1
MINISTRY OF HEALTH PROTECTION UKRAINE
BUKOVINA STATE MEDICAL UNIVERSITY
IT IS «RATIFIED»
on the methodical meeting of department
obstetrics and gynaecology with a course
child's and juvenile gynaecology of БДМУ
“___”_____________2009
protocol №____
The Head of department docent S.P. Polova
METHODICAL INSTRUCTIONS
for practical lesson
«Unmaturing of pregnancy»
MODULE 2: Pathological motion of pregnancy, births and puerperium
SEMANTIC MODULE 3: Pathological motion of pregnancy, births and puerperium
Educational discipline: Obstetrics and gynaecology
Course 5
Faculty
Speciality
Amount of hours – 4
Made methodical pointing
Doc. Semenyak A. B.
Chernivtci – 2009
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1. Actuality of theme
The problem of the involuntary premature breaking of pregnancy has not only medical but also social value, as
closely associated with the question of fruitlessness, death of fetus, birth of sick children which give high
morbidity and considerable level of child's death rate.
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2. Duration of employment: 4 hours
3. Educational purpose
A student must know:
Classification of involuntary abortions for the term of pregnancy and clinical form.
Classification of premature births.
Reasons involuntary premature breaking of pregnancy and premature births.
Diagnostics of abortions in the early and late terms of pregnancy and premature births.
Treatment of early and late involuntary abortion.
Features of conduct of premature births.
A student must be able:
1. To set reasons the involuntary premature breaking of pregnancy.
2. To diagnose premature births.
3. In good time to conduct prophylactic and medical measures at involuntary abortions premature births.
4. To make the plan of conduct of premature births.
5. To define beginning of the first period of births, objectively to estimate the dynamics of childbirth (degree
of opening of neck of uterus, duration of labor).
6. To estimate partograme.
7. To determine and estimate palpitation of the fetus.
8. To determine beginning of the second period of births, objectively to estimate
the dynamics of
advancement of head of the fetus to the family ways.
9. To give help in births and to conduct the anaesthetizing of births.
10. To demonstrate active tactic of conduct of the III period of births (on a phantom).
11. To demonstrate expecting tactic of conduct of the III period of births (on a phantom).
12. To determine general bleeding in births.
13. To estimate the state of new-born after a scale Аpgar.
14. To draw conclusions (resume) of births.
15. To set maturity of the fetus.
A student must master practical skills:
1. To diagnose reasons of breaking of pregnancy, premature births.
2. To be able to distinguish the periods of breaking of pregnancy, premature births.
3. To be able to diagnose the clinical forms of the involuntary breaking of pregnancy and premature births.
4. To estimate the state of neck of uterus.
5. To be able to apply medical measures at all clinical forms of the involuntary breaking of pregnancy and
premature births.
6. To estimate the results of amnioscopy, amniocentesis, interpretation of KTG, US.
7. Conduct of premature births.
8. Conduct and record of partograme.
4. Base knowledges abilities of skill, that themes necessary for the study (intersubject integration)
Name of previous disciplines
Got skills
Anatomy
To describe the anatomic structure of woman
pelvis, uterus and additions
Physiology
To describe physiology processes in a
womanish organism during births, to give
clinical interpretation to reasons of beginning
of births.
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Pharmacology
To define preparation and to expect a dose for
treatment of breaking pregnancy and
anaesthetizing of births.
5. Advices to the student
5.1. Table of contents of theme
I. DETERMINATION OF CONCEPT, CLASSIFICATION AND FREQUENCY OF UNMATURING
OF PREGNANCY
Unmaturing of pregnancy is the involuntary breaking of pregnancy in a term from conception to 37
weeks.
Involuntary breaking of pregnancy two and more one times successively name the usual unmaturing of
pregnancy. With this problem 1% all women.
Breaking of pregnancy in a term from conception to 22 weeks is named involuntary abortion.
CLASSIFICATION OF INVOLUNTARY ABORTIONS
It is conducted on the basis of different criteria:
1. Term of pregnancy at involuntary abortion:
• early (to 12 weeks)
• late (from 12 to 20 weeks)
2. Clinical form of МВ:
• threatening
• abortion in motion
• incomplete
• complete
• that did not take place
• infected
• usual abortion
Breaking of pregnancy in a term 22-37 weeks name premature births (ПП).
