How to understand that the child's head fell into the pelvis and when to give birth. Normal childbirth

In the arsenal of modern medicine there are several methods that help more or less accurately determine when a birthday may be used, which will allow women and doctors as far as possible to prepare for him in advance ...

The average duration of pregnancy is 280 days, but this figure should be treated as averaged. This term depends on many factors, including duration menstrual cycle. His biology

the programmed duration is 28 days, with individual possible oscillations from 21 to 35 days. In 54% of healthy women, the duration of the menstrual cycle is 26-29 days, in 20% - 23-25 \u200b\u200bdays, in 18% - 30-25 days. Depending on the duration of the menstrual ovulation cycle, therefore, the conception may occur within the 8-20th day of the cycle.

With a 28-day menstrual cycle ovulation (the output of the egg from the ovary), as a rule, comes on the 14-15th day. However, under the influence stressful situations, physical Loads, inflammatory diseases Possible fluctuations in timing. The offensive of pregnancy depends not only on the moment of ovulation, but also from the viability of the egg and the duration of the fertilizing ability of spermatozoa. At the same time, the pregnancy can occur not only if the sexual act fell on the day of ovulation, but also if he was the day before - for 2 - 3 days before ovulation. Sperm and the spermatozoa retain their viability during this time and in the case when sexual intercourse occurs 2-3 days after ovulation (during this time the possibility of fertilizing the egg and attaching it to the uterine wall) is preserved.

To determine the deadline for the occurrence of labor, it is necessary to know the duration of pregnancy, which has long been taken to calculate according to the menstrual cycle. Pregnancy, calculated from the first day of the last menstruation, continues on average 9 solar or 10 obstetric (lunar) months, i.e. 280 days. But the birth of a mature fruit is exactly after 280 days only in 5 ° about women. As practice shows, timely childbirth can begin in terms of the 38th to 42nd week, so the probability of error in determining their presumptive date is large enough.

Diagnostic methods

The estimated duration of childbirth can be installed on the basis of several data. At the same time, the date of the last menstruation (with a regular cycle) and the results of ultrasound research are the greatest practical importance.

According to the date of the last menstruation, the lifetime period is determined as follows: from the first day of the last menstruation is counted back 3 months and add 7 days.

The duration of childbirth The doctor may be allegedly called in the inspection of a woman. The main diagnostic criteria for its definition are the magnitude of the uterus, the length of the fetus and the size of its head.

With a deadline of pregnancy, the stomach circumference, measured by a centimeter ribbon at the navel level, exceeds 90 cm; The bottom of the uterus is located below the sword-shaped process, and the standing height of the bottom of the uterus (it is measured from the Lonatic joint to the bottom of the uterus) is equal to 34-35 cm; The diameter of the fetus head measured with a pomp (doctor palpags - grips the fetus head, measures it with an instrument for measuring the sizes of the pelvis), is about 12 cm. The specified parameters fluctuate depending on the mass of the fetus and the severity of fatty fiber. Under the deadline of pregnancy, the primary fetal head is pressed to the entrance to the pelvis, in repeated - movable over the entrance to a small pelvis.

For the diluted fetus, the length fluctuations from 47 to 52-57 cm are characteristic. To determine the length of the fetus, the doctor centimeter ribbon measures the distance from the lower pole of the preempting head to the bottom of the uterus and the amount obtained is multiplied by 2. The frontal-occipital size of the head of the dudening fetus, measured by a baser To be 9-11 cm.

Determine the term of pregnancy can also be in the height of the bottom of the uterus, measured by a centimeter ribbon: X \u003d C + 3, where C is the standing height of the bottom of the uterus, and 3 is the coefficient found during observations. The uterus at the first vaginal study allows you to determine the size of the uterus and the term of pregnancy. The date of birth is being calculated from the date of delivery of up to 40 weeks. Early turnout to the doctor for up to 12 weeks allows to determine the term of pregnancy more accurately.

Ultrasound examination significantly improves the accuracy of determining the term of pregnancy. Up to 12 weeks, it is calculated based on the coccicco-darken-sized fetus, with a larger period - determining the size of the head, the length of the hip and the diameter of the abdomen.

Each pregnant ultrasound procedure It must be carried out at least 3 times during the pregnancy period (in 10-12 weeks, 20 - 22ndels.30-32The). The date of birth is calculated on the basis of the results of the ultrasound conducted on different timing Pregnancy.

A less reliable method is to determine the date of delivery by the date of the first movement of the fetus. The primordines begin to feel the movements of 20 weeks, repeatedly - in 18 weeks. Accordingly, by the date of the first movement of the fetus, the primordial should be added 20 weeks, in repeatedly 22 weeks.

How much will the baby weigh?

Funny ripe fruit has the following signs: weight - from 2500 to 4000 g, length - more than 45 cm, head circle - 32 - 34 cm, belt upper limb - 35 cm, pelvis - 28 cm. Crying own sinks And the nose is dense, the nails are solid, protrude above the tips of the fingers, the hair on the head, eyebrows and eyelashes are well outlined. A child who emerged in a timely manner, at birth with a loud cry, actively moves, smoothly and deeply breathing. He has pink leather, flush hair is stored only on the shoulders and top of the back, the subcutaneous fiber is well developed, the lens of the raw lubrication are visible on the skin. The genitals are well developed: the boys testicles are omitted in the scrotum, the girls have small sex lips and clutors covered with large sexual lips. On the head of the duddy newborn, the seams and springs are well defined; They should not be narrow, and the bones of the skull are dense.

Not only the term of pregnancy, but also the estimated mass of the fetus, is important for choosing childbirth tactics. To determine it, the following formulas exist:

1) The coincidence is 14%: the mass of the shyuda \u003d 1/2 20 by the mass of the body's body.

2) Coincidence-17%: Massageloda \u003d coolant * VDDM, where coast - the abdomen of the abdomen is pregnant, VDDM - height one hundred bottom of the uterus.

3) coincidence - 25-35%: the mass of the fetus \u003d coolant + VDDM / 4

4) coincidence-60 - 66%: the mass of the fetus \u003d VSDM [(J - T): 2] * l, where J - the distance between the III lumbar vertebra and the top of the tailbone, measured with a pazer; T - the thickness of the folds of the abdominal wall above the navel, measured by a pomp; L is the frontal-occipital size of the head according to the ultrasound.

5) the mass of the fetus \u003d coolant (C + T) / 2, where the standard of the base of the bottom of the uterus, measured by a centimeter ribbon; A measured database measured in the bottom of the bottom of the uterus.

