The main signs of full-term newborn: description and features. Morphological and physiological features of the fetus in different periods of intrauterine life

Iron / hard

full-term called a fetus born after 40-42 weeks (10 lunar months) after conception or 280 days. To determine full-term, forensic doctors measure the length of the body. In addition, useful information is established by the presence or absence of ossification nuclei (Becklar's nuclei) in the lower parts of the child's femurs. In a child born full-term, the body reaches a length of about 50 cm, head circumference 34-35 cm, chest circumference 32-34 cm. Physiological fluctuations in the duration of pregnancy are significant from 210 to 367 days. In the modern sense, full-term delivery is delivery at a gestational age of 37 to 42 completed weeks (259-293 days). A fetus born between 28 and 37 weeks is considered premature, and a fetus born before 28 weeks is considered a miscarriage. Postterm is considered

pregnancy over 42 weeks.

Prematurity and maturity are not identical concepts. Prematurity determines the time the fetus stays in the womb, and maturity characterizes the degree of development of the fetus.

Under maturity understand the degree physical development fetus, providing the possibility of its existence outside the maternal organism (extrauterine life). Maturity is determined by the state of the body parts of the fetus (weight and length of the body, head size, development of the external genital organs, etc.) in a complex. Signs of maturity are body length and weight, circumference, other head sizes, shoulder width and other indicators previously given for full-term newborns. However, in addition to these common features for full-term and maturity, the latter is also characterized by some others that are unique to it:

Elasticity of the skin with a well-developed subcutaneous fat layer;

The presence of vellus hair only in the area of ​​​​the shoulder blades and shoulder girdle;

thick hair on the head 2 - 3 (more than 1) cm long;

dilated pupils without membranes, transparent corneas;

elastic, elastic cartilage of the nose and auricles;

Protrusion of the nails on the fingers beyond their ends and reaching their ends on the toes;

· the testicles lowered into the scrotum in boys, the closure of the small labia in girls with large ones, the closeness of the genital slit;

The nucleus of ossification in the lower epiphysis of the thigh with a diameter of 0.5-0.7 cm;

umbilical cord length 45-60 cm;

The umbilical ring is located in the middle between the womb and the xiphoid process.

Mature is usually considered a nine-month-old fetus of at least 45 cm and a body weight of at least 2500 g. With the normal development of pregnancy, a full-term fetus is usually mature.

Viability

Viability in forensic medicine is understood as the ability of the fetus to continue to live outside the mother's body in normal external conditions. If a mature full-term fetus does not have malformations that are incompatible with life, then it is recognized as viable. Premature fetuses that have reached the minimum degree of maturity necessary for life can also be viable. When certain conditions of existence are created, fetuses after 7 months of pregnancy, sometimes even more premature ones, can survive and develop. In forensic medicine, fetuses are recognized as viable after 8 months of maturation in the womb (body length not less than 40 cm, weight not less than 1500-1600 g, head circumference 28 cm).

Today we will list and briefly characterize the signs of a full-term newborn. In addition, we will focus on the issues of postmaturity or prematurity. How can this be determined by the child and how do children differ? What threatens this newborn?

For this reason, it is necessary to know not only the signs of full-term and maturity of the newborn, but also be able to correctly diagnose and be aware of possible problems. If we consider the child as an object of childbirth, then this must be done based on the size of the head, since this is the most voluminous part of the fetal body, which experiences the greatest difficulties during movement through the birth canal. Now we propose to talk in more detail about the signs of a full-term newborn.

full-term baby

What is fetal maturity? This is a certain state of the child, which characterizes the readiness of the internal organs to ensure the life of the baby outside the womb. After the birth of a child, a neonatologist must necessarily examine.

The doctor needs to evaluate three parameters:

  • determination of the term of a newborn child, the signs of which we will consider in this section;
  • assess the degree of physical development;
  • morphological and functional maturity.

Which baby is considered full term? These signs include:

  • birth date - from thirty-eight to forty-two weeks;
  • body weight must be more than two and a half kilograms;
  • body length - from forty-six centimeters or more.

It is very important to note that there are a number of other signs of a full-term newborn. We are talking about morphological and functional maturity. We will talk about this in detail later. Summing up everything said in this section, we can highlight the main signs of a full-term newborn:

  • gestational age;
  • body mass;
  • body length.

External signs

Let's start with the main features that are visible to the naked eye. The first item on this list is to highlight a loud and demanding voice. Second - the skin should be pink and velvety. Be sure to pay attention to the fact that the skin of the newborn should be clean, and the fat layer should be uniform. The third is the presence of an open large fontanel. However, according to statistics, in fifteen percent of cases, a small one is also open. The fourth external sign is the formation of the auricle, all arcs must be clearly expressed. Fifth sign - the navel is located in the center of the abdomen, nail plates should completely cover the nail phalanges. The sixth sign is that girls have a closed genital slit, and boys have testicles lowered into the scrotum.

Functional features

In this section, we list the functional signs of a full-term newborn. These include the following:

  • the limbs of the baby should be bent at the joints;
  • movements are chaotic and quite active;
  • children are characterized by increased muscle tone;
  • body temperature is stable, deviations within the normal range up to six tenths of degrees Celsius are possible;
  • the breathing of the newborn is also stable - from forty to sixty breaths per minute;
  • the heartbeat is heard well, rhythmic (the norm is from one hundred twenty to one hundred and forty beats per minute);
  • in a full-term baby, all reflexes are symmetrical, it is possible to cause specific ones.

