervix of the uterus, changes
shape and consistency of the uterus, increasing its size, the positive bio-
cal reaction to the pregnancy. Recognition is performed by refuted-
ca, palpation, examination of external genitalia, and mucous membrane
vagina with the help of mirrors and a vaginal examination. Use methods
Au diagnosis based on the determination of the content in the urine of pregnant women,
chorionic gonadotropin and its reaction with the antiserum. In the second
half of pregnancy, there are signs clearly indicating
the presence of the fetus in the womb. These include fetal movements felt by py-
Coy, listening to the heartbeat, palpation of the head, buttocks, legs, py-
check these x-rays, elektrofonokardiografii,
echography. Day of birth can be calculated by adding 280 days to the date of first
date of last menstrual period, or count the first day of the last
menstruation 3 months ago and added to the resulting number of 7 days (form-
mule Naegeli). Determination of fetal movements and listening to his heart
tones are usually possible only at the end of the 18th week of pregnancy re-
Rodia, and primiparous - 20 weeks. Establish the true duration
sequence of a woman's pregnancy is difficult: it is difficult to know the exact time of ovulation
and time of fertilization. However, in most cases, women are nurturing,
UT Child 10 obstetric months (month - 28 days), or 280 days if
come from the first day of last menstrual period. Primary and early turnout
systematic monthly visits to the antenatal clinic significantly
reduce the percentage of errors in determining the gestational age, and conse-
Indeed, the period of prenatal leave.
Ectopic pregnancy.
Subsidence and the development of the ovum outside the matrix
ki. Presents a great danger to the life of the pregnant woman. The fertilized
egg can be grafted on the ovaries, peritoneum, omentum and other organs
abdominal cavity, but more often in the tubes (99%). Causes of disease - Sun-
palitelnye changes in the fallopian tubes, their underdevelopment, various tumor
genital organs, endocrine disorders, alter motility
tubes. Ectopic pregnancies may end in abortion, or tubal,
when the ovum is expelled into the abdominal cavity, or rupture of the pipe
due to its germination chorionic villi (the elements of the ovum).
And in fact, in both cases there is intraperitoneal bleeding,
result of which blood accumulates in the pipe, and okolotrubnom zamatoch-
space. When you break the tube bleeding is particularly
strong.
Symptoms and flow. Progressing tubal pregnancy or first-
nothing makes itself felt. In all the signs of the patient, as in the uterine preg-
multi-temporal (delay menstruation, nausea and vomiting in the morning, cyanosis
vagina and cervix, the uterus). Usually at this stage and it
mistaken for uterine. But already during the first weeks, more often between 4 and 6
weeks, the pregnancy is violated. On the pipe rupture incident evidence-
proof of the characteristic clinical picture of a sudden there is a sharp
rezhushaya pain in lower abdomen radiating up and down in an-
domain of the vulva, or rectum, dizziness, obmo-
rochnoe status, pallor, decreased blood pressure
tion, heart rate - rapid and feeble. Bleeding from the genital pu-
children may not be as decidua has no time-otslo
o.s from the walls of the uterus.
Violation of the type of tubal abortion can occur for a long time and have
most diverse clinic. Typically, the background of a short delay, menstrua-
tion, the patient observed cramping abdominal pain, feeling of-
ing weakness, dizziness, durnotnoe state. A few days later
appear dark spotting spotting from the genital tract. These
Symptoms are intermittent in nature.
Body temperature is usually normal or slightly elevated. For values of
considerably internal bleeding symptoms are similar to those of discontinuities
ve pipe.
Treatment. If you suspect an ectopic pregnancy the patient urgently
hospitalized. Once the diagnosis is shown an emergency opera-
tion, both are struggling with anemia and shock. The prognosis for vnema-
accurate pregnancy if it is promptly recognized and held right-
correctly treated, is favorable. Deaths are rare.
Cervical pregnancy.
