How is fetal weight measured by ultrasound? How to calculate a baby's weight in the womb

Among the complications, it should be noted perforation of the uterus, exacerbation of inflammatory diseases of the internal genital organs, and the development of intrauterine synechiae.

Features of the postoperative period

In the postoperative period, antibiotic therapy is necessary. The patient should abstain from sexual activity for 1 month after surgery.

Information for the patient

The appearance of signs of acute (or exacerbation) of the inflammatory process of the genital organs after curettage of the walls of the uterine cavity is an indication for a visit to the local gynecologist.

Source: Gynecology - national guide, ed. IN AND. Kulakova, G.M. Savelyeva, I.B. Manukhina 2009

42. Tools and sequence of operation - induced abortion.

Gynecological surgeries

Today we’ll go through the question of what gynecological operations exist. Induced abortion:

Induced abortion is the termination of pregnancy up to 12 weeks, which is carried out at the request of the woman, for social or medical reasons. The operation is performed under intravenous anesthesia.

Contraindications are chronic inflammation of the uterine appendages in the acute stage and the 3rd or 4th degree of vaginal cleanliness.

Bimanual examination to determine the size of the uterus and its position;

Treatment of the external genitalia with iodonate;

Insertion of speculum into the vagina;

Taking the cervix with bullet forceps and bringing it down;

Measuring the length of the uterine cavity with a probe;

Expansion of the cervical canal with Hegar dilators (up to No. 12);

Destruction of the fertilized egg by an abortionist;

Curettage of the uterine cavity with curettes No. 4-6;

Assessment of uterine contractility and determination of blood loss volume.

Tubectomy

Indications: tubal pregnancy, hydrosalpinx, pyosalpinx, hematosalpinx.

The sequence of actions of the doctor when performing the operation:

Applying clamps to the mesosalpinx and uterine tube;

Excision of the fallopian tube and ligation of blood vessels;

Peritonization of the round uterine ligament;

Adnexectomy

Indications: benign ovarian tumors, inflammatory saccular tumors of the appendages (pyovar, abscess of the appendages). The sequence of actions of the doctor when performing the operation:

Layer-by-layer incision of the anterior abdominal wall (Pfannenstiel or lower-median laparotomy) after treatment of the surgical field;

Examination of the internal genital organs and assessment of their condition;

Removal of the uterus and appendages into the wound, fixation of the uterus with a ligature;

Applying clamps to the suspensory ligament, uterine tube and ovarian ligament;

Removal of the uterine appendages and ligation of blood vessels;

Inspection of the removed specimen and its internal lining, urgent cytohistological examination;

Peritonization by the round uterine ligament and leaves of the broad ligaments;

Toilet and inspection of abdominal organs;

Counting swabs and instruments;

Layer-by-layer suturing of the wound of the anterior abdominal wall;

Determination of the volume of blood loss.

Supravaginal amputation of the uterus without appendages

Indications: uterine fibroids, uterine adenomyosis. The sequence of actions of the doctor when performing the operation:

Layer-by-layer incision of the anterior abdominal wall (Pfannenstiel or lower-median laparotomy) after treatment of the surgical field;

Examination of the internal genital organs and assessment of their condition;

Removal of the uterus and appendages into the wound, fixation of the uterus with bullet forceps or Museau forceps;

Applying clamps to the round uterine ligaments, uterine tubes and own ovarian ligaments;

Cutting off the uterine appendages and round uterine ligament, ligation of blood vessels;

Opening the plica vesicouterinae and bringing the bladder down;

Application of clamps to the ascending branches of the uterine arteries and their ligation after intersection;

Cutting off the body of the uterus at the level of the internal os;

Suturing the cervical stump with interrupted catgut sutures;

Peritonization due to plica vesicouterinae and broad uterine ligaments,

Inspection of the removed drug;

Toilet and inspection of abdominal organs;

Counting swabs and instruments;

Layer-by-layer suturing of the wound of the anterior abdominal wall;

Determination of the volume of blood loss.

44. The concept of the position and type of the fetus. Leopold's maneuvers for transverse position of the fetus (demonstration on a phantom).

/ Leopold's techniques

Leopold-Levitsky's techniques

To determine the location of the fetus in the uterus, four methods of external obstetric examination according to Leopold-Levitsky are used.

The doctor stands to the right of the pregnant or laboring woman, facing the woman.

The first step is to determine the height of the uterine fundus and the part of the fetus that is located in the fundus. The palms of both hands are located on the fundus of the uterus, the ends of the fingers are directed towards each other, but do not touch. Having established the height of the fundus of the uterus in relation to the xiphoid process or navel, the part of the fetus located in the fundus of the uterus is determined.

The pelvic end is defined as a large, softish and non-balloting part. The fetal head is defined as the large, dense and voting part.

With transverse and oblique positions of the fetus, the uterine fundus is empty, and large parts of the fetus (head, pelvic end) are identified on the right or left at the level of the navel (with a transverse position of the fetus) or in the iliac regions (with an oblique position of the fetus).