CLASSIFICATION OF PREMATURE BIRTHS
1. Premature births in 22-27 weeks (mass of fetus 500-1000gram, unfavorable prognosis for
fetus).
2. Premature births in 28-33 weeks (mass of fetus 1000-1800 gram, doubtful prognosis for fetus).
3. Premature births in 34-37 weeks (mass of fetus 1900-2500gram, sufficiently favourable prognosis
for fetus).
II. REASONS OF UNMATURING OF PREGNANCY.
Reasons are very varied. They can be divided on follow groups:
А. Social reasons
• unsettled state of domestic life
• extremely high or low age of mother
• low social status
• insufficient feed
• professional to harmfulness
• action of unfavorable terms of external environment
• harmful habits
B. Medical reasons.
1. From the side of fetust:
• genes and chromosomal anomalies
ІІ. From the side of maternal organism:
1. Genetic factors.
2. Features of obstetric-gynaecological anamnesis of mother.
3. Somatic status of woman.
4. Anatomic factors:
• hysteromyoma
• anomalies of structure of uterus
• neck insufficiency
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5. Endocrine violations:
• insufficiency of lutes phase of menstrual cycle
• hyperandrogenia
• violation of lipometabolism
• saccharine diabetes
• parafunction thyroid
6. Factors of inflammatory genesis:
• chronic infections (urinoexcretory, respiratory system)
• infections carried during pregnancy (sharp infections of bacterial and viral genesis of any
localization)
7. Complication of motion of this pregnancy:
• lasted existent threat of breaking of pregnancy
• gestosis
• high water-level
• twice
• anomalies of location of placenta
• anaemias of pregnant
8. Immunological violations, which are characterized by making the organism of mother of the
antibodies directed against its own structure:
• AFS ( antefosfolipide syndrome)
• conflict by system of АВО or factor of rhesus
III. SOME QUESTIONS OF ETIOLOGY AND PATHOGENY OF UNMATURING OF
PREGNANCY
CHROMOSOMAL VIOLATIONS
Possibility to use them for the study of genesis of the involuntary breaking of pregnancy appeared in
connection with development of methods of genetic researches.
On the early stages of development of pregnancy of involuntary abortion it is possible to examine as
adaptation mined-out in the process of evolution, as a result birth of children with abnormal development is
relatively the rare phenomenon.
It is considered during many years, that about 50% cases of the involuntary breaking of pregnancy in
early terms conditioned by chromosomal anomalies. With age a selection weakens, that is why at extremely
high age of parents more frequent there are the anomalies of fetation.
HORMONAL DISFUNCTIONS
In etiology of the involuntary breaking of pregnancy in a 1 trimester hormonal violations in the
organism of mother. From them hypofunction of ovaries and hyperandrodeny different genesis is most
frequently.
Mechanism of breaking of pregnancy at inferiority 2 phases of menstrual cycle related not only to
insufficiency of progesteron which is synthesized in a yellow body, as progesteron is synthesized in chorion,
and in future – in a placenta. Large value in genesis of early abortion is had by insufficient secretory
transformation of endometrium
Insufficiency of lutes phase can be conditioned: to the declines of honadotropin-relisin hormone, FSH
and LH, that results in violation of steroidogenesis in ovaries, and also damage of receptors of еndometrium.
Insufficiency of lutes phase at women with unmaturing of pregnancy can be conditioned by not only an
inferior steroidogenesis but also frequent abortions, chronic endometritis, defects of development of uterus,
infantilism, endometrial synechias.
Early abortion can be predefined by the change of normal correlations of gonadotropic hormones in a 1
phase of menstrual cycle.
Among endocrine reasons of unmaturing of pregnancy a considerable place occupies hyperandrogenia
(21-48%). Reason of unmaturing more frequent is the effaced forms of hyrerandrogenia, which or appear
during pregnancy or they can be diagnosed out of pregnancy by the functional tests of loadings.
Hyperandrogenia of any genesis pregnancy is often complicated by the stop of developmment and
death of fruit. Hyperandrogenia can be over renal (30%), ovaries (12%) and mixed (58%) genesis.
One of endocrine factors of unmaturing can be the parafunction thyroid, both increase and decline.