Is rare. Attachment and development
ovum occurs in the cervical canal, between the inner and outer-
nym throat. The reasons for the anomaly - the frequent induced abortion, re-di-
agnostic scraping and inflammation of the mucous membrane of the uterus, under-
development of cancer, tumors, scars in the internal os and
etc.
Symptoms and over. The main feature - the bleeding that appears in the
first or second half of pregnancy. Arises from the detachment of the plans,
cents, or compromising the integrity of the cervix thinned blood vessels. In the knowledge-
most significantly in the first pregnancy is aborted her polo-
wine, very rarely wore.
Recognition. When the diagnosis account for the absence of menstrua-
tions, the presence of other signs of pregnancy, the results of ASC-vaginal
study, ultrasound is used.
Treatment. Emergency surgery - hysterectomy (removal of
of the uterus). Attempts to remove the fertilized egg through the vagina leads to profuz-
Nome bleeding. In exceptional cases, in the absence of conditions for
surgery as an emergency measure, you can use a tight Tampa
Nadu vaginal clamping on blood vessels of the cervix at the time of trans-
portation patient to a specialized treatment facility. Forecast-
depends on the timeliness of operations.
Drop small pieces of the fruit.
Observed during delivery of the after-
circulation of amniotic fluid in violation of the normal chlenoraspolozheniya
the fetus.
Drop foot is quite often the breech, and
also in oblique and transverse position of the fetus. In the latter cases, it
contributes to the favorable outcome of labor - the commission samopovorota.
Vypadechieruchkch possible at any position of the fetus. Most often observed
given at the cross, when (almost half of the cases), together with otoshed-
Shimi water drops pen, which is a serious oslozhenie birth. You-
drop handles breech of great practical importance is not
has since pen, running down the birth canal with the buttocks, not sam-
Rudnjana flow of labor. In contrast, loss of pens at the head-predlezha
FDI is a dangerous complication of childbirth, as head, advancing to
birth canal with a pen, sometimes encounters such a strong pro-
mation from the past that its further progress, even
with good labor, is very slow, and at half-
Mr. fallout pen and just stops. As a consequence, labor is strongly
tightened, threatening death to the fetus from asphyxia and intracranial injuries.
Loss of the umbilical cord. The reasons for it: irregularly narrowed pelvis, mpogopo-
que, multiple pregnancy, fetal transverse lie, preterm labor,
excessive length of the cord (75 cm or more). Danger pressing precipitated pu-
guilty of the head, resulting in asphyxia can occur, and death
the fetus. Suspicion of umbilical cord prolapse occurs in the case of the resistant-
fetal heart rate changes immediately after the outpouring of water. Should not be
attempt to straighten the cord with your finger. In the absence of conditions for the immediate-
tion of vaginal delivery (with cephalic presentation) in order to
produce fruit cesarean section. If possible, vaginal rodoraz-
solutions to immediate forceps delivery, or (when pelvic proposed
Jania) extraction of the fetus in the leg.
Care of pregnant women. One of the main conditions of the normal course of preg-
multi-temporal - compliance with a number of hygienic and dietary rules. It should be
Avoid sudden movements, heavy lifting and significant fatigue.
Need to sleep at least 8 hours a day, at bedtime walks. Be-
belt should be protected against infectious diseases, carefully
monitor the cleanliness of the skin as the sweat out harmful for the body
metabolic products, is better to wash in the shower. Healthy women can
to take air and sun baths, avoiding overheating of the body. In
osepne-zimpee UFobluchepie time to apply. Pregnant, twice a day,
should wash with warm soapy water vulva, as well as
mammary gland. To prevent cracks in the nipple to wipe a hard
towel. If the nipples are flat or inverted, it is desirable to make their weight-
blacks. It is necessary to check the status of the oral cavity and make the necessary san-
tion. Sexual intercourse should be limited. Prohibited alcohol and Ku-
renie as They have a toxic effect on the body and the negative
respect to affect the fetus. Clothing as a free and easy, not fol-
em to wear tight bras, tightening belts, etc. In the second half
pregnancy is recommended bandage, which should support but not
compress the abdomen. Shoes, especially in the last months of pregnancy - in
low-heeled shoes. In addition to general hygienic measures are useful spe-
Alno gymnastic exercises designed to strengthen the abdominal
press, the deepening of breath in the body and improve blood circulation and limfoobrasche-
of. Pregnant women in a number of cases sent to the specialized
and resorts.
