A complicated obstetric history is a factor of complications during pregnancy and childbirth.

Obstetric history (anamnesis obstetrica) is part of the history devoted to the generative (childbearing) function of a woman (the nature of menstruation, the number of pregnancies, abortions and births, the characteristics of their course and the nature of complications). It is produced according to a certain scheme.

1) Passport data. Last name, first name, patronymic, age, profession, place of work, address, etc.

2) The reasons that prompted the woman to seek medical treatment. help. Complaints about cessation of menstruation, changes in appetite, nausea, vomiting in the morning, aversion to certain odors, the appearance of edema in the 2nd half of pregnancy, headache and etc.

3) Family history. Heredity - mental illness, alcoholism, drug addiction, developmental defects and other diseases that can be inherited or have an adverse effect on the development of the fetus.

4) Previous illnesses. In particular, rickets can cause deformation of the pelvic bones; infectious diseases and pathology of the nasopharynx can affect the health and sexual development of the girl; diseases of the kidneys, liver, heart and lungs aggravate the course of pregnancy and childbirth (fetoplacental insufficiency, toxicosis, premature birth, weakness labor activity).

5) Menstrual function. Delayed (after 15-16 years) appearance of menstruation is characteristic of infantilism; type of menstruation - cycle duration, amount of blood lost, presence of pain, etc.; A change in the nature of menstruation after the onset of sexual activity, childbirth or abortion is a sign of inflammatory disease of the internal genital organs; the exact date of the last menstruation - to calculate the gestational age.

b) Secretory function. The presence of discharge from the genital tract, its nature (purulent and mucous, watery indicate inflammatory diseases, bloody issues, especially during sexual intercourse, are characteristic of cervical cancer).

7) Sexual function. Age at which sexual activity began, length of marriage; information about the husband’s health (gonorrhea, syphilis, drug addiction, alcoholism, tuberculosis).

8) Childbearing function, or obstetric history. Detailed data on the course of each pregnancy (toxicosis, heart disease, kidney disease, etc.), each birth (urgent or premature, with surgery), the course of each postpartum period (bleeding, endometritis, mastitis, etc.). It is necessary to find out the weight of each child at birth, how many children are alive, and if they died, then for what reason. If there are miscarriages, it is necessary to establish their nature, the timing of termination of pregnancy, complications after abortion (causing a tendency to miscarriage and bleeding during subsequent births).

Federal Agency for Health and Social Development of the Russian Federation

GOU VPO IGMA

Department Obstetrics and gynecology

Izhevsk 2013

Passport details:

1.FULL NAME.:

.Age: 25 years old

.Marital status: Married

.Profession, position: accountant, Positive LLC

.Date of admission: 03/11/13

.Pregnancy, Childbirth: 1 pregnancy, 1 childbirth

.Blood type, Rh factor: AB(IV) Rh+

.Diagnosis on admission: Pregnancy 39-40 weeks. Mild preeclampsia degrees. Bronchial asthma, long-term remission.

.Accompanying illnesses: bronchial asthma

Pregnancy history:

Flow real pregnancy:

2nd trimester - denies general diseases, noted nausea, vomited several times, blood pressure - 120/80 mm Hg. Art.

2nd trimester - denies general diseases, heartburn appears, weight gain is 8 kg, blood pressure is 120/80 mm Hg. Art. First fetal movement at 16 weeks.

2nd trimester - total weight gain during pregnancy is 10 kg, uniform. Blood pressure - 120/80 mm Hg. Art. Reason for hospitalization: preeclampsia, childbirth.

Obstetric history:

1.Menstrual function: Menarche at 13 years old, the cycle was established immediately, 5-6 days after 28 days, heavy, painless. . The date of the last menstruation is 06/11/12.

.Secretory function: vaginal discharge is mucous, moderate, transparent, odorless.

.Sexual function: Beginning of sexual activity at age 21, first marriage. My husband is 27 years old, healthy, without bad habits.

.Fertility:

1st pregnancy - real

Contraception before pregnancy: condoms.

1. The function of the digestive and urinary organs is unremarkable.
2. Allergy history - without any peculiarities.
3. Heredity is not burdened.
4. Bad habits No.
5. Prof. No harm
6. My husband is healthy.

Objective examination data:

1.Complaints of pain during contractions, no headache, clear vision, slight swelling in the lower extremities, general condition is satisfactory.

.The physique is correct, proportional, normosthenic type, height - 155 cm, weight - 70.8 kg, t - 36.6.

.Nervous system: pupillary reflexes are preserved, sleep is restful.

.State of mind: good mood, slight fear of childbirth.

.The cardiovascular system: heart sounds are clear, rhythmic, there is no accent of the second tone, blood pressure in both arms is 120/80 mm Hg. Art., pulse 76 beats per minute.

.Respiratory organs: vesicular breathing, no wheezing, respiratory rate - 16 per minute.

.Genitourinary system: no dysuric disorders.

Outdoor data obstetric research at the time of admission:

1.Pelvis dimensions:

d. spinarum - 22 cm, d. cristarum - 26 cm, d. trochanterica - 32 cm, c. externa - 23 cm.

2.The height of the uterine fundus is 37 cm, the abdominal circumference is 101 cm, the estimated size of the fetus is 3737

.Lumbosacral diamond - 11cm x 11cm

.Wrist joint index - 15cm

.The state of contractile activity of the uterus - the uterus contracts upon palpation.

.The position of the fetus is longitudinal, presentation is occipital, position is first, view is anterior, the fetal heartbeat is clear, the listening location is below the navel on the left, frequency is 130 per minute, rhythmic, sonorous.

