FIRST STAGE OF LABOR

The woman in labor spends the first stage of labor in the prenatal ward. External obstetric examination during the period of dilatation is carried out systematically, noting the condition of the uterus during and outside of contractions. Entries in the birth history are made every 2 hours. The fetal heartbeat is listened to every 15 minutes. Observation of the insertion and advancement of the fetal head along the birth canal is carried out using external palpation techniques, vaginal examination, listening to the fetal heartbeat, and ultrasound examination. Conducting a vaginal examination is mandatory upon admission to the maternity hospital and discharge. amniotic fluid, and also according to indications - in case of deviation from the norm in the course of labor. However, to clarify the obstetric situation (keeping a partogram, orientation in insertion and advancement of the head, assessing the location of sutures and fontanelles) during childbirth, it can be performed more often.

Diagnosis of rupture of amniotic fluid in most cases is not difficult. Detection of the fetal head or buttocks or umbilical cord loops during vaginal examination indicates rupture of amniotic fluid. In doubtful cases, fluid is taken from the posterior vaginal fornix for examination, for which a “posterior” speculum is inserted. The content of amniotic fluid in the fluid taken from the posterior fornix is ​​determined using a microscopic examination of a dried smear (the so-called fern phenomenon). Amniotic fluid is alkaline and turns the test strip dark blue. The presence of blood or urine in the contents of the posterior vaginal fornix can cause a false positive test result. Also during the study, the presence of meconium admixture, often observed during fetal hypoxia, is noted, although its initial detection is not pathognomonic for this pathology. If “clean” amniotic fluid leaks first, and then meconium appears, then you should think about fetal hypoxia. If the amniotic fluid is stained with blood, then the possibility of placental abruption is excluded. At premature birth and if chorioamnionitis is suspected, a culture of discharge from the posterior vaginal fornix is ​​performed. In case of premature birth and rupture of amniotic fluid, the degree of maturity of the fetal lungs is determined using a foam test (see “Analgesia of labor”).

When contractions are severely painful, anesthesia is necessary to maintain reciprocal contraction of the upper and lower segments of the uterus, eliminate spasm of smooth muscle fibers with a circular anatomical orientation, and to prevent cervical ruptures during childbirth.

In the first stage of labor, adherence to strict bed rest optional. It is possible to carry out the most convenient actions for a woman (shower, massage of the sacral area, etc.).

For early diagnosis of intrauterine hypoxia, an assessment of the fetal condition is necessary, and therefore it is advisable to use periodic auscultation of the fetal heart and continuous CTG. Periodic auscultation of the fetal heart in the first stage of labor is carried out every 15 minutes, and in the second stage - after each attempt. According to retrospective studies, the use of this diagnostic method reduces the risk of fetal death, severe asphyxia of the newborn and late neurological disorders. In addition, with continuous CTG, a low Apgar score in the newborn is less common than when only periodic cardiac auscultation is used to monitor the fetal condition. When using only the method of periodic auscultation of the heart, signs of incipient fetal hypoxia may be missed.

SECOND STAGE OF LABOR

During the period of passage of the fetal head through the pelvic cavity, the most physiological position of the woman in labor is on her side. In this position, the tone of the uterus decreases, resulting in an increase in the amplitude of contractions. The frequency of contractions does not increase or even decreases slightly, the birth process accelerates, the uteroplacental blood flow and blood supply improve, which is beneficial for the fetus.

The biggest mistake in labor management is artificial stimulation of pushing at the beginning of the 2nd period with the uterine os fully open and the head standing high. It is optimal to lower the head to the pelvic floor with the woman in labor on her side; 4–8 contractions and pushing will be enough for the birth of the fetus. With longer attempts, the uteroplacental circulation deteriorates, which can affect the condition cervical region fetal spine.

You can observe the forward movement of the head: first, a protrusion of the perineum is noticeable, then stretching, the color of the skin becomes bluish. The anus protrudes and gapes, the genital slit opens and, the genital slit, appears again at the beginning of the next attempt - cutting in the head. After some time, after the end of the pushing, the head ceases to hide - the eruption of the head begins. It coincides with the beginning of extension of the head (birth to the parietal tuberosities). By extension, the head gradually emerges from under the pubic arch, the occipital fossa is located under the pubic symphysis, the parietal tubercles are tightly covered by stretched tissues.

Through the genital slit, the forehead is first born, and then the entire face when the perineum slides off them. The born head makes an external turn, then the shoulders and torso emerge along with the flow of posterior water.

The advancement of the fetal head during the expulsion period should occur continuously and gradually. The fetal head should not remain in the same plane for more than an hour. During the eruption of the head it is necessary to provide manual assistance. When extending, the fetal head puts strong pressure on the pelvic floor, stretching it, which can lead to rupture of the perineum. The walls of the birth canal compress the fetal head, and there is a threat of impaired blood circulation to the brain. Providing manual assistance during cephalic presentation reduces the risk of these complications. Manual aid for cephalic presentation is aimed at preventing perineal ruptures. It consists of several moments performed in a certain sequence.

● The first point is to prevent premature extension of the head. It is necessary that during eruption the head passes through the genital slit with its smallest circumference (32 cm), corresponding to the small oblique size (9.5 cm) in the flexed state. The obstetrician, standing to the right of the woman in labor, places the palm of her left hand on the womb, placing four fingers on the fetal head in such a way as to cover its entire surface protruding from the genital slit. Light pressure delays the extension of the head and prevents its rapid advancement along the birth canal.

● The second point is to reduce perineal tension (Fig. 5.). The obstetrician places his right hand on the perineum so that four fingers are pressed firmly against the left side of the pelvic floor in the area of ​​the labia majora, and thumb- to the right side of the pelvic floor. Using all fingers, the obstetrician carefully pulls and lowers the soft tissue towards the perineum, reducing the stretch. The palm of the same hand supports the perineum, pressing it against the erupting head. Reducing the tension in the perineum in the manner described allows you to restore blood circulation and prevent the occurrence of ruptures.

