The Kyrgyz State Medical Institute for Retraining and Advanced Training named after S.B. Daniyarov, in the Department of Nursing in Obstetrics, Gynecology, and Pediatrics, is offering a course on “Research Methods in Obstetrics.”
Classes are taught by Mafinat Dzharakhovna Ibragimova.
This course helps students hone their professional knowledge and practical skills necessary for conducting modern examination methods in obstetric practice. Particular attention is paid to the sequence of examinations, the evaluation of the results, and their significance for the timely detection of possible pregnancy complications and the patient’s condition.
The knowledge gained is aimed at improving the quality of medical care, enhancing the professional competencies of healthcare workers, and applying modern approaches in practice.
This course contributes to the enhancement of specialists’ professional training and the strengthening of practical skills necessary for the safe and high-quality provision of medical care to women during pregnancy and childbirth.
The Kyrgyz State Medical Institute for Retraining and Advanced Training named after S.B. Daniyarova continues to work to improve the professional competencies of medical workers and introduce modern educational approaches into the postgraduate medical education system.
Obstetric research methods of examination of pregnant and parturient women
When examining a pregnant woman or a woman in labor, a general and specialized medical history is used, along with a general physical examination, specialized obstetric examination, and laboratory and additional diagnostic methods. These include hematological, immunological (serological, etc.), bacteriological, biochemical, histological, and cytological tests; cardiac function testing; and endocrinological and mathematical diagnostic methods to identify possible diseases, pregnancy complications, and fetal developmental abnormalities. When indicated, fluoroscopy and radiography, amniocentesis, ultrasound, and other modern diagnostic methods are used.
SURVEY OF A PREGNANT WOMAN AND A WOMAN IN LABOR
The pregnant and postpartum women are interviewed according to a specific plan. The interview consists of a general and a specific section. All data obtained is recorded in the pregnant woman’s medical record or birth history.
General anamnesis
Passport data : last name, first name, patronymic, age, place of work and profession, place of birth and residence.
Reasons that prompted the woman to seek medical help (complaints).
Working and living conditions.
Heredity and past illnesses. Hereditary diseases (tuberculosis, syphilis, mental illnesses, oncological illnesses, multiple pregnancies, etc.) are of interest because they can adversely affect fetal development, as can toxic exposures, particularly alcoholism and drug addiction in parents. It is important to obtain information about all infectious and non-infectious diseases and surgeries suffered in early childhood, puberty, and adulthood, their course, and treatment methods and duration. Allergy history. Past blood transfusions.
Special anamnesis
Menstrual function: time of menarche and establishment of menstruation, type and nature of menstruation (3- or 4-week cycle, duration, amount of blood lost, presence of pain, etc.); whether menstruation has changed since the onset of sexual activity, childbirth, abortion; date of the last normal menstruation.
Secretory function : the nature of vaginal discharge, its quantity, color, odor.
Sexual function: at what age did you start having sex, how many marriages did you have, duration of marriage, time from the start of sexual activity to the first pregnancy, time of your last sexual intercourse.
Age and health of the husband.
Reproductive (generative) function. This section of the medical history collects detailed information about previous pregnancies in chronological order, the current pregnancy, the course of previous pregnancies (whether there were any toxicosis, gestosis, cardiovascular, renal, hepatic, or other organ diseases), their complications, and outcomes. The presence of these conditions in the past necessitates particularly careful monitoring of the woman during the current pregnancy. It is essential to obtain detailed information about the course of previous abortions, each birth (duration of labor, surgical interventions, sex, weight, fetal growth, condition at birth, length of stay in the maternity hospital), and the postpartum periods, complications, methods, and duration of their treatment.
Past gynecological diseases : time of occurrence, duration of the disease, treatment and outcome
The course of the current pregnancy (by trimester):
1st trimester (up to 12 weeks) – general illnesses, pregnancy complications (toxicosis, threat of miscarriage, etc.), date of first visit to the antenatal clinic and gestational age established during the first visit.