Objective signs of 36-week pregnancy.

In 36 weeks of pregnancy, the bottom of the uterus is directly under mesia-shaped process; There is almost impossible to move the edge of the palm between the upper-winding uterine departments and the rib arc. Pregnant marks a particularly strong "sign up" in the opposite region. The distance from the bottom of the uterus to the upper edge of the symphysis, measured by a centimeter ribbon, is 33-34 cm (with a looser measurement - 23-25 \u200b\u200bcm); The circumference of the abdomen is 90-92 cm. The head is dense, is located above the entrance to a small pelvis, limitedly mobile, and the primary unawares are often pressed to the entrance. Anterior-rear (frontal-occipital) head size is 10.5-11.5 cm.

To measure the head through the abdominal wall, the latter is covered by divorced large and middle fingers (more often than right); to the most remote points on the head, fixed with the fingers, with the help of another hand attach the thazomer buttons; From the figures obtained, it is necessary to take 0.3-1 cm (depending on the thickness of the abdominal wall).

Fetal length at 36-week pregnancy.

It is also necessary to measure through the abdominal wall of the pregnant length of the fetus. With a greater or less accuracy, it can be done with another mobile over the head. Pressing the abdominal wall, one leg of the pelvomer put on the lowest point of the head (or buttocks, if there is a berium preview); The other leg of the thazomer is placed at the opposite end of the body of the fetus, that is, on the most remote part of it, located in the bottom of the uterus. With a 36-week pregnancy, the length of the fetus is alive in this way.

Example: The result of measuring the fetus length is 24 cm; Uponing the number (24 x 2 \u003d 48) and reducing from the work on average 2 cm, we obtain the length of the fetus equal to 46 cm.

Determination of the deadlines.

To determine the date of delivery, it is necessary to carefully compare all data obtained in a survey and study of the pregnant woman.

Usually enjoy the following calculations.

1 . From the first day of the last menstruation, it is counted 3 months ago and add 7 days to the resulting date, which indicates the day of the expected delivery.

2. The day of the first movement of the fetus is added on average for 20 weeks (140 days). The resulting calendar date indicates the day of the upcoming birth.

Of course, as already mentioned above, determining the term of childbirth according to the pollingity of pregnant women not accurately. It is necessary to carefully compare the resulting calendar dates with the results of an objective study.

Signs of 40-week pregnancy and approximations.

Approaching childbirth (40 weeks of pregnancy) is determined by the following features. The bottom of the uterus - in the middle between the navel and the sword-shaped process. In this regard, part of the abdominal wall between the bottom of the uterus and the sword-shaped process is free.

The height of the bottom of the uterus above the upper edge of the symphiz, measured by a centimeter ribbon, is 28-30 cm.

The feeling of "sign up" in the opposite region ceased 2-3 weeks ago. The abdominal circle is 96-97 cm. The navel is sucked. The head is dense, pressed to the inlet or stands in the inlet pelvis (at the primary). In repeatedly, it is pressed to the inlet of the pelvis or limitedly mobile.

The occipulous head size is 11-12 cm.

With the feeling of the abdomen it is easy to see that the uterus quickly "hardens" is reduced by hand. This testifies to the great excitability of the mother-in-law muscles, about its readiness for generic activities.
2-3 days before delivery, there is a drop in the weight of a pregnant woman (on average per 1, kg).

Sometimes there is a restless behavior of pregnant, insomnia, excitement, complaints, fear of childbirth.

The last trimester of pregnancy is the most responsible and difficult period. A woman is looking forward to meeting with the baby, paying attention to the slightest changes in the body. They can be both positive and negative. An explicit harbinger of childbirth is considered to omit the child's head. If it is pressed to the entrance to a small pelvis, it means that the generic activity will begin in the coming days. A sign of pathology can be too early moving the fetus or, on the contrary, a process delay. After paying attention to the problem in a timely manner, you can easily fix it before childbirth and avoid complications.

Causes and mechanisms for the omission of the fetus in a small pelvis

The mechanism of training the body is launched in 3-4 weeks before the long-awaited event. Causes of this process:

• Aging placenta. Starting from 36 weeks, the number of hormone generated placenta decreases. Reducing the level of progesterone leads to an increase in the cutting of the uterus, launching a generic act.
• Generic dominant. This term is called special condition Women who helps her relax, trust instincts and survive childbirth. For the formation of dominants in the brain, sympathetic and parasympathetic nervous systems. Eclectic activity in them rises 1.5-2 weeks before the child appears to the light and reaches his peak in the most responsible moment.
• Maturity of the fetus. An increase in growth rates and a decrease in the number of arrogant waters is stress for the mother's body. In response to this, adrenal glands begin to highlight more cortisol - stress hormone, which in turn stimulates the production of prostaglandins.

The final stage is the omission of the baby's head into the pelvic cavity, where he will wait for the beginning generic activity.

The births themselves begin at the moment when a sufficient number of prostaglandins and oxytocin accumulate in the body of a pregnant woman, and the generic paths become soft, elastic under the influence of estrogen.

Signs of fruit omission

Depending on the individual characteristics of the body, a woman can not feel anything when the child leaves from the uterus, but may experience a whole range of new sensations, some of which may even be painful. It is understood that the fruit fell into the pelvis, a certain symptoms will help.

Exterior signs

• The belly shifts into the navel area.
• The distance between the belly and breasts is palm.
• The campaign changes - becomes duck.

Feel

• It becomes easier to breathe. The fruit no longer squeezes the diaphragm and does not interfere with its oxygen filling.
• Cleans to displays heartburn, belching. Increased uterus does not press the stomach and intestines.
• Back pain disappear, as the load on the spine is reduced. At the same time appear easy sensations In the area of \u200b\u200bthe pelvis, the swelling of the legs increase.
• Pupile calls for urination. Light incontinence may appear.
• Stop constipation.
• Dissension appear white color, without smell.

Also, the difference can be seen with a naked eye in the mirror. If a woman has observed all pregnancy for his belly, then surely pay attention to the changes.

Influence on the mother's body

Outstanding the belly in all women occurs in different time. In gynecology, this process is also called the formation of the fetus or omission of the uterus. On the one hand, it facilitates the physical condition of the pregnant woman, and on the other, it causes a lot of concerns and discomfort.

Positive changes

With the omitting of the fetus in the cavity of the pelvis it becomes easier to breathe. The kid stops painfully resting in the ribs, aperture, digestive organs. The woman disappears the belching, shortness of breath, heartburn.