Rice. 5. Reducing perineal tension.

● The third point is the removal of the head from the genital slit without pushing (Fig. 6.). At the end of pushing with the thumb and forefinger right hand The obstetrician carefully stretches the vulvar ring over the erupting head. The head gradually emerges from the genital slit. When the next attempt occurs, the obstetrician stops stretching the vulvar ring and again prevents the extension of the head. The steps are repeated until the parietal tubercles of the head approach the genital slit. During this period, a sharp stretching of the perineum occurs and there is a risk of rupture.

Rice. 6. Removing the head from the genital slit without pushing.

At this point, regulation of pushing is extremely important. The greatest stretching of the perineum, the threat of its rupture and injury to the fetal head, occurs if the head is born during pushing. To avoid injury to the mother and fetus, it is necessary to regulate the pushing - turning it off and weakening, or, conversely, lengthening and strengthening.

The regulation is carried out as follows: when the parietal tubercles of the fetal head pass the genital fissure, and the suboccipital fossa is located under the pubic symphysis, when pushing occurs, the obstetrician instructs the woman in labor to breathe deeply in order to reduce the force of pushing, since pushing is impossible during deep breathing. At this time, the obstetrician uses both hands to delay the advancement of the head until the end of the contraction. Outside of the attempt, the obstetrician squeezes the perineum above the fetal face with his right hand so that it slides off the face. With his left hand, the obstetrician slowly lifts the head up and straightens it. At this time, the woman is instructed to push so that the birth of the head occurs with low tension. Thus, the obstetrician, using the commands to push and not to push, achieves optimal tension of the perineal tissues and the successful birth of the densest and largest part of the fetus - the head.

● The fourth moment is the release of the shoulder girdle and the birth of the fetal body (Fig. 7.). After the head is born, the woman in labor is instructed to push. In this case, an external rotation of the head and an internal rotation of the shoulders occurs (from the first position the head turns to face the mother’s right thigh, from the second position - to the left thigh). Usually the birth of the shoulders occurs spontaneously. If spontaneous birth of the fetal shoulders has not occurred, then the obstetrician grasps the head in the area of ​​the temporal bones and cheeks with both palms. Easily and carefully pulls the head downwards and backwards until the anterior shoulder fits under the pubic symphysis.

Then the obstetrician with his left hand, the palm of which is on the lower cheek of the fetus, grabs the head and lifts its top, and with his right hand carefully removes the back shoulder, moving the perineal tissue from it. This is how the shoulder girdle is born. The obstetrician inserts the index fingers from the back of the fetus into the armpits, and lifts the torso anteriorly (on the mother's stomach).

Rice. 7. Release of the fetal shoulder girdle.

Depending on the condition of the perineum and the size of the fetal head, it is not always possible to preserve the perineum; it ruptures. Since the healing of an incised wound proceeds better than a lacerated one, in cases where a rupture is imminent, a perineotomy or episiotomy is performed.

THIRD STAGE OF LABOR

During the afterbirth period, you cannot palpate the uterus so as not to disrupt the natural course of afterbirth contractions and the correct separation of the placenta. The natural separation of the placenta avoids bleeding. During this period, the main attention is paid to the newborn, the general condition of the woman in labor and signs of placental separation.

The succession period is expectant. The doctor monitors the appearance of pallor of the skin, an increase in heart rate of more than 100 beats per minute, a decrease in blood pressure (BP) by more than 15–20 mmHg. Art. compared to the original one. It is necessary to monitor the condition of the bladder, since a full bladder prevents uterine contraction and disrupts the normal course of placental abruption. To determine whether the placenta has separated from the uterus, signs of placental separation are used.

Schroeder's sign: when the placenta is separated and lowered into the lower part of the uterus, the uterine fundus rises above the navel and deviates to the right, which is noticeable upon palpation. In this case, the lower segment protrudes above the pubis (Fig. 8.).

Rice. 8. Location of the uterus in the afterbirth period. 1 - before separation of the placenta; - after separation of the placenta (Schroeder's sign); 3 - after the birth of the placenta.

Alfeld's sign: if the placenta has separated, the clamp placed on the umbilical cord stump at the genital slit will drop by 10 cm or more (Fig. 9.).

Rice. 9. Alfeld’s sign of separation of the placenta.

Küstner-Chukalov sign: the umbilical cord is retracted into the vagina when pressing with the edge of the hand over the pubis, if the placenta has not separated. If the placenta has separated, the umbilical cord does not retract (Fig. 10).

Rice. 10. Sign of separation of the placenta according to Küstner–Chukalov: on the left - the placenta has not separated; on the right – the placenta has separated.

Dovzhenko's sign: the woman in labor is asked to take a deep breath and exhale. If the placenta has separated, the umbilical cord does not retract into the vagina when you inhale.

Klein's sign: the woman in labor is asked to push. If placental abruption occurs, the umbilical cord remains in place; and if the placenta has not separated, the umbilical cord is retracted into the vagina after pushing.

The diagnosis of placental separation is made based on the combination of the listed signs. In order for the birth of the placenta to occur, the woman in labor is instructed to push. If the birth of the placenta does not occur, then external methods of removing the placenta from the uterus are used. Attempts to isolate the placenta before separation of the placenta are prohibited.

In order to combat bleeding, it is possible to use light tugging on the umbilical cord to release the placenta.

Isolation of the placenta according to the Abuladze method (strengthening the abdominal press): the anterior abdominal wall is grasped with both hands so that the rectus abdominis muscles are tightly grasped with the fingers. There is a decrease in volume abdominal cavity and eliminating muscle discrepancies. The woman in labor is asked to push, the placenta is separated, followed by its birth.

Rice. 11. Method for isolating separated placenta according to Abuladze.