Specific reflexes of newborns:

  • sucking;
  • search;
  • prehensile;
  • trunk and others.

prematurity

Now let's turn to the issue of criteria for prematurity, postmaturity of the baby. Premature baby is born before the end of intrauterine development, that is, before the thirty-seventh week of pregnancy. Such babies have a small body weight, weight less than two and a half kilograms, and their height does not reach forty-five centimeters. Newborns have problems with thermoregulation and lack of response to external stimuli. It is important to note the statistical information: such babies are born in about 10% of cases.

It is worth knowing that there is a term "extreme prematurity" if the baby is born for up to twenty-two weeks. This condition is the line between a miscarriage and a premature baby. Body weight in this case is a decisive factor: if it reaches half a kilogram, then this is a premature baby, and just one gram less is a miscarriage.

Prematurity is usually classified according to the body weight of the newborn.

Prematurity problems can be both in mom or dad, and in the child. They are briefly listed in the table below.

Manifestation of prematurity

The signs of full-term, prematurity and postmaturity of a newborn considered by us in the article are reflected in the behavior and development of the baby. We invite you to talk about how prematurity in newborns manifests itself. Now we will give a general clinical picture. Firstly, the newborn has a disproportion of the body (very big head). In addition, the sutures of the skull are open, so the bones are malleable. Secondly, the auricles are soft. Thirdly, the child is in the frog position, as muscle hypotension is noted. The fourth sign is that the testicles of the boys have not yet descended into the scrotum, and the large labia of the girls have not yet fully developed. Fifth, specific reflexes are extremely weakly expressed. Sixth - shallow and weak breathing (up to 54), low blood pressure (about 55-65). Seventh - frequent urination and regurgitation.

Postmaturity

What are the features of a post-term newborn baby? Signs of postmaturity in the mother should be diagnosed by a doctor using CTG and ultrasound. These symptoms include:

  • lack of labor activity;
  • reduction in abdominal circumference;
  • rather large fruit;
  • compaction of the child's skull;
  • meconium in amniotic fluid;
  • reduced concentration of glucose in the amniotic fluid;
  • urinalysis shows low levels of estriol.

It is worth noting that there are two types of post-term pregnancy:

With true postmaturity, the child is in serious danger, because hypoxia develops.

What are the causes of postmaturity and how do they affect the child?

How does a post-term pregnancy affect the baby? The baby has the following symptoms:

  • thin body;
  • dry and wrinkled skin;
  • peeling on the skin;
  • lack of fetal lubrication;
  • long nails and hair;
  • open eyes;
  • increased activity.

Pay attention to the fact that the skin of postterm newborns acquires a yellowish tint. To prevent a post-term pregnancy, it is very important to undergo a CTG procedure three times a week (after 40 weeks). The baby's heartbeat and movements will help determine exactly how the baby is feeling.

The causes of this phenomenon are unknown, but doctors distinguish two large groups:

Note that there is also a psychological factor. If the expectant mother is afraid of childbirth and is not psychologically ready for them, then the pregnancy may be delayed. In this case, you need the support of loved ones or a consultation with a psychologist.

Differences between a full-term and premature baby

A full-term baby is distinguished by a number of features. He is ready for life outside the womb, has certain reflexes, the skin is able to maintain a certain temperature regime, the heart rate is stable, normal breathing and activity. A premature baby is the exact opposite: he is not ready for life outside the womb, he is not able to maintain a temperature regime, the heart rate and breathing are unstable, low blood pressure, and the reflexes of newborns are poorly developed.

Of great importance in childbirth is the weight of the fetus, the shape and size of the head, as well as the degree of maturity of the fetus. In most cases, the head is the presenting part, but it is very important that it still matches the size of the pelvis.

Signs of fetal maturity:

The conclusion about the maturity of the fetus is made by a pediatrician or obstetrician-gynecologist. In their absence, this should be done by the midwife. The length of the full-term fetus is more than 47 cm (with normal development, not more than 53 cm). The weight of the fetus should be more than 2500 g. The optimal weight is 3000-3600 g. With a weight of 4000 g or more, the child is considered large, with a weight of 5000 g or more - giant. The degree of maturity can be judged by bone density (according to ultrasound of the fetus, vaginal examination and examination of the newborn).

The skin of a mature newborn is pale pink in color, with well-defined subcutaneous fatty tissue, many folds, good turgor and elasticity, remnants of a cheese-like lubricant, without the slightest sign of maceration.
The length of the hair on the head is more than 2 cm, the vellus hairs are short, the nails extend beyond the fingertips. The ear and nasal cartilages are elastic. The breast is convex, healthy child movements are active, the cry is loud, the tone is active, reflexes are well expressed, including searching and sucking. The child opens his eyes. The umbilical ring is located in the middle of the distance between the pubis and the xiphoid process, in boys the testicles are lowered into the scrotum, in girls the labia minora is covered by the labia majora.

Mature fruit head:

The fetal skull consists of two frontal, two parietal, two temporal and one occipital bones, as well as the main and ethmoid. The bones of the skull are separated by sutures, of which the knowledge of the sagittal, or sagittal, suture, which runs between the parietal bones and which determines the position of the head during occipital insertion, is most necessary. In addition, sutures are distinguished: frontal, coronal, lambdoid. In the area of ​​​​the suture connection there are fontanelles, of which highest value have a big one and a small one.