Data from internal obstetric research 03/16/2013 at 7:40

a) The external genitalia are developed correctly, the vagina has not given birth.

b) the cervix is ​​centered, up to 0.5 cm long, soft, thin, opening 3 cm.

c) the amniotic sac is intact

d) presenting part - head, pressed to the entrance to the pelvis

e) there are no exostoses, the cape is not reachable, the size of the diagonal conjugate is > 12 cm.

f) diagnosis based on the study: 1st period of 1st term labor, cephalic presentation.

Laboratory research.

1. complete blood test:

Hemoglobin ---100 g\l

Red blood cells---3.4*10 12\l

Leukocytes---4.5*10 9\l

Eosinophils ---2%

Basophils --- 0%

Sticks.--- 1%

Segments.--- 49%

Lymphocytes--- 39%

Monocytes--- 9%

ESR--- 37mm/h

platelets 320*10 9\l

Clotting time: 6min20sec

bleeding time: 5min35sec

1. Analysis of urine.

Yellow color

Transparency - slightly cloudy

Specific gravity - 1011

Protein - not detected

Leukocytes - 1-2 per cell.

Flat epithelium 1-3 in n/z.

total protein 69.8.2 g\l

fibrinogen 5.2 g/l

1. Smear microscopy:

leukocytes 12-15 in p/w

epithelium: 4-7

flora: unit. cocci

Trichomonas - negative

Conclusion: 1st degree of vaginal cleanliness.

1. ECG: sinus rhythm, heart rate 85-57 per minute, respiratory arrhythmia, vertical EO.

Summary of pathological findings:

1. Bronchial asthma.
2. Cervical erosion.
3. Ureaplasma.
4. Varicose veins veins of the lower extremities.

Diagnosis and its rationale:

First pregnancy, 39-40 weeks, occipital presentation, first position, anterior view, large fetus. Complicated obstetric history. 1st period of 1st term birth.

The following signs of pregnancy are present: cessation of menstruation (last menstruation 06/11/11), the uterus is enlarged, its standing height is 37 cm, abdominal circumference is 101 cm, palpation of the abdomen reveals parts of the fetus and its movement; The fetal heartbeat can be heard well (especially on the left, below the navel).

From obstetric history it is known that this pregnancy the first in a row.

Justification for the duration of pregnancy: the date of the first day of the last menstruation is 06/11/12, 279 days have passed from this day to the present, which corresponds to 39 weeks of pregnancy.

Based on data from external obstetric examination and vaginal examination, the longitudinal position of the fetus was determined in the anterior view of the occipital presentation, the first position.

Estimated weight of the fetus: multiply the circumference of the abdomen (101 cm) by the height of the uterus (37 cm), it turns out approximately 3737 g, therefore the fetus is large.

From the obstetric anamnesis it is known that the woman has cervical erosion, which is an aggravation of the obstetric anamnesis.

The onset of the first stage of labor is indicated by the appearance of contractions and vaginal examination data: effacement of the cervix and opening of the uterine pharynx, formation of the fetal bladder.

From the obstetric history it is known that these births are the first. pregnancy obstetric birth

Estimated due date:

Urgent birth: due date at the last menstrual period is 06/18/13.

Birth management plan, rationale, birth prognosis:

Childbirth is managed conservatively with the use of antispasmodics and analgesics. Carry out prevention intrauterine hypoxia fetus and bleeding during childbirth. Delivery should be carried out with a functional assessment of the pelvis.

Considering that the fetus is in an anterior occipital presentation and the size of the mother's pelvis corresponds to the size of the fetus, we can predict a normal course of labor.

Progress of labor (16.03.13)

1.1st stage of labor (dilation period)

Management tactics: Active monitoring of the mother’s condition (color of the skin and visible mucous membranes, pulse, blood pressure, function Bladder and intestines; when pouring out amniotic fluid determine their quantity, color, transparency, smell, and conduct a vaginal examination) and the fetus (listen to the fetal heartbeat every 15 minutes, observe the nature of the insertion of the fetal head - this can be determined by external palpation techniques, during vaginal examination, listening to the fetal heartbeat, ultrasound examination) .

The bladder must be emptied, since overfilling it can interfere with the normal course of labor.

Pain relief for childbirth: Sol. Promedoli 1% 1-2 ml subcutaneously.

Prevention of vomiting: Seduxen 5-10 mg.

:40 - the amniotic fluid was opened, the amniotic fluid was clear. General state satisfactory, no headache, clear vision. Pulse - 76 per minute, blood pressure - 120/80 mm Hg. Art. Contractions in 4-5 minutes for 35 seconds. The fetal head is pressed against the entrance to the pelvis. The fetal heartbeat is clear, rhythmic, up to 136 beats per minute. Dilation 4cm.

Vaginal examination:

Indication: rupture of amniotic fluid.

Data: the cervix is ​​smoothed, the edges are of medium thickness, soft, the opening of the pharynx is 4-5 cm. Amniotic sac No. The head is pressed against the entrance to the pelvis.

Diagnosis: 1st stage of 1st term labor, cephalic presentation, large fetus, rupture of amniotic fluid. Complicated obstetric history.

Conclusion: continue conservative management of labor.

:40 - General condition is satisfactory, headache does not hurt, vision is clear. Pulse - 76 per minute, blood pressure - 120/80 mm Hg. Art. Contractions every 3 minutes, 40 seconds. The fetal head is pressed against the entrance to the pelvis. The fetal heartbeat is clear, rhythmic, up to 136 beats per minute. Cervical dilatation is 7cm.

2.II stage of labor (period of expulsion)

Tactics: Enhanced monitoring of the condition of the mother in labor and the birth canal. After each attempt, be sure to listen to the fetal heartbeat, since during this period it occurs more often acute hypoxia fetus and intrauterine death may occur.