Using the second Leopold-Levitsky technique, the position, position and type of the fetus are determined. The hands move from the bottom of the uterus to the lateral surfaces of the uterus (approximately to the level of the navel). The lateral parts of the uterus are palpated using the palmar surfaces of the hands. Having received an idea of ​​​​the location of the back and small parts of the fetus, a conclusion is made about the position of the fetus. If small parts of the fetus are palpable on both the right and left, you can think about twins. The back of the fruit is defined as a smooth, even surface without protrusions. With the back facing posteriorly (posterior view), small parts are palpated more clearly. In some cases, it can be difficult and sometimes impossible to determine the type of fetus using this technique.

Using the third technique, the presenting part and its relationship to the entrance to the pelvis are determined. The technique is carried out with one right hand. In this case, the thumb is moved away from the other four as much as possible.

The presenting part is grasped between the thumb and middle finger.

This technique can determine the symptom of head voting. If the presenting part is the pelvic end of the fetus, the symptom of balloting is absent. With the third technique, to a certain extent, you can get an idea of ​​the size of the fetal head.

The fourth Leopold-Levitsky technique determines the nature of the presenting part and its location in relation to the planes of the small pelvis. To perform this technique, the doctor turns to face the legs of the woman being examined. The hands are positioned lateral to the midline above the horizontal branches of the pubic bones. Gradually moving your hands between the presenting part and the plane of the entrance to the small pelvis, determine the nature of the presenting part (what is presenting) and its location. The head can be movable, pressed against the entrance to the pelvis, or fixed by a small or large segment.

A segment should be understood as a part of the fetal head located below the plane conventionally drawn through this head. In the case when in the plane of the entrance to the small pelvis a part of the head was fixed below its maximum size for a given insertion, they speak of fixing the head with a small segment. If the largest diameter of the head and, therefore, the plane conventionally drawn through it has dropped below the plane of the entrance to the small pelvis, it is considered that the head is fixed by a large segment, since its larger volume is located below the first plane.

Pelvic dimensions

There are usually four pelvic sizes measured: three transverse and one straight. Distantia spinarum- the distance between the anterosuperior iliac spines. The buttons of the pelvis are pressed to the outer edges of the anterosuperior spines. This size is usually 25 - 26 cm. Distantia cristarum- the distance between the most distant points of the iliac crests. After measuring distantia spinarum, the buttons of the pelvis are moved from the spines along the outer edge of the iliac crest until the greatest distance is determined, this distance will be distantia cristarum, it averages 28 - 29 cm. Distantia trochanterica- the distance between the greater trochanters of the femurs. The most prominent points of the greater trochanters are found and the buttons of the pelvis gauge are pressed against them. This size is 30 - 31 cm. Based on the size of the external dimensions, one can judge with some caution the size of the small pelvis. The relationship between the transverse dimensions is also important. For example, normally the difference between distantia spinarum and distantia cristarum is 3 cm; if the difference is smaller, this indicates a deviation from the norm in the structure of the pelvis. Conjugata externa- external conjugate, i.e. direct size of the pelvis. The woman is laid on her side, the underlying leg is bent at the hip and knee joints, and the overlying leg is extended. The button of one branch of the pelvis is installed in the middle of the upper outer edge of the symphysis, the other end is pressed against the suprasacral fossa, which is located between the spinous process of the V lumbar vertebra and the beginning of the middle sacral crest (the suprasacral fossa coincides with the upper corner of the sacral rhombus). The external conjugate is normally 20 - 21 cm. The upper outer edge of the symphysis is easily determined; to clarify the location of the suprasacral fossa, slide your fingers along the spinous processes of the lumbar vertebrae towards the sacrum; the fossa is easily determined by touch under the protrusion of the spinous process of the last lumbar vertebra. The outer conjugate is important; its size can be used to judge the size of the true conjugate. To determine the true conjugate, subtract 9 cm from the length of the outer conjugate. For example, with an outer conjugate of 20 cm, the true conjugate is 11 cm, with an outer conjugate with a length of 18 cm, the true one is 9 cm, etc. The difference between the outer and true conjugate depends on the thickness of the sacrum, symphysis and soft tissues. The thickness of bones and soft tissues varies in women, so the difference between the size of the external and true conjugate does not always exactly correspond to 9 cm. The true conjugate can be more accurately determined by the diagonal conjugate. Diagonal conjugate (conjugata diagonalis) is the distance from the lower edge of the symphysis to the most prominent point of the sacral promontory. The diagonal conjugate is determined during a vaginal examination of a woman, which is performed in compliance with all the rules of asepsis and antiseptics. The II and III fingers are inserted into the vagina, the IV and V are bent, their back rests against the perineum. The fingers inserted into the vagina are fixed at the top of the promontory, and the edge of the palm rests against the lower edge of the symphysis. After this, the second finger of the other hand marks the place of contact of the examining hand with the lower edge of the symphysis. Without removing the second finger from the intended point, the hand located in the vagina is removed and measured with a pelvis or a centimeter tape with the help of another person, the distance from the top of the third finger to the point in contact with the lower edge of the symphysis. The diagonal conjugate with a normal pelvis is on average 12.5-13 cm. To determine the true conjugate, 1.5-2 cm is subtracted from the size of the diagonal conjugate. It is not always possible to measure the diagonal conjugate, because with normal pelvic sizes the promontory is not reached or can be felt with labor. If the promontory cannot be reached with the end of an extended finger, the volume of this pelvis can be considered normal or close to normal. The transverse dimensions of the pelvis and the external conjugate are measured in all pregnant women and women in labor without exception. If during examination of a woman there is a suspicion of narrowing of the pelvic outlet, the size of this cavity is determined. The dimensions of the pelvic outlet are determined as follows. The woman lies on her back, legs bent at the hip and knee joints, spread to the side and pulled up to the stomach. The direct size of the pelvic outlet is measured with a conventional pelvic meter. One button of the pelvis is pressed to the middle of the lower edge of the symphysis, the other to the top of the coccyx. The resulting size (11 cm) is larger than the actual one. To determine the direct size of the pelvic outlet, subtract 1.5 cm from this value (taking into account the thickness of the tissues). The transverse size of the pelvic outlet is measured with a measuring tape or a pelvis gauge with intersecting branches. The inner surfaces of the ischial tuberosities are felt and the distance between them is measured. To the resulting value you need to add 1 - 1.5 cm, taking into account the thickness of the soft tissues located between the buttons of the pelvis and the ischial tuberosities. Determining the shape of the pubic angle is of well-known clinical importance. With normal pelvic sizes it is 90 - 100°. The shape of the pubic angle is determined by the following technique. The woman lies on her back, legs bent and pulled up to her stomach. The palmar side of the thumbs is placed close to the lower branches of the pubic and ischial bones, the touching ends of the fingers are pressed against the lower edge of the symphysis. The location of the fingers allows us to judge the angle of the pubic arch. The oblique dimensions of the pelvis have to be measured with a constricted pelvis.

