NARROW BASIN — the concept used in obstetrics for designation of obstacles in labor during the passing of a fruit through a small pelvis of the woman in labor. The first works about At. t. belong to Deventer (N. of Deventer, 1701).
Distinguish anatomically the narrow (narrowed) basin and functionally (clinically) narrow basin. Anatomically a narrow basin — a basin, in which at least one of the main sizes (see. An obstetric research) it is reduced by 2 cm and more (with change of a form of a basin or without that).
The basin is considered functionally narrow, to-ry is narrow for passing of this fruit at this childbirth i.e. if obstacles (sometimes insuperable) for advance of a fruit on patrimonial ways are created. Functionally narrow basin — a concept clinical, it it is possible to define only in the course of a childbed. Anatomically the normal basin (see) can be functionally narrow (e.g., at a large fruit, hydrocephaly of a fruit, etc.) and vice versa, anatomically the narrow basin can be functionally full (e.g., at the small sizes of a fruit).
Classification. In a crust, time there are several classifications of narrow Tazy, but any completely does not answer practical problems of modern obstetrics. It is accepted to distinguish At. t. on extent of narrowing and in a form of a basin.
Distinguish four extents of narrowing of a basin. The I degree — a true conjugate (see. The obstetric research) is less than 11 cm (to 9 cm inclusive); at this extent of narrowing childbirth, as a rule, happens in natural patrimonial ways. The II degree — a true conjugate to a hmenypa
of 9 cm (to 7 cm inclusive); childbirth can come to the end in natural patrimonial ways at the small sizes of a fruit, but the thicket should resort to operational delivery. The III degree — a true conjugate
of Fig. 1. The diagrammatic representation of forms of an entrance to a small pelvis at some types of a narrow basin: and — at a normal basin (it is given for comparison); — obshcheravnomernosu-zhenny; in — flat; — all-narrowed flat; d — poperechnosuzhenny; e — to-sosuzhennom; — osteomalacic. The fat line showed outlines of an entrance to a small pelvis.
it is less than 7 cm (to 5 cm inclusive); the fruit can be born in natural patrimonial ways only after fetaldestructive operation (see); it is possible to take the living child only by means of Cesarean section (see). The IV degree — a true conjugate less than 5 cm \a fruit cannot be born in natural patrimonial ways even after fetaldestructive operation therefore the IV extent of narrowing is the absolute indication for Cesarean section (even at a dead fruit).
In a form of a basin (fig. 1) distinguish anatomically a narrow basin without change of a form of a basin (obshcheravnomernosu-zhenny) and anatomically a narrow basin with change of a form of a basin. Carry a flat basin (a simple flat basin and a ploskorakhitichesky basin), an obshchesuzhepny flat basin, a poperechnosuzhenny basin, and also seldom found forms to the last: kososu-zhenny (kososmeshchenny, or asymmetric), funneled,
about with t e about m and l I am t and h e with to 11 y, with p about N d and l about l and with t e - a tichesky basin, a basin with exostoses and bone tumors, a basin after changes and other rare forms.
Obshcheravno me rnos e in N of N y y a basin (fig. 1, b) is characterized by uniform reduction of all sizes by 1 — 2 cm, the form of a basin at the same time does not change. Distinguish 4 options of an obshcheravno-mernosuzhenny basin — hypoplastic, infantile, a basin of men's type and dwarfish. The hypoplastic basin is characterized by proportional reduction of all its sizes, usually occurs at women of low growth (130 — 150 cm), but in proportion put. Infantile (youthful, children's) the basin unlike a hypoplastic basin is characterized by an underdevelopment of wings of ileal bones, narrowness and small curvature of a sacrum, insignificant promotion of its kpereda, high standing of the cape, a narrow pubic arch. An entrance to a small pelvis of a prodolnoovalny form (dominance of the direct size over cross), sidewalls of a basin it is sometimes funneled meet to an exit of a basin. Such basin often occurs at the women having and other signs of infantility (low growth, an infantile constitution, an underdevelopment of mammary glands, etc.). Basin of men's type is characterized by massive bones, almost vertical position of wings of ileal bones, a narrow pubic arch and a sacrum, a high pelvic cavity, is funneled narrowed to an exit of a basin. Occurs at tall women with a men's constitution. The dwarfish basin differs in the expressed uniform narrowing of all sizes, has the correct proportions, but is sharply reduced in sizes and volume. Occurs at dwarfs, at cretinism.