The advancement of the fetal head during the expulsion period should occur gradually, constantly, and it should not stand in the same plane in a large segment for more than an hour. During the eruption of the head, they begin to provide manual assistance. When extending, the fetal head puts strong pressure on the pelvic floor, and it is greatly stretched, and a rupture of the perineum may occur. On the other hand, the fetal head is subjected to strong compression from the walls of the birth canal, the fetus is exposed to the threat of injury - impaired blood circulation to the brain. Providing manual assistance during cephalic presentation reduces the possibility of these complications.

Manual aid for cephalic presentation is aimed at protecting the perineum. It consists of several moments performed in a certain sequence.

The first point is to prevent premature extension of the head. The head, erupting through the genital slit, should pass its smallest circumference (32 cm), drawn along a small oblique dimension (9.5 cm) in a state of flexion.

The person delivering the baby stands to the right of the woman in labor, places the palm of his left hand on the pubis, and places the palmar surfaces of four fingers on the head, covering its entire surface emerging from the genital slit. Light pressure delays the extension of the head and prevents its rapid movement along the birth canal.

The second point is to reduce perineal tension. To do this, the right hand is placed on the perineum so that four fingers are pressed tightly to the left side of the pelvic floor in the area of ​​the labia majora, and thumb- To right side. The soft tissues are carefully pulled with all fingers and moved towards the perineum, thereby reducing the tension of the perineum. The palm of the same hand is used to support the perineum, pressing it against the erupting head. The excess soft tissue reduces perineal tension, restores blood circulation and prevents rupture.

The third point is the removal of the head from the genital slit without pushing. At the end of pushing with the thumb and forefinger right hand The vulvar ring is carefully stretched over the erupting head. The head is gradually removed from the genital slit. At the beginning of the next attempt, the stretching of the vulvar ring is stopped and the extension of the head is again prevented. This is repeated until the head approaches the genital slit with its parietal tubercles. During this period, the perineum sharply stretches, and there is a danger of its rupture.

The fourth point is the regulation of pushing. The greatest stretching and the threat of rupture of the perineum occurs when the head in the genital fissure is located by the parietal tubercles. At the same moment, the head experiences maximum pressure, creating a threat of intracranial injury. To avoid injury to the mother and fetus, it is necessary to regulate pushing, i.e. turning them off and weakening or, conversely, lengthening and strengthening them. This is done as follows: when the fetal head is positioned by the parietal tubercles in the genital fissure, and the suboccipital fossa is located under the pubic symphysis, when pushing occurs, the woman in labor is forced to breathe deeply in order to reduce the force of pushing, since pushing is impossible during deep breathing. At this time, both hands delay the advancement of the head until the contraction ends. Outside the attempt, with the right hand they squeeze the perineum above the fetal face in such a way that it slides off the face, with the left hand they slowly lift the head up and straighten it. At this time, the woman is asked to push so that the birth of the head occurs with low tension. Thus, the person leading the labor with the commands “push” and “don’t push” achieves optimal tension of the perineal tissues and the successful birth of the densest and largest part of the fetus - the head.

The fifth moment is the release of the shoulder girdle and the birth of the fetal body. After the birth of the head, the woman in labor must push. In this case, an external rotation of the head occurs, an internal rotation of the shoulders (in the first position, the head turns towards the opposite position - towards the mother’s right thigh, in the second position - towards the left thigh). Usually the birth of the shoulders occurs spontaneously. If this does not happen, then the head is grabbed with the palms in the area of ​​the right and left temporal bones and cheeks. The head is easily and carefully pulled downwards and backwards until the anterior shoulder fits under the symphysis pubis. Then with the left hand, the palm of which is on the lower cheek, they grab the head and lift its top, and with the right hand they carefully remove the back shoulder, moving the perineal tissue from it. The shoulder girdle was born. Midwife introduces index fingers hands from the back of the fetus in armpits, and the torso is lifted anteriorly (up onto the mother’s stomach). The child was born.

To prevent bleeding, administration of methylergotomine is indicated before the appearance of the parietal tubercles of the fetal head (causes contraction of the uterus, which helps stop bleeding).

Depending on the condition of the perineum and the size of the fetal head, it is not always possible to preserve the perineum and it ruptures. Considering that an incised wound heals better than a lacerated one, in cases where there is a threat of rupture, a perineotomy or episiotomy is performed.

:30 - General condition is satisfactory, headache does not hurt, vision is clear. Pulse - 76 per minute, blood pressure - 120/80 mm Hg. Art. Push every 1-2 minutes for 50 seconds. The fetal head in the pelvic cavity. The fetal heartbeat is clear, rhythmic, up to 130 beats per minute.

:55 - A live, full-term boy was born without visible malformations. Weight - 3680 g, height - 52 cm, head circumference - 34 cm, chest circumference - 32 cm. Apgar score at the 1st minute - 7 points, at the 5th minute - 8 points. The integrity of the soft birth canal is not compromised.

3.III stage of labor (afterbirth period)

Management tactics: Wait and see. Active monitoring of the woman in labor: skin should not be pale, pulse should not exceed 100 beats per minute, blood pressure should not decrease by more than 15-20 mm Hg. Art. compared to the original one. Monitor the condition of the bladder; it must be emptied, because... an overfilled bladder prevents uterine contraction and disrupts the normal course of placental abruption.

Signs of placental separation:

1.The placenta has separated and descended into the lower part of the uterus, the fundus of the uterus rises above the navel, deviates to the right, the lower segment protrudes above the womb (Schroeder's sign).

.A ligature placed on the umbilical cord stump at the genital fissure, when the placenta is separated, lowers by 10 cm or more (Alfeld sign).