A large fontanel is located at the junction of the streloid, frontal and coronal sutures and has the shape of a rhombus. The small fontanelle has a triangular shape and is located at the intersection of the sagittal and lambdoid sutures. The small fontanel is a conducting point in the case of childbirth with an anterior occipital presentation. The fetal head has a shape adapted to the size of the pelvis.

Thanks to the seams and fontanelles, which are fibrous plates, the bones of the head have mobility. If necessary, the bones can even go one another, reducing the volume of the head (configure). On the head, it is customary to distinguish the sizes with which the head erupts during various biomechanisms of childbirth: small wasp size, medium oblique size, large oblique size, pit size, sheer or vertical size, two transverse sizes.

In addition to the size of the head, the size of the shoulders is taken into account, which is on average 12 cm with a circumference of 34-35 cm, as well as the size of the buttocks, which is 9 cm with a circumference of 28 cm.

Determination of the estimated weight of the fetus:

In order to assess the development of the fetus and compliance with the birth canal, it is necessary to determine its estimated weight. In modern conditions, this can be done with the help of ultrasound. The biparietal size of the head, the dimensions of the limbs are determined, and the probable weight of the fetus is calculated from these data by the computer. Without ultrasound and a computer, you can use other methods and formulas:

According to the Rudakov method, the length and width of the semicircle of the palpated fetus are measured, and the mass of the fetus is determined using a special table.
According to the Jordania formula, the circumference of the abdomen is multiplied by the value of the height of the fundus of the uterus (during a full-term pregnancy).
According to the Johnson formula. M \u003d (VDM - 11) multiply by 155, where M is the weight of the fetus; VDM - the height of the bottom of the uterus; 11 and 155 special indexes.
according to the Lankowitz formula. It is necessary to add the values ​​​​of the height of the fundus of the uterus, the circumference of the abdomen, body weight and height of the woman in centimeters, multiply the resulting amount by 10. When calculating, take the first 4 digits.

All methods for determining the estimated fetal weight, even the use of ultrasound, give errors. And the use of external obstetric measurements sometimes gives very large errors, especially in women who are very thin and very fat. Therefore, it is better to use several methods and take into account the peculiarities of the physique.

Biomechanism of childbirth:

The combination of flexion, translational, rotational and extensor movements performed by the fetus when passing through the small pelvis and soft sections of the birth canal is called the biomechanism of childbirth. A. Ya. Krassovsky, I. I. Yakovlev made a great contribution to the study of the mechanism of childbirth.

When considering the biomechanism of childbirth, the following concepts are used:
The leading (wire) point is the lowest point on the presenting part of the fetus, which enters the small pelvis, passes along the wire axis of the pelvis and first appears from the genital gap.
The point of fixation is the point with which the presenting or passing part of the fetus rests against the lower edge of the symphysis, the sacrum, or the tip of the coccyx in order to bend or straighten.
The moment of the biomechanism of labor is the most pronounced or main movement that the presenting part performs at a certain moment, passing through the birth canal.
It is necessary to distinguish between the concepts of presentation and insertion of the fetal head. Presentation is when the fetal head is not fixed and stands above the entrance to the small pelvis. Insertion - the head is fixed to the plane of entry into the small pelvis with a small or large segment, placed in one of its subsequent planes: in the wide, narrow part or at the exit from the pelvis.

So, the biomechanism of childbirth is a set of movements that the fetus makes when passing through the mother's birth canal.

The peculiarities of the biomechanism of childbirth are influenced by the presentation, insertion, type, shape and size of the pelvis and fetal head. First, the head of the fetus, and then the trunk with limbs, move along the birth canal, the axis of which passes through the center of the classical planes of the pelvis. The promotion of the fetus is facilitated by contractions of the uterus and parietal muscles of the pelvis.

The biomechanism of labor in the anterior view of the occipital insertion of the fetal head:

I moment - insertion and bending of the fetal head. Under the action of expelling forces, the head with its swept seam is inserted into the transverse or into one of the oblique dimensions of the plane of entry into the small pelvis. The occiput and small fontanel are turned anteriorly. At the first position, the head is inserted with an arrow-shaped suture into the right oblique dimension, and at the second position - into the left oblique dimension of the plane of entry into the small pelvis.

In the period of exile, the pressure of the uterus and abdominal pressure is transmitted from above to the spine of the fetus and through it to the head. The spine is connected to the head not in the center, but closer to the back of the head (eccentric). A two-armed lever is formed, at the short end of which the back of the head is placed, at the long end - the forehead. The pressure force of the expelling forces is transmitted through the spine primarily to the back of the head - the short arm of the lever. The back of the head drops, the chin approaches the chest. The small fontanel is located below the large one and becomes the leading point. As a result of flexion, the head enters the pelvis smallest size- small oblique (9.5 cm). With this reduced circle (32 cm), the head passes through all the planes of the pelvis and the genital gap.

I. I. Yakovlev proposed dividing the first moment into two (separately consider inserting the head and bending the head). He also noted that even with normal childbirth, a deviation of the sagittal suture from the axis of the pelvis anteriorly or posteriorly is possible, i.e. asynclitpic insertion (see: "Basic obstetric concepts"). True, during normal childbirth, this physiological asynclitism with a deviation in each direction by about 1 cm.

As another point, I. I. Yakovlev singled out sacral rotation, i.e., pendulum-like advancement of the fetal head with alternating deviation of the sagittal suture: either towards the promontory (anterior asynclitism), then towards the pubis (posterior asynclitism). One of the parietal ossicles drops forward while the other lingers and then slides off. The alignment of the head relative to the axis of the pelvis is due to the configuration of the bones. Due to the pendulum movement, the head descends into the cavity of the small pelvis.

II moment - inner turn fetal heads. The internal rotation begins when it passes from the wide part of the small pelvis to the narrow one and ends at the pelvic floor. The head performs translational movement forward (lowers) and simultaneously rotates around the longitudinal axis. In this case, the back of the head turns anteriorly, and the forehead - backwards. When the head descends into the pelvic cavity, the sagittal suture passes into an oblique size: in the first position, it is in the right oblique, and in the second position, it is in the left. At the exit of the pelvis, the swept seam is set in its direct size. In the process of rotation, the occiput moves along the arc by 90 ° or 45 °.

With the internal rotation of the head, the swept suture passes from the transverse to the oblique and on the pelvic floor - to the direct size of the exit plane from the small pelvis. Internal rotation of the head is associated with various reasons. It is possible that this is facilitated by the adaptation of the advancing head to the dimensions of the pelvis: the head, with its smallest circumference, passes through largest dimensions pelvis. At the entrance, the largest size is transverse, at the cavity - oblique, at the exit - straight. Accordingly, the head rotates from the transverse dimension to the oblique and then to the straight line. II Yakovlev associated the rotation of the head with the contraction of the muscles of the pelvic floor.

III moment - extension of the head. Contraction of the uterus and abdominals expel the fetus towards the top of the sacrum and coccyx. The muscles of the pelvic floor resist the movement of the head in this direction and contribute to its deviation anteriorly, towards the genital gap. Extension occurs after the region of the suboccipital fossa fits under the pubic arch. Around this point of fixation, the head unbends. When unbending, the forehead, face and chin erupt - the whole head is born. Extension of the head occurs during cutting and cutting through the vulva with a circle (32 cm) passing through a small oblique size.

IV moment - internal rotation of the shoulders and external rotation of the fetal head. During the extension of the head, the shoulders with their largest size (biacromial) are inserted into the transverse dimension or into one of the oblique dimensions of the pelvis - opposite to where the sagittal suture of the head was inserted.

When moving from the wide part of the small pelvis to the narrow one, the shoulders, moving in a helical manner, begin an internal turn and due to this they pass into an oblique, and on the pelvic floor - into a straight size of the exit from the small pelvis. The internal rotation of the shoulders through the neck is transmitted to the born head. In this case, the face of the fetus turns to the right (in the first position) or to the left (in the second position) thigh of the mother. The back of the child's head turns to the mother's thigh, which corresponds to the position of the fetus (in the first position, to the left, in the second, to the right).

The posterior shoulder is located in the sacral recess, and the anterior shoulder cuts through to the upper third (to the point of attachment of the deltoid muscle to the humerus) and rests against the lower edge of the symphysis. A second fixation point is formed, around which the lateral flexion of the fetal body in the cervicothoracic region occurs in accordance with the direction of the deepening of the birth canal. In this case, the back shoulder is born above the perineum, and then the front shoulder is completely released. After the birth of the shoulder girdle, the child's body is born quickly and without obstacles, less voluminous compared to the head and shoulder girdle.

The biomechanism of labor in the posterior view of the occipital insertion of the fetal head:

The formation of a rear view of the occipital presentation may depend on the condition of the fetus (the largest head sizes, poor mobility of the cervical vertebrae, etc.), on the birth canal of a pregnant woman (anomalies of the pelvis or pelvic floor muscles, etc.). The posterior view often passes into the anterior in the process of expulsion. The head rotates 135°. However, in some cases (1% with internal rotation), the head rotates with the back of the head to the sacrum, and childbirth occurs in the posterior view.

I moment - flexion of the head. The small fontanel becomes a wire point. In the pelvic cavity during rotation, the middle point between the small and large fontanelles becomes a wire point. The head with its swept seam (small fontanel at the back) is inserted into the transverse or into one of the oblique dimensions of the plane of entry into the small pelvis. The head is bent to a medium oblique size.

II moment - internal rotation of the head. It begins at the transition of the head from the wide to the narrow part of the small pelvis and ends at the pelvic floor. In this case, there may be several options for turning into a posterior or anterior view of the occipital presentation. If the original posterior view remains in this view, then head rotations can occur in this way:

1. When inserted into one of the oblique dimensions of the plane of entry into the small pelvis, the head describes an arc of 45° or less; the small fontanel turns backward, and the large fontanel turns anteriorly.
2. When the head is inserted into the transverse dimension of the plane of entry into the small pelvis, it rotates 90 ° so that the swept suture passes from the transverse to the oblique (respectively position), and then into the direct dimension of the plane of the exit from the small pelvis, while the small fontanelle rotates to the sacrum, and large - to the symphysis.
3. If the rear view goes into the front view, then the head is rotated as follows:
in the posterior view of the second position, the swept suture turns clockwise, passing from the right oblique to the transverse, then to the left oblique and, finally, to the direct size of the exit plane from the small pelvis;
in the posterior view of the first position, the swept seam of the head turns counterclockwise, passing from the left oblique, first to the transverse, then to the right oblique and, finally, to the direct size of the exit from the small pelvis; at the same time, the small fontanel describes a large arc - about 135 ° and stops near the pubic articulation with a small fontanel.

III moment - additional flexion of the fetal head. After the end of the internal rotation, the head fits under the pubic articulation with the border of the scalp of the forehead. The first fixation point is formed. The head is bent as much as possible so that the back of the head falls as low as possible. The parietal and occipital tubercles are cut through.

IV moment - extension of the fetal head. After the birth of the parietal tubercles and the occipital tubercle, the head rests against the sacrococcygeal junction with the region of the suboccipital fossa - the second fixation point. Around this point of fixation, extension occurs and the rest of the forehead and face are born. The head is cut through the genital gap with an average oblique size (10 cm, circumference 33 cm).

V moment - internal rotation of the shoulders and external rotation of the fetal head. It occurs in the same way as in the anterior occipital presentation. In the posterior view of the occiput presentation, the head advances along the birth canal with difficulty, the period of expulsion is longer than in the anterior view. Additional flexion of the head occurs with strong and prolonged attempts, while the woman in labor spends a lot of effort. The pelvic floor is subjected to more significant stretching, ruptures of the perineum occur more often. Due to the length of the period of exile and the difficulty in moving the head through the birth canal, there are often violations of the fetal gas exchange.

The influence of the mechanism of childbirth on the shape of the head:

The head, passing through the birth canal, adapts to the shape and size of the mother's pelvis. Under the pressure of the walls of the birth canal, the bones of the skull move one on top of the other in the area of ​​\u200b\u200bthe seams and fontanelles, for example, one parietal bone overlaps another, the occipital and frontal bones can go under the parietal. As a result of these displacements, there is a change in the shape of the head, its adaptation to the shape and size of the birth canal.

Changing the shape of the head when it passes through the birth canal is called a configuration. The wider the sutures and the softer the bones, the greater the ability of the head to be shaped. Especially significant is the configuration with narrowing of the pelvis. The shape of the head changes depending on the mechanism of childbirth. In cases of occipital presentation, the head is extended towards the back of the head, taking on a dolichocephalic shape. With an anterior presentation, the head is elongated in the direction of the crown, with a frontal presentation, in the direction of the forehead, etc. Most often, the configuration of the head is blurred, does not affect health and disappears soon after childbirth.

On the presenting part in the region of the wire point, a generic tumor occurs. It is a swelling, swelling of the tissues in the lowest front part of the presenting part. Swelling of tissues occurs due to difficulty in the outflow of venous blood from that part of the presenting part, which is located below the contact belt. It is formed after the outpouring of water only in living fruits. Aggravated by stiff neck. With occiput presentation, the birth tumor is located in the region of the small fontanel and extends to the right or left parietal bone, depending on the position.

In the first position, most of the birth tumor is located on the right parietal bone, in the second position - on the left. In cases of facial presentation, the birth tumor is formed on the face, buttock - on the buttock. In normal childbirth, the birth tumor does not reach a large size and disappears a few days after childbirth. If the expulsion period is long (for example, with a narrow pelvis), the tumor reaches a large size, the skin in the tumor area becomes purple-red. With very fast delivery and a small head, the birth tumor is insignificant or does not form at all.

With difficult passage of the head through the birth canal and operative delivery, a blood tumor, or cephalhematoma, may occur on the head, which is formed due to hemorrhage under the periosteum of one, less often both parietal bones; it is a soft, irregularly shaped swelling located within one bone, and does not go beyond the line of boundary sutures and fontanelles.

Ancestral banishing forces:

The ancestral banishing forces include contractions and attempts.
Contractions are repetitive contractions of the muscles of the uterus.
Attempts are rhythmic contractions of the abdominal press and parietal muscles of the pelvis and pelvic floor that join contractions.

Due to contractions, the cervix opens, which is necessary for the passage of the fetus and placenta from the uterine cavity, the contractions contribute to the expulsion of the fetus, pushing it out of the uterus.

Each fight develops in a certain sequence, according to the rule of a triple downward gradient. First, a group of cells begins to contract in one of the upper sections of the uterine body (pacemakers), contractions spread to the bottom of the uterus, then to the entire body of the uterus, and finally, to the area of ​​the lower segment and cervix. The contractions of the uterus gradually increase, reach the highest degree, then the muscles relax, turning into a pause.

Characteristics of the contraction: duration, frequency, strength, rate of rise and fall, soreness. Determining the frequency, duration and strength of cotton wool, one cannot take into account only the information received by the woman in labor. A woman calculates the duration of the cotton wool, focusing on pain. This subjective information may not be accurate.

A woman can react very painfully to subthreshold precursor contractions, sometimes she does not feel the onset of a contraction or may feel soreness after the contraction stops and relaxes (trace reaction). The midwife, examining contractile activity, places the palms of her hands with spread fingers on the anterior wall of the uterus (one palm is closer to the bottom, the second to the lower segment), i.e., controlling contractions in all parts of the uterus. Such contractions and relaxation of the uterus must be controlled for at least three contractions, note the strength, regularity, direction of spread of myometrial contractions (triple downward gradient).