The flat basin (fig. 1, c) is flattened in the perednezadny direction (the sacrum is brought closer to a pubic symphysis) and is characterized by reduction of the direct sizes of all departments of a basin (see). Other sizes of a basin are not changed. Distinguish a simple flat (deventerovsky) and ploskorakhitichesky basin. The simple flat basin is formed at the expense of the shift of a sacrum of a kpereda, reduction of all direct sizes of a basin, especially true conjugate is noted. Cross and its slanting sectional dimensions are not changed (sometimes they even increase). Ileal bones are not changed, a difference between distantia cristarum and distantia spinarum usual (3 cm). The Ploskorakhitichesky basin differs from simple flat in the fact that the sacrum is as if turned around the horizontal axis which is carried out through an upper part therefore the basis of a sacrum approaches a pubic symphysis, and the top of a sacrum departs kzad. Therefore the true conjugate is shortened, and other direct sizes of a basin increase a little. All basin is flattened not only in perednezadny, but also in the vertical direction (a «low» basin), and reduced in volume (but to comparison with a normal and simple flat basin). The sacrum is flattened, shortened, the tailbone is located almost perpendicularly to a sacrum and turned in a pelvic cavity. Wings of ileal bones are flattened, ileal crests are as if developed owing to what the distance between ileal awns (distantia spinarum) approaches in the size distance between crests (distantia cristarum); sometimes, at considerable deformation of a basin, distantia spinarum becomes equal or even exceeds the size distantia cristarum. The entrance to a small pelvis has the pochkovidny form, its direct size is reduced, and cross it is more, than normal. Formation of the false cape as a result of ossification of a cartilage between I and II sacral vertebrae is quite often noted. In an exit of a basin the cross and direct sizes it is more, than normal. The Ploskorakhitichesky basin is usually observed at the women who had rickets in the childhood. In a crust, time meets seldom.
The sky basin all-narrowed plo (fig. 1, d) is characterized by signs of a ploskorakhitichesky and obshcheravnomernosuzhenny basin. Shortening of a true conjugate is noted. The direct sizes of a pelvic cavity and exit of a basin sometimes it is slightly more, than normal. Such form of a basin is observed at women of low growth, with symptoms of the postponed rickets (deformation of extremities, a thorax).
Cross with at e in N of N y y the basin (fig. 1, e) is characterized by reduction of cross sectional dimensions at not changed (or increased) the direct size of an entrance to a basin and several reduced other direct sizes of a small pelvis (in a wide and narrow part of a cavity of a small pelvis). Flattening of a sacrum and more acute (on 3 — 4 ° less), than normal, a pubic corner is sometimes observed (a subpubic corner, T.). Occurs, as a rule, at the women who had rickets.
The Kososuzhenny basin
(fig. 1, e) is characterized by asymmetry due to cave-in in a pelvic cavity of one of ileal bones and thereof change of a form of an entrance to a small pelvis. The Kososuzhenny basin is formed with a unilateral pressure, long since the early childhood, upon an ileal bone (e.g., during the shortening of one leg or a disease of a backbone with development of scoliosis). Depending on the reason of narrowing of a basin allocate
to a ks of l gi ches to and y, about a stake and ot a chesky,
ankylotic narrow basin; meets at diseases of a backbone and hip joints.
The funneled basin is characterized by gradual narrowing of a pelvic cavity from an entrance to an exit, the direct size of an entrance to a small pelvis is a little increased, an exit of a basin is narrowed in the diameter, an acute pubic angle. Basin is high, a sacrum narrow long flattened. The cape of a sacrum is located highly (a big tilt angle of a basin), is frequent due to connection V of a lumbar vertebra with a sacrum. A version funneled is kyphotic the pop-rechnosuzhenny the basin, to-ry is formed owing to a rachiocampsis of a kzada (hump) in lumbar or its lumbosacral department. Owing to kompensatorno the arising lordosis the inclination of a basin decreases. The cape of a sacrum deviates kzad, and the sacrum is flattened. Ileal bones are as if developed, at the same time their wings disperse, and lower parts (together with sciatic hillocks) approach. All this leads to increase in the direct size of an entrance to a small pelvis and reduction cross and partly a direct exit of a basin of the sizes. Low located kyphosis can cover an entrance to a small pelvis therefore the last sharply decreases (the so-called covered basin).