Mother's body self-cleaning from slags, harmful substances. During this period, the complexion is improved, pass dark Circles Under the eyes and smoothed wrinkles.

Negative changes

Running down, the child's head is putting pressure on the pubic and hip bones. It causes discomfort when sitting, walking, while sleep. To adjust the new state, the pregnant woman has a characteristic "duck" gait, and at night she has to sleep on the side or with a special pillow.

Urinary incontinence is another unpleasant consequence of the last weeks of the baby. In some it causes a number of complexes and even leads to a nervous breakdown. In order not to worry on trifles, wear special gaskets. They have a greater absorbency, unlike ordinary.

Intimate flora after the omission of the fetus becomes more sensitive to various viruses and bacteria. During this period, it is especially important to monitor hygiene, not to translate and eat right.

Frost head omission time before childbirth

The deadline for omission of the fetus head - individual feature Each woman. Most often, the event occurs on 36-38 weeks of pregnancy, less often - closer to 40 weeks. For re-pregnancy The uterus falls 2-5 days before delivery.

Later, the omission of the uterus happens in women with well developed abdominal wall. Some omit does not occur at all or happens a few hours before the appearance of Chad. This is not a pathology and does not affect the health of the child.

The danger to the kid is of relaxed and untrained Mother's peritoneum muscles. They do not provide a fetus sufficient fixation in the pelvis.

It is worth alarming if the belly falls too early (up to 35 weeks) or change led to the appearance strong pain, unusual discharge. In this case, the probability is high premature birth or miscarriage. Need to immediately take horizontal positionCall ambulance and contact your doctor's pregnancy. After hospitalization, patients prescribe tocolic preparations that reduce the tone of the uterus.

In what cases does not fall the stomach

Several factors affect the entry of the fetus on the eve of labor:

• level physical training women;
• fetal weight;
• the nature of the prelationship;
• what account is pregnant;
• the number of fruits.

If a few days left until the appointed date, and the position of the belly has not changed, do not panic. You may have just a weakly developed musculature, narrow pelvis or second pregnancy. Analyze your overall condition, the presence of accompanying symptoms.

What to do with premature abdomen

Early lowering the fetus head into the pelvic cavity is fraught with its transfer. From this, the baby can be born with a deformed skull: a flattened forehead or bevel over one side. The degree and type of change depend on the form of the mother's pelvis.

Symptoms of premature omit:

• permanent pressure on bladder;
• frequent urges for urination;
• feeling foreign bodies In the upper vaginal departments.

Bandage during pregnancy reduces the load on the legs, supports the fruit

For accurate diagnosis Problems consult a doctor. If the diagnosis is confirmed, measures should be taken. Most effective methods of maintaining the fetus:

• Wearing a bandage. The device supports the child's head in the correct position and does not allow further advancement of the fetus by the generic paths. In addition, the bandage redistributes the burden on the spine and speeds up the recovery process after delivery.
• Gymnastics for pregnant women. Special postures contribute to the discharge of the head up and facilitate discomfort. Lying on the back lift the pelvis and delay in this position for 5-10 seconds. Then stand on your knees and lift the pelvis above the chest level. Repeat the exercises every day of 3-4 approaches.
• Osteopathy. A skilled specialist for one session will move the fruit head from the entrance to the pelvis.

If the risks of the premature start-up of childbirth are great, the doctor can put a pregnant woman to preserve the hospital.

Outmunction of the fetus before childbirth - joyful and at the same time an exciting event. To avoid unwanted surprises, you should begin preparations for the upcoming process in advance when you give birth. Basic recommendations:

When fulfilling all tips, the child will take the correct position and will be on the light according to the schedule. It's time to go to the hospital, you will understand the waters and fights that will appear at the same time interval and intensify.

Pregnant women are always monitance with special attention as changes in their body. Some begin to worry that the belly fell, others worries that in the period of 38-39 weeks of pregnancy it has not yet happened.

As a rule, the abdominal omission is one of the harbingers of childbirth. In connection with these, the question arises, for how many days or weeks before childbirth, the stomach is lowered? For each woman, the term is individual.

There is a lot of reasons when this does not happen. But this does not mean that the woman's body is not prepared for childbirth. For obstetricians, the concept of "abdomen" is not only a harbinger of childbirth, but also the indicator of the proportionality of the pelvic ring the parameters of the baby's head.

After 37 weeks of pregnancy in the crust big Hemispheres The brain of the woman begins to form a "dominant of childbirth." From that moment on, the training of the body to the generic process begins.

The relaxine hormone is produced, which contributes to the relaxation of connective tissue, tendons. Under the action of this hormone, the articular joints of the pelvic ring of women begin to "disperse" a little, especially this process is expressed in the Lonnoye. Thanks to these processes, the Women's pelvis adapts to the upcoming birth.

Many women are already interested in 35-36 weeks, for how long the belly is descended before childbirth.

By the beginning of 37 weeks, the lower segment of the uterus occurs. This site anatomically corresponds to the freak of the uterus, but it is in last weeks Pregnancy He begins to significantly increase in size. Due to this, the lower part of the uterus increases, as a result of which the fetus head is empty and fixed to the bones of a small pelvis.

Such a change in the position of the fetus leads to changes in the state of the uterus: its bottom is significantly lowered.

After omitting the head to the entrance to a small pelvis, a change in the position of the center of gravity has a woman. The woman appears a gait that obstechers call the "proud flow". Since the main burden falls on the lower back, the woman walks with a straightened back, slightly raising his head, often she holds her hand lower back.

What features can you understand that the belly fell?

A woman can not always notice the difference in, as this distance may be minor (somewhat cm) and not always distinguishable to the eye. However, there are a number of other signs for which it is possible to reliably determine that the belly fell.

Subjective signs

It is no secret that most pregnant women, especially in the third trimester of pregnancy, suffer from heartburn.

This is due to the growth of the uterus and its pressure on all organs abdominal cavity, in particular on the stomach.

As a result of such a pressure, the contents of the stomach in the esophagus are increasingly racing, which causes a feeling of heartburn.

When the abdomen is omitted before childbirth, the pressure on the stomach is significantly reduced. A woman can notice that it is practically not worried about the heartburn and she does not have to take antacid drugs ("," Rutacid ",", etc.).

• Reducing shortness of breath.

Reducing shortness of breath occurs at the following reason: the desired uterus ceases to put pressure on the diaphragm. Thanks to this, respiratory movements are performed without effort, and shortness of breath stops disturbing.