More objective data is provided by tonometry (registration of uterine contractions using a hysterograph or tocograph). The strength of the contraction with ultrasound tonometry is estimated in mm Hg. Art. With palpation determination, the strength of the contraction is determined by a qualitative sign (weak, moderate, strong), this skill is transmitted from teacher to student during practical exercises in the clinic. The pain of contractions is characterized by the woman herself. Soreness is very subjectively divided into weak, moderate and strong.

At the beginning of labor, the duration of the contraction is only 20 s, by the end of them it is almost 1 minute. Pauses between contractions at the beginning of labor last 10 minutes, then shorten, by the end of the period of expulsion of the fetus, contractions occur every 3 minutes. As labor progresses, contractions become stronger and more painful. Contractions can be frequent, long and painful, but weak. In this case, they are already talking about anomalies of labor activity.

There are three types of uterine muscle contractions: contractions, retractions, and distractions.
Contractions - contractions of the muscles of the uterus, followed by their relaxation, they are characteristic of the body of the uterus, thanks to which the fetus is pushed out of the fetus. Contractile contractions are the most active type of contractions.

Retractions - contractions of the muscles of the uterus, which are combined with their displacement. Some fibers are pushed into others, and, after displacement, they do not return to their place. Such contractions are characteristic of the lower part of the uterus, in which the lower muscle fibers are shortened and this contributes to improved distraction and opening of the cervix. The neck and lower segment stretch, become thinner and shift upward. At the same time, on the border with the upper sections of the uterus, above which there are no retractions, but only contraction contractions, a border, or contraction, ring is formed. It is formed by muscle fibers displaced upward. The contraction ring is located above the upper edge of the symphysis by as many transverse fingers or centimeters as the neck is open (this can be used for diagnostic purposes).

Distraction - relaxation of the circular (circular) muscles of the cervix, which contributes to the opening of the cervix.

Consequently, due to contractions, the fetus is expelled from the fetus, and due to retractions and distractions, the cervix opens. The body of the uterus and the cervix have a different structure and different innervation. In the region of the body of the uterus, there is a longitudinal arrangement of fibers, and in the region of the isthmus and neck, it is circular. The body of the uterus is innervated by sympathetic fibers, and the cervix is ​​innervated by parasympathetic fibers. Therefore, if the body of the uterus relaxes, then the cervix closes (as happens during pregnancy). During childbirth, the muscles of the body of the uterus contract, and the muscles of the cervix relax, which contributes to the expulsion of the fetus.

During contractions, intrauterine pressure increases, and during attempts, intra-abdominal pressure also increases.
Attempts occur reflexively due to irritation by the presenting part of the fetus of the nerve elements embedded in the cervix, pelvic floor muscles and parametric fiber.

Attempts arise involuntarily, but the woman in labor can regulate them to a certain extent (increase with tension and weaken with deep breathing).

Simultaneous increase in intrauterine pressure (contractions) and intra-abdominal pressure (attempts) contributes to the advancement of the fetus in the direction of least resistance, i.e., into the small pelvis and further out.

A full-term newborn is a child born at a gestational age of 37-42 weeks. In a full-term newborn, due to the prevailing development of the brain, the head makes up 1/4 of the body. Of particular importance is the determination of head circumference at birth (and in dynamics) of body weight, as well as its shape. The variants of the normal form include the following: dolichocephalic - elongated in the anterior-posterior direction, brachiocephalic - in the transverse direction, and the tower skull. The bones of the skull are malleable, they can overlap each other along the sagittal and coronal sutures. Features are reflected in the maturity table.

A premature newborn is a baby born before 37 weeks of gestation. Live births at 22 to 28 weeks gestation and surviving the first 168 hours of life. Normal developmental parameters in the period of 28-37 weeks include children with a body weight of 1000.0 to 2500.0 g, a length of 38-47 cm, a head circumference of 26-34 cm and a chest of 24-33 cm. According to statistics from different countries, premature from 6 to 13% of children are born.

Body weight cannot be the main criterion for prematurity. There is the concept of "low birth weight" or "low weight" - these are children weighing less than 2500.0 g at birth who were born at term.

Postterm newborns include children born after 294 days or 42 weeks of gestation. The frequency of birth of such children is from 8 to 12%. In children, clinical signs of trophic disorders are observed: a decrease in skin turgor, thinning of the subcutaneous fat layer, desquamation, dryness and flaking of the skin, lack of lubrication, dense skull bones, often with closed sutures.

The study of the shape and size of the fetal head is of particular importance in obstetrics. In the vast majority of births (96%), the head first passes through the birth canal, making a series of successive movements (turns).

The head, due to its density and size, experiences the greatest difficulties in passing through the birth canal. After the birth of the head, the birth canal is usually sufficiently prepared to advance the trunk and limbs of the fetus. The study of the head is important for the diagnosis and prognosis of childbirth: the location of the sutures and fontanelles is used to judge the mechanism of childbirth and their course.