Osteom and l of a yata ches to and y a basin (fig. 1, g) treats very rare forms anatomically of the narrowed basin, is formed at a softening of pelvic bones, as a result of disturbance of exchange of calcium, phosphorus, a lack of vitamins. It is characterized by a coronoid form of a pubic symphysis, rapprochement of sciatic hillocks, reduction of all (especially cross) sizes of a basin, low standing of the cape of a sacrum.
Spondil about l and stet a chesky basin is formed as a result of sliding of a body of the V lumbar vertebra from the basis of a sacrum (see the Spondylolisthesis). The smallest size of an entrance to a small pelvis is not the true conjugate, but distance from a pubic symphysis to the V lumbar vertebra which is given in a basin; back ileal awns and acanthas of sacral vertebrae (a median sacral crest) considerably act; the tilt angle of a basin small, the plane of an entrance to a basin is located almost horizontally.
Basin with exostoses and bone tumors - seldom found version anatomically a narrow basin. Exostoses are formed of cartilaginous educations in the field of synchondroses of a basin (a pubic symphysis, sacroiliac
joints, the cape). Have an appearance of thorns, outgrowths, hilly educations. New growths from bones and cartilages are most often localized on a back wall of a basin, quite often expand, occupying a considerable part of his cavity. Are diagnosed at a palpation or with the help rentgenol. or ultrasonic examination of a basin. Considerable bone educations create absolute obstacles for the birth of a fruit, small — can cause an injury to a fruit in the period of exile.
Abroad Caldwell's classification gained distribution (W. E. Caldwell) with sotr. (1934, 1940), according to a cut At. t. distinguish in size (obshcheravnomernosuzhen-ny), in a form of an entrance to a small pelvis (ginekoidny, androidny, antropoidny, platipelloidny), etc., being options of the listed types. The Ginekoidny basin (fig. 2, a) — typically wives -
Fig. 2. The diagrammatic representation of main types of a narrow basin (on Caldwell's classification with sotr.): and — ginekoidny
(normal); — androidny; in — antropoidny; — platipelloidny. Fat the line showed outlines of an entrance to a small pelvis.
the sky basin, occurs approximately at 50% of women. The Androidny basin (fig. 2, b) — a basin of men's type, is characterized by triangular shape of an entrance to a small pelvis, flattening of a sacrum, narrowing of the direct size of a cavity of a small pelvis, a funneled form. The Antropoidny basin (fig. 2, c) differs in increase in the direct size of an entrance to a small pelvis, the deep sacral hollow in parallel located walls of a basin. The flattened form and reduction of the pryakhmy size of an entrance to a small pelvis, a well-marked sacral hollow, walls of a basin in parallel located are characteristic of a platipel-loidny basin (fig. 2, d). Kirkhnkhoff (N. of Kirchnhoff, 1964), besides, allocates so-called long basins, among to-rykh distinguishes a basin with the double cape, a simple long basin and a channel long basin. The long basin is formed due to connection V of a lumbar vertebra with a sacrum and formation of the head (or two capes — a basin with the double cape). Tilt angle of a basin big. At a simple long basin pelvic curvature remains, the internal direct dimensions of a basin and the direct size of an exit of a basin are not changed. At a so-called channel long basin pelvic curvature smoothes out, the tailbone forms almost right angle with a sacrum, the direct sizes of a basin and an exit of a basin decrease, the pelvic cavity becomes less capacious and reminds the channel. Pubic corner quite often acute.
Depending on the size of a true conjugate nek-ry foreign obstetricians subdivide a narrow basin on small, average and wide, and also suggest to divide an entrance to a small pelvis into front and back segments (the greatest cross sectional dimension), considering a form of these segments (semi-oval, semicircular, reniform, etc.), their area, a form of a pubic arch, sciatic cutting, curvature and an inclination of a sacrum, i.e. all that can matter for the mechanism of childbirth.
Diagnosis of a narrow basin is based on data of the anamnesis, survey, measurement of a basin (pelvimetriya), vulval, and in need of ultrasonic (see. Ultrasonic diagnosis, