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Keywords: a history of labors, caesarian section, an obstetrics, juvenile primapara, labors the first urgent, pathological labors, an anemia, rodorazreshajushchaja operation, a history of labors on an obstetrics for students
the HISTORY of LABORS
the Diagnosis: labors the first, urgent, induced, pathological at juvenile primapara. Rodorazreshajushchaja operation caesarian sections concerning clinically narrow basin. Gestatsionnyj a pyelonephritis of a moderate degree in a stage of an exacerbation. A contagious molluscum. An anemia of pregnant 1-st degree. ORST 1-st degrees.
the Passport part.
- the Surname, a name, a patronymic - ******** ***** *************
- Age - 16 flying
- the Nationality - Russian
- the Trade, a place of work - does not work
- the Home address - ********, street *******, ä.*
- Has acted in a hospital - on September, 7, 2002 at 18-20
- the Date started of a curatio - on September, 10, 2002 at 17-00
the Anamnesis of life.
Was born in. Rossosh in family of employees the first child under the account. Feeding - thoracal. Grew and educed in conformity with the years. In the childhood has transferred an epidemic parotitis, a chicken pox, an infectious disease (1995), a grippe, ORVI. Treatment by hormonal preparations denies. Material conditions, a feed - satisfactory. Smoking, the use of alcohol, narcotics denies. Hereditary diseases in family, and also the tuberculosis, venereal, malignant denies.
During the present pregnancy has transferred a grippe on 22-23 week (7 days). It was treated by antipyretic and antiviral preparations. Gestatsionnyj a pyelonephritis in second half of pregnancy.
The allergological anamnesis is not burdened.
the Obstetric anamnesis.
A menses about 11 flying for 6-7 days in 29 days. Were established in 1 year. Morbid, abundant, are accompanied by a febricula (delicacy, headaches, pains in the bottom of a belly). Sexual life about 15 flying. Will consist in first marriage; the marriage is registered. To the husband 25 flying, is able-bodied. Pregnancy the first. Gynecologic diseases denies.
Flow of the present pregnancy.
The first day of last menses - on December, 9 2001 years. The first appearance in female consultation - on June, 4 2002 years at time of 27-28 weeks. An initial blood pressure - 120/80 mm Hg on both arms. In first half of pregnancy: till 9 weeks - a nausea, a vomiting. In second half of pregnancy: on 33 week - threat of premature births, a nephropathy pregnant (protein in is wetted - 0,066 g/l). It was treated permanently in ************** to hospital within 7 days. Received a papaverine, Nitroxolinum. During pregnancy of 6 times has visited female consultation.
Prospective time of labors:
- On a menses - on September, 16 (9.12.01);
- On the first sheveleniju - on September, 27 (10.05);
- On the first appearance - on September, 10 (4.06 for 27-28 weeks);
- Itself considers - on September, 9.
OBJECTIVE RESEARCH
the General condition: body height - 158 sm, initial weight - 50 kg. An increase for pregnancy - 11,7 kg. A maximum permissible hemorrhage - 300 ml. A body temperature - 36,6°C. A body build - proportional, the constitution - normosthenic. Integuments acyanotic, moderately wet. A pilosis for female phylum. Cicatrixes of pregnancy on a skin of a belly look like pink arcuate strips. The white line of a belly and peripapillary irrigators pigmented. The belly-button is protruding. The hypodermic fatty tissue is moderately expressed, in regular intervals distributed. The mild pastosion of anticnemions is marked. Peripheric lymph nodes are not enlarged.
the Thyroid glandis palpated in range of an isthmus, not enlarged.
Osteomuscular system- muscles are advanced moderately, at a palpation are painless, without inspissations. The tonus of muscles is kept. Joints not deformirovny, at a palpation are painless. Restrictions of motility it is not observed.
System of a respiratory organs- the chest is symmetric, is not deformed. Frequency of respiratory locomotions - 18-20 in one minute. In the season outside of pains - respiration deep, rhythmical. At a relative percussion in symmetric plots the clear pulmonary note above all fields is marked, focal changes of a percussion note it is not marked. Borders mild correspond to norm. At an auscultation - respiration vesicular above all pulmonary fields.
Cardiovascular system.Pulse symmetric, average filling, 78 impacts in one minute. The pulsation of peripheric arterias is palpated. Arterial pressure - 125/80 mm Hg on both arms. A Crocq's disease it is not marked. The chest in range of heart - is not changed, the apical beat is determined in the fifth intercostal space, on 2 sm knutri from a mammilar line. Borders of relative and absolute dullness of heart correspond to age norm. At an auscultation - cardiac sounds clear, rhythmical. Hums, scission of tints it is not revealed.
Organs of digestion.the Oral cavity is sanified. Tongue wet, pink colour, a normal form and size. The mucosa desen pink, is not present the expressed defects. Tonsils are not enlarged.
Organs of a uropoiesis.Positive sign Pasternatskogo from the dextral side (in connection with an exacerbation gestatsionnogo a pyelonephritis). The parturient woman marks uchashchennye desires on an emiction.
Nervous system and sense bodys.the Olfaction and taste are not changed. Function of a hearing aid is not broken. Alalias are not present. The vestibular apparatus without deflections. Locomotions of a mimic musculation free. The tremor is not observed. At a palpation on a course of nerve cords of morbidity is not present. Meningialnye signs are absent.
the Obstetric status.
Mammary glands enlarged in volume, at a palpation mild. Papillas and peripapillary irrigators pigmented. Diameter of peripapillary circles - 5 see. Erektilnost a papilla sufficient. A belly of the oval form. Kresttsovyj the rhombus is symmetric, has the dimensions: erect - 11 sm, horizontal - 9 see
The dimensions of a basin: distantia spinarum - 24 sm, distantia cristarum - 26 sm, distantia trochanterica - 29 sm, conjugata externa - 19 see Index Solovjeva - 13 see
A circle of a belly - 96 see. The height of standing of a uterine fundus - 40 sm is higher than a bosom.
A position of a fetus longitudinal (it fixed by the first and second method of outside obstetric research - in a uterine fundus are determined breeches), a position - the first (fixed by the second method - the backrest is inverted to the left side, fine parts - to dextral). The presenting part - the head, lays above an input in a small basin (it fixed by the third method - the head ballots). Prospective weight of a fetus: on Rudakov - 3800 g, on Strojkovoj - 3640. Palpitation of a fetus is auscultated in the best way on 2-3 sm below a belly-button and on 3-4 sm to the left from an average line. Tints clear rhythmical, a heart rate of a fetus=136 impacts in one minute.
Time of a bursting of waters - 700 (fetal bladder instrumentalno is opened), waters light, 500 ml. The beginning of pains at 9-00. The beginning of attempts at 18-30.
the Data of additional researches:
- Ultrasonic research (9.09.02) - depth of a placenta normal, is posed in a uterine fundus, on its back wall. A degree of ripeness=3. Frame lobate. Kaltsinaty. Congenital faults are not found. A moderate oligoamnios. In a uterus it is longitudinal the fetus in length of 55 sm, the head presentation, the first position is posed. Palpitation (+). The conclusion: a duration of gestation of 39-40 weeks, a moderate oligoamnios.
- Rentgenpelviometrija. Å=1000 mkZv. Diameters of a basin. Straight lines: an input - 10,5 sm, a wide part of 12,2 sm, a narrow part - 10,5 sm; transversal: an input - 12,0 sm, mezhostnyj - 9,6 sm, bituberoznyj - 10,4 see. The dimensions of the head: small a sand - bar - 9,4 sm, frontooccipital - 12,0 see. The conclusion: obshcheravnomernosuzhennyj a basin.
THE LABORATORY DATA AND THE CONCLUSION OF ADVISERS
Blood group I (0.) Rh (+). RW (-) 4.06 - 4267, RW (-) 16.07 - 6533. Unguentum initial (12.04!): GN (-), tr (-), L-individual, a flora - blended. Unguentum repeated (16.06): GN (-), tr (-), L-individual, a flora - blended. A feces on eggs of helminths (4.06) - negative. The Australian antigen (-) 4.06. A staphylococcus from a nasal cavity (-) 6.06. On a HIV it is not surveyed!!!
The conclusion of the oculist - it is able-bodied, the conclusion of an otolaryngologia - it is able-bodied, the conclusion of the therapist - it is able-bodied, the conclusion of the stomatologist - it is sanified.
Consultation of the dermatologist (9.09). Complaints to appearance of epidermal formations of noninflammatory character with pupkoobraznym vdavleniem and clotty contents. The diagnosis: the Contagious molluscum. Treatment: the cryolysis is lead. The conclusion: in the general chamber can be; labors do not counterindicative by natural way.
Analyses of urine:
7.09. Protein - 0,33 g/l, colour - straw-coloured, cloudy, reaction alkaline, leucocytes 10 in sight, relative density 1020, erythrocytes - 15-17 in sight.
9.09. Protein - is not present, colour - straw-coloured, cloudy, reaction alkaline, leucocytes 10 in sight, relative density 1020, erythrocytes - 15-17 in sight.
The analysis of a blood: 9.09.
erythrocytes - 3,2*1012/ë;
a haemoglobin - 94 g/l;
the CENTRAL PROCESSING UNIT - 0,88;
thrombocytes - 163*109/ë;
leucocytes - 5,6*109/ë:
eosinocytes - 3 %;
relating to stab neutrophile neutrophils - 5 %;
segmentojadernye neutrophils - 70 %;
lymphocytes - 17 %;
monocytes - 5 %;
a sedimentation rate - 26 mm / ch.
FLOW OF LABORS
******** ***** ************* has acted in a maternity home on September, 7 2002 years in 1820. The diagnosis at entering: pregnancy of 39-40 weeks. A gestosis of 2-nd half of pregnancy, gestatsionnyj a pyelonephritis in a stage of an exacerbation.
Taking into account ORST 1 degrees, a large fetus, a mature neck, the acceleration of a delivery on September, 10 is recommended, carrying out of an amniotomy is shown.
On September, 10. It is transferred from branch of a pathology of pregnancy in antepartum akushersko-observatsionnogo branches for a scheduled amniotomy. Generic activity is not present, the head press to an input in a small basin. Palpitation of a fetus of 140 ud/minutes. Waters are whole.
7-00.ÀÄ=125/80 mm Hg. ×ÑÑ=76 ud/minutes t=36,5°C.
I vaginalnoe research.
On a vulva - epidermal formations of 2-3 mm with pupkoobraznymi vdavlenijami (a contagious molluscum). Muscles of a pelvic bottom resilient. A vagina free nerozhavshej. The uteral cervix long 2 sm, is softened completely, the cervical canal passes 2 dactyls. Fetal bladder is whole. It is opened instrumentalno. 500 ml of light amniotic waters were gave vent. The head press to an input in a small basin. Bones of a skull of normal density. Cape do not achieve. Tumours and exostoses in small to a basin are not present.
The diagnosis: pregnancy of 39-40 weeks. A combined gestosis of 2 half of pregnancy on a background gestatsionnogo a pyelonephritis of a mild degree. Juvenile primapara. A contagious molluscum. An amniotomy. An anemia pregnant. ORST 1-st degrees.
The plan of conducting labors: conservatively waiting
9-00.ÀÄ=120/80 mm Hg. ×ÑÑ=72 ud/minutes t=36,6°C. A condition satisfactory. Regular, morbid pains in 6-7 minutes for 15-20 seconds. It is weted itself. Palpitation of a fetus clear, rhythmical, a heart rate of 140 ud/minutes. The head press to an input in a small basin. Light waters stream.
11-00.ÀÄ=125/80 mm Hg. ×ÑÑ=78 ud/minutes t=36,7°C. A condition satisfactory. Regular, morbid pains in 4-5 minutes for 20-25 seconds. Palpitation of a fetus clear, rhythmical, a heart rate of 136 ud/minutes. The head press to an input in a small basin. Light waters stream.
12-00.ÀÄ=130/80 mm Hg. ×ÑÑ=76 ud/minutes t=36,6°C. Duration of an anhydrous phase of 5 hours. Generic activity 3 hours. A condition satisfactory. Regular, morbid pains in 4-5 minutes for 35 seconds. Palpitation of a fetus clear, rhythmical, a heart rate of 140 ud/minutes. The head press to an input in a small basin. Light waters stream
II vaginalnoe research.
Muscles of a pelvic bottom resilient. A vagina free, nerozhavshej. The uteral cervix flattened, softened completely, edges of a neck pliable, disclosing 2 see. Fetal bladder is not present. The head press to an input in a small basin. Bones of a skull of normal density. A sagittal suture in the right slanting dimension. A small fontanel at 2 o'clock. Cape do not achieve. Tumours and exostoses in small to a basin are not present.
The diagnosis: Labors the first, urgent, induced. 1 season, 1 phase. A gestosis of 2 half of pregnancy on a background gestatsionnogo a pyelonephritis of a mild degree in a stage of an exacerbation. Juvenile primapara. A contagious molluscum. An anemia pregnant, ORST 1-st degrees.
With the purpose of an anesthesia introduction narcotic analgetika is necessary.
Sol. Promedoli 2 % - 1 ml. Intravenously.
Sol. Promedoli 2 % - 1 ml. Intramuscularly.
Sol. Atropini sulfatis 0,1 % - 1 ml. Subcutaneously.
Sol. Dimedroli 1 % - 2 ml. Intramuscularly.
Sol. Sibasoni 0,5 % - 2 ml. Intramuscularly.
14-00.the Condition satisfactory. ÀÄ=125/85 mm Hg. ×ÑÑ=74 ud/minutes t=36,7°C. Regular, morbid pains in 4-5 minutes for 35 seconds. Palpitation of a fetus clear, rhythmical, a heart rate of 140 ud/minutes. The head press to an input in a small basin.
15-30.Pains regular, morbid in 5-6 minutes for 30-40 seconds. ÀÄ=120/80 mm Hg. ×ÑÑ=76 ud/minutes t=36,6°C. Palpitation of a fetus clear, rhythmical, a heart rate of 136 ud/minutes. The head press to an input in a small basin. Light waters stream.
III vaginalnoe research.
A vagina free, nerozhavshej. The neck flattened. Edges istonchennye, pliable. Discovering 4 see. Fetal bladder is not present. The head press to an input in a small basin. A sagittal suture in the right slanting dimension, a small fontanel at 2 o'clock. Cape do not achieve. Tumours and exostoses in small to a basin are not present.
The diagnosis: Labors the first, urgent, induced. 1 season, 1 phase. Juvenile primapara. Delicacy of generic activity. Obshcheravnomernosuzhennyj a basin of 1-st degree. A large fetus. A contagious molluscum. A gestosis of 2 half of pregnancy on a background gestatsionnogo a pyelonephritis in a stage of a moderate exacerbation. An anemia pregnant.
Sol. Oxytocini 5 EÄ (6 dropping in one minute)
Fiz. A solution - 400 ml.
17-30.ÀÄ=125/85 mm Hg. ×ÑÑ=80 ud/minutes t=36,7°C. Introduction of Oxytocinum (20 dropping in one minute) proceeds. Pains in 3-4 minutes for 35-40 seconds. The head press to an input in a small basin. Light waters stream. Palpitation of a fetus clear, rhythmical. A heart rate of 136 ud/minutes
18-30.Pains potuzhnogo character.
IV vaginalnoe research.
A vagina free, nerozhavshej. Discovering complete. The head is posed in an input in a small basin, in an attempt does not move ahead. A sagittal suture in the right slanting dimension. A small fontanel at 2 o'clock. On the head a generic tumour in range of a small fontanel. Cape do not achieve. Tumours and exostoses in small to a basin it is not revealed.
The diagnosis: labors the first, urgent, induced. 2-nd season. Clinically narrow basin. ORST 1 degrees. A large fetus. Gestatsionnyj a pyelonephritis of a moderate degree in a stage of an exacerbation. A contagious molluscum. An anemia pregnant.
The plan of conducting labors: the delivery is shown by caesarian sections.
The written approval to operation, application of a narcosis, and carrying out of a possible hemotransfusion is received.
Conditions:
- Temperature 36,4°Ñ. Pulse of 80 ud/minutes. A blood pressure of 120/80 mm Hg.
- Number vaginalnyh researches - 4.
- Generic activity of 10 hours.
- the Anhydrous season of 11,5 hours.
19-00.the immediate surgery caesarian sections in the inferior segment of a uterus Is lead. Under an endotracheal narcosis a transversal suprapubic section poslojno the abdominal cavity is opened. A vesicouterine sheaf rassechena cross-section. The inferior uterine segment is opened is acute also a wound of a uterus is dissolved with dactyls. The arm entered into cavities of the uterus, seizes the head and 10.09.02 the alive, worn boy in mass of 3960 On Apgar - 6-7 points at 19-10 is taken. It is transferred neonatologu. The afterbirth which was settled down on a forward wall in a fundus with transition to a back wall is unbound by an arm. The cavity of the uterus proterta a sterile napkin, is checked by an arm - walls smooth. A wound of a uterus poslojno it is typical ushita in 3 floors continuous sutures "Poliglikamid". A hemostasis complete. A toilet of an abdominal cavity, the account of napkins and instruments: all! Appendages from both sides without seen pathological changes. An abdominal wall poslojno ushita tightly. The intradermal suture, aseptic label, toilet of a vagina is imposed on a skin. A hemorrhage - 500 ml. Urine on a catheter - 300 ml, light.
The surgeon *******, the assistant ********.
the Diagnosis:labors the first, urgent, induced, pathological at juvenile primapara. Rodorazreshajushchaja operation caesarian sections concerning clinically narrow basin. Gestatsionnyj a pyelonephritis of a moderate degree in a stage of an exacerbation. A contagious molluscum. An anemia of pregnant 1-st degree. ORST 1-st degrees.
the Substantiation of the diagnosis:labors urgent as a duration of gestation 39-40 weeks induced as tool dissection of fetal bladder was effected and were carried out introductions of Oxytocinum with a view of an acceleration of generic activity. Labors pathological - as operation caesarian sections was carried out rodorazreshajushchaja. Clinically narrow basin - as ORST 1-st degrees (on the data rentgenpelviometrii and direct measurement of the dimensions of a basin) and a large fetus. An anemia of pregnant 1-st degree - on the basis of the general analysis of a blood. A contagious molluscum - the conclusion dermatovenerologa.
Initial processing neonatal and processing of a navel string.the Born child wipe off sterile cotton or a gauze. Sterile ballonchikom slime from a nose and a mouth of the child is pumped out. Before initial processing neonatal arms are processed according to regulations of an asepsis. For prophylaxis oftalmoblennorei the solution of Albucidum (Sol. Sulfacyl-natrii - 30 %) was used 30 %. Prophylaxis is lead by the midwife after a pretreatment of arms an antiseptic solution. Eyelids proterty by dry sterile cotton and in each eye it is dripped on 1 drop of 30 % of a solution sodic salt Albucidum.
Processing a navel string was effected in two stages with keeping regulations of an asepsis. The first stage: after the arrest of a pulsation of a navel string on it, one on distance of 10 sm from the umbilical ring, and by the second two clamps are imposed on 2 sm outside from him. The plot of a navel string between clamps is processed 5 % by an alcoholic solution of Iodum and crossed. The second stage: the child unbound from mother is transferred on pelenalnyj a table, the residual of a navel string wipe a sterile gauze napkin, a navel string hardly wring out and in special forcepses put a sterile metal bracket, the navel string is entered between branshami brackets, forcepses with a bracket close.