Isolation of the placenta using the Credet-Lazarevich method (imitation of a contraction) can be traumatic if the basic conditions for performing this manipulation are not met. Necessary conditions for the discharge of the placenta according to Crede-Lazarovich: preliminary emptying of the bladder, bringing the uterus to the middle position, lightly stroking the uterus in order to stimulate its contractions. Technique of this method: the obstetrician grasps the fundus of the uterus with his right hand. In this case, the palmar surfaces of the four fingers are located on the posterior wall of the uterus, the palm is on its bottom, and the thumb is on the anterior wall of the uterus. At the same time, the whole hand is pressed on the uterus towards the pubic symphysis until the placenta is born (Fig. 12).

Rice. 12. Method for isolating separated placenta according to Crede-Lazarevich.

Isolation of the placenta according to the Genter method (imitation of labor forces): the hands of both hands, clenched into fists, are placed with their backs on the fundus of the uterus. With gentle downward pressure, the placenta is gradually born.

Rice. 13. Method for isolating separated placenta according to Genter.

If there are no signs of placental separation within 30 minutes after birth, anesthesia is indicated, followed by manual separation of the placenta and release of the placenta. The sequence of manipulation: with one hand the obstetrician holds the fundus of the uterus. The other hand, dressed in long glove, inserts into the uterine cavity and carefully separates the placenta from its walls. The obstetrician then removes the placenta and massages the fundus of the uterus through the anterior abdominal wall to reduce bleeding. Infectious complications occur quite rarely after this operation.

The next important task is to examine the placenta and soft birth canal. To do this, place the placenta on a flat surface with the mother side up and carefully examine the placenta; Normally, 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. It is also necessary to determine whether blood vessels pass through the membranes, which is noted when there is an additional placenta lobe. If torn vessels are noticeable on the membranes, there is probably an additional lobe left in the uterus. In this case, manual separation and removal of the retained additional lobe are also performed. The discovery of torn membranes indicates that there are fragments of them in the uterus. Based on the location of the rupture of the membranes, the location of the placental site in relation to the internal os can be determined. The closer to the placenta the rupture of the membranes, the lower the placenta was located, and the higher the risk of bleeding in the early postpartum period. Examination of the external genitalia is carried out on the delivery bed. Then, in a small operating room, the vaginal walls and cervix of all primiparous and multiparous women are examined using vaginal speculum. Detected tears are sutured. After the birth of the placenta, the postpartum period begins, the woman in labor is called a puerpera. During the early postpartum period (2 hours after separation of the placenta), the postpartum woman is in the maternity ward. It is necessary to monitor her general condition, the condition of the uterus, and the amount of blood loss. After 2 hours, the postpartum woman is transferred to the postpartum ward.

This topic is quite extensive, you can talk for a long time about what and how. I will only give general concepts so as not to burden you for a long time.

We are connected to our mother's and father's family. This connection is extremely important for us and is reflected in all areas of our lives: both in general success and in love, family relationships, social and monetary spheres, not to mention damage and family curses. Often the negative trace can be traced from there.

Well, just a few more words about “where the legs grow from” or where the birth canals are attached to us. This information is known experienced psychologists and psychotherapists. They are attached from the back, approximately the projection of the kidneys. The left side is my mother's, the right is my father's.

I feel this connection with my hand, I see some images that help change the situation in the right direction.

Before work, it is worth asking the client whether his closest female and male relatives are alive or not: mother and grandmother and, accordingly, father and grandfather.

You can, of course, work only with this knowledge and simply connect the person, but it is much better and more effective in the process of telling the person what I see, and the feedback gives a different, much more powerful result and a new understanding and vision of the situation.

You can work here with a magic wand with the consciousness of a magician, but in me such a wand is built in automatically - 17 lassos, and therefore the work turns out to be quite interesting.

In this regard, I will give you two examples. I had previously worked with my client from Moscow, who was in his early thirties, as a psychotherapist, sexologist and psychologist. When we worked with the female (mother’s) family, no special problems arose; we strengthened the connection, cleaned the mother and grandmother and the birth canal in general. I usually fix the alignment with a mandala of the color of the manipura chakra.

Strange things began to happen in the masculine gender. The first thing that turned out to be: there was no connection between the guy and the father, as if there was some kind of interruption. I began to look at the situation further, found my father (he had already died), and then approached my grandfather.

I saw the last one so golden, important, like a saint. I ask about my grandfather (he is alive): “Who is your grandfather, just like a saint?” He answers: “No one, an ordinary drunk, I never had contact with him or my father.”

I thought something was wrong here. I see how this golden image begins to build a connection. And the thought comes that this is not the client’s grandfather, but the Spirit of the Family in the male line, which is why he looked appropriate.

And then, when a few minutes later the connection and alignment was completed, and we were finishing our work, the following information came out from the client: if the contact and connection with the father was always bad and there was no understanding, then the grandfather did not want the grandson to be born at all. He asked his daughter to have an abortion. So, the situation was really not simple, and we solved it quickly and radically through the Spirit of the Family, building a system and putting everything in its place.

To be continued…

Childbirth is the process of expulsion or removal from the uterus of a child and placenta (placenta, membranes, umbilical cord) after the fetus reaches viability. Normal physiological childbirth occurs through the natural birth canal. If the child is removed by caesarean section or using obstetric forceps, or using other delivery operations, then such birth is operative.

Typically, timely birth occurs within 38-42 weeks of obstetric period, counting from the first day of the last menstrual period. At the same time, the average weight of a full-term newborn is 3300±200 g, and its length is 50-55 cm. Childbirth occurs at 28-37 weeks. pregnancy and earlier are considered premature, and more than 42 weeks. - belated. The average duration of physiological labor ranges from 7 to 12 hours for primiparous women, and from 6 to 10 hours for multiparous women. Labor that lasts 6 hours or less is called rapid, 3 hours or less - rapid, more than 12 hours - protracted. Such births are pathological.