.When pressing with the edge of the hand above the womb, the uterus rises up, the umbilical cord does not retract into the vagina if the placenta has separated, the umbilical cord is retracted into the vagina if the placenta has not separated (Kustner-Chukalov sign).

.The woman in labor takes a deep breath and exhales if, when inhaling, the umbilical cord does not retract into the vagina, therefore, the placenta has separated (Dovzhenko’s sign).

.The woman in labor is asked to push: with a detached placenta, the umbilical cord remains in place; and if the placenta has not separated, the umbilical cord is retracted into the vagina after pushing (Klein's sign).

The correct diagnosis of placental separation is made based on the combination of these signs. The woman in labor is asked to push, and the placenta is born. If this does not happen, then external methods of removing the placenta from the uterus are used:

1.Abuladze's method (strengthening the abdominals). The anterior abdominal wall is grasped with both hands in a fold so that the rectus abdominis muscles are tightly grasped with the fingers, the discrepancy of the abdominal muscles is eliminated, and the volume of the abdominal cavity is reduced. The woman in labor is asked to push. The separated afterbirth is born.

.Genter method (imitation ancestral forces). The hands of both hands, clenched into fists, are placed with the back surfaces on the fundus of the uterus. Gradually, with downward pressure, the placenta is slowly born.

.The Crede-Lazarevich method (imitation of a contraction) may be less gentle if the basic conditions for performing this manipulation are not met. The conditions are as follows: emptying the bladder, bringing the uterus to the midline position, lightly stroking the uterus in order to contract it. Technique of the method: the fundus of the uterus is grasped with the right hand, the palmar surfaces of four fingers are located on back wall uterus, the palm is at the bottom of it, and the thumb is on the front wall of the uterus; at the same time, use the whole hand to press the uterus towards the pubic symphysis until the placenta is born.

It is necessary to examine the afterbirth and soft birth canal. To do this, the placenta is placed on smooth surface maternal side up and carefully examine the placenta; the surface of the lobules is smooth and shiny. If there is any doubt about the integrity of the placenta or a defect in the placenta is detected, then a manual examination of the uterine cavity is immediately performed and the remnants of the placenta are removed.

When examining the shells, their integrity is determined, whether they pass through the shells blood vessels, as happens with an additional lobule of placenta. If there are vessels on the membranes, they break off, therefore, the additional lobule remains in the uterus. In this case they also produce manual release and removal of the retained additional lobule. If torn membranes are found, it means that their fragments lingered in the uterus. The closer to the placenta the rupture of the membranes, the lower the placenta was attached, the greater the danger of bleeding in early postpartum period. In the absence of bleeding, the membranes are not artificially removed. After a few days they will come out on their own.

Women in labor in the afterbirth period are not transportable.

Examination of the external genitalia is carried out on the delivery bed. Then, in a small operating room, all primiparous and multiparous women are examined using vaginal speculums, the vaginal walls and cervix. Detected tears are sutured.

:10 - The general condition is satisfactory, the head does not hurt, vision is clear, the skin and visible mucous membranes are of normal color and moisture. Pulse - 76 per minute, blood pressure - 110/70 mm Hg. Art. The afterbirth separated and was born on its own after 15 minutes, intact, all membranes, umbilical cord 60 cm, total blood loss 150 ml. The integrity of the soft birth canal is not compromised. The uterus is dense, painless, moderate bleeding, urine is light.

Duration of labor by period and in general:

The duration of labor is 6 hours 10 minutes, which corresponds to the normal period. The second period is 5 hours (fast). The second period is 25 minutes (normal). The second period is 15 minutes (normally up to 40 minutes).

The mechanism of these births, described point by point:

The first moment is flexion of the head. At the end of the opening period, the head stands at the entrance of the pelvis so that the sagittal suture is located in the transverse or slightly oblique dimension of the pelvis. During the period of expulsion, the pressure of the uterus and abdominal press is transmitted from above to the pelvic end, and through it to the spine and head of the fetus. The back of the head drops, the chin approaches chest, the small fontanel (wire point) is located below the large one.

As a result of flexion, the head enters the pelvis smallest size, namely small oblique (9.5 cm) instead of the straight size (12 cm) with which it was installed earlier.

The second point is the internal rotation of the head with the back of the head anterior, or correct rotation. The head makes translational movements forward (lowers) and simultaneously rotates around the longitudinal axis. In this case, the back of the head (and the small fontanel) turns anteriorly, and the forehead (and large fontanel) - posteriorly. The sagittal suture, located in the transverse (or slightly oblique) size of the entrance to the pelvis, gradually changes position. When the head descends into the pelvic cavity, the sagittal suture becomes oblique (the first position is the right oblique). At the outlet of the pelvis, the sagittal suture is installed in its direct size.

The third point is extension of the head. When the flexed head reaches the pelvic outlet, it encounters resistance from the pelvic floor muscles. Contractions of the uterus and abdominal press direct the fetus downwards. The pelvic floor muscles resist the movement of the head in this direction and contribute to its deflection anteriorly (upward). Under the influence of these two forces, the head extends, which is facilitated by the shape of the birth canal. Extension of the head occurs after the area of ​​the suboccipital fossa comes close to the pubic arch. The head extends around this fulcrum. During extension, the parietal region, forehead, face and chin appear successively from the genital fissure, i.e. the entire head is born (with a plane passing through the small oblique size, the circumference of which is 32 cm).