Duration of pregnancy. Determining the date of birth. Duration of pregnancy. Determining the due date.

Determining the true duration of pregnancy is difficult due to the fact that it is difficult to establish the exact date of ovulation, the time of sperm movement and fertilization. Therefore, data on the duration of pregnancy are contradictory. Cases of the birth of mature children during pregnancy lasting 230-240 days have been described; Along with this, there were cases of very significant prolongation of pregnancy (post-term pregnancy, delayed birth); observations are known when pregnancy lasted over 300 days (310-320 days or more). However, in most cases, pregnancy lasts 10 obstetric (lunar, 28 days each) months, or 280 days, if we calculate its beginning from the first day of the last menstruation.

To determine the due date, 280 days are added to the first day of the last menstruation, i.e. 10 obstetric, or 9 calendar, months. Usually, calculating the due date is simpler: from the date of the first day of the last menstruation, count back 3 calendar months and add 7 days. For example, if the last menstruation began on October 2, then by counting back 3 months (September 2, August 2 and July 2) and adding 7 days, the expected date of birth is determined - July 9; if the last menstruation began on May 20, then the expected due date is February 27, etc.

Rice. 4.25. Height of the uterine fundus at different stages of pregnancy

The expected due date can be calculated by ovulation: from the first day of the expected but not occurring menstruation, count back 14-16 days and add 273-274 days to the found date. When determining the due date, the time of the first fetal movement is also taken into account. To the date of the first movement, 5 obstetric months are added for primigravidas, 5.5 obstetric months for multipregnant women, and the estimated due date is obtained. However, it should be remembered that this sign has only an auxiliary meaning.

Objective research data helps determine the due date: measuring the length of the fetus and the size of its head, the circumference of the pregnant woman’s abdomen, the height of the fundus of the uterus, the degree of its excitability (with palpation, the administration of small doses of oxytocin and other irritations, the uterus contracts greatly).

Determination of the estimated fetal weight using the Jordanya formula. Jordania formula. Lankowitz formula. Johnson's formula.

To determine the estimated weight of the fetus, special formulas can be successfully used. Determination of the estimated fetal weight according to Jordania:

Y = coolant x VDM,

where Y is the weight of the fruit, g; OB - abdominal circumference, cm; VDM - height of the uterine fundus above the womb, cm.

Measuring the length of the fetal femur.

Determination of the estimated fetal weight according to Lankowitz:

Y=(OJ+VDM+RB+MB) x 10,

where Y is the mass of the fruit, g; OB - abdominal circumference, cm; VDM - height of the uterine fundus above the womb, cm; RB - height of the pregnant woman, cm; MB - body weight of the pregnant woman, kg; 10 is a conditional coefficient.

Also worthy of attention is the proposal of A.V. Lankowitz (1961) determined the estimated mass of the fetus with the stereometric sense inherent in each person. Through careful palpation, you can determine more or less accurately the size of the body being palpated. Estimated fetal weight was determined in 2000 pregnant women. It was determined almost correctly (±200 g) in 57% of newborns, with a small error (±201-500 g) - in 32.4%, with a significant error (±501-1000 g) - in 10%, and with a gross error - in 0.6% of newborns.

Determination of estimated fetal weight according to Johnson:

Y=(VDM-11) x 155,

where Y is the weight of the fetus, VDM is the height of the uterine fundus above the womb, cm; 11 is a conditional coefficient for a pregnant woman weighing up to 90 kg (for a pregnant woman weighing more than 90 kg, this coefficient is equal to 12), 155 is a special index.

/ gynecology 5th year exam / a / Methods for determining the condition of the fetus

Methods for determining the condition of the fetus.

NON-INVASIVE METHODS

The development of modern medical technologies makes it possible to assess the condition of the fetus throughout pregnancy, from the first days from fertilization of the egg to the moment of birth of the fetus.

Alpha-fetoprotein level determination carried out as part of screening programs to identify pregnant women at increased risk of congenital and inherited fetal diseases and complicated pregnancy. The study is carried out between the 15th and 18th weeks of pregnancy. The average level of alpha-fetoprotein in the blood serum of pregnant women is at 15 weeks. - 26 ng/ml, 16 weeks. - 31 ng/ml, 17 weeks. - 40 ng/ml, 18 weeks. - 44 ng/ml. The level of alpha-fetoprotein in the mother's blood increases with certain malformations in the fetus (neural tube defects, pathology of the urinary system, gastrointestinal tract and anterior abdominal wall) and the pathological course of pregnancy (threat of miscarriage, immunoconflict pregnancy, etc.). The level of alpha-fetoprotein is also increased in multiple pregnancies. A decrease in the level of this protein can be observed in Down syndrome in the fetus. If the level of alpha-fetoprotein deviates from normal values, further examination of the pregnant woman in a specialized perinatal medical center is indicated.

Ultrasound Currently, during pregnancy, it is the most accessible, most informative and at the same time safe method of studying the condition of the fetus. Due to the high quality of the information provided, ultrasonic devices operating in real time, equipped with a gray scale, are most widely used. They allow you to obtain a two-dimensional image with high resolution. Ultrasound devices can be equipped with special attachments that allow Doppler studies of blood flow velocity in the heart and blood vessels of the fetus. The most advanced of them make it possible to obtain a color image of blood flows against the background of a two-dimensional image. When performing ultrasound examinations in obstetric practice, both transabdominal and transvaginal scanning can be used. The choice of sensor type depends on the stage of pregnancy and the purpose of the study. During pregnancy, it is advisable to conduct a 3-fold screening ultrasound examination:

when a woman first contacts her about delayed menstruation in order to diagnose pregnancy, localize the fertilized egg, identify possible deviations in its development, as well as the abilities of the anatomical structure of the uterus;

at a gestational age of 16-18 weeks. in order to identify possible anomalies of fetal development for the timely use of additional methods of prenatal diagnosis or raising the question of termination of pregnancy;

at a period of 32-35 weeks. in order to determine the condition, localization of the placenta and the rate of fetal development, their correspondence to the gestational age, the position of the fetus before birth, its estimated weight.

With ultrasound examination, diagnosis of intrauterine pregnancy is possible already from 2-3 weeks, while in the thickness of the endometrium the fertilized egg is visualized in the form of a round formation of reduced echogenicity with an internal diameter of 0.3-0.5 cm. In the first trimester, the rate of weekly increase in the average size of the fertilized egg is approximately 0.7 cm, and by 10 weeks. it fills the entire uterine cavity. By 7 weeks During pregnancy, in most pregnant women, examination in the cavity of the fetal egg can reveal the embryo as a separate formation of increased echogenicity, 1 cm long. At this time, visualization of the heart is already possible in the embryo - an area with a rhythmic oscillation of small amplitude and mild motor activity. When performing biometry in the first trimester, the main importance for establishing the gestational age is the determination of the average internal diameter of the ovum and the coccygeal-parietal size of the embryo, the values ​​of which strictly correlate with the gestational age. The most informative method of ultrasound examination during early pregnancy is transvaginal scanning; transabdominal is used only when the bladder is full in order to create an “acoustic window”.

Ultrasound examination in the second and third trimesters allows one to obtain important information about the structure of almost all organs and systems of the fetus, the amount of amniotic fluid, the development and localization of the placenta and diagnose disorders of their anatomical structure. The greatest practical significance in conducting a screening study from the second trimester, in addition to a visual assessment of the anatomical structure of the fetal organs, is the determination of the main fetometric indicators:

with a cross-section of the fetal head in the area of ​​best visualization of the midline structures of the brain (M-echo), the biparietal size (BPR), fronto-occipital size (FOR) is determined, on the basis of which it is possible to calculate the fetal head circumference (HC);

with a cross-section of the abdomen perpendicular to the fetal spine at the level of the intrahepatic segment of the umbilical vein, at which the cross-section of the abdomen has a regular rounded shape, the anteroposterior and transverse diameter of the abdomen is determined, on the basis of which the average abdominal diameter (AMD) and its circumference (AC) can be calculated;

with free scanning in the area of ​​the pelvic end of the fetus, a clear longitudinal section of the fetal femur is achieved, followed by determination of its length (DL).

Based on the obtained fetometric indicators, it is possible to calculate the estimated weight of the fetus, while the error when changing generally accepted calculation formulas usually does not exceed 200-300 g.

To qualitatively assess the amount of amniotic fluid, measurement of “pockets” free of fetal parts and umbilical cord loops is used. If the largest of them has a size of less than 1 cm in two mutually perpendicular planes, we can talk about oligohydramnios, and if its vertical size is more than 8 cm, we can talk about polyhydramnios.

Currently, tables of organometric parameters of the fetus depending on the gestational age have been developed for almost all organs and bone formations, which should be used if there is the slightest suspicion of a deviation in its development.

Cardiotocography (CTG)- continuous simultaneous recording of fetal heart rate and uterine tone with a graphical representation of physiological signals on a calibration tape. Currently, CTG is the leading method of monitoring the nature of cardiac activity, which, due to its simplicity in implementation, informativeness and stability of the information obtained, has almost completely replaced phono- and electrocardiography of the fetus from clinical practice. CTG can be used to monitor the condition of the fetus both during pregnancy and during labor).

Indirect (external) CTG is used during pregnancy and childbirth in the presence of an intact amniotic sac. Heart rate is recorded using an ultrasonic sensor operating on the Doppler effect. Registration of uterine tone is carried out by strain gauge sensors. The sensors are attached to the woman's front wall with special straps: an ultrasound one - in the area of ​​stable recording of heartbeats, a strain gauge - in the area of ​​the fundus of the uterus.

Direct (internal) CTG is used only if the integrity of the amniotic sac is compromised. The heart rate is recorded using a needle spiral electrode inserted into the presenting part of the fetus, which makes it possible to record not only the fetal heart rate, but also record its ECG, which can be deciphered using special computer programs. Direct recording of intrauterine pressure is carried out using a special catheter inserted into the uterine cavity connected to a pressure measurement system, which makes it possible to determine intrauterine pressure.

The most widespread use of CTG is in the third trimester of pregnancy and during childbirth in women at high risk. CTG recording should be carried out for 30-60 minutes, taking into account the fetal activity-rest cycle, taking into account that the average duration of the fetal resting phase is 20-30 minutes. Analysis of CTG recording curves is carried out only in the fetal activity phase.

CTG analysis includes assessment of the following indicators:

average (basal) heart rate (normal - 120-160 beats/min);

fetal heart rate variability; distinguish instantaneous variability - the difference in the actual heart rate from “beat to beat”, slow intra-minute fluctuations in heart rate - oscillations that have the greatest clinical significance. The magnitude of the oscillation is assessed by the amplitude of the deviation of the fetal heart rate from its average frequency (normally 10-30 beats/min);

myocardial reflex - an increase in the fetal heart rate by more than 15 beats/min (compared to the average frequency) and lasting more than 30 s; increased heart rate is associated with fetal movements; The presence of heart rate accelerations on the cardiotocogram is a favorable prognostic sign. He is one of the leaders in cardiac tocogram evaluation;

decreased fetal heart rate; in relation to the time of uterine contractions, early, late and variable contractions are distinguished (normally this sign is not observed);

slow oscillations in the form of a sinusoid in the absence of instantaneous variability, lasting more than 4 minutes; This is a rare and one of the most unfavorable types of fetal heartbeats detected by CTG - sinusoidal rhythm.

An objective assessment of the cardiotocogram is possible only taking into account all of the listed components; in this case, the disparity of their clinical significance should be taken into account.

If signs of disturbance in the fetal condition appear during pregnancy, functional tests should be performed: non-stress test, step test, sound test, etc.

Comprehensive cardiotocographic and ultrasound diagnostics of the state of respiratory movements, motor activity and tone of the fetus, as well as a qualitative assessment of the amount of amniotic fluid allows us to assess the biophysical profile of the fetus.

INVASIVE METHODS

Invasive intrauterine interventions during pregnancy have become widespread with the advent of ultrasound diagnostic technology, which has high resolution, ensuring the relative safety of their implementation. Depending on the stage of pregnancy and indications for diagnostics in order to obtain fetal material, chorionic biopsy, amniocentesis, cordocentesis, biopsy of fetal skin, liver, tissue of tumor-like formations, aspiration of fetal urine from the bladder or renal pelvis are used. All invasive procedures are carried out in compliance with the rules of asepsis, in an operating room.

Amnioscopy also applies to invasive research methods. Using an endoscope inserted into the cervical canal, the quantity and quality of amniotic fluid can be assessed. A decrease in the amount of water and the detection of meconium in it is considered an unfavorable diagnostic sign. The method is simple, but it is not feasible for all pregnant women, but only in cases where the cervical canal can “miss” the instrument. This situation occurs at the very end of pregnancy, and not for all women.

Amniocentesis - puncture of the amniotic cavity for the purpose of aspiration of amniotic fluid is carried out using transabdominal access under ultrasound guidance. The puncture is performed at the site of the largest “pocket” of amniotic fluid, free from fetal parts and umbilical cord loops, avoiding trauma to the placenta. Depending on the diagnostic purposes, 10-20 ml of amniotic fluid is aspirated. Amniocentesis is used to identify congenital and hereditary diseases of the fetus, to diagnose the degree of maturity of the fetal lungs.

Cordocentesis - puncture of the vessels of the fetal umbilical cord in order to obtain its blood. Currently, the main method of obtaining fetal blood is transabdominal puncture cordocentesis under ultrasound guidance. The manipulation is carried out in the II and III trimesters of pregnancy. Cordocentesis is used not only to diagnose fetal pathology, but also to treat it.

Chorionic villus biopsy (chorion biopsy) is performed using different methods. Currently, aspiration transcervical or transabdominal puncture chorionic villus biopsy is used in the first trimester of pregnancy. Aspiration of chorionic villi is carried out under ultrasound control using a special catheter or puncture needle inserted into the thickness of the chorion. The main indication for chorionic villus biopsy is the prenatal diagnosis of congenital and hereditary diseases of the fetus.

Fetal skin biopsy - obtaining fetal skin samples by aspiration or forceps method under ultrasound or fetoscopic control for the purpose of prenatal diagnosis of hyperkeratosis, ichthyosis, albinism, etc.

Liver biopsy - obtaining samples of fetal liver tissue by aspiration for the purpose of diagnosing diseases associated with a deficiency of specific liver enzymes.

Tissue biopsy of tumor-like formations - is carried out using the aspiration method to obtain samples of tissue of a solid structure or the contents of cystic formations for diagnosis and selection of pregnancy management tactics.

Aspiration of urine for obstructive conditions of the urinary system - puncture of the bladder cavity or fetal renal pelvis under ultrasound control to obtain urine and its biochemical study to assess the functional state of the renal parenchyma and clarify the need for antenatal surgical correction.

The normal weight of an unborn child is a problem that interests many expectant mothers. For some, it’s pure curiosity - what weight will my baby be? For others, it is important that everything is normal, that development goes according to plan. In any case, despite the fact that the child is in the womb and cannot simply be placed on a scale, separated from the mother’s body, it is quite possible to find out the approximate weight and this can be done at home.

The most popular ways to predict fetal weight

There are several ways to calculate the weight of the fetus and the weight of the unborn child. They are named after the inventors:

• Lankowitz;
• Bublichenko;
• Yakubova;
• Jordania;
• as well as using ultrasound.

In order to use the formulas of these scientists, you need to have some information about your body:

• own weight;
• height of the uterine fundus;
• abdominal circumference;
• pregnant woman's height.

In the case of determining weight using ultrasound indicators, the doctor makes calculations based on already known data on the relationship between gestational age, linear characteristics of the fetus and weight.

Basic formulas for calculating fetal weight

All formulas by which it is customary to determine the approximate weight of the fetus were derived experimentally and have a high degree of accuracy, but in order for them to be as reliable as possible, many factors should be taken into account.

• Lankowitz formula: we sum up the circumference of the uterus and the height of its fundus (in cm), as well as the weight (in kg) and height (in cm) of the woman and multiply the result by 10 - the result is quite accurate.
• Yakubova’s formula: sum the uterine circumference and standing height and multiply the resulting value by 25.
• According to Zhordania, they calculate the product of the circumference of the uterus and its standing height.
• The simplest formula is Bublichenko: the weight of the expectant mother is divided by 20.

How to correctly measure the main indicators for calculating fetal weight

First of all, you need scales and a measuring tape. The circumference of the abdomen (uterus) is measured at the level of the navel, and the height of the fundus is determined as shown in the figure below. But it must be taken into account that some factors significantly distort the results. They are deftly recognized by an experienced professional, but can be missed by an amateur (a pregnant woman). So, the results will be inaccurate if:

• twins are pregnant;
• there is a lot of subcutaneous fat;
• too much intrauterine fluid (or too little);
• suspect the presence of fetal growth retardation syndrome, etc.

If there are no problems mentioned above, the woman may well be able to calculate the child’s weight at home, but in other cases it is better to ask the supervising doctor about this.

How to interpret the results

By calculating the expected weight of the child, you can understand how normal the pregnancy is. The normal range is 2500-4000 g. If the weight is below normal, intrauterine malnutrition is suspected when the placenta does not work enough. And if the pregnant woman is overweight, she should urgently adjust her weight and monitor both herself and the child, since giant children have a high risk of various diseases such as diabetes.

The meaning of fetal weight for the obstetrician

The weight of the unborn child is calculated for a reason - this is very important for future obstetric practice. In case of a sharp deviation of the predicted results from the norm, doctors advise planning a cesarean section, and there are several reasons for this:

• a premature baby may be too weak, so his birth should be made as simple as possible for him;
• a giant child may suffer from certain metabolic diseases from birth, so a cesarean section is also indicated for him;
• When large children are born, the likelihood of their congenital injuries is too high, as well as more negative consequences for the mother herself.

So, the child’s weight should be calculated not only out of idle curiosity, but also for diagnosing the normal development of the fetus, as well as planning childbirth. This can be done at home, which is not difficult for any mother, but will protect you from possible risks.

