NARROW TEA.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

NARROW TEA. In obstetrics, the anatomically and clinically narrow female pelvis is distinguished. Anatomically narrow is called the pelvis, in which at least one of the main dimensions, i.e. interoestinal dimension, the distance between the most distant points of the iliac crest, the intervertebral size, the outer conjugate, is reduced by 1.5-2 cm or more. Clinically, the pelvis is considered to be narrow if obstruction to the passage of the fetus occurs in childbirth. The anatomically normal pelvis can be clinically narrow (with a large and giant fetus, hydrocephalus) and, conversely, an anatomically narrow pelvis can be functionally full (for example, with small fetal sizes). Anatomical narrowing of the pelvis may be due to disorders of its development, diseases of bones and joints (for example, rickets , tuberculosis), fracture of pelvic bones.

Depending on the size of the true conjugates, four degrees of pelvic narrowing are distinguished. At the first degree of constriction, the true conjugate is 11-9 cm, at grade II 8.9-7.5 cm, at grade III 7.4-4.5 cm, at grade IV 6.4 cm or less.

The most frequently encountered forms of the anatomically narrow pelvis include the transversely deformed pelvis, pelvis with a decrease in the direct size of the wide part of the pelvic cavity, a simple flat, flat-scaly, and uniformly constricted pelvis.

The transversal pelvis is characterized by a decrease in the transverse dimensions of the small pelvis by 0.6-1 cm or more with a normal or increased size of the true conjugate. The shape of the entrance to the small pelvis is round or longitudinally-oval. Often there is a flattening of the sacrum or a decrease in the interocular size. The pelvis with a decrease in the direct size of the wide part of the pelvic cavity (less than 12.5 cm) is distinguished by the flattening of the sacrum, down to the disappearance of its curvature, the absence of a difference between the direct dimensions of the entrance to the small pelvis, the wide and narrow part of its cavity. Symptoms of a simple flat pelvis are flattening of the sacrum, a decrease in all the direct dimensions of the pelvis, an increase in interosteal and intertubular size, a transverse-oval shape of the entrance to the pelvis. For a flat-skeletal pelvis, a flat sacrum, a reduced true conjugate and enlarged other direct pelvic dimensions, a transverse-oval shape of the pelvic inlet, an obtuse sublubic angle are characteristic. Equivalently dense, the pelvis is called, in which all dimensions (straight, transverse and oblique) are reduced by 1-2 cm or more.

Diagnostics. Pelvic narrowing can be diagnosed by ultrasound examination, as well as suspected of referring to rickets , tuberculosis spondylitis, pelvic pelvic injuries, as well as to the complicated course and adverse outcome of previous labor, operative delivery, stillbirth, craniocerebral trauma of the newborn. The narrow growth of a woman (less than 145 cm), disability (shortening of the leg, deformation of the spine, etc.), incorrect position (transverse, oblique) or fetal presentation may indirectly indicate the narrowing of the pelvis.

Of particular importance is the external measurement of the pelvis. Normally the distanceia spinarum is 25-26 cm, the distance between the most distant points of the iliac cristae is 28-29 cm, the intermittent dimension (distantia trochanterica) is 30-31 cm, the outer conjugate is 20-21 cm There was no direct relationship between these dimensions and the true size of the small pelvis. Most authors consider the pelvis narrow with an external conjugate of 18.5-18 cm or less.

However, with a narrow pelvis, pelvic, transverse and oblique fetal positions are more likely, the fetal head is not inserted into the small pelvis at the end of pregnancy, premature rupture of amniotic fluid. Pregnant women with an anatomically narrow pelvis belong to the high-risk group, and they should be hospitalized for 2 to 3 weeks before the expected date of delivery to choose a rational method of delivery.

The course of labor in an anatomically narrow pelvis depends primarily on the extent of its narrowing. At III and IV degree of narrowing of the pelvis, which are practically not presently present, the births through the natural birth canals with a live donated fetus are impossible, therefore, a planned cesarean section is indicated. When I and II degree of narrowing of the pelvis and the average size of the fetus, birth can be conducted through the natural birth canal.

The outcome of labor for I and II degree of pelvic narrowing depends on the size of the fetal head, its ability to conformation, the features of the presentation of the fetus, the nature of the labor. Possible complications: early discharge of amniotic fluid, anomalies of labor and prolonged delivery, rupture of the uterus, damage to the pubic symphysis and sacroiliac joints, ruptures of the perineum, subsequent formation of genitourinary and intestinal fistula, hypoxia of the fetus and asphyxia of the newborn, etc. The management of births through natural birth canal in women with I and II degree of pelvic narrowing requires monitoring of control of the fetus and contractile activity of the uterus, functional evaluation of the pelvis during childbirth. To determine the correspondence between the size of the pelvis and the head of the fetus, monitor its position and progress. With the fetal head fixed at the entrance to the small pelvis, the Vasten-Genkel trait is determined - the location of the fetal head in relation to the pubic symphysis. The palm of the investigator is located on the pubic symphysis and slides up the abdominal wall of the parturient woman. If the front surface of the head of the fetus is above the pubic symphysis, the palm of the investigator, encountering it, deviates anteriorly - the Vasten-Genkel symptom is positive, i.e., there is a pronounced discrepancy between the size of the fetal head and the pelvis of the woman in childbirth, the birth can not end independently through the natural birth canal. In the case of a slight discrepancy between these dimensions, the direction of movement of the palm of the investigator during the transition to the head of the fetus does not change - the Vasten-Genkel symptom is "level", labor in this case is possible with good labor activity and a sufficient configuration of the fetal head. If the palm of the investigator falls under the described motion, the Vasten-Henckel sign is negative, i.e. The size of the fetal head corresponds to the size of the mother's pelvis, the labor ends up on its own.

If there are such signs of mismatch between the size of the fetal head and the pelvis of the mother, as a violation of the insertion of the fetal head, its expressed configuration, the positive sign of Vasten-Henckel, the prolonged standing of the fetal head in one plane of the pelvis (especially with full cervical opening and vigorous labor) Urine and the appearance of blood in it, the dilatation of the lower segment of the uterus and the threat of its rupture, it is necessary to immediately terminate the birth . In the absence of conditions for delivery through the natural birth canal, a caesarean section is resorted to, while the dead fruit shows fruit-destroying operations.