2nd trimester (13-28 weeks) – common illnesses and complications during pregnancy, weight gain, blood pressure numbers, test results, date of first fetal movement.
Third trimester (29–40 weeks) – overall weight gain during pregnancy, its uniformity, blood pressure measurements, blood and urine tests, illnesses and pregnancy complications. Reasons for hospitalization.
Determining the due date or pregnancy period
GENERAL OBJECTIVE EXAMINATION
A general objective examination is performed to identify diseases of the most important organs and systems that may complicate pregnancy and childbirth. Pregnancy, in turn, can exacerbate existing conditions, lead to decompensation, etc. The objective examination is performed according to generally accepted guidelines, beginning with a general assessment, temperature measurement, and examination of the skin and visible mucous membranes. The circulatory, respiratory, digestive, urinary, nervous, and endocrine systems are then examined.
SPECIAL OBSTETRIC EXAMINATION
Special obstetric examination includes three main sections: external obstetric examination, internal obstetric examination and additional research methods .
External obstetric examination
External obstetric examination is performed by inspection, measurement, palpation and auscultation.
An examination helps determine whether a pregnant woman’s appearance is appropriate for her age. Attention is paid to the woman’s height, build, and the condition of her skin, subcutaneous tissue, mammary glands, and nipples. Particular attention is paid to the size and shape of her abdomen, the presence of pregnancy scars (striae gravidarum), and the elasticity of her skin.
Pelvic examination is important in obstetrics because its structure and size have a decisive impact on the course and outcome of labor. A normal pelvis is one of the main conditions for a successful labor. Abnormalities in pelvic structure, especially a decrease in its size, complicate labor or present insurmountable obstacles. Pelvic examination is performed by inspection, palpation, and measurement. During the examination, attention is paid to the entire pelvic region, but particular attention is paid to the lumbosacral rhomboid (Michaelis’s rhomboid) . The Michaelis rhomboid is the outline of the sacrum, which has the contours of a diamond-shaped area. The superior angle of the rhomboid corresponds to the spinous process of the fifth lumbar vertebra, the inferior angle corresponds to the apex of the sacrum (the origin of the gluteus maximus muscles), and the lateral angles correspond to the superior posterior spines of the ilium. The shape and size of the rhombus can be used to assess the structure of the pelvic bone and detect any narrowing or deformation, which is of great importance in labor management. Its dimensions are: the horizontal diagonal of the rhombus is 10-11 cm, and the vertical diagonal is 11 cm. Depending on the degree of pelvic narrowing, the horizontal and vertical diagonals will be different sizes, resulting in a change in the shape of the rhombus.
During an external obstetric examination, measurements are taken with a centimeter tape (wrist circumference, Michaelis diamond size, abdominal circumference, and the height of the fundus of the uterus above the pubis) and an obstetric caliper (pelvimeter) to determine the size of the pelvis and its shape.
Using a tape measure, measure the greatest abdominal circumference at the navel (90-100 cm at the end of pregnancy) and the fundal height—the distance between the upper edge of the pubic symphysis and the fundus of the uterus. At the end of pregnancy, the fundal height is 32-34 cm. Measuring the abdomen and the fundal height above the pubis allows the obstetrician to determine the gestational age, the estimated fetal weight, and identify lipid metabolism disorders, polyhydramnios, and multiple pregnancies.
The external dimensions of the greater pelvis can be used to estimate the size and shape of the lesser pelvis. Pelvic measurements are taken with a pelvimeter. Only certain dimensions (pelvic outlet and additional measurements) can be measured with a tape measure. Typically, four pelvic dimensions are measured—three transverse and one direct. The patient lies supine, with the obstetrician sitting at her side, facing her.
INTERNAL (VAGINAL) EXAMINATION
An internal obstetric examination is performed with one hand (two fingers, the index and middle, four fingers, half a hand, or the whole hand). This internal examination allows one to determine the presenting part, the condition of the birth canal, observe the dynamics of cervical dilation during labor, the mechanism of insertion and advancement of the presenting part, and more. In women in labor, a vaginal examination is performed upon admission to the maternity hospital and after the amniotic fluid has broken. Subsequently, a vaginal examination is performed only when indicated. This procedure allows for the timely detection of complications during labor and the provision of assistance. A vaginal examination of pregnant women and women in labor is a serious procedure that must be performed in compliance with all aseptic and antiseptic precautions.