Characteristics of normal vaginal delivery

• Singleton pregnancy.
• Head presentation of the fetus.
• Full proportionality between the fetal head and the mother's pelvis.
• Full-term pregnancy (38-40 weeks).
• Coordinated labor activity that does not require corrective therapy.
• Normal biomechanism of childbirth.
• Timely release of amniotic fluid when the cervix is ​​dilated by 6-8 cm in the active phase of the first stage of labor.
• Absence of serious ruptures of the birth canal and surgical interventions during childbirth.
• Blood loss during childbirth should not exceed 250-400 ml.
• The duration of labor for primiparous women is from 7 to 12 hours, and for multiparous women from 6 to 10 hours.
• Birth of a living and healthy child without any hypoxic-traumatic or infectious damage and developmental abnormalities.
• The Apgar score at the 1st and 5th minutes of the child’s life should correspond to 7 points or more.

Stages of physiological childbirth through the natural birth canal: development and maintenance of regular contractile activity of the uterus (contractions); changes in the structure of the cervix; gradual opening of the uterine pharynx up to 10-12 cm; advancement of the child through the birth canal and its birth; separation of the placenta and discharge of the placenta. There are three periods during childbirth: the first is the dilation of the cervix; the second is the expulsion of the fetus; the third is subsequent.

The first stage of labor - dilatation of the cervix

The first stage of labor lasts from the first contractions until the cervix is ​​fully dilated and is the longest. For primiparous women, it ranges from 8 to 10 hours, and for multiparous women, 6-7 hours. In the first period there are three phases. First or latent phase The first stage of labor begins with the establishment of a regular rhythm of contractions with a frequency of 1-2 per 10 minutes, and ends with smoothing or pronounced shortening of the cervix and opening of the uterine pharynx by at least 4 cm. The duration of the latent phase is on average 5-6 hours. In primiparous women, the latent phase is always longer than in multiparous women. During this period, contractions are usually not painful. As a rule, no drug correction is required during the latent phase of labor. But in women of late or young age, if there are any complicating factors, it is advisable to promote the processes of dilation of the cervix and relaxation of the lower segment. For this purpose, it is possible to prescribe antispasmodic drugs.

After the cervix dilates by 4 cm, the second or active phase the first stage of labor, which is characterized by intense labor and rapid opening of the uterine pharynx from 4 to 8 cm. The average duration of this phase is almost the same in primiparous and multiparous women and averages 3-4 hours. The frequency of contractions in the active phase of the first stage of labor is 3-5 per 10 minutes. Contractions most often become painful. Pain sensations predominate in the lower abdomen. When a woman is active (standing, walking), the contractile activity of the uterus increases. In this regard, drug pain relief is used in combination with antispasmodic drugs. The amniotic sac should open on its own at the height of one of the contractions when the cervix opens 6-8 cm. At the same time, about 150-200 ml of light and transparent amniotic fluid is poured out. If spontaneous discharge of amniotic fluid has not occurred, then when the uterine pharynx is dilated by 6-8 cm, the doctor must open the amniotic sac. Simultaneously with the dilation of the cervix, the fetal head moves through the birth canal. At the end of the active phase, the uterine os opens completely or almost completely, and the fetal head descends to the level of the pelvic floor.

The third phase of the first stage of labor is called deceleration phase. It begins after the uterine pharynx is dilated by 8 cm and continues until the cervix is ​​fully dilated to 10-12 cm. During this period, it may seem that labor has weakened. This phase in primiparous women lasts from 20 minutes to 1-2 hours, and in multiparous women it may be completely absent.

During the entire first stage of labor, the condition of the mother and her fetus is constantly monitored. They monitor the intensity and effectiveness of labor, the condition of the woman in labor (well-being, pulse rate, breathing, blood pressure, temperature, discharge from the genital tract). The fetal heartbeat is regularly listened to, but most often constant cardiac monitoring is performed. During normal labor, the baby does not suffer during uterine contractions, and its heart rate does not change significantly. During labor, it is necessary to assess the position and advancement of the head in relation to pelvic landmarks. A vaginal examination during labor is performed to determine the insertion and advancement of the fetal head, to assess the degree of opening of the cervix, and to clarify the obstetric situation.

Mandatory vaginal examinations performed in the following situations: when a woman enters the maternity hospital; when amniotic fluid ruptures; with the onset of labor; in case of deviations from the normal course of labor; before anesthesia; when bloody discharge from the birth canal. One should not be afraid of frequent vaginal examinations; it is much more important to ensure complete orientation in assessing the correct course of labor.

Second stage of labor - expulsion of the fetus

The period of expulsion of the fetus begins from the moment the cervix is ​​fully dilated and ends with the birth of the child. During childbirth, it is necessary to monitor bladder and bowel function. Fullness of the bladder and rectum interferes with the normal course of labor. To prevent the bladder from overflowing, the woman in labor is asked to urinate every 2-3 hours. In the absence of independent urination, catheterization is used. It is important to have timely emptying of the lower intestine (enema before childbirth and during a prolonged period). Difficulty or absence of urination is a sign of pathology.

Position of the woman in labor

The position of the woman in labor during labor deserves special attention. In obstetric practice the most popular are back birth, which is convenient from the point of view of assessing the nature of the course of labor. However, the position of the woman in labor on her back is not the best for the contractile activity of the uterus, for the fetus and for the woman herself. In this regard, most obstetricians recommend that women in the first stage of labor sit, walk for a short time, or stand. You can get up and walk both with intact and emptied water, but provided that the fetal head is tightly fixed at the pelvic inlet. In some cases, it is practiced for a woman in labor to stay in a warm pool during the first stage of labor. If the location is known (according to ultrasound data), then the optimal one is position of the woman in labor on that side where the back of the fetus is located. In this position, the frequency and intensity of contractions does not decrease, the basal tone of the uterus remains normal. In addition, studies have shown that in this position the blood supply to the uterus, uterine and uteroplacental blood flow improves. The fetus is always positioned facing the placenta.