• Starting urination.

Due to the fact that the head of the child is lowered into a small pelvis, there is an excessive pressure on the bladder, which is located in anatomical intimacy with the uterus. Pregnant notes that it became much more common to test the urinary call.

• Strengthening.

This is due to the increased load on this back during this period.

Objective signs

• Reducing the frequency of respiratory movements.

This is due to the relief of breathing and a decrease in shortness of breath.

• Reducing the pulse rate.

Lightweight and hearts - organs whose work is very affected by each other. Therefore, when the breath disappears, the load on the heart decreases, which is manifested by a minor gentle of the pulse.

• Changing the height of the bottom of the uterus.

If you take the distance from the LONA joint, to the upper point of the uterus (bottom), then it can be determined that this distance decreased by 3-4 cm.

• The fetus head is tight pressed to the entrance in a small pelvis.

This feature is determined only by an obstetrician, he puts his hand on the head of the fetus and determines that it is fixed to the bones of the pelvis.

• Moving the center of gravity, in connection with which a woman is changing a gait.

After how much to give birth, if the belly dropped?

There can be no accurate answer to this question, as the processes of preparation for childbirth in all women are individual and occupy miscellaneous number time. But in general, there are some features:

• From the primary from the moment the belly dropped, and the beginning of the generic activity usually passes longer than in repeated.

This is due to the fact that the forerunners developing in primarmerer, last longer, since the formation of generic dominants occurs. Usually, after the ease of the abdomen, the women begins a generic activity after 2 weeks.

• The harbingers of childbirth in repeatedly may appear only a few days before delivery, so after the abdomen is omitted before the start of childbirth, there may be less time (about 1 week).

These numbers are very relative, as they depend on many factors.

In what cases does the stomach be sinking before childbirth?

Some women do not accept abdomen before childbirth for a number of reasons:

1. Incorrect fetal position (oblique or transverse).

With this pathology, it does not fix the fetus head to the pelvis bones, so there are no signs of abdominal omission. The belly of such pregnant women has a special form: it is pulled out on the sides.

Significant increase in quantity calopal fluid It hinders the omission of the bottom of the uterus. The head of the child in such cases is often not fixed to the pelvic ring. Oil flooded water With this pathology, they are not divided into front and rear.

If the child's head exceeds the size of a woman's pelvis, then no dense fixation takes place to the bones, as a result of which the head is as it were over the pelvis, which prevents the omission of the abdomen.

1. Some fruit diseases.

The increase in the fetal head at hydrocephalus also interferes with its dense fixation to the bones of the pelvis.

1. Incorrect position of the fetus head.

Oposhera refer to this category of pathologies "asclit insert", which means changing the position of the fetus head.

This happens at the following states:

• Extensive head positions (frontal, lobnamed).

Normally, the child is bent, but with an increase in the angle between the neck and the chin of the fetus there are extensive states. An extreme degree is a facial insert when the child will take place to the bones of the pelvis face.

• Adntable and reckable asynclitism is a pathology in which the child's head is inserted when the slope into one of the sides (right or left).

The asclit insertion of the head creates a number of serious complications during childbirth and is often the cause of operational delivery!

findings

Announce belly before childbirth - an important feature Woman's body readiness for childbirth. But obstetrics give this sign important Also for another reason: the stomach falls in the event that the size of the fetus head and the pelvic ring are comparable.

Thus, this feature It must be treated with high attention, as it reflects many physiological processes before childbirth: the formation of the lower segment of the uterus, fixing the head to the pelvis bones, the adaptation of the pelvic ring, the correct position of the head.

Passport part.

1. Full name: Elena Alexandrovna
2. Age: 19 years
3. Place of work: unemployed
4. Residence: Ryazan ul. Konayeva d. 16 sq.2
5. Date and time of receipt: 01/11/2003 at 755 m.

Received with complaints about pulling abdominal pains, minor bright allocations.

A. General: Born 2 child, body weight does not know, heredity is not burdened, domestic conditions without features within the normal range, suffered: wind-haired OSPU, Korea rubella, ARVI, Angina, Ampnenectomy in 2002, allergic history is not burdened.
B. Special:
1. Menstruation: Started from 13 years, for 4 days, after 22 days, painless, the cycle was installed in 3 months.
2. Sex life: since 14 years old, marriage is not registered, the child's father is healthy (alcoholism, tuberculosis and venusal diseases Do not suffer).
3. There are no gynecological diseases.
4. Pregnancy II, 40 weeks, childbirth I. In 2000, a medical abortion, without complications (pregnancy: 21 weeks) at the request of a woman.
5. For a real pregnancy:
Date of the last menstruation: 04/04/02-10.04.02
The course of the first half of pregnancy: toxicosis, treatment outpatient.
Date of the first fetal movement: 08/16/02
The course of the second half of pregnancy: 22 week of threat of miscarriage, treatment in the hospital (papaverine, cocarboxylase, glucose, Brikanil, Vita-Ming E).
First visit for women's advice: 10.06.02., Pregnancy term: 9-10 weeks, visited 14 times.
Body weight gain for pregnancy: 16 kg.

Objective study.

A. General.
1. General state Satisfactory, height 159 cm., Weight of 81.3 kg, normostic physique, body temperature 36.6 °, edema are missing, skin poko-you in the area of \u200b\u200bthe white line of the abdomen, on the nipples and the near-block circles of pygm.
2. Psychoneurological status without features.
3. Circulatory organs: without features, A.D.-120/80, Clear heart tones, no noise, arteries are soft, elastic, the arterial pulse is the same on both hands, good filling, uniform, rhythm correct, frequency -80 boot-dock per minute.
4. Respiratory organs: breathing through the nose is free, pain sensations And there is no dryness in the nose, there are no secretions, pain in chest No, the voice is clean. The normostic shape of the chest, the frequency of respiratory movements18, there are no swelling, the chest type of breathing. When the chest palpation is absent, the chest rigidity is normal, voice trembling is symmetrically on both sides and is not changed. When percussion, the sound is clear pulmonary, symmetrical on both sides. Auscultation: Breathing Vesicular symmetrical on both sides, there are no wheezes.
5. Appetite is preserved, there are no intolerance to the products, dryness in the mouth and the unpleasant taste is not, swallowing free; Heartburn, belching, nausea, vomiting, me-theorism is absent, the separation of the gases is free, the chair is normal without particularly infections. Cracks of lips and snacks are absent, mucous color pink, without integrity disorders, teeth without features, the language is clean, wet, without falling, there is no smell of mouth. Liver and intestines without features.
B. Special.
1. Outdoor obstetric examination:
Belly-form Ovoid (ovoid), abdominal circle -107, you-honeycomb dna uteri-38
The position of the fetus is longitudinal, I position, front view, occipital prediction, head pressed to the entrance to a small pelvis.
Fetal heartbeats are listening below the navel on the left, clear, rite-friendly, 134 per minute.
Exterior sizes of the pelvis: 25-29-34-20, Solovyov-16.5 index; Dimensions of rhombus Michaelis - longitudinal size-13, transverse-10, the magnitude of the lane corner is 100 o.
The nature of the generic activity: contractions in 4-5 minutes to 20-25 CE-Kund, the middle force, moderately painful.
Opening of the cervix in Shatz Unterbergeru: on 2 transverse fingers (4 cm.)
Estimated fetal mass: 3400-3800.
Estimated term of pregnancy and childbirth:
-The latest menstruation (04/04/02.-3 months + 7 days): 01/13/03 - 40 weeks
-The first fetal movement (08/16/02 + 5 1/2): 16-17.01.03.-40 weeks
- by the first turnout in the LCD (10.06.02 - term 9-10 weeks): 6.01.03.-40 weeks.
- Uzi (5.12.02- term 35 weeks): 9.01.03-40 weeks
-To time of conception: does not know
- by the standing height of the bottom of the uterus over Lone (38 cm): 39-40 weeks
- by the formula of the Sculstical: X \u003d ((LX2) -5) / 5, L-27.5 40 weeks

Vaginal research

(11.01.03 at 17.00-time receipts in the maternity hospital): Exterior genitals are developed correctly, exhaustion on the female type. Protectness of normal height. There is no vagina, there are no partitions in the vagina, there are no strictures and scar changes.
The neck is smoothed, the edges are thin, the opening of the uterine diet is 4 cm., Frucent bubble is intact, flat; Open, 100 ml flowed. light waters; The head is offered outside the plane in-yes in a small pelvis; Skil-shaped seam in the right braid size, small springs on the left of the specialist, the big right at the rear; Capacity pelvis satisfactory, CD-13 cm, CV-11 cm.

Pregnancy II, 40 weeks, childbirth I; first period of childbirth; The occipital presence, the head is pressed to the entrance in a small pelvis; Flat fetal bubble; amniotomy; Heated obstetric and gynecological history.

Handbirth plan.

With considering young age Gentlemen (19 years old), first labor, normal sizes pelvis (25-29-34-20), presumably medium in the magnitude of the fetus (approximately 3400), the longitudinal position, the occipital presence of the fetus with the head pressed to the entrance to the small pelvis, but the presence of a medical abortion in history, as well as a burdened obstetric Gynecological anamnesis (in the first half of pregnancy-cocosis, in the second half at the 22nd week of the threat of miscarriage, transferred during the ability of the disease: ARZ, chronic sinusitis) Giving birth to PER VIAS Naturalis with the prevention of intrauterine hypoxia of the fetus, bleeding in the third period of RO -Od.

The flow and conduct of childbirth.

17.00 11.01.03
Satisfactory condition arterial pressure 120/80, pulse 86 beats in Mi-Chicku. Fights in 5-6 minutes to 20-25 seconds; middle force. The position of the fetus is a long-dollar, the head will take place, pressed to the entrance to the small pelvis. Masual fetal heartbeat, rhythm 136 beats per minute. Vaginal Study: The neck is smoothed, the edges of the tone, the opening of the uterine seva by 4 cm., Frucent bubble is intact, flat; Open, 100 ml flowed. light waters; The head is offered outside the entrance plane in a small pelvis; sweat-shaped seam in the right braid size, small springs on the left in front, large on the right behind; Capacity pelvis satisfactory, CD-13 cm, CV-11 cm.
Diagnosis: pregnancy II, 40 weeks, childbirth I; first period of childbirth; The occipital pre-lying, the head is pressed to the entrance in a small pelvis; Flat fetal bubble; Amnioto Mia.
Plan: Giving birth to PER VIAS Naturalis with the prevention of intrauterine hypoxia of the fetus, bleeding in the third period of birth.
19.00 11.01.03
The condition is satisfactory, consciousness is saved. Pulse 86 Ud / min.
Arterial pressure on right hand - 120/80 mm Hg, on the left -
125/80 mm Hg.st. Fights 4-5 minutes to 25-30 seconds, painful. Head at the ride to the entrance in a small pelvis. Fetal heartbeat clear, rhythmic, 140 per minute.
21.30 11.01.03
The condition is satisfactory, consciousness is saved. Pulse 72 Ud / min.