The internal examination begins with an examination of the external genitalia (hair growth, development, swelling of the vulva, varicose veins), the perineum (its height, rigidity, presence of scars), and the vestibule of the vagina. The phalanges of the middle and index fingers are inserted into the vagina and examined (width and length of the lumen, folds and extensibility of the vaginal walls, presence of scars, tumors, septa, and other pathological conditions). The cervix is then located and its shape, size, consistency, maturity, shortening, softening, position along the longitudinal axis of the pelvis, and patency of the os for a finger are determined. During the examination during labor, the degree of cervical effacement (preserved, shortened, or effaced), the degree of dilation of the os in centimeters, and the condition of the os margins (soft or firm, thick or thin) are determined. During a vaginal examination, the condition of the fetal bladder (integrity, disruption, degree of tension, and the amount of foremilk) is determined. The presenting part (buttocks, head, and crura) is determined, as is their location (above the pelvic inlet, at the inlet with a small or large segment, in the cavity, or at the pelvic outlet). Identification points on the head include the sutures and fontanelles, and at the pelvic end, the sacrum and coccyx. Palpation of the inner pelvic walls reveals bone deformities and exostoses, and assesses pelvic capacity. At the end of the examination, if the presenting part is high, the diagonal conjugate (conjugata diagonalis) is measured, the distance between the promontory (promontorium) and the lower edge of the symphysis (normally 13 cm). To do this, insert your fingers into the vagina and try to reach the promontory, touching it with the tip of your middle finger. Place the index finger of your free hand under the lower edge of the symphysis pubis, marking the point on your hand that directly touches the lower edge of the pubic arch. Then, remove your fingers from the vagina and wash them. An assistant measures the marked distance on your hand with a tape measure or pelvic measuring device. The size of the diagonal conjugate can be used to estimate the size of the true conjugate. If the Soloviev index (0.1 of the Soloviev circumference) is up to 1.4 cm, subtract 1.5 cm from the diagonal conjugate size; if it is greater than 1.4 cm, subtract 2 cm.
Determining the position of the fetal head during labor
At the first degree of head extension (anterior cephalic insertion), the circumference of the head passing through the pelvic cavity corresponds to its straight diameter. This circumference is the major segment of the anterior cephalic insertion.
At the second degree of extension (frontal insertion), the largest circumference of the head corresponds to the largest oblique diameter. This circumference is the largest segment of the head when it is inserted frontally.
At the third degree of head extension (facial insertion), the largest circumference corresponds to the “vertical” dimension. This circumference corresponds to the large segment of the head when it is in facial insertion.
Determining the degree of insertion of the fetal head during labor
The basis for determining the height of the head during vaginal examination is the ability to determine the ratio of the lower pole of the head to the linea interspinalis.
The head of the fetus is located above the pelvic inlet: with gentle upward pressure, the head moves away and returns to its original position. The entire anterior surface of the sacrum and the posterior surface of the pubic symphysis are accessible to palpation.
The head is located as a small segment at the entrance to the lesser pelvis: the lower pole of the head is determined 3-4 cm above the linea interspinalis or at its level, the sacral notch is 2/3 free. The posterior surface of the pubic symphysis is palpated in the lower and middle sections.
The fetal head is located in the pelvic cavity: the lower pole of the fetal head is 4-6 cm below the linea interspinalis, the sciatic spines are not visible, and the sacral cavity is almost entirely filled by the fetal head. The posterior surface of the pubic symphysis is not accessible to palpation.
The head on the pelvic floor: the head occupies the entire sacral cavity, including the coccyx area; only soft tissues are palpable; the internal surfaces of the bony landmarks are difficult to access for examination.