The fourth point is the internal rotation of the body and external rotation of the head. The shoulders, with their transverse size, fit into the transverse or slightly oblique size of the pelvis; in the pelvic cavity the rotation of the shoulders begins and they become oblique. At the bottom of the pelvis they are installed in the direct size of the pelvic outlet (one shoulder - to the symphysis, the other - to the sacrum). The rotation of the shoulders is transmitted to the head, when they are installed in the direct size of the pelvic outlet, the face turns towards the mother's hip. After the birth of the shoulder girdle, the remaining parts of the fetus are expelled. This happens quickly and without obstacles, since the fetal body, less voluminous compared to the head and shoulder girdle, passes through the birth canal, maximally expanded by the head in front.

Newborn:

Gender - boy, weight - 3680 g, head circumference - 34 cm, head shape - dolichocephalic, chest circumference - 32 cm, which corresponds to the mechanism of childbirth.

primary toilet of the newborn and primary treatment of the umbilical cord:

The umbilical cord is wiped with a sterile swab soaked in 96% alcohol and crossed between two clamps at a distance of 10-15 cm from the umbilical ring. The end of the newborn's umbilical cord together with the clamp is wrapped in a sterile napkin. The eyelids are wiped with sterile swabs. Blenorrhea is prevented: the lower eyelid of each eye is pulled back and 1-2 drops of a 30% solution of albucid or a freshly prepared 2% solution of silver nitrate are instilled onto the everted eyelids with a sterile pipette. Areas of skin densely covered with cheese-like lubricant are treated with a cotton swab soaked in sterile petroleum jelly or sunflower oil.

Condition of the postpartum woman in the first two hours after birth:

The general condition is satisfactory, the head is not dizzy or painful, vision is clear, the skin and visible mucous membranes are of normal color and moisture. Pulse - 76 per minute, blood pressure - 110/70 mm Hg. Art., heart sounds are clear, rhythmic. The integrity of the tissues of the soft birth canal is preserved, there is no bleeding.

Forecast of the postpartum period:

Considering the normal course of labor and the early postpartum period (in the first 2 hours), the absence of complications in these periods, and birth healthy child, the postpartum woman should be considered practically healthy, but she needs a special regime that will create conditions for the correct involution of the genital organs, healing of microtraumas and normalization of the function of all organs and systems. The main points of this regime are the prevention of infectious diseases (compliance with asepsis, antiseptics, toilet of the external genitalia, antibiotic therapy), constant monitoring of the condition of vital organs and body systems, proper nutrition, caring for the postpartum woman, etc. Only if all these points are observed, is it possible to quickly restore the postpartum woman’s body and preserve her health. Destination:

1.Table No. 15

.Toilet external genitalia

.Tab. Analgini 0.5 for pain

.Oxytocini 1.0 ml x 2 times a day

.Blood and urine tests

Based on the data obtained during childbirth and the early postpartum period, I make a final diagnosis: 1st pregnancy, 40 weeks, occipital presentation, first position, anterior view, large fetus. Complicated obstetric history.

Expanded epicrisis:

Full name, born in 1986, entered the maternity hospital No. 5, March 11, 2013 at 9:10 a.m. with complaints of periodic pain in the lower abdomen and swelling in the lower extremities. Based on complaints, medical history, general examination, external obstetric examination, vaginal examination, a preliminary diagnosis was made: 1st pregnancy, 40 weeks, occipital presentation, first position, anterior view, large fetus. Complicated obstetric history.

Based on the diagnosis, conservative labor management tactics were chosen.

In the first stage of labor, in the conditions of the prenatal room, active monitoring of the condition of the woman in labor and the fetus was carried out, anesthesia was performed as indicated, and a vaginal examination was performed as indicated (rupture of amniotic fluid).

In the second period, monitoring of the condition of the mother and fetus was intensified, obstetric care was provided to protect the perineum, and prevention of bleeding and intrauterine fetal hypoxia. A live boy was born without visible malformations, weighing 3737 g, height - 52 cm. The soft tissues of the birth canal were examined.

In the third period, active expectant monitoring of the woman in labor continued in order to timely identify signs of bleeding, delayed separation of the placenta and birth of the placenta, and provide appropriate obstetric care. The soft tissues of the birth canal were examined.

During the first two hours of the postpartum period, the postpartum woman was under close medical supervision in order to timely identify complications and provide appropriate preventive and therapeutic measures. The soft tissues of the birth canal were examined.

Pregnancy is a difficult period for many women, associated with difficult pregnancy, worries and worries, unstable emotional state. In addition, doctors often scare expectant mother the diagnoses given to her. In exchange cards you can sometimes find an abbreviation such as OAA during pregnancy. What is it and how scary is it? You will find answers to these questions in the article.

TAA during pregnancy: explanation

The abbreviation “OAA” means “complicated obstetric history.” Let's break it down piece by piece. Anamnesis is the history of the disease from its onset to the visit to the doctor. But pregnancy is not a disease, but a condition. Therefore, in this area, obstetric history is everything that is interconnected with other pregnancies and their course. What does the word “burdened” mean? Previously, there could have been some that had an impact on the bearing of the unborn baby and a successful delivery.

What does OAA refer to?

We learned a little about the concept of OAA during pregnancy. We know the decoding, but the essence is not yet entirely clear. This term includes:

• abortions;
• miscarriage;
• childbirth that occurred prematurely;
• the birth of a child with various defects, malnutrition;
• stillbirth;
• early placental abruption;
• abnormalities of placenta attachment;
• birth canal injuries;
• adhesions, scars;
• narrowness of the pelvis;
• fetal asphyxia;
• condition of other children after birth;
• congenital defects and complications in previous children;
• other complications.

These factors have a huge impact on the course of subsequent pregnancies and their outcome, and therefore must be taken into account by the doctor in order to reduce possible risks to the maximum.

There is a concept similar to OAA - OGA, which means “burdened gynecological history.” It includes everything related to a woman’s health in terms of gynecology: the course menstrual cycles, malfunctions in them, sexually transmitted diseases. The concept of OGA is closely related to OAA, which is why they are often referred to in the general terms “complicated obstetric and gynecological history.”