125/80 mm Hg. St .. Fights 3-4 minutes to 25-30 seconds, somewhat weakened. The head is pressed to the entrance in a small pelvis. The fetal heartbeat is clear, rhythmic, 130 in min-ta. With the purpose of stimulation of labor activity assigned SOL. Oxytocini 1ml-5 ED, Glu-goat-5% -400.0 V / in drip.
23.00 11.01.03
The condition is satisfactory, consciousness is saved. Pulse 88 UD / min.
Arterial pressure on the right hand - 125/80 mm Hg, on the left -
125/80 mm Hg.st. Fights in 2-3 minutes to 35-40 seconds, strong. The head is pressed to the entrance in a small pelvis. Fetal heartbeat clear, rhythmic, 140 per minute. Opening of the cervix complete (12 cm.)
23.20. 11.01.03
The condition is satisfactory, consciousness is saved. Pulse 90 Ud / min.
Arterial pressure on the right hand - 125/80 mm Hg, on the left -
125/80 mm Hg.st. There were swells. Head on a pelvic day. Maski fruit heartbeat, rhythmic, 136 per minute.
23.55. 11.01.03
In the forefront of the occipital presence in the right biomechanism of the birth was born a lively dandy boy with a two-hand tougy cordial cordhouse around the neck. PU-BUN 80 cm long. APGAR-7/8 points, weight 3270, height 51 cm. After 5 minutes, it was often separated in 5 minutes, and it was intermittent, inspected: it is possible, with the foci of calcinosis, overalls all stood. Surface waters green with admixture of meconia. Generic way Watching: cervixed edges Thin, flabby, under the tools are sprawling. The front lip is rare, breaks for 9, 13, 15, 18 hours. Easy with Ketgutov seams under intravenous anesthesia. Deep break back wall Vagina and crotch I degree. Eashadles with Ketgutov seams. There are 10 seams. Blood lodge 300.0, AD-110/70 mm. RT. Art., Pulse 90 beats per minute.
The primary processing of the newborn is manufactured: the child born is wiping sterile gauze. Sterile can be sucking mucus from the nose and mouth of the child and applied it to the mother's chest. Pupovina should not be stretched. Watching a child and follow his behavior.
Prevention of ophthalmoblenium 20% albucidium solution 10 minutes after birth and 2 hours.
Underplow processing are carried out in two stages:
1) After the termination of the pulsation of the umbilical umbilicals, two clamps are superimposed on it, one at a distance of 10 cm from the umbilical ring, and the second for 2 cm of the duck from it. The PU-PU-PARTY, which was between the clamps, is treated with a 5% alcoholic solution of iodine and crossed it.
2) Child's separated from mother is transferred on a pan on a changing table. The residue of the umbilical cord is wiped with a sterile marlevary napkin, the umbilical cord is tightly pressed between the index and thumbs.
If the mother had a rezes-negative belonging of the blood, then a newborn to the residue of a bundle of 5 cm long would impose a sterile silk ligature so that if necessary, it was necessary to replace blood transfusion through the vessels of the umbilical. At a distance of 2.5 cm. The duck from the place of imposition of the ligature of the umbilical cord is cutting with sterile scissors. The surface of the cord cut slicer is treated with a 5% alcoholic solution of iodine. The residue of the umbilical cord with the silk ligature is tied with a sterile marlevary napkin in the form of a cap. After treatment of umbilical cord machines produce primary treatment of skin. Sterile cotton balls, moistened sterile vaseline oil, remove raw-like lubrication, as well as blood remnants, mucus and oily water from the face, scalp, chest, abdomen, back, limbs, finishing the toilet of the newborn it is weighed, they measure its growth, head sizes and Handers, on the hands of the bracelets of the canlenka on the bracelets are pre-writing the name of the mother, the number of childbirth history, the floor of the child, body weight, growth, date of birth. Then, after measurements, a sterile warm splicer is put on a child, it is cleaned into a sterile diaper and a blanket, put in the crib and leave for 2 h under observation.
The newborn is examined by a pediatrician and measured: body weight-3270, height-51 cm, head of the head-35 cm., Breast circle-33 cm. APGAR 7/8 (after 1 minute -Serdo-2, breathing-2, color -1, Tonus-1, reflexes-1, score-7 points; through 5-palpal-2, breathing-2, color-2, tone-1, reflexes-1, score-8 points).
Duration of childbirth: I-11 hours, a second period-55 minutes, III-5 minutes, a total duration-12 hours.
Final diagnosis: childbirth I, urgent. Flat fruit bubble. Amniotomy, ro-achievement. The cervical breaks of the I Art., The rear wall of the vagina, the crotch of the I degree.
Appointments: cold for 2 hours, crotch processing, ampiox 1 tablet 4 times a day.

Biomechanism of data delivery.

The totality of the movements made by the fruit during passing through the generic paths is called biomechanism of childbirth.
The fetus in these kinds was in the longitudinal position, the occipital pre-lying, the first position, the lead. Distinguish 5 moments of childbirth.
1. Flexing the head. (Flexio Capitis)
2. Squeeze the head.
3. Internal turn of the Kepened Head, or correct rotation. (Rotatio Capitis Interna Normalis)
4. Extension of the head. (Extensio, Deflexio, Capitis)
5. Internal rotation of the body and the outer turn of the head. (Rotatio TRUNCI INTER-NA ET CAPITIS EXTERNA)
The first point is flexing the fetus head. In the period of expulsion, the pressure of the uterus and the abdominal press is transmitted from above to the pelvic end. And through it on the spine and the head of the fetus. The spine is connected to the head not in the center, but closer to the back of the head; In this regard, the "lever" is formed, at the end of the short shoulder of which there are hides, and the long-forehead. The power of intrauterine and intra-abdominal pressure is transmitted, first of all, on the back of the "lever" short shoulder. As a result, in the entrance to a small pelvis, the head moves around the imaginary transverse axis, as a result of which the chin approaches the chest, the head is lowered into the entrance to a small pelvis, small spring is located below large. With further promotion by the generic channel, small spring should be on a wired pelvic axis, being a drive point. The leading (wired) point is called the point of the fetus, which first falls into the inlet of the small pelvis, follows the wired axis of the pelvis and the first is first shown at birth. The flexion of the head leads to a relative decrease in the prerequisite part of the fetus. As a result of flexion, the head passes all the planes of the small pelvis more freely, its own least, a small sideline, the diameter of which is 9.5 cm, with a mound of 32 cm.
The second moment lowering the head into the pelvis cavity. The head falls to the re-stroke from a wide part into a narrow, where resistance from the last, resulting in an internal turn of the head.
The third moment is the internal turn of the head. It begins at the head of the head in the pelvis cavity and ends at a time when it reaches the bottom of the pelvis. Fruit trusting simultaneously with progressive movement turns around a pro-dollar axis. At the same time, the cooler of the fetus turns the Kepenta, to the Lonnoy Artician, and the Lichiko - the Zada, to the sacrum.
The fourth moment is the extension of the head. The extension of the head occurs at the exit of a small pelvis. Reducing the uterus and abdominal press guide the fruit of the book. The bent head reaches the pelvic floor, the muscles and fascia of the pelvic bottom have to be resistive to its further advancement. As a result, the head deflects the smallest resistance site - a vulvive ring, rotates around the imaginary transverse axis, the kleon is deflected - is inflicted. The head is cut, teething and born. The size of the teething is a small oblique-9.5 cm. Generic tumor forms, smiling in the field of small spring. Head shape: Dolichetephalicic.
The fifth moment is the inner rotation of the body and the outer turn of the head. The shoulders at the outlet of the small pelvic turn out of the transverse size in a straight line. At the beginning, the lane arc suits the front shoulder, after the fixation of which a tooo-blast bends in the shaven-thoracic department, while the back shoulder is born. After birth, the body and legs of the fetus are easily born. At the time of the inner turn of the shoulders, the head turn is performed. Futher's face turns to the mother's thigh, depending on the position of the fetus: at the first position - to the right misfortune, at the second position - to the left.

The course and maintenance of the postpartum period.