Target: determination of estimated fetal weight

Resources: pelvis gauge, measuring tape, couch, scales, stadiometer.

Execution algorithm.

1. Determine the pregnant woman’s weight, body weight, height (see relevant standards).

2. Determine the estimated fetal weight using the Johnson method. According to Johnson's formula, M = (VDM-11)x155, where M is the mass of the fetus, VDM is the height of the uterine fundus, 11 is a conditional coefficient for a pregnant woman’s weight up to 90 kg. if the pregnant woman weighs more than 90 kg, this coefficient is 12; 155 is a special index.

3. Determine the estimated fetal weight using the Lankowitz method. . According to the Lankowitz formula, M = (VDM + woman’s abdominal circumference in cm + woman’s body weight in kg + woman’s height in cm)x10.

4. Determine the estimated fetal weight using the Jordania method. According to the Jordania formula, the mass of the fetus in g. equal to the product of the abdominal circumference in cm and the height of the uterine fundus above the womb in cm.

5. Record your findings in your medical records.

Standard “Determining the duration of contractions”

Target: Determining the nature of labor.

Resources: stopwatch, birth history.

Action algorithm.

1. Explain to the woman in labor the need for this study.

2. Sit on a chair to the right of the woman in labor and facing her.

3. Place a warm hand on the mother's belly.

4. Using the second hand, note the duration of the contraction (the time the uterus is in good shape), evaluate the strength of the tension of the uterine muscle mass and the reaction of the woman in labor, and record the end of the contraction.

5. Determine the time between pauses.

6. To characterize contractions in terms of duration, frequency, strength, pain, it is necessary to evaluate 3-4 contractions following each other. Record the frequency of uterine contractions for 10 minutes.

7. Record the result in the birth history graphically on a partogram.

Note: To characterize contractions in terms of duration, frequency, strength, pain, it is necessary to evaluate 3-4 contractions following each other.

Standard "Partogram"

(Appendix 2 to the clinical protocol “Physiological childbirth from the Appendix to the order of the Minister of Health of the Republic of Kazakhstan dated 04/07/2010”. It is the only document for monitoring the course of normal (physiological) childbirth.

A partogram is taken upon admission to the hospital of a patient with an established diagnosis of “Childbirth”. Filling rules

Patient information:

2. Number of pregnancies and births,

3. Birth history number,

4. Date and time of admission to the delivery unit,

5. Time from lithium amniotic fluid.

Fetal heart rate: recorded every half hour

(listened to every 15 minutes) - marked with a dot -.

Amniotic fluid: the color of the amniotic fluid is noted when

each vaginal examination:

I - amniotic sac is intact;

C - amniotic fluid is light, clean;

M - water with meconium (any color intensity);

B - admixture of blood in the waters;

A - absence of water/discharge.

Head configuration:

0 - no configuration;

The seams come apart easily;

The seams overlap each other, but separate when pressed; -+++ - the seams overlap each other and do not separate.

Cervical dilatation: assessed at each vaginal examination and marked with a cross (x).

Alert line: the line should start from the point of cervical dilatation by 3 cm and continue to the point of full dilatation in increments of 1 cm per hour. Line of Action: Runs parallel to the Line of Alertness, 4 o'clock to the right.

Head drop: assessment of head passage should be carried out

by first performing an abdominal examination and only then a vaginal one:

5/5 - the head is 5 fingers above the pubis - above the entrance to the pelvis;

4/5 - 4 fingers above the pubis - pressed to the entrance to the pelvis;

3/5 - 3 fingers above the pubis - most of the head above the pubis can be felt;

2/5 - 2 fingers above the pubis - a smaller part of the head can be felt above the pubis

1/5 - head in the pelvic cavity.

Time: Marked to the left of the line. For ease of filling, it is better to write down in multiples of 30 minutes. For example, 13.00 or 13.30.

Uterine contractions: Along with the dilation of the cervix and the advancement of the fetal head, uterine contractions (contractions) serve as a clear indicator of labor activity. The frequency of contractions is plotted along the time axis. Each cell represents one contraction. The different intensity of the shading reflects the intensity of the contractions.

Oxytocin: when prescribed, its quantity/concentration and administered dose per minute (in drops or units) are recorded every 30 minutes. Medication Prescriptions: Any additional medication prescriptions are recorded.

Pulse: every 30 minutes is marked with a dot - .

Blood pressure: recorded every 4 hours and marked with a line in the middle of the corresponding cell. Body temperature: recorded every 4 hours.

Protein (protein), acetone and amount of urine: recorded with each urination.

Standard “Assessment of the “maturity” of the cervix”

Purpose of the study: determining the readiness of the birth canal for childbirth.

Resources: gynecological chair, individual diaper; sterile gloves, forceps, cotton balls, 1% iodonate solution or 2% iodine solution.

Action algorithm.

1. Explain to the pregnant woman the need for research.

2. Place the woman on a gynecological chair on an individual diaper.

3. Treat the external genitalia with one of the disinfecting solutions (1% iodonate solution or 2% iodine solution).

4. Wear sterile gloves.

5. With your left hand, spread the labia majora with your first and second fingers, and insert the second and third fingers of your right hand into the vagina.