Mature fruit head: 1) The facial bones are firmly connected. 2) The bones of the cranial part are connected by sutures. 3) Fontanelles. 4) When passing through the birth canal, the sutures and fontanelles allow the bones of the skull to go behind each other. The bones of the fetal skull bend easily. The skull of the fetus consists of two frontal, two parietal, two temporal and one occipital, main and ethmoid bones. In obstetrics, the following sutures are of particular importance: arrow seam(sutura sagitalis) passes between the parietal bones. In front, the seam passes into a large fontanelle, in the back - into a small one. frontal suture(sutura frontalis) is located between the frontal bones; has the same direction as the swept seam. Coronal suture(sutura caronalis) connects the frontal bones with the parietal, runs perpendicular to the sagittal and frontal sutures. Lambdoid seam(sutura lambdoidea) connects the occipital bone with the parietal.


The large (anterior) fontanel (fonticulus magnus s. anterior) is located at the junction of the sagittal, frontal and coronal sutures, has a diamond shape. Four sutures extend from the large fontanelle: frontal sutures anteriorly, swept posteriorly, corresponding sections of the coronal suture to the right and left.

The small (posterior) fontanel (fonticulus parvus, s posterior) is a small depression in which the sagittal and lambdoid sutures converge. The small fontanel has a triangular shape; three sutures depart from the small fontanel: anteriorly swept, to the right and left the corresponding sections of the lambdoid suture.

There are four secondary fontanelles: two each on the right and left sides of the skull. Pterygoid fontanel (pterion) is located at the junction of the parietal, main, frontal and temporal bones. The stellate fontanel (asterion) is located at the junction of the parietal, temporal and occipital bones.

Dimensions heads mature fruit are as follows:

Direct size (diameter fronto-occipitalis) - from the glabella (glabella) to the occiput - is 12 cm. Head circumference in direct size (circumferentia fronto-occipitalis) - 34 cm.

Large oblique size (diameter mento-occipitalis) - from the chin to the occiput - is 13-13.5 cm. The head circumference for this size (circumferentia mento-occipitalis) is 38-42 cm.

Small oblique size (diameter suboccipito-bregmaticus) - from the suboccipital fossa to the first corner of the large fontanel - is 9.5 cm. The head circumference corresponding to this size (circumferentia suboccipito-bregmatica) is 32 cm.

The average oblique size (diameter suboccipitio-frontalis) - from the suboccipital fossa to the border of the scalp of the forehead - is 10 cm. The head circumference for this size (circumferentia suboccipito-frontalis) is 33 cm.

The vertical or vertical size (diameter verticalis, s. trashelo-bregmaticus) - from the top of the crown (crown) to the sublingual region - is 9.5-10 cm. The head circumference corresponding to this size (cipcumferentia trashelo-bregmatica) is 32 cm.

Large transverse size (diameter biparietalis) - the largest distance between the parietal tubercles is 9.25-9.5 cm.

Small transverse size (diameter bitemporalis) - the distance between the most distant points of the coronal suture - 8 cm.

Dimensions torso the following:

The size of the shoulders - the diameter of the shoulder girdle (diameter biacromialis) - is 12 cm. The circumference of the shoulder girdle is 35 cm.

The transverse size of the buttocks (diameter bisiliacalis) is 9-9.5 cm. The circumference is 28 cm.

35. The first toilet of a newborn. Processing of the umbilical cord. Prevention of ophthalmoblenorrhea.

Immediately after the birth of the head, it is necessary to suck out from the oral cavity and nasopharynx using a catheter connected to an electric vacuum device, masses consisting of amniotic fluid, mucus and blood. The child is taken to a warm tray covered with two sterile diapers, located at the mother's feet and carried out: 1) repeated aspiration from the oral cavity and nasopharynx; 2) prevention of blenorea; 3) primary ligation of the umbilical cord; 4) show the child to the mother and lay it on the stomach; 5) evaluate the state on the Apgar scale in the first minute.

Secondary treatment of the umbilical cord and secondary prevention of blenorea is carried out in a specially designated place for newborns on a heated changing table and, only if the midwife is dressed in a sterile gown and her hands are prepared in compliance with the rules of asepsis and antisepsis. The staple is not applied to the umbilical cord residue, but is replaced with a ligature under the condition of: thick and juicy umbilical cord, Rh-negative mother's blood, low-weight newborns and children in serious condition. The primary treatment of the skin, weighing, measuring the length, head circumference, chest circumference and swaddling are carried out. Without fail, before the mother and child are transferred to the postpartum department, the baby is applied to the mother's breast.

36. Honey and non-medical indications for abortion late dates. Late term abortion methods.

37. Fetal hypoxia. Causes. Classification. Diagnosis and treatment.

Fetal hypoxia (HP) is a pathological condition that develops under the influence of oxygen deficiency during pregnancy and childbirth.

Etiopathogenesis: 1) fetoplacental insufficiency in obstetric and extragenital pathology 2) Violations of the structure of the placenta, 3) drugs Þ chronic fetal hypoxia, accompanied by ¯ tension of O2 in the blood, CO2, decompensated acidosis, impaired EBV, a decrease in the content of corticosteroids Þ on the function of the central nervous system, cardiovascular system, regulation of homeostasis, vascular permeability, a decrease in the immunological reactivity of the fetal body. Hypoxic states of the fetus are associated with changes in the complex mother-placenta-fetus system.

Distinguish acute and chronic GP. Symptoms of acute fetal hypoxia often occur during childbirth. Chronic fetal hypoxia (more than 7-10 days) is a consequence of a long-term obstetric or extragenital pathology, leading to a retardation of the fetus in development.