01/13/03. - 2 days after childbirth.
No complaints. Satisfactory condition. Pulse 70 beats per minute. AD-120/80 mm. RT. Art. Dairy glands and nipples without features. The uterus is 14 cm. Lesse, raft. Isolation of bloody, moderate. Seams within the normal range. Appointments - internally: glucose 40% - 20 ml, vitamin C 5% - 5 ML;
Intramuscularly: vitamins B1, B6 1 ml, but-shp 2 ml.

01/14/03 - 3 days after childbirth.
No complaints. Satisfactory condition. Pulse 70 beats per minute. AD-120/80 mm. RT. Art. Dairy glands and nipples without features. The uterus is 12 cm. Lemon, raft. Isolation of blood-serous, moderate. Seams within the normal range.
Appointments: Table number 15, toilet seams, cleansing enema, shower. Intravenously: gluco-for 40% - 20 ml, vitamin from 5% - 5 ml; Intramuscularly: vitamins B1, B6 1 ml, but-shp 2 ml.
Epicriz of childbirth.

Taraskina Elena Aleksandrovna, 19 years old, entered the maternity hospital 01/11/2003 at 75 35 minutes (came independently) with complaints about pulling abdominal pains, minor bright allocations. She conducted a vaginal study: the neck of the fork, up to 2 cm., Zev is closed, through the head of the head. Capacity pelvis satisfactor-naya. Diagnosed: Pregnancy II, 40 weeks. Position of the fetus Longitudinal, prediction. Head, second position, front view. Birth I urgent. Fights lasted at 12.00, amniotomy produced at 17.00, watered waters in the amount of 100 ml, bright. Full discovery at 23.00, the beginning of Poomo at 23.20, the child was born in 23.55. There is a gentle, half-male, body-3270, height 51 cm. After 5 minutes, he was separated independently and released (by Schultsu), inspected: the foci of calcinosis , shells all stood out. Surface waters green with admixture of meconia. The generic path is viewed: the edges of the neck are thin, flabby, under the tools are sprawling. The front lip is rare, breaks for 9, 13, 15, 18 hours. Eschita with ketgut seams under intravenous anesthesia. Deep gap of the rear wall of the vagina and the pro-inability of the I degree. Eashadles with Ketgutov seams. There are 10 seams. Blood lodge 300.0, AD-110/70 mm. RT. Art., Pulse 90 beats per minute. After 2 hours, the parental was translated into the postpartum separation. The final diagnosis was set: pregnancy II, 40 weeks, the situation of the fetus is longitudinal, the presence of the head, the second position, the fore. Birth I, urgent. Flat fruit bubble. Amniotomy, relaxation. The cervical breaks of the I Art., The rear wall of the vagina, the crotch of the I degree. Currently, to be in the postpartum department of the Maintenance Road No. 4.
Recommendations for the hygiene of the postpartum period.
1. Relatives must show a special concern for returning from mother's maternity hospital.
2. It is necessary to carry out general cleaning in the apartment, in advance to purchase objects of care for the newborn.
3. During the postpartum period to sleep during the day, since at night will have a crap-toben.
4. It is necessary to follow the purity of the body:
Daily - shower;
Daily - kneading warm water to the belt. Milk glands are clean with soap additionally. A special towel is allocated for wiping.
It is necessary to fed out the outdoor genital organs with boiled water 2 times a day, thoroughly flush before and after arms.
Wash your legs before bed.
5. Change the bed linen should no less often 1 times a week, which is more often.
6. To maintain the mammary glands, wearing a bra champ brace in order not to squeeze the chest. It should be changed daily.
7. It is necessary to sleep in a separate bed, over the sheets of the oilcloth and on top of it a bedding made of soft tissue fabric, which must be changed daily.
8. The food of the maternity hospital should be full (contain sufficient number of nutrients). Nursing women should not eat alcohol drinks and sharp seasonings. It is allowed to drink milk, faint sweet tea.
9. Sex life is possible only after 2 months from the birth of a child and after the permission of the doctor. Pregnancy during feeding a child is not desirable.
10. Physical exercises Within the norms are recommended to all healthy wives after childbirth. It is necessary to gradually be included in the work.

Contraception after childbirth

Physiological method
Hormonal contraception
pills
Injection
Capsules for subcutaneous administration
Intrauterine contraception
Spirals
Barrier contraceptives (condom, diaphragms, caps, sponges)
Spermocides
Surgical contraception
sterilization
Postpartum contraception has a number of features. Breastfeeding ensures the child most full nutrition And at the same time is an effective method of natural contraception (method of lactation amenorrhea). Other concentration methods can be used to enhance contraceptive action Breastfeeding, as well as in case a woman stops breastfeeding. But contraceptive methods used by nursing mothers should not have the harmful effects on feeding or child health. Therefore, we expect special recommendations in the postpartum period.
Method of lactation amenorrhea
Efficiency at proper use About 98%. This method will be effective only under the observance of a number of conditions:
1. Zhenichnia feeds kid only with breasts without a report
2. The child takes the breast every 3 hours during the day and 1 time at night, and the gap between the night feedings should not exceed 6 hours. The more often the kormlo occurs, the more effective method is effective.
3. Appointments have not appeared yet
4. After the birth, no more than 6 months passed
The advantages of the method is to promote breastfeeding, with all the aroused out of this positive moments. The disadvantages of the method include a sharp decreasing efficiency in the introduction of a doctoral and increasing the intervals between the Cormle.
Barrier methods
The use of the diaphragm, the cap or condom does not affect the lactation and health of the child. After delivery, the diaphragm size and cap should be clarified, since it is necessary to need largerthan before childbirth. It is desirable to wait for the end of the postpartum period directly (6 weeks after childbirth) before applying a diaphragm. The selection and the introduction of the diaphragm must hold a doctor for the first time. The use of spermicides solves the problem of vaginal dryness during sexual intercourse (frequent phenomenon in nursing women). The effectiveness of about 80-90% is somewhat increasing with co-use with spermicides. This method of contraception can be used no earlier than 6 weeks after delivery.
The positive properties of the method include the lack of influence on the health of the child and the mother. The disadvantages of the method, in addition to the need to select a diaphragm with a doctor-gynecologist, include the connection of the use of a method with sexual act, as well as special care for the diaphragm after each intercourse.
The positive properties of the condom can be attributed to its availability, the lack of influence on the health of the child and the mother. The condom is the only method of contraception, which protects against sexually transmitted diseases (AIDS, hepatitis B and C, Syphilis, etc.). The deficiencies of the method include the connection of the application of a condom with sexual act, relative high costs with long-term use, some decrease in the quality of the genital sensations, as well as the need to clearly follow the instructions for the use of a condom.
The positive properties of spermicides include the lack of influence on the health of the child and the mother, as well as some protective effect on sexually transmitted infections. The disadvantages of the method include the connection of the use of spermicides with a sexual act, the relative high cost in prolonged use, a slight decrease in the quality of sexual sensations for oral sexual contacts.
Combined oral contraceptives
Efficiency up to 100% with proper use.
In case the woman feeds the baby breasts, the use of combined oral contraceptives (COC) is possible only from the age of 7 after childbirth. If Women has stopped breastfeeding, the use of COP is possible from that moment. If the woman did not feed the child with breasts, then start taking Koks Major from the 4th week after childbirth.
The positive properties of this method of contraception include practically 100% efficiency in proper use, some protection against the development of re-extractive diseases of the small pelvis, protection against some diseases of women's alternating organs and breasts, positive influence on the condition of the skin inlets and hair, the lack of communication of the application of the method with a sexual act.
To the negative properties of this method, it is necessary primarily to attribute its influence on lactation, which leads to a decrease in the amount of milk and the duration of lactation, changes the qualitative composition of milk (therefore Kok cannot be used when breastfeeding). In addition, the purpose of KOC should be made by a doctor after the appropriate examination and definition possible factors risk.
Hormonal implants (NORPLANT)

Efficiency up to 99%.
Norplant nursing women need to be introduced 6 weeks after childbirth, and non-nursing - from 4 weeks after childbirth.
Norplant is a purest hormone implant - i.e. 6 silasty capsules containing one of two female genital hormones (Gestagen), which does not have any significant action on education, quantity and quality breast milk, Lactation duration (milk generation). Capsules are introduced by small surgical manipulation on inner side forearm for a period of 5 years.
The advantages of this method include the absence of a negative impact on the health of the mother and child, high efficiency with proper use, from the possibility of the connection of the use of a method with a sexual act. One Implantation of Norplanta provides reliable protection against development unwanted pregnancy For a period of 5 years, after which the effectiveness of the Narplant drops sharply, which requires the removal of the capsules. The removal of the NORPLATA is possible at any time.
Against the background of applying the Nedplant, especially in the first months after implantation, inter-measurement may occur. blood discharge. Over time, they disappear without the use of additional events. There may be some change in body weight, dizziness, etc.
The disadvantages of the method include the need for advice with the doctor before using the injection. Interrupt the use of the method (i.e., extract capsules) can only doctor. The ability to conceive after the cancellation of the drug is restored during the year.

Intrauterine equipment

Intrauterine facilities (IUD) do not affect the lactation or health of the child and especially benneously acceptable during lactation due to high efficiency. In uncomplicated childbirth and absence of contraindications intrauterine equipment It may be in addition immediately after delivery and in the postpartum period. The optimal administration time is a bundle 6 weeks after delivery, which reduces the number of expulsions (loss) of the Navy. Nursing women are experiencing less pain when administered, they have less side phenomena (eg, bleeding, pain). In the presence of infection or suspicion of it, the introduction of the Navy should be postponed before cure.
Natural methods
Natural methods (measurement of rectal temperature, calendar method, research is not recommended to begin to apply before restoring re-green menstruation, as it is difficult to determine the period of ovulation and the first menstruation after delivery. Cervical mucus is difficult to interpret until renewed re-government menstruation. The basal temperature of the body changes when the mother wakes up at night for breast feeding. Therefore, "Early Morning" Rises basal temperature After ovulation is not reliable. But at the same time there are no daily effects and spouses carry joint responsibility. The effectiveness of this method is low (subject to all rules no more than 50%).
Vasectomy (men's sterilization)
Vasectomy can be made to a spouse at any time. But this method of contraceptive is irreversible and acceptable for those who are absolutely sure that he does not want to have children anymore. The method does not affect male potency. With the slightest doubt, vasectomy should not be applied.
Women's sterilization
Women's sterilization (pipe occlusion) most effective method Pre-emergence from unwanted pregnancy. But this method of contraception is irreversible and admission for those who are absolutely sure that he does not want to have children anymore. According to the law, in our country, medical sterilization as a method of contraception can be carried out only in those who are not under 35 years old or has no less than two children or medical testimony. Therefore, one should not decide on the use of the method under the influence of the circumstances and emotional stress.
Abstinence from sexual intercourse (abstinence)
Abstinence does not affect breast-feeding. When abstaining 100% effective protection against pregnancy. This method can be used at any time. But for some couples, long periods of the postpartum abstinence of hardening. Therefore, the abstinence is convenient to use as an intermediate method.
Condom, Pharmatex, Patenttex-oval, perhaps, these are the most pro-time methods for pregnancy protection during the first few months after childbirth, while a woman feeds the baby with breasts.

Recipe.

RP.: SOL. DIBAZOLI 1%
Pro Inject 10ml
D.T.D. No. 10.
S. Entering 2 ml in 2 ml with a hypertensive crisis.
#

RP: TAB. Papaverini Hydrochloridi 0.04 №50
D.S. Take inside 1 tablet 3 times a day. Hypotensive
#
RP: TAB. FuraMidi 0.04 №80
D.S. Take inside 1 tablet before eating in the morning. Diuretik
#
RP: Oxytocini Pro Inject 1 ML Stimulator Uterus
(1 ml \u003d 5 ED)
D.T.D. No. 10.
S. Imagine to / in drip diversion in 400 ml. Glucose solution.

RP.: SOL. Glucosae 5% - 400.0
D.S. Divide oxytocin.
#
RP: Dr. HENDEVITUM №80 Vitamins.
D.S. Take inside 1 dragey 2 times a day.
#
RP: Dr. "Ferroplex" №50 emergency
D.S. Take inside 1 dragey 3 times a day after meals.
#

RP: Tinct. Valerianae 30 ml. Sedative
D.S. Take inside 30 drops 3 times a day.
#
RP.: SOL. Sulfacili Natrii 30% -10 ML. Sulfanimide
D.S. Hard 2 drops 2 times in each eye (2 times after 2 hours) for the tyaks of ophthalmoblennoriy.
#
RP.: SOL. Synestroli 2% -3 ML. Hormonal
D.S. Insert 1 ml per day per day.
#
RP: TAB. Ampicillini 0.25 №40 Antibiotic.
D.S. Take inside 2 tablets 4 times a day per hour before meals.
#
magnesium sulfate for browch
RP: SOL. Magnesii Sulfatis 25% - 10ml
D.S.: Insert 10 ml in / m after 3 hours (3 injections).

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