Twins.
Multiple pregnancy occurs when the fertilization of two
or more eggs (fraternal twins), or the development of embryo-
electrons from a single fertilized egg (identical twins).
Symptoms and flow. Multiple pregnancy occurs more frequently,
What starshezhenschina. Can proceed normally, but often there are
spontaneous abortion, premature delivery, toxemia of pregnancy. But
Even in uncomplicated pregnancy, a woman may feel tired,
there are shortness of breath, frequent urination, constipation due to significant
relatively larger size of the uterus. Developing fetuses are generally more
or less the same, the difference in their weight is small, sometimes there
pronounced irregularity until the second death of the fetus. Decay
decomposition in the uterus may be different: most of the fruit, both are pro-
longitudinal position and cephalic presentation.
Recognition. Based on the dynamic observation. Ultrasonic
Wai diagnosis helps to clarify the diagnosis in the earliest periods (from 2-3
weeks).
Ditokia often occur normally. There are complications: untimely
mennoe rupture of membranes and loss of small parts of the first fetus
weakness of the tribal forces from overdistension of the uterus, fetal hypoxia (see
Asphyxia), abruptio placenta second fetus after birth
of the first (see Premature detachment of placenta), a late break
second shell of the fruit, hypotonic bleeding in early poslerodo-
PTO period (see bleeding during labor and after birth). If you have any
complications during the first expulsion of the fetus to accelerate the extraction of the one-
gas shut-end or operational methods - forceps,
necessarily tie up the ends of the fruit, and the mother's umbilical cord to
second fetus died from blood loss, as twins have a common circulatory-
schenie. After 10-20 minutes of the resumption of clashes reveal a bag of pu-
zyr second fetus (amniotic fluid released slowly!) and the provision
lyayut the natural flow of labor.
In the second transverse position of the fetus is carried out at the turn of foot.
This manipulation and immediate extraction of produce also for the occurrence of
venii fetal hypoxia, or bleeding from the birth canal at the location
head over the entrance to the pelvis, and if it is in the pelvic cavity, place
forceps. Breech fetus is extracted by the stem or
inguinal fold. Particular attention should be given post-partum period. Necessary
carefully monitor the status of women in travail, the number of blood-vyde
representations of the genital tract, uterine tone, as due to its expansion ve-
ably hypotonic bleeding.
Fraternal twins can be a same-sex and opposite-sex, a DAR-
tical or different blood group, as a rule, they do not like each other-
hectares. Identical twins are always unisexual, apparently at times indistinguishable.
Blood type is the same.
Full-term (maturity) of the fetus. Donoshen post - the normal development
fetus occurring during gestation in the 39-40 weeks of pregnancy.
The concept of "full term" and "maturity" are not identical. Is a mature fruit,
well adapted to extrauterine existence. The extent of his zrelos-
ty depends on the individual duration of pregnancy in each
women and the environment in which it occurred in utero develop-
ment. There are cases when the fetus is born a few weeks earlier,
is mature and, conversely, multiple pregnancies complicated by
pregnancy and diseases of the mother, born in a timely manner, it
turns out to be functionally immature.
However, as a rule, full-term fetus is mature.
Weight at term maturity of the fruit varies from 2500 to 6000 g or more.