It is not recommended to feed a woman in labor during labor for a number of reasons: the food reflex is suppressed during labor. During childbirth, a situation may arise in which anesthesia is required. The latter poses a risk of aspiration of stomach contents and acute respiratory distress.

From the moment the uterine os opens completely, the second stage of labor begins, which consists of the actual expulsion of the fetus, and ends with the birth of the child. The second period is the most critical, since the fetal head must pass through the closed bony ring of the pelvis, narrow enough for the fetus. When the presenting part of the fetus descends to the pelvic floor, contractions are joined by contractions of the abdominal muscles. Attempts begin, with the help of which the child moves through the vulvar ring and the process of his birth occurs.

From the moment the head is cut in, everything should be ready for delivery. As soon as the head has erupted and does not go deeper after pushing, they proceed directly to the delivery. Help is necessary because, as the head erupts, it puts strong pressure on the pelvic floor and ruptures of the perineum are possible. During obstetric care, the perineum is protected from damage; carefully remove the fetus from the birth canal, protecting it from adverse effects. When the fetal head is brought out, it is necessary to restrain its excessively rapid advancement. In some cases they perform perineal dissection to facilitate the birth of a child, which avoids failure of the pelvic floor muscles and prolapse of the vaginal walls due to their excessive stretching during childbirth. Usually the birth of a child occurs in 8-10 attempts. The average duration of the second stage of labor for primiparous women is 30-60 minutes, and for multiparous women it is 15-20 minutes.

In recent years, in some European countries, the so-called vertical birth. Proponents of this method believe that in the position of the woman in labor, standing or kneeling, the perineum is easier to stretch and the second stage of labor is accelerated. However, in this position it is difficult to monitor the condition of the perineum, prevent its ruptures, and remove the head. In addition, the strength of the arms and legs is not fully used. As for the use of special chairs for vertical childbirth, they can be classified as alternative options.

Immediately after the birth of the child, if umbilical cord is not compressed, and it is located below the level of the mother, then a reverse “infusion” of 60-80 ml of blood occurs from the placenta to the fetus. In this regard, the umbilical cord should not be crossed during a normal birth and the newborn is in satisfactory condition, but only after the pulsation of the blood vessels has stopped. In this case, until the umbilical cord is crossed, the child cannot be raised above the plane of the delivery table, otherwise a backflow of blood from the newborn to the placenta occurs. After the birth of the child, the third stage of labor begins - the afterbirth stage.

The third stage of labor is the afterbirth

The third period (afterbirth) is determined from the moment of birth of the child until the separation of the placenta and the discharge of the placenta. In the afterbirth period, during 2-3 contractions, the placenta and membranes are separated from the walls of the uterus and the afterbirth is expelled from the genital tract. In all women giving birth in the afterbirth period, to prevent bleeding, intravenous drugs that promote uterine contraction. After birth, a thorough examination of the child and mother is carried out in order to identify possible birth injuries. During the normal course of the afterbirth period, blood loss is no more than 0.5% of body weight (on average 250-350 ml). This blood loss is physiological, since it does not have a negative effect on the woman’s body. After expulsion of the placenta, the uterus enters a state of prolonged contraction. When the uterus contracts, its blood vessels are compressed and bleeding stops.

Newborns are given screening assessment for phenylketonuria, hypothyroidism, cystic fibrosis, galactosemia. After the birth, information about the characteristics of the birth, the condition of the newborn, and the recommendations of the maternity hospital are transmitted to the antenatal clinic doctor. If necessary, the mother and her newborn are advised by specialized specialists. Documentation about the newborn is sent to the pediatrician, who subsequently monitors the child.

It should be noted that in some cases, preliminary hospitalization in a maternity hospital is necessary to prepare for delivery. In the hospital, in-depth clinical, laboratory and instrumental examinations are carried out to select the timing and method of delivery. An individual birth management plan is drawn up for each pregnant woman (mother in labor). The patient is introduced to the proposed delivery plan. Obtain her consent to the proposed manipulations and operations during childbirth (stimulation, amniotomy, cesarean section).

Caesarean section is performed not at the woman's request, since this is an unsafe operation, but only for medical reasons (absolute or relative). Childbirth in our country is not carried out at home, but only in an obstetric hospital under direct medical supervision and control, since any birth is fraught with the possibility of various complications for the mother, fetus and newborn. The birth is led by a doctor, and the midwife, under the supervision of a doctor, provides manual assistance at the birth of the fetus and carries out the necessary treatment of the newborn. The birth canal is examined and repaired by a doctor if it is damaged.

The umbilical cord is an important link between mother and baby. Through it, oxygen and other nutrients enter the fetus, and decay and metabolic products return back. During pregnancy, doctors carefully monitor the condition of the pregnancy, as in some cases this helps predict and correct the outcome of childbirth. In particular, if a short umbilical cord is diagnosed, due to which the child may suffocate in the womb. This is a fairly common pathology, about which expectant mothers should know as much information as possible in order to understand how to behave in the event of such a diagnosis.

This is an ordinary internal organ, which, like all others, has its own characteristics, inherent only to this or that woman (child). If its length does not correspond to normal values ​​initially, from the moment of conception, this is an individual parameter that depends on heredity or some kind of genetic predisposition. But sometimes the sizes are reduced due to a number of factors that the expectant mother should be aware of in advance. Here are the main reasons for a short fetal umbilical cord:

• around the neck, legs, arms and other parts of the child’s body;
• the formation of false knots on the umbilical cord is a consequence varicose veins one of the vessels in one (one node) or several (many nodes) places;
• the presence of true knots on the umbilical cord, which are formed due to excessive activity of the baby;
• the fetus is in an incorrect position.

So a short umbilical cord during childbirth may be due to: individual characteristics the course of pregnancy and the activity of the baby inside the womb. Depending on the causes and size, several types of this pathology are distinguished.

Origin of the word. The word “navel” (and, accordingly, umbilical cord) has Old Russian roots. In the Proto-Slavic language it meant “kidney,” that is, something convex.

Species

Obstetricians and gynecologists distinguish between absolutely and relatively short umbilical cords, each of which has its own characteristics and requires an appropriate attitude.

1. The most common is an absolutely short umbilical cord, the length of which is less than 40 cm. For comparison: the parameters of a normal one range from 40 to 70 cm.
2. Sometimes a relatively short umbilical cord is diagnosed in a child, which normally corresponds to normal values ​​(40-70 cm), but due to some factors (see reasons above) it becomes shorter.

Both types of short umbilical cord are dangerous. But if the relative has a chance to return to its original position and exclude the development of complications by the time of birth, then with the absolute the risk of their occurrence is maximum. Therefore, it is so important to make a diagnosis in time and clarify its type. What signs indicate this pathology?

This is interesting! It turns out that the navel is a very personal, individual indicator of each person, just like fingerprints. No two are alike.

Symptoms

Among young mothers, the question of how to detect a short umbilical cord in advance in order to be fully prepared for childbirth is becoming very relevant. The answer is unlikely to sound reassuring. Doctors say there are no symptoms during pregnancy - at least on the mother's side. Typically, signs of pathology appear only at the most crucial moment - when labor has already begun.

• Increased duration of labor: for primiparous women - more than 20 hours, for multiparous women - more than 15 hours.
• Acute vaginal bleeding.

If we talk about the symptoms of this pathology during pregnancy, then the only sign is, but it can also indicate other problems associated with the fetus and its gestation. Therefore, this marker is relative, but not absolute for a short umbilical cord. However, it is he who should alert doctors and expectant mother about a possible deviation. Hypoxia can be acute and chronic. Signs of exacerbation:

• rapid (more than 160 beats per minute) and then slow (less than 120 beats per minute) heartbeat of the child;
• an increase in his motor activity, which can be sharply replaced by a decrease;
• the appearance of meconium in the amniotic fluid.

Symptoms of the chronic form of intrauterine hypoxia:

• slow heartbeat in a child (less than 120 beats per minute);
• gradual decrease in his motor activity.

Only a child can help diagnose a short umbilical cord during pregnancy, so the doctor needs to constantly monitor his heartbeat, and the mother needs to more closely monitor his motor activity. Any changes or deviations from the norm should be alarming. Moreover, the diagnosis of this pathology will not greatly dispel doubts.

With the world - one by one. Some peoples have very interesting traditions and beliefs associated with the umbilical cord. So, after childbirth, the umbilical cord was not thrown away, but hidden. When the child turned 6 or 7 years old, he was given it to untie (this was very difficult to do, since by that time it had dried out very much) or it was crushed and added to his food. It was believed that this would give him wisdom.

Diagnostics

The problem is that a short umbilical cord in a fetus is difficult to diagnose. The range of studies and methods for monitoring her condition is very narrow. All of them allow the doctor only to assume the presence of pathology, but not to confirm 100% about it. Which ones are most accurate?

It is very rare that a diagnosis of an absolutely short umbilical cord is made on 2 ultrasounds, since its size cannot be determined using this diagnostic technique. The doctor can see the formation of nodes (false and true), entanglement of the baby, improper development of blood vessels - i.e. those factors that can provoke pathology, but not the pathology itself. Thus, a short umbilical cord on ultrasound can only be assumed.

• Doppler (Doppler) study

This is a more informative diagnostic method, during which the movement of blood through the umbilical vessels is studied. If it is disturbed, there is a risk of pathology. But again, the doctor will not be able to give an accurate diagnosis.

• Constant observation by a gynecologist

During routine examinations, the gynecologist regularly measures the baby's heart rate, which may indicate pathology. In addition, a thorough analysis of the obstetric and gynecological history is carried out - the course of the entire pregnancy, previous births, their characteristics, and outcomes.

• Cardiotocography

This diagnostic method involves computer synchronous recording of the child’s heartbeats, his activity and their comparison with uterine contractions. If they are not connected to each other in any way, this is a sign of umbilical cord pathology.

If the fetus has a very short umbilical cord, which is visible to the naked eye even on an ultrasound, this is both good and bad. On the one hand, such an accurate diagnosis allows you to immediately begin preparing the woman in labor for. On the other hand, even before birth, a short umbilical cord can lead to various complications in the development of the child. What measures do doctors take to reduce the risk of unwanted consequences?

From the life of celebrities. There are people who have their belly button removed due to various diseases (for example, umbilical hernia). This interesting part of the body is missing from Karolina Kurkova, the famous Czech model, and no less than the star film director Alfred Hitchcock.

Treatment

What to do if the fetus has a short umbilical cord - at least there is a suspicion of this pathology? Even with high innovative medical technologies, there is still no effective drug treatment. The following activities are recommended.

1. Hospitalization and constant medical supervision until childbirth with repeated entanglement around the neck.
2. performed if the umbilical cord is short and this leads to acute oxygen deficiency and fetal hypoxia.
3. A planned caesarean section is prescribed if, according to diagnostic studies, a short umbilical cord threatens the life of the child.
4. If a short umbilical cord is detected already at the time of natural birth, the doctor makes a dissection of the perineum to help the baby be born.

A woman should know everything she can expect during childbirth if there is a risk of a short umbilical cord. Constant medical supervision will allow you to remain calm and prevent complications and unpleasant consequences for the life and health of the mother in labor and her child.

Interesting fact. The navel is the center of gravity of the human body, which explains why African athletes win more often than Europeans. Their legs are longer, which makes their navel 3 centimeters (on average) higher than others.