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Violation of tolerance to glucose (saccharine diabetes) is the most widespread disease of the endocrine
system. Depending on weight of diabetes and adequacy of correction of level of glucose of blood, pregnancy
can make off the involuntary breaking in any terms, and also death of fetus. Diabetes is accompanied by
violation of many aspects of metabolism, and these violations go beyond the scopes of violation only exchange
of glucose
ANATOMIC REASONS
Insufficiency the neck of uterus is principal (to 40%) reason of abortion.
Among women which suffer by unmaturing, the defects of development of uterus meet in 10-15% cases.
In most women with violation of genesial function of defect of development of uterus unite with hypofunction
of ovaries. Hysteromyoma is widespread of high quality tumour to the myometrium, that meets in an obstetric
clinic at the patients of senior genesial age.
FEATURES OF SOMATIC STATUS OF WOMAN
The group of high risk on unmaturing of pregnancy is made by women with the diseases of the vascular
system and another chronic diseases of organism.
COMPLICATION OF THIS PREGNANCY
Among factors which are instrumental in unmaturing of pregnancy, the complications related to
pregnancy take considerable seat: a gestosis, anomalies of attachment, is placentas, premature removing a layer
by the layer of the normally or low located placenta.
IMMUNOLOGICAL ASPECTS OF UNMATURING OF PREGNANCY
Pregnancy from immunological positions is an allotransplant, that has on to a 50% stranger maternal
organism antigens of paternal origin.
INFECTIOUS DISEASES OF MOTHER
Among reasons of unmaturing one of the first places is occupied by the infectious diseases of mother.
At sharp viral infections in mothers in majority there are spontaneous abortions, stillborn, births of children
with anomalies of development. A certain role in unmaturing of pregnancy is had by an infection, that flows
latently, chronic infectious diseases (tonsillitis, pyelonephritis and other) and also urogenital infection.
FACTORS OF EXTERNAL ENVIRONMENT
Risk of ABORTION rises at smoking abuse by an alcohol. The role of caffeine in genesis of abortion
remains doubtful.
IV. CLINIC AND DIAGNOSTICS OF EARLY AND LATE ABORTION
Clinical diagnostics of early and late abortion basis on the following signs:
• confirmation of fact of presence of pregnancy (delay of menstruation, doubtful and reliable signs of
pregnancy)
•
appearance of pain symptom, symptom of pathological (bloody) excretions from sexual ways and
change from the side of body and neck of uterus
Depending on expressed of clinical symptoms distinguish the following stages of the breaking of
pregnancy:
• threatening abortion
• abortion in motion
• incomplete abortion
• complete abortion
At threatening feeling of weight or insignificant pains is marked in lower departments and in the region
of sucrum. Bloody excretions from sexual ways, as a rule, are absent. An uterus is megascopic according to the
term of delay of menstruation, changes from the side of vaginal part the necks of uterus are absent.
Abortion in the motion is characterized by appearance of spasm pains in the lower departments of
stomach, strengthening of degree of expressed of symptom of bloody excretions. The uterus answers on the
sizes of term of delay of pregnancy, vaginal part of neck of uterus is shortened, softened, the channel of neck of
uterus is exposed (a fruit egg can be in a cervical channel, in this connection the lower pole of him can be
accessible for feeling).
Abortion in motion can be completed by incomplete abortion, when a fruit egg is partly outcast from the
cavity of uterus. Placenta stay too long in an uterus. By an important moment for diagnostics of incomplete
abortion there are the anamnestic pointing in the presence of previous (see more high) stages of the wilful
breaking of pregnancy. Clinical picture of incomplete abortion is characterized by the presence of insignificant
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pain that heaves up, in the lower departments of stomach and insignificant moderate bloody excretions, from
sexual ways. The body of uterus is not answer the term of delay of menstruation of term of pregnancy (less).
Patients with complete of abortion, for medical help, as a rule, does not apply. A diagnosis is foreseen
retrospectively throuw on information of anamnesis.
At pregnancy, that does not develop, after death of fruit egg retractive activity of uterus is absent, lost
fruit egg it is not outcast from an uterus, but is added to the second changes.
V. TACTIC OF SUBSEQUENT DIAGNOSTIC AND MEDICAL MEASURES included
• information of obstetric-gynaecological anamnesis of woman
• fact and term of pregnancy
• stages of involuntary abortion
VI. USE OF BRIDLES IN EARLY TERMS AT USUAL UNMATURING OF PREGNANCY
It is thus expedient to draw on трансвагінальне ultrasonic research, that allows to conduct the detailed
analysis of anatomic structure of embryo and structures of fruit egg, necessary for the estimation of character of
motion of pregnancy and drafting of prognosis.
VII. TREATMENT OF EARLY AND LATE INVOLUNTARY ABORTION
The first trimester is a most difficult period and in a great deal determines development of pregnancy.
Most researchers consider that ABORTION in a 1 trimester in 90% cases is the display of natural selection, and
in therapy of early ABORTION include spasmolysants, vitamin therapy, sedative therapy.
TREATMENT OF PREGNANT WITH INSUFFICIENCY of the neck of uterus.
Nosotropic treatment is surgical correction. There are different methods and modifications directed on
narrowing of internal pharynx by imposition of circular stitch. However, in spite of their variety, a question
about the surgical correction not is fully decided. For the surgical correction different modifications of method
of Shirodcar , method of Macdonald and other.
ТOCOLITIC THERAPY FOR TREATMENT OF LATE WILFUL ABORTION
Apply tocolitic (partusisten, bricanil, hinipral) therapy for the correction tone and retractive activity of
myometrium. Depending on the degree of expressed of clinical displays of the wilful breaking of pregnancy,
possibly both parenterally and peroral introduction of tocolitic. How complex therapy of threatening late it
follows to remember ABORTION possibility of parenterally application of sulfate of magnesium (МgSO4),
aspirin, indomethacin.
PREMATURE BIRTHS
Premature births are births with the spontaneous beginning progress of childbirth and birth by fetus
weight more 500 gr in the term of pregnancy from 22 to 37 weeks.
In connection with the features of obstetric tactic and nursing of children which borned at the different
terms of гестації expediently to select such periods:
- 22-27 weeks;
- 28—33 weeks;
- 34-37 weeks pregnancy.
On the modern stage of organization of obstetric help in Ukraine the leadthrough of premature births is
optimum in the specialized obstetric permanent establishments in which terms are for the leadthrough of
intensive therapy and reanimation of new-born.
Expediently providing of rights for woman giving birth in bringing in of near to the presence on births.
Principles of conduct of premature births:
1. Estimation of degree of the forecast risk of development of maternal and fetus pathologies with the
purpose of determination of level of grant of stationary help.
2. Determination of plan of conduct of births and informed concordance of him with a woman.
3. Control after the state of mother and fetus in births with the conduct of partograma.
4. Prophylaxis of respirator distress -syndrome to 34 weeks pregnancies.
5. Anaesthetizing of births after testimonies.
6. Estimation of the state of child, support of thermal chainlet, leadthrough of primary rest room of
new-born, common stay of mother and child from the first hours after birth at nursing of children with small
weight.
Diagnostics and confirmation of births:
Confirmation of births:
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at pregnant after 22 weeks spasm pains appear at the bottom of stomach and sacrum with
appearance of mucous bloody or watery (in the case of effluence of waters round a fetus) excretions from a
vagina:
- presence 1 fights during 10 minutes, that proceeds 15-20 seconds;
- the change of form and location of neck of uterus is progressive shortening of neck of uterus and its
smoothing. Opening of neck of uterus is the increase of diameter of road clearance of neck of uterus, is
measured in centimetres;
- gradual lowering of head of fetus to the small pelvis in relation to the plane of entrance in a small
pelvis (from data of external obstetric research)
Executions sequence at the conduct of premature births
1. During hospitalization of pregnant (woman giving birth) in obstetric permanent establishment in the
receiving-surveying separation (a doctor is the gynaecologist of accoucheur):
- carefully meets with the exchange card of woman in relation to motion of this pregnancy and
supervision of her in womanish consultation. Attention applies on information of general, infectious and
obstetric-gynaecological anamnesis, clinical-laboratory indexes of ambulatory inspection of expectant mother;
- for the estimation of the state of woman giving birth the inspection is carried out: general review,
measuring of temperature of body, pulse, arteriotony, breathing, inspection of internalss after organs and
systems;
- measuring of height of standing of bottom of uterus, circumference of stomach and sizes of pelvis is
carried out. A term concernes pregnancies and date of births, expected mass of fetus:
- it asks about feeling of motions of fetus
by woman, that gives birth and auscultation and
palpitation of fetus is conducted;
- external and internal obstetric research is conducted : position, position and type of position of
fetus, character of sexual activity, opening of neck, concernes uteruses and period of births, finding of head of
fetus in relation to the planes of small pelvis;
- from data of anamnesis, exchange card and results of physical and obstetric inspection
woman giving birth writes down in history of births risk factors and degree of the forecast fetus and
obstetric risk after a scale Copland, sparing attention, above all things, to the factors of risk, the term of
pregnancy, obstetric diagnosis, is set, tactic of conduct of pregnant concernes (woman giving birth);
- to 34 weeks pregnancies at opening of neck of uterus less than 3 sm, tocolis or treatment of threat of
premature births is conducted to absence of аmnionitis, preeclampsia, bleeding, absence of suffering of fetus
(to conduct not tocolis more than 24-48 hours). In 2 hours after the beginning of tocolis to confirm the
diagnosis of premature births by establishment of smoothing, whether opening of neck of uterus. If premature
births make progress - токоліз is abolished. Farther births are conducted on partograma.