More often than 3400-3500 g for males and 3200-3400 g for girls. Growth
varies from 47 to 56 cm (average 50-52 cm). Newborns with
length of less than 45 cm are considered as premature. Full-term baby
increased from 45 to 47 cm is determined individually, based on an analysis
all the features that characterize the maturity of the fetus. These features are-
Xia: the development of adequate fat, pink skin, kept down
only on the shoulder girdle, hair length not less than 2-3 cm, cartilage
Ear nose and thick, hard nails and the fingers extend beyond
the tips of the past, place of origin of the umbilical cord is located midway between
vagina and the xiphoid process, or slightly below, the testes in males (for
a few pathological exceptions) fell into the scrotum, the girls
clitoris and labia minora are covered with large labia. Mature
the fetus is very active: moving limbs, a loud
cry. These figures are averages. Deviations from these in that
or another occur frequently and are dependent on many factors: the WHO-
Rasta parents and their physical condition (health, height, weight), if-
tional to the preceding birth mother (with subsequent birth weight and length
to grow normally), etc.
Jaundice during pregnancy. Acute degeneration of the liver. Disorders of function of ne-
Cheney - the body that takes an active part in metabolic processes,
most notably manifested in the form of jaundice that develops when
all forms of toxicity far come of pregnancy. However, sometimes yellow-
ha during pregnancy has an independent significance and is one-
Noah form of toxicity.
Symptoms and flow. Jaundice may occur at any time pregnancies,
ty, but most often develops in the first half. First, icteric
color can be seen on the sclera eyes, in the future - throughout the body.
Accompanied by itching, especially facial skin, enlarged liver or
soreness. Jaundice can be kept for weeks or even
months, not only breaking the general condition of the patient. If you do not pass during the
pregnancy, it is stored in the first few days postpartum.
Recognition. Pregnant woman who has found at least one of the symp-
volumes, indicating liver damage should be immediately hospitalizations
lysed, as These phenomena may indicate a hidden while proceeding
more severe forms of toxemia of pregnancy. When the diagnosis -
jaundice pregnant women - should be excluded afebrile period of illness
Hepatitis, which is characterized by acute onset of disease, weakness,
disturbance of bowel function (constipation, diarrhea), and vomiting. Botkin's disease
and jaundice, complicate pregnancy may go into acute dystrophy
the liver.
Acute degeneration of the liver - one of the most rare and severe diseases,
occur at any stage of pregnancy.
Symptoms and flow. A slight icteric coloration of the skin in 2-3 days
becomes shafrannozheltoy. Liver first increases and becomes bo-
leznennoy, and then rapidly decreases until it is wrinkling. State
tion the patient is rapidly deteriorating: itching, vomiting, agitation, ship-
goad seizures, coma, and then developed with a fatal outcome. Simul-
simultaneously with the increase in the severity of the disease usually occur premature
nye spontaneous labor.
Treatment. Immediate termination of pregnancy, but it rarely saves
sick.
Delay lohny. Blood, mucus, degenerated and disintegrated organic
Kia elements form etc. postpartum discharge - lochia. In the first 2-3
the day they have a blood character. Then before the end of the first week after the ro-
Dov become dark red color with a brown tint, then yellowish-
is due to the impurity-and-white large number of leukocytes. With 10 days you will-
division of watery light, they were mixed with ever-increasing if-
tional to the mucus, thus becoming sero-mucous-konsisten
tion. By the number-scarce, by the end of the third week of almost ceased,
will soon disappear completely. From the first days postpartum in the lochia
revealed a diverse microbial flora, among which the pathogenic
species, most often Streptococcus.
Symptoms and flow. Lochia has a kind of rotten smell, similar to a
healthy women with menstrual odor. If they delay,
Xia in the uterus or the vagina and the bacteria multiply in them, then when-
acquire an unpleasant odor may become even malodorous.
Occasionally, due to spasm of the internal os of the uterus or blockage sheech-
tion channels are dropping pieces of shell, blood clots, etc.
allocation at all stops. The temperature rises to 38 39shS, but on-
schee feel sick quite satisfactory. Such a state of na-
lohiomegroy turns out that, with rare exceptions, is not a samosa-
toyatelnym disease - but only one manifestation of metroendometrita
(See Postpartum infectious diseases).
Treatment. Is the appointment of ice on the lower abdomen, antibiotics,
sulfonamides, as well as tools that reduce the uterus.
It is advisable to put the patient on his stomach, which contributes to the free
outflow discharge.
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