Clinic: 1) violation of heart rate (first tachy-, then bradycardia), 2) deterioration in the sonority of heart tones Þ 3) increasing deafness of tones); 4) appearance of arrhythmia Þ 5) decreased fetal movement 6) passing meconium, 7) changes in the indicators of CBS, amniotic fluid and fetal blood.

Diagnostics: 1) registration of his cardiac activity. 2) Fetal CTG. 3) Functional load test (diagnosis of chronic fetal hypoxia). 4) oxytocin test. 5) Tests with holding the breath on inspiration and on exhalation. 6) The cold test gives a decrease in heart rate up to 10 beats. in min. During hypoxia, there are no rhythm changes. 7) Ultrasound (fetometry, placentography, "Biophysical profile"), 8) doppler flowmetry, 9) amniocentesis (pH of amniotic fluid, delta OD450, hormone levels, phospholipids), 10) cordocentesis (blood counts), 11) cardiomonitoring with computer evaluation of the obtained data, blood pH from the skin of the fetal head (during childbirth).

Treatment: a) treatment of the underlying disease of the mother, b) regulation of uterine tone, v) FPI correction

Compliance with bed rest (preferably on the left side to exclude inferior vena cava syndrome - the so-called "crocodile posture"). 1- Oxygen therapy. 2- In / in glucose (500 ml - 10% solution) + 10 units of insulin + cocarboxylase 100 mg + Vit C (10 ml - 5%). 3- In / improved uteroplacental circulation: eufillin, sigetin, ATP or chimes. Reopoliklyukin 200 ml intravenous drip. 4- Use of tocolytics: MgSO4 or Alupent.

Scheme treatment of acute hypoxia fetus: Position on the left side, O2, IV 100 ml of 10% glucose solution + 4 IU of insulin + 50 mg of cocarboxylase and 5 ml of 5% Vit C, 10 ml of 2.4% solution of Eufillin IV slowly + 2 ml 1 % sigetin + ATP (2 ml - 1%), intravenous drip of NaHCO3 (60-80 ml - 5%). In / in 10 ml of 10% Ca gluconate solution. If the presenting part is available, atropine sulfate is administered subcutaneously to the fetus (0.1 ml -0.1%). In the absence of the effect of the treatment of acute and chronic GP, urgent delivery is indicated.

Maturity should be understood as a certain degree of physical development of the infant. The need to establish maturity during a forensic medical examination of the corpse of a newborn infant is due to the fact that a child who has reached it (in the absence of deformities, developmental anomalies and diseases incompatible with life) is always viable, which is important for resolving a number of procedural issues by law enforcement officers.

"Maturity" is a morphological concept and characterizes the degree of intrauterine development of the fetus, which is delivered for examination, and the concept of "full-term" refers to the stages of pregnancy, the signs of which remain in the mother's body. Therefore, the forensic medical examination of the corpse of a newborn in solving these two issues is limited only to determining its maturity. The definition of a full-term pregnancy cannot be the subject of an examination due to the lack of an object of study.

Signs of fetal maturity

Fetal maturity criteria (1966)

  • elasticity of the skin with a well-developed subcutaneous fat layer;
  • the presence of vellus hair only in the area of ​​​​the shoulder blades and shoulder girdle;
  • thick hair on the head 2-3 (more than 1) cm;
  • dilated pupils without a membrane, transparent corneas;
  • elastic, elastic cartilage of the nose and auricles;
  • the protrusion of the nails on the fingers beyond their ends and reaching their ends on the toes;
  • testicles descended into the scrotum in boys
  • the closure of the small labia in girls with large ones, the closeness of the genital slit.

Kasper-Güntz fetal maturity indicators

Metric indicators of individual bones of term infants.

Criteria for fruit maturity (modern ???)

The skin of a mature newborn is pale grayish in color, subcutaneous fatty tissue is well developed. Blocked sebaceous glands are found on the wings of the nose. The cartilages of the nose and ears are elastic. The length of the hair on the head is 2 cm. The fluff on the trunk and hands usually disappears, the nails on the hands go beyond the ends of the fingers, on the legs they reach the ends of the fingers. In boys, the testicles are located in the scrotum, in girls, the large labia cover the small ones. Subcutaneous adipose tissue is well developed. mammary glands perform. An important sign of the maturity of the newborn, according to most authors, is the presence of ossification nuclei (in the sternum (ossification point of Zhuravleva), calcaneus, talus, femur and humerus). So in a mature newborn in the lower epiphyses of the femur, Beklar's nuclei can be detected - ossification islands with a diameter of about 0.5-0.6 cm.

Currently, the signs that make it possible to judge the maturity of a newborn are the length and weight of the body, head size, shoulder width and other anthropometric data.

In some cases, to resolve the issue of maturity according to the detected parts of the fetus, the data of Kasper and Gunz on the size of some bones of a mature newborn child can be used: the length along the diagonal of the parietal bone is 7.6 cm; frontal in height - 5.6 cm, in width - 4.5 cm; clavicle length - 3.4 cm; shoulder blades - 3.2 cm; humerus - 7.5 cm; elbow - 7 cm; radial - 6.6 cm; hips - 8.7 cm; tibia - 7.9 cm; small tibia - 7.7 cm.

When conducting a forensic medical examination (examination) of the corpses of newborn infants, the question of their maturity, like other issues, is resolved on the basis of not one, but the entire set of signs, where one of the main ones is the histological examination of internal organs.



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