The prophylaxis of respirator distress syndrome of fetus is conducted:
- at the threat of premature births by i/m introduction of dexametason for 6 mg every 12 hours on a
course 24 mg, whether betametasone for 12 mg every 24 hours, on a course 24 mg;
- in the case of beginning of premature births of introduction of dexametason of i/m for 6 mg every 6
hours (on a course 24 mg), betametasone for 12 mg in 12 hours (on a course 24 mg) (the repeated courses of
this prophylaxis are not conducted);
- diprospan for 1,7 ml i/m in 24 hours.
Supervision and help of woman giving birth in births
With the purpose of dynamic and evident supervision after motion of births, state of mother and fetus,
and also with the purpose of timely prophylaxis of possible complications the record of partograma is used in
births .
Supervision on the state woman giving includes conservative procedures which are brought by the
gynaecologist of accoucheur to partogroma:
1) The state of fetus is estimated:
- the heart-throbs of fetus are counted up for 1 minute of each 15 minutes during an active phase
and every 5 minutes during the second period of births, these indexes are brought to partpgrama.
- if frequency of heart-throbs of fetus less than 110 or more than 170 shots for a minute, it is
considered as beginning of development of distress fetus.
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2) The common state of mother is estimated:
- it is taken temperature body - every 4 hours; the parameters of pulse concerne - every 2 hours;
arteriotony - every 2 hours; urine - the amount of - every concernes 4 hours;
- the level of albumen and acetone concernes after testimonies;
- breathing character concernes periodically.
3) Efficiency of childbirth it concernes:
- by frequency, duration and intensity of spasm - hourly in a latent phase and every 30 minutes in an
active phase; at normal duration of premature births there is a tendency to the increase of speed of opening of
neck of uterus which in a latent phase is 0,8 sm/hour; in active - 3.5 sm/hour .
- the dynamics of internal obstetric research is every 4 hours;
- by the level of lowering of head of fetus - during the leadthrough of every external and internal
obstetric research .
4) If the break of fruit bubble took place, attention applies on the color of amnion waters:
- the presence of thick meconium testifies to the necessity of careful supervision and possible
interference for the grant of help in the case of distress fetus;
- absence of effluence of liquid after the break of fruit bubble specifies on diminishing of
volume of fetus liquid, that can be related to distress fetus.
Anaesthetizing of births on the concordance of woman
If woman, that gives birth suffers from pain during labor:
- it is psychologically supported and is calmed down;
- it is suggested to change position of body; it is encouraged to active motions; it is offered to the
partner to massage her the back, to hold her arm and to wipe a person by a sponge between the fights; it is
offered to the woman to adhere to the special technique of breathing (deep inhalation and slow exhalation) - in
most cases it diminishes feeling of pain;
Requirements which behave to the medicinal anaesthetizing: anaesthetic an effect, absence of negative
influence on the organism of mother and
fetus, simplicity and availability for all establishments. For
anaesthetizing of births is used no inhalations (systems) and inhalations анестетики, regional anaesthesia.
Systems analgetic is used also to that end (at opening of neck of uterus no more than 5-6 sm).
Narcotic analgetic not used.
Grant of hand help in the II period of births
A right for a woman to choose position which is comfortable is provided in the II period of births, both
for her and for a medical personnel. A medical personnel adopts births in a clean dressing-gown, mask, glasses
and sterile gloves.