After processing a navel string initial processing of integuments neonatal is effected. The sterile wadded globules moistened with a sterile liquid paraffin, remove syrovidnaja greasing, and also residues of a blood, slime and amniotic waters from the person, a pilar part of a head, a breast, a belly, a back, extremities.
Body height (56 sm) and mass neonatal (3950 ã) are measured.
On the child the following documentation is got: a history of development neonatal, bracelets, the information on a birth, the passport neonatal.
the Resume of labors.
******** ***** *************, 16 flying, acted on September, 7. 1-n pregnancy, 1 labors urgent, pathological. The immediate surgery caesarian sections is effected. A general hemorrhage of 500 ml. The boy, 56 sm, 3950 g, on Apgar of 6-7 points was born.
THE POSTOPERATIVE SEASON
On September, 11. t=36,6°C, Ps=70 ud/mines, ÀÄ=120/80 mm Hg.
The general condition satisfactory. Complaints to moderate pains in range of the inferior segment of a uterus. Mammary glands mild, papillas clean. The colostrum is abjointed. The belly mild, in regular intervals participates in the act of respiration, a peristalsis awake, gases do not depart, do not disturb. A belly morbid in range of a postoperative suture. The dressing, a toilet of a suture, processing by ozone, is imposed an aseptic bandage. Signs of a boring of a peritoneum are not present. A uterus dense. The bottom is higher than a bosom 16 sm. Lochias bloody, moderate. The stool is late.
Purposes:
- a table ¹0;
- Cefazolinum of 10 ml 4 times day;
- change of a bandage.
On September, 12. t=36,6°C, Ps=73 ud/mines, ÀÄ=100/70 mm Hg.
The general condition satisfactory. Complaints to moderate pains in range of the inferior segment of a uterus. Mammary glands mild. The colostrum is abjointed. The belly mild, in regular intervals participates in the act of respiration, a peristalsis awake, gases depart. A belly morbid in range of a postoperative suture. The dressing, a toilet of a suture, processing by ozone, is imposed an aseptic bandage. A uterus dense. The bottom is higher than a bosom 14 sm. Lochias bloody, moderate. An independent stool and an emiction.
On September, 13. t=36,6°C, Ps=75 ud/mines, ÀÄ=120/75 mm Hg.
The general condition satisfactory. Complaints to moderate pains in range of the inferior segment of a uterus. Mammary glands mild. The colostrum is abjointed. The belly mild, in regular intervals participates in the act of respiration, a peristalsis awake, gases depart. A belly morbid in range of a postoperative suture. The dressing, is imposed an aseptic bandage. A uterus on an average line of a belly. The bottom is higher than a bosom 14 sm. Lochias bloody, moderate. An independent stool and an emiction.
THE EPICRISIS
- ******** ***** *************, 16 flying. Has acted on September, 7 2002 years.
- Pathological labors. Rodorazreshajushchaja operation caesarian sections. Duration of labors of 8,5 hours. A hemorrhage of 500 ml.
- Neonatal: the boy, 56 sm, 3950 g, on Apgar - 6-7 points.
- the Postlabor season proceeds normally.
ADVICE AT THE EXTRACT
It is necessary to keep a regimen of day (dream not less than 8 ch in day, daily walks on fresh air), it is rational to eat. From a ration to exclude acute, bitter, strongly salty, smoked products. It is necessary to abstain from smoking and the use of alcohol. It is possible to take warm douche, to be washed in a bath it is possible not earlier than in 4 weeks after labors. Twice day it is necessary to carry out a toilet of outside sexual organs, to change linen. A feeding - 6-7 times day in 3-3,5 hours with a 6-one hour's interval for the night. After a feeding residues of milk are necessary for decanting, and papillas to treat a disinfectant solution. Sexual life within the first 6 weeks after labors is not recommended.
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Keywords: a history of labors, caesarian section, an obstetrics, a history of labors, caesarian section, an obstetrics, a history of labors, operation caesarian sections, a student's history of labors on an obstetrics, juvenile primapara, labors the first urgent, pathological labors, a history of labors on an obstetrics for students
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