6. By palpating the cervix, determine its consistency, length, position in relation to the pelvic axis, and patency of the cervical canal.

7. Assess the degree of “maturity” of the cervix. The neck is considered mature if it is shortened to 2 cm. or less, softened, the cervical canal allows 1 finger or more to pass through, the axis of the cervix coincides with the wire axis of the pelvis.

8. Remove disposable gloves and throw them away according to infection prevention rules.

9. Wash your hands with soap and water.

10. Make a note in your medical records.

27.Standard "Amniotomy"

Indications: labor induction, labor stimulation, flat amniotic sac, polyhydramnios, incomplete placenta pregnancies, arterial hypertension.

Resources: jaw of bullet forceps, disposable gloves.

Action algorithm:

1. Perform a vaginal examination, clarify the degree of dilation of the uterine pharynx, the presenting part, the location of the presenting part in relation to the planes of the pelvis.

2. Insert the bullet forceps into the vagina (under hand control) between the middle and index fingers.

3. At the height of the contraction with maximum tension in the amniotic sac, puncture it.

4. Insert your index finger and then your middle finger into the resulting hole in the amniotic sac, gradually expanding the hole. Amniotic fluid should flow out slowly under the control of the hand (prevention of prolapse of the umbilical cord and small parts).

Standard “Preparing a midwife for childbirth”

Target: prevention of complications, compliance with asepsis and antiseptics.

Resources: 2-3 warm diapers, a cap, socks, disposable sterile bags for childbirth, sterile gloves, liquid soap with a dispenser, a disposable towel, 1% erythromycin ophthalmic ointment, 10 units of oxytocin in a syringe.

Primary kit for a newborn: 2 clamps, 1 scissors, 10 haze balls.

Secondary set for newborn: scissors, measuring tape, umbilical clip (clamp).

Cervical Exam Kit(use according to indications): single-leaf vaginal speculum, needle holder, 2 forceps, tweezers, gauze balls.

Action algorithm.

1. Put on the treated apron (wipe twice with a rag moistened with a 1% chloramine solution).

2. Treat your hands mechanically.

3. Dry your hands with a sterile towel.

4. Put on a sterile disposable gown and gloves.

5. Put on a disposable sterile shirt and shoe covers for the woman in labor.

6. Remove the necessary diapers and napkins from the opened sterile delivery bag.

7. Lay out sterile umbilical cord clamps and scissors to cut it.

Everything is ready for the birth.

During the second half of pregnancy, the body weight of the expectant mother begins to increase sharply. While waiting for the birth of a child, a woman can add 10 to 20 kg to her usual weight. At the same time, pregnant women are interested in answers to the questions: what is the current weight of the baby, and how to calculate the weight of the child in the mother’s womb? It is quite difficult to answer these questions with high accuracy, although certain formulas exist.

Determination of fetal weight using the Jordania formula

Determination of the approximate weight of the fetus using this formula is carried out after the 35th week of pregnancy. To do this, you need to know only 2 quantities:

• abdominal circumference in cm (measurements are taken at the level of the navel);
• VSDM (height of the uterine fundus) in cm, which is measured from the top point of the uterine fundus to the pubic symphysis.

The formula itself looks like this: abdominal circumference (cm) x VSDM (cm) = fetal weight (g) +/- 200 g.

Where +/- 200 g – variations in approximate weight. If you have massive bones, then +200g, if the bone is narrow, then -200g.

Example. The pregnant woman is 37 weeks pregnant. Abdominal circumference – 93 cm, VSD – 34 cm. Estimated weight of the child 93 x 34 = 3162 g +/- 200 g.

Determination of fetal weight using Yakubova’s formula

Exactly the same data is used in this formula, only here they are added first. How to calculate a child’s weight according to Yakubova?

Let's take the data of the same pregnant woman and get the following numbers.

Fetal mass = (abdominal circumference + VSDM) x 100 / 4. Substitute the data and get (93 + 34) x 100 /4 = 3175 g. The difference with the first example was 13 grams.

other methods

In addition to these methods, there are many others. For example, the “calendar method”, in which the weight of the fetus and the gestational age are determined by the size of the uterus. To calculate using this method, you need to know the following parameters:

• the width of the anterior semicircle (180*) of the pregnant uterus in its widest part (measurements are taken when the pregnant woman is lying on her back);
• VSDM in centimeters.

The differences in calculations using different methods are small, you have already seen this in the first two examples.

It should be understood that the data obtained by any of these methods are approximate and there is simply no exact formula with clear rules for calculating the weight of the embryo in the mother’s womb. And knowing how to calculate a child’s weight at the moment is not so important. The dynamics of the baby’s weight growth itself are of greater importance. It is this factor that will most fully characterize the stable and normal development of the fetus in the womb. Therefore, a pregnant woman needs to constantly monitor the dynamics of her own weight in order to be sure of a stable increase in the weight of the unborn child.