It should be noted that the diagnosis of OAA during pregnancy (what it is, we explained above) is given to many women. So in Russia their number is approximately 80 percent. High probability is unfortunately not uncommon.

How to minimize risks?

Since TAA is directly related to the health status of the pregnant woman, it is first of all necessary to prepare for the new expectation of a child in advance. There is special preconception preparation for such women, which can be completed without OAA, but in this case it will be simpler.

OAA during pregnancy - what is it and how to minimize risks? With this diagnosis, a woman must undergo a number of examinations, as well as preventive measures:

• Be examined for infections, and if they are detected, be cured.
• Examine hormonal background and adjust it if necessary.
• Treatment of diseases associated with pregnancy various systems and many others.

Thanks to such methods, the risk of possible involuntary termination of pregnancy is significantly reduced and the health of the expectant mother is maintained.

In addition, if a woman knows that she has OAA, then it is important to register as early as possible, since lost time can affect the preservation of the child’s life and its proper development.

The doctor should be aware of everything that concerns the health of the pregnant woman. It happens that a woman previously terminated her pregnancy by medication or there was a miscarriage for some reason. In this case, during a new pregnancy, these factors may still remain. Moreover, termination of pregnancy causes trauma to the uterus. Therefore, we cannot exclude the presence and influence of such factors on new pregnancy.

Also, the presence of complications in previous pregnancies may be due to the fact that there were features in the structure of the organs that cannot be changed.

Measures being taken

Do you have OAA during pregnancy? How to treat? In this matter, you need to completely trust your doctor and strictly follow his instructions. Knowing that the pregnant woman has had OAA in the past, the specialist must take the necessary measures to prevent possible complications. To do this, the following is done: the risk group is determined, individual measures are selected to accompany pregnancy. In some cases, for example, a woman needs to be hospitalized at certain times when there is the greatest likelihood of risks. In addition, women with OAA are most often hospitalized two weeks before the upcoming birth.

Unfortunately, many women do not tell their doctor that they have previously had an abortion or miscarriage. Specialist without knowing about similar phenomena, may underestimate possible risks, and the consequences in the future will be disastrous. It is best to tell your doctor everything.

C-section

For women expecting a second child, cesarean section during the first pregnancy is also a risk factor, since it leaves a scar. Moreover, it is possible that this could lead to the death of both the baby and his mother.

After operations on the uterus, a cesarean section is indicated for subsequent births, because in this case the passage of the child through the natural birth canal is risky. Throughout pregnancy, it is filled out by specialists. exchange card, anamnesis and medical history are carefully studied, and the presence of unfavorable heredity is determined. All this information serves to make a decision about what kind of childbirth will be: natural or by cesarean.

Often, a second pregnancy can end tragically just like the first: intrauterine death child for some reason. Medical staff must identify possible ongoing pathological processes and take all measures to prevent a tragic outcome. In order to avoid possible dire consequences, you need to plan your pregnancy in advance.

Child health and OAA

Do you have OAA during pregnancy? What is it and how can it affect the child’s health? This diagnosis can have a significant impact on the baby’s health. For example, the presence of infectious diseases of the genital tract, due to which this diagnosis was made, can lead to infection of the child during childbirth. But if the doctor is a competent specialist, then this simply cannot happen.

It is also necessary to remember that hereditary factors can have a huge impact on bearing a child. A pregnant woman with diseases such as hypertension and diabetes can pass them on to her daughter, for whom they will become a real problem when she is expecting her child.

OAA itself is not hereditary. However, often hereditary diseases may appear precisely during the period of waiting for a child. Therefore, at the stage of pregnancy planning, you need to know well detailed information about the health of relatives. It doesn’t hurt to undergo genetic testing.

Emotional mood

Women with OAA during/during pregnancy are at risk for possible complications during pregnancy and childbirth. But this is connected not only with physiology. Such women have a completely different attitude towards a new pregnancy than women with a favorable history.

Such pregnant women must attend a variety of preventive and therapeutic measures held in antenatal clinic and hospital.

It must be remembered that OAA during pregnancy is not a death sentence, but rather an indication to the doctor to choose the right path. There is no need to be alarmed if the abbreviation OAA appears on the card. It is quite possible that there will be no complications during pregnancy. But if the doctor does not know about OAA, risks are most likely to arise.

Do you have OAA during pregnancy? What it is, you now know. Now there is no need to panic, it is better to listen to some advice. For the correct and full development of pregnancy, it is necessary to attend consultations with specialists, follow all recommendations and prescriptions prescribed by them, and lead a correct lifestyle. It is important not to miss appointments with the doctor, and also to tell him truthfully all the necessary information so that the unborn baby is born healthy.

A lot depends on the mother herself, so every effort must be made to ensure that the pregnancy proceeds easily and the upcoming birth is successful.

Concerns information related to previous pregnancies and childbirth.

An obstetric examination is the process of examining a pregnant woman or a woman in labor, which includes an objective examination, collection of anamnesis data, clinical, laboratory serological and biological studies and other special methods of obtaining data.