Complications

The dangerous consequences of a short umbilical cord can affect the health of both the mother and the baby. The most common complications include:

• difficult birth process;
• difficulties in moving the baby through the birth canal: for example, too slow;
• this may result in birth injuries to the mother;
• cardiac dysfunction in a child;
• acute fetal hypoxia;
• injuries of varicose vessels;
• hemorrhage in the umbilical cord;
• its rupture;
• placental abruption due to strong tension of the short umbilical cord.

The consequences for the child are especially dangerous if the umbilical cord is too short. The same hypoxia, even if the birth ended successfully, may further affect the development of his higher mental functions (memory, attention, perception, thinking, speech), adaptation, and behavior. Therefore, it is better to avoid all these complications by discussing the issue with your doctor in advance. caesarean section. And even better - from the very moment of conception, take care that all this does not happen.

News of modern medicine. In aesthetic medicine there is such a service as umblikoplasty - navel correction.

Prevention

To prevent a short umbilical cord at birth from harming the baby, a woman needs to initially know about the existence of such a pathology and take all possible preventive measures. Since the main cause of this trouble is the hyperactivity of the fetus in the womb, it needs to be controlled. It's up to mom.

1. During pregnancy, a woman should not worry or be nervous: the baby feels this very well, he also begins to worry, fidget, and the result is twisting of the umbilical cord, which causes it to become short.
2. For the same purpose, you need to talk to your child more often, listen to calm (preferably classical) music, and read beautiful poetry to him.
3. Sometimes intrauterine activity of the fetus is caused by a lack of oxygen. Therefore, we need to walk more fresh air and drink clean water in sufficient quantities.
4. Breathing exercises also reduce the risk of developing a short umbilical cord.

The diagnosis of “short umbilical cord” is often heard in the last weeks of pregnancy. This should not scare the woman, but put her in the right mood. Doctors should give her detailed advice on how to behave and what depends on her during childbirth. Modern medicine is ready for such difficulties and overcomes such situations with honor, preserving the life and health of mother and baby.

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Umbilical cord- This is an organ in the form of a long thin tube that connects the fetus with the mother’s body.

Functions, structure, blood circulation

The formation of the organ begins in the second week of gestation; as the fetus grows, the umbilical cord also increases.
The length of this organ can reach 60 centimeters, diameter 2 centimeters. The surface is covered with special membranes. This tube is quite dense, it feels like a dense hose.

Since the main function of the organ is to supply the fetus with nutrients and remove metabolic products, its basis is blood vessels: 2 arteries and a vein. Initially, 2 veins are formed, but during fetal development one of them closes. The vessels are very well protected from pinching and rupture. They are enveloped in a shell of a thick jelly-like substance called Wharton's jelly. The same substance has the function of transferring certain substances from the fetal blood into the amniotic fluid.

Arterial blood, rich in nutrients and oxygen, flows through the vein to the fetus; through the arteries, already used venous blood is drained from the fetus’s body to the placenta, which performs the purification function ( the fetal liver is not yet able to cope with this work). In the fetus before birth, 240 ml of blood per minute passes through the arteries, in the fetus at the twentieth week - only 35 ml per minute.

In addition to the above elements, the umbilical cord contains:

• Vitelline duct– it carries nutrients from the yolk sac to the embryo,
• Urachus– connecting channel between the placenta and bladder.

Umbilical cord blood test (cordocentesis)

The procedure is carried out under ultrasound control. A thick needle is used to pierce the umbilical cord where it attaches to the placenta and a blood sample is taken.

The procedure is performed for diagnostic purposes if:

• Hereditary neutropenia,
• Chronic granulomatosis,
• Mixed immunodeficiency.

Most often, this analysis is prescribed in cases where ultrasound examination later pregnancy reveals developmental disorders. In such cases, it is necessary to carry out a karyotype analysis ( set of chromosomes) fruit. Using special analysis methods, the result can be obtained within two to three days after blood sampling.

A few years ago, cordocentesis ( fetal cord blood test) was used to determine hemophilia, thalassemia, hemoglobinopathy, Down syndrome. Today, for these purposes, amniotic fluid analysis is used, as well as chorionic villus biopsy ( BVH).

After childbirth

In order for blood to flow normally through the vessels of the umbilical cord, it is necessary to maintain a certain level of hormones in the Wharton jelly. During childbirth, the amount of oxytocin- a hormone that induces labor. The vessels contract and the blood flow stops - organ atrophy begins, which occurs for several hours after the birth of the child.
Already 15 minutes after the birth of the baby, blood circulation in the umbilical cord stops ( if childbirth takes place without pathology). In this process, the temperature of the medium also plays a certain role - when cooling, the vessels also contract.

How and when is it cut?

After the baby is born, the umbilical cord is clamped on both sides with special clamps, after which it is cut.
Today, there is a lot of debate about how quickly a baby’s umbilical cord should be cut: immediately after birth or after it stops pulsating.
In America and Europe, this procedure is carried out within 30 - 60 seconds after the birth of the baby. There is an opinion that the baby does not receive cord blood, which is very useful for him, and may develop anemia.

American scientists conducted a study that proves that cutting done a little later reduces the likelihood of developing sepsis, respiratory diseases, respiratory diseases, anemia, cerebral hemorrhage, and visual impairment.

According to research by specialists from the World Health Organization, 80 ml of blood from the placenta enters the baby’s body within 60 seconds after birth, and 100 ml after another 2 minutes. This is an additional source of iron for a newborn, sufficient to provide the baby with this element for a whole year!
The term “late” cutting by specialists means cutting 2 to 3 minutes after birth. This should not be confused with some practices of savage tribes who leave the umbilical cord uncut at all ( after a few days it dries up on its own). As for cutting after the complete cessation of pulsation or 5 minutes after birth, such babies often experience functional jaundice. Therefore, everything is good in moderation.