In the second period of births the supervision is conducted after the common state of woman giving
birth, haemodynamic indexes (arteriotony, a pulse is every 10 minutes) state of fetus, is control of cardiac
activity of fetus every 5 minutes, by advancement of head of fetus on a maternity channel.
Conduct of the III period of births
With the purpose of bleeding prophylaxis during the first minute after birth of fetus intramuscular 10 is
entered oxitocin.
It is conducted controlled advancement for an umbilical cord only on condition of presence of signs of
separation of placenta from an uterus. Thus one hand carries out the careful controlled sipping for an umbilical
cord, and the second hand that is directly above pubis, there is an uterus and is some taken from a bosom, that
west-to-east relatively controlled advancement.
In default of signs of removing a layer by the layer of placenta and external bleeding during 30 minutes
after birth of fetus the hand separation of placenta and selection of dung is conducted.
The massage of bottom of uterus through the front abdominal wall of woman giving birth is carried out
at once after birth of dung. After it it is offered to the woman to empty an urinary bladder. The cannulation of
urinary bladder is carried out after testimonies.
After birth of dung make sure in that placenta, the shells of fruit bubble are fully remote and an uterus
grew short.
An early puerperium provides for: review of maternity ways in mirrors, renewal of integrity of crotch in
the case of the conducted episiotomy or perineotomy continuous or separate stitches by filament, supervision
after the common state of mother, retractive function of uterus and amount of bloody excretions, every 15
minutes during 2nd hours after births in a maternity hall and at next 2 o'clock in a post-natal chamber.
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Use of ice-bag on the bottom of stomach in an early puerperium is not used.
5.2. Theoretical questions to employment:
1.
What is abortion and preterm labor?
2.
What are the classification of abortion?
3.
What causes abortion and labor?
4.
What are the stages of spontaneous abortion?
5.
What are clinical characteristics of abortion threat, inevitable abortion, incomplete abortion,
complete
abortion and preterm labor?
6.
What is the different between incomplete abortion and complete abortion?
7.
What is pregnancy that does not develop?
8.
What is usual abortion?
9.
What are signs pregnancy that does not develop?
10.
What kind of examinations are performed to women with threatening abortion and preterm
labor?
11.
What methods of treatment for abortion and preterm labor do we use?
12.
What methods of examinations and tests are preformed at inevitable abortion?
13.
What tests do we use for pregnancy after complete abortion?
14.
What are methods of treatment of inevitable abortion?
15.
What instruments are used for curettage of uterine walls?
16.
What drugs do we use for treatment of threatening abortion, inevitable abortion and preterm
labor?
17.
What are possible complications during and after operative treatment of inevitable abortion?
18.
What are peculiarities of postoperative care?
19.
What are operation techniques of curettage?
20. What objective signs of childbirth and its efficiency in the II period of births?
21. What features of conduct of the II period of births?
22. Than is the III period of births, his duration characterized?
23. Does active tactic of conduct of the III period of births consist in what?
24. Does expecting tactic of conduct of the III period of births consist in what?
5.3. Practical works (task) which are executed on employment:
In the gynaecological separation:
1. To collect anamnesis, execute internal vaginal research and research by mirrors.
2. To estimate a clinical form and stages of involuntary abortion.
3. To estimate involuntary abortion after the term of pregnancy.
4. To diagrammatize medical measures depending on the stage of involuntary abortion.
In the maternity separation:
1. To collect anamnesis, execute external research of woman giving birth, draw conclusion about the
period of births, which she is in.
2. To define finding ahead, position, position, type of fetus, degree of insertion of head by external
methods.
3. To estimate the state by the fetus method of auscultation.
4. To conduct the prophylaxis of respirator distress-syndrome of fetus.
5. To estimate the state of neck of uterus at worn and premature families.
6. To estimate the state of new-born after a scale Аpgar (in the case of demonstration of births).
In an educational room:
1. To rotin on a phantom methods of estimation of degree of insertion of head by the method of internal
obstetric research
2. To rotin on a phantom technique of obstetric help in the II period of births.
3. To demonstrate on a phantom active tactic of conduct of the III period of births.
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4. To demonstrate on a phantom expecting tactic of conduct of the III period of births (signs of
removing a layer by the layer of placenta, selection of the removed layer by a layer placenta).
5.
5.4. Materials for self-control
А. Questions for self-control:
1. What possible reasons of involuntary abortions in the early and late terms of pregnancy and premature
births?
2. What moments of biotmechanism of births do you know?
3. What medical tactic for the prophylaxis of respirator distress-syndrome?
4. What signs of beginning of premature births?
5. How many periods have births?
6. What features in every period of births?
7. What of you know the methods of anaesthetizing of births?
Б. Tasks for self-control
1. In the obstetric separation the pregnant is delivered in a term 25-26 weeks. Complaints about
rhythmic pain down stomach and in small of the back, which every 6-7 minutes are, lasts 30-40 seconds. It is
set at internal obstetric research, that the neck of uterus is smoothed out, opening 4 sm. What is called
this condition?
A. Preterm labor
B. Early abortion
C. Late abortion
D. Complete abortion
E. Incomplete abortion
В. Теsts
. 1. Remote effects of artificial abortions are
A. Uterine wall perforation
B. Incomplete removal
C. Traumas of the urinary bladder
D. Traumas of the rectum
E. Disorder of menstrual function
2. Abortion is made according to the desire of a women until
A. 12 weeks
B. 16 weeks
C. 20 weeks
D. 22 weeks
E. 28 weeks
3. The sign of full remove of conceptus is
A. Pain
B. Bleeding
C. No bleeding
D. Smaller size of the uterus
E. Opening of cervix
4. Interrupting of pregnancy in late term can be performed depending on indications to
A. 22 weeks
B. 24 weeks
C. 26 weeks
D. 28 weeks
E. 32 weeks
5. After abortion the control
A. Discharge from genitalia
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B. Pulse rate
C. Arterial pressure
D. Temperature
E. All mentioned
6. Dilation of the cervical canal is done by
A. Speculum
B. Retractor
C. Hegars dilators
D. Forceps
E. Curettes
7. We use for uterine sound
A. Process of the uterine cervix
B. Dilation of the cervical canal
C. Examination of the cervical canal
D. Examination of length and form of the uterine cavity
E. Curettage
8. Interrupting of pregnancy in late term is done by
A. Oxytocin
B. Methylergometrin
C. 5% Iodone solution
D. Iodonate
E. 20% Glucose solution
Literature
Basic
1. Бодяжина В.И., Жмакин К.Н., Кирющенков А.П. Obstetrics. IT IS, 1998. -С. 107-113.
2. Запорожан В.М. Obstetrics and gynaecology - 2000. - С. 172-177.
3. Айламазян Е.К. Obstetrics. С-Petersburg, 1998. - С. 113-116.
Additional
1. Obstetrics
and
gynaecology
/
Степанковская
Г.К.,
Л.В., Михайленко Е.Т. и др.; под ред. Г.К. Стспанковской. К.: 1997. - С. 187-190.
2. Дуда И.В., Дуда В.И. Obstetrics. - Минск -1997. - С. 80-92.
Тимошенко
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1. After the term of pregnancy involuntary abortions divide on:
A. Early
В. Late
С. Second
D. Primary
Е. Correct answers A, В*
2. Early abortions arise up:
А. To 8 weeks of pregnancy
В. To 10 weeks of pregnancy
С. To 12 weeks of pregnancy *
D. To 14 weeks pregnancies
Е. To 16 weeks of pregnancy
3. Late abortions arise up:
А. From 8-10 weeks of pregnancy
В. From 12-20 weeks of pregnancy*
С. From 20-24 weeks of pregnancy
D. From 25-28 weeks of pregnancy
Е. From 28-30 weeks of pregnancy
4. Premature births are breaking of pregnancy in a term:
A. 5-10 weeks pregnancies
В. 12-14 weeks pregnancies
С. 14-18 weeks pregnancies
D. 18-22 weeks of pregnancy
Е. 22-37 weeks of pregnancy*
5. All belongs to the clinical forms of involuntary abortion, except for:
А. Threat abortion
В. Abortion, that began
С. Abortion in motion
D. Complete, incomplete
Е. Premature families *
6. To reasons, unmaturing of pregnancy take:
А. Socially demographic
В. Medical (from the side of embryo, mother)
С. Endocrine, immunological violations
D. Factors of inflammatory genesis
Е. All transferred*
13
14
15
most modern
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