Questions to obtain medical history information

The obstetric history should include the following information:

1. Full name of the patient, her residential address.
2. Age group. The most favorable and suitable age for bearing the first child from 18 to 26 years. The first birth over the age of 26 takes longer and is often accompanied by a primary or secondary form of labor weakness, so perineal rupture may occur.
3. Profession, namely character labor activity, sanitary and hygienic working conditions, length of the working day and the presence of harmful factors.
4. Living conditions - the nature of housework, food, rest, addictions.
5. Past pathologies. Data on past pathologies greatly simplifies the formulation of a correct prognosis for childbirth and the identification of negative changes in the pelvis.
   • The consequence of rickets is a flat-rachitic pelvis, tuberculosis of the hip or knee joint, and injury to the bones of the legs. All these factors become the causes of pelvic defects. Scarlet fever, tonsillitis, diphtheria, influenza, rheumatism of the joints, pneumonia, suffered in childhood or puberty, can be complicated by damage to the kidneys and heart. Liver and other organs and systems. Such complications often cause the development of toxicosis during pregnancy, worsening obstetric and prognosis for the upcoming birth. It is important to consider whether the patient suffered from gynecological pathologies and whether she underwent surgery on the vagina, uterus and perineum.
6. Menstrual functions. The timing and nature of the formation of menstruation is also taken into account in the situation when an obstetric history is collected. The normal menstrual cycle is characterized by a strict rhythm and a specific duration of three to five days, moderate blood loss and painless occurrence.

   • It is important! Late start the first menstruation or its prolonged absence indicates developmental deficiency female body. Women with this pathology may experience weakness in labor, uterine atony, as well as complications that correlate with too much narrow pelvis. It is important to establish changes in menstrual function after marriage, abortion, childbirth, and the timing of the last menstruation, when the expected date of birth of the child is calculated.

7. Sex life of a woman. It is not recommended to have sexual intercourse in the first trimester of pregnancy, as the risk of miscarriage increases, as well as in the last two months of bearing a child, especially right before childbirth, as there is a risk of infection or premature birth.
8. Generative functions - information about the course of the disease and the results of each pregnancy, childbirth, and postpartum rehabilitation.
   • The nature of the complications received during past pregnancies and childbirths is premature breaking of waters, premature labor, too long labor, weakness during labor, bleeding and operations such as fetal rotation, fetal extraction, cesarean section, etc.
   • Numerous abortions preceding childbirth can negatively affect the course of pregnancy, provoke complications during childbirth, after childbirth and in the early postpartum period, for example, atonic or hypotensive bleeding. It is necessary to clarify the weight of the child and his vital activity during previous births, taking into account the fact that the weight of the newborn with each subsequent birth increases slightly.

   • It is important! A timely established complicated obstetric history gives the specialist the opportunity to exercise caution and carry out some treatment and preventive measures in a timely manner, namely, hospital treatment, prevention of fetal asphyxia, and bleeding in the postpartum period.

9. The course of a real pregnancy is the presence of nausea with vomiting at the beginning of pregnancy, the presence of swelling and the time of its formation, its localization and extent, the normal functioning of the bladder and intestines.
   • If the first examination of a pregnant woman is carried out only in the second half of pregnancy, then the doctor should familiarize herself with the data of urine tests, identify blood pressure indicators, and establish the position and beating of the fetal heart during pregnancy. Much attention should be paid to the woman’s complaints of headaches, blurred vision, increased swelling, and increased blood pressure. The described set of symptoms when protein is detected in the urine and an increase in blood pressure indicates toxicosis. At the same time, the doctor determines whether the woman applied for consultation, finds out information about the organization of treatment and preventive measures, when fetal movement was first detected, and the passage of mental and physical preparation for the birth of a child.

The importance of anamnesis

Obstetric history plays a role important role for the current pregnancy. An example of an obstetric history has not received official recognition in medicine, but any obstetrician will not deny the high significance of such information.

A burdened obstetric history may include the following conditions:

• presence of complicated childbirth in the woman’s past;
• single or multiple births;
• miscarriages;
• abnormal fixation of the placenta and its too early detachment;
• injury to the birth canal;
• the presence of adhesions on the fallopian tubes;
• presence of scars on the uterus;
• the presence of a threat of uterine rupture;
• specific anatomical structure - too narrow pelvis;
• fetal asphyxia if the umbilical cord is wrapped around the child’s neck;
• stillbirth.

All of these factors influence subsequent pregnancies and their course. In addition, perinatal mortality of newborn children, the health of previous children, their birth injuries and the presence of congenital anomalies also affect obstetric history.

Such features must be taken into account in order to minimize the risk of developing pathology in the next child. When considering a caesarean section, the doctor should base his or her opinion on fetal x-rays.

It is important!

Timely identification of the causes of stillbirth and death of a child during the perinatal period makes it possible to influence subsequent pregnancies and births.

Often, stillbirth and congenital developmental anomalies have several causes: intracranial injury during birth with a large fetus in a woman in labor with a narrow pelvis, incompatibility of the woman and child with respect to the Rh blood factor. The birth of a child in adulthood when the newborn’s body is affected by hemolytic disease.

Before carrying out diagnostic measures, doctors try to obtain as much information as possible from the patient himself. This helps not only to guess possible diagnosis, it and establish the scale of the upcoming surveys. The totality of the data obtained is referred to as “history”. What it is and why it is needed is unknown to many patients.

History - what is it in medicine?

To understand what the word “history” means in medicine, you can consult a dictionary of medical terminology. This definition is usually used to denote the totality of all information about the patient and his diseases, which was obtained by interviewing the patient himself and his relatives and loved ones. The information obtained as a result is used to determine the cause of the disease, make a diagnosis and for the purpose of further choosing a method of treatment and prevention.

The method of interviewing patients was purposefully developed and introduced into clinical practice by the following well-known medical figures: Zakharyin, Mudrov, Ostroumov. Even in modern medicine anamnesis continues to occupy a leading position in the process of obtaining information about the disease and the patient’s health status. It is given paramount importance in the process of diagnosing mental illnesses and a number of somatic diseases.

Uncomplicated anamnesis

Having understood the term anamnesis and what it is, it is necessary to highlight its main forms. When collecting information about the patient and further making a diagnosis, doctors pay attention to the features of the medical history. Doctors talk about such a variety as an uncomplicated anamnesis if the patient has no symptoms.

Chronic inflammatory and infectious processes in the body, the patient’s water-salt balance is normal. In other words, an unburdened history is the complete absence of prerequisites for the development of the alleged pathology. IN clinical practice This is rare, since the disease is almost always the result of a disorder or malfunction in the human body.

Aggravated medical history

Doctors use the term “complicated anamnesis” when the patient’s history contains information about the presence of other pathologies that affect the outcome of the underlying disease. The term “complicated obstetric history” is often used - it is applicable to a situation where there is a serious threat to the process intrauterine development fetus and normal delivery. IN obstetric practice This anamnesis is used based on the presence of concomitant problems that occurred during previous gestations:

Anamnesis of life

Anamnesis of this type is practically the entire life history of the patient. The life history includes information about the physical, mental and social development of the subject. The amount of information received varies and depends directly on the conditions in which medical care is provided. When emergency conditions Doctors find out only the basic points that are necessary for diagnosis and treatment. The more details the life history contains, the more better doctor can understand the patient and his individual characteristics.

Having this information, doctors are able to accurately diagnose, make a prognosis regarding the identified disease, and give individual recommendations regarding the prevention of complications. Among the basic information obtained during the collection of a life history:

• features of mental and physical development;
• living conditions and characteristics of family life;
• bad habits;
• past illnesses;
• allergy history.

Family history

Family or genealogical history– information about the patient regarding the composition of his family, the situation in it, and the diseases of its individual members. The family history contains information about the age of the patient’s parents, the characteristics of their profession, and the financial condition of the family. Information is collected in detail about each family member:

• when and what childhood diseases did he suffer from;
• how many children are in the family;
• developmental characteristics of each child.

Such an anamnesis may also contain information about visits to preschool institutions, school, features of the daily routine, academic performance and additional loads. A complete picture helps to identify all predisposing factors to the development of a particular pathology. Special attention is paid to identifying hereditary diseases.

Medical history

When doctors compile a medical history, anamnesis is always one of its first components. Specialists collect information about the occurrence and course of the disease. Cases have been established when the pathology does not manifest itself in any way after the appearance of the first symptoms, but then a complication develops, which experts mistakenly mistake for the onset of the disease. Separately install:

• sequence of complaints;
• features of the onset of the disease.

The information obtained gives reason to suspect whether a malignant process is observed, an acute disease or a chronic pathological process. Given this option, doctors first try to establish the causative factors and circumstances contributing to the development of the disease. Then they pay attention to the reason that served as the basis for contacting doctors. The medical history details:

• sequence of the disease;
• changes in subjective and objective information about the disease;
• the presence of periods of remission and their duration.

Gynecological history

Girls visiting a gynecologist for the first time are unfamiliar with the term anamnesis: what it is in gynecology and what it is used for is unknown to them. This type of information is obtained directly from the patient herself. The questions asked by the doctor concern the woman’s reproductive function. The specialist determines the nature of menstruation, its frequency, and the volume of discharge. He also pays attention to the presence of abortions or miscarriages in the past. The gynecological history contains information about past gynecological diseases, the time of menopause and menopause.

Obstetric history

Obstetric medical history is an integral part of the life history, which contains information regarding the generative function of the female body. Doctors determine the number of pregnancies, the characteristics of their course and the process of delivery, and the nature of the complications that have arisen. Pay attention to:

• pregnant woman's regime;
• number of births in the past;
• for what and for what duration was treatment carried out.

Later they find out:

• whether the pregnancy ended at term;
• whether the baby was not full term or was born later due date;
• what kind of maternity benefit was used.

Allergy history

This type of history includes information about identified allergic diseases the patient and his relatives. Allergic reactions can develop when the body is exposed to a wide range of allergens. Thus, the pharmacological and allergological history contains information about the patient’s intolerance to certain groups of drugs. If possible, determine the type of allergen. When compiling an anamnesis, the observed manifestations of allergies are clarified:

• hives;
• swelling of the mucous membranes of the nose.

Psychological history

The psychological history contains full information regarding the characteristics of the patient’s mental development, his heredity. Experts pay attention to:

• personality type;
• features of professional activity;
• range of interests of the patient.

Special attention is paid to family relationships - misunderstanding, lack of constant contact with loved ones can lead to the development serious pathologies psyche. It is worth noting that psychological history can be subjective and objective.

Doctors pay much attention to the second type of medical history. This is due to the peculiarities of the development of the pathology: the patient, due to his illness, cannot normally interpret what happened to him in the past. During the survey, doctors should carefully examine hereditary burden:

• mother's condition during pregnancy;
• features of the birth process;
• early delivery;
• physical and .

How is anamnesis collected?

Young specialists who know almost everything about anamnesis: what it is, what it is needed for, do not always know how to collect it correctly. Anamnesis is collected taking into account the rules of deontology. During this procedure, the doctor should try to achieve mutual understanding in communication with the patient.

The dialogue should be built on trust - this way the specialist will be able to collect more valuable information that patients are not always ready to share. Professionals must ensure compliance medical confidentiality Therefore, history taking is carried out in the absence of other patients. First, the doctor listens to the patient, recording everything he says, and then begins to ask questions.

Anamnesis data

Before collecting anamnesis, doctors conduct a thorough examination of the patient. This suggests the type possible pathology, which determines the nature and number of questions addressed to the patient. The list of specified parameters may change. However, there are a number of questions that the specialist asks all patients. The information obtained is entered into the medical history.

Case history - example

A correctly collected anamnesis (we have already found out what it is) helps to make a preliminary diagnosis. The patient's medical history is included in his medical history.