In newborns

The remainder of the cut umbilical cord dries out quite quickly and falls off on its own within a few days.
A small wound remains at the site of its attachment. You need to take special care of it and then the wound will heal without problems.

Usually, daily treatment of the navel area with brilliant green, hydrogen peroxide, and do not wet it until the remainder of the umbilical cord falls off is enough. You should also let your navel “breathe” for a minute while changing the diaper.

But sometimes wound healing is complicated. Doctor's help required:

• If the body around the wound is swollen and red,
• If a foul-smelling, pus-like liquid leaks from the wound.

It is normal if a little ichor is released from the wound before complete healing.

Ultrasound

During an ultrasound examination, parameters such as:

• The junction of the placenta and the umbilical cord,
• The junction of the umbilical cord and the abdominal wall of the fetus,
• The presence of a normal number of arteries and veins.

The study allows you to detect expansion of the umbilical ring, single artery syndrome ( often combined with congenital heart defects and other genetic disorders), entanglement around the neck, cysts.

Doppler measurements can detect circulatory disorders in the vessels of the placenta and in the fetal body.

entwinement

Causes of pathology:

• Periodic stress,
• Lack of oxygen.

In the first case, an increased amount of adrenaline enters the fetus’s body, causing it to actively move.
In the second case, the lack of oxygen causes discomfort to the fetus, which also forces it to move more, increasing blood circulation and thereby receiving more oxygen.
The child may become entangled in the umbilical cord and unravel after a while. Therefore, this condition is not always dangerous.
Entanglement can be detected using ultrasound from the fifteenth week of gestation. In order to determine how much the baby’s body is being compressed, Doppler testing is done. In the event that there is a possibility of oxygen starvation, the examination is carried out more than once.

How to prevent entanglement?

• Spend more time in the fresh air, walk, do light exercises,
• Avoid stress
• Do special breathing exercises,
• Visit your gynecologist on time and undergo all necessary examinations.

Long or short

Violation of the length of the umbilical cord is the most common anomaly of the organ. The norm is 50 centimeters, that is, approximately the body length of a newborn baby.
More often, the umbilical cord is too long - 70 or even 80 centimeters. With such a length, there is a possibility of part of the umbilical cord falling out during the outpouring of water ( if observed breech presentation ). Also, an umbilical cord that is too long can cause it to become wrapped around the neck. But there is no evidence that length affects the likelihood of entanglement. If the loops are not wrapped tightly, then the birth can proceed normally, and there is no danger to the baby’s life.

If the length of the umbilical cord is less than 40 centimeters, and sometimes even up to 10 centimeters, they speak of shortening. With such a short umbilical cord, there is a high probability of fetal malposition. A short umbilical cord can create tight loops around your baby's neck. In addition, during childbirth it is more difficult for the baby to roll over and pass through the birth canal. With strong tension, there is a possibility of placental abruption.

False and true nodes

True node is formed in the first weeks of gestation. During this period, the fetus is still very small and its active movement causes “tangling” of the umbilical cord.
Such a knot poses a danger during childbirth, since as the fetus passes through the birth canal, the knot may tighten and the fetus will begin to suffocate. If the baby is not born very quickly, it may die. This happens ten percent of the time.

False knot– this is an increase in the diameter of the umbilical cord.

Reasons:

• Varicose veins,
• Tortuosity of blood vessels,
• Displacement of Wharton's jelly.

This is a harmless condition that does not in any way interfere with the normal development of the fetus and childbirth.

Hernia

This is a fairly rare disorder of fetal development. In case of a hernia, any internal organs The fetus develops under the umbilical cord membrane. More often this happens with the intestines. This disorder is usually detected by ultrasound examination. However, sometimes it is very minor. In such cases, there is a danger of organ injury during cutting of the umbilical cord. Therefore, before cutting, the obstetrician must very carefully examine the navel area and the part of the umbilical cord located in close proximity to the baby’s body.
Very often, such a disorder is combined with other developmental defects. A hernia can only be treated surgically.

Umbilical cord prolapse

One of the first stages of labor is the breaking of amniotic fluid. Sometimes the flow of water captures the umbilical cord, which penetrates the cervix or even the vagina. This is exactly the situation that is called loss.
This phenomenon is dangerous because the fetus moves along the cervix and can compress the umbilical cord, that is, the movement of blood and oxygen into its body is blocked.
Prolapse is more common during early labor and during breech presentation.
The prolapse is detected after the water comes out. A woman in labor may feel “something foreign” in the vagina. If at this moment the woman is not in the maternity hospital, she should get on all fours, lean on her elbows and urgently call an ambulance.
In some cases, the umbilical cord is inserted into place. Sometimes surgical delivery is prescribed.

Cyst

This is a fairly rare pathology, and it is usually possible to determine the cyst with accuracy only after the birth of the child.
This formation may be in a single copy or there may be several of them. Most often they are formed in Wharton jelly.
Cysts are noticeable during ultrasound examination. They do not in any way affect the blood circulation between the fetus and the placenta.
In most cases, cysts are combined with fetal malformations, so if cysts are present, it is recommended to undergo genetic analysis.
Cysts are divided into false and true.

False– without capsule, located in Wharton’s jelly tissue. They are quite small and are found in all segments of the umbilical cord. The reasons for the appearance of such cysts often remain unknown. Sometimes they appear at the site of hematoma or edema.

True cysts are formed from particles of the vitelline duct. Such cysts have a capsule and can be quite large - up to one centimeter in diameter. They are always formed near the fetal body. It is not always possible to distinguish a false cyst from a true one.

The rarest type of umbilical cord cysts are umbilical mesenteric cysts. Such formations appear if the formation of the fetus is disrupted in the early stages of pregnancy. In this case, between the bladder and urachus ( umbilical cord component) a cavity is formed in which fetal urine accumulates. Only ten similar cases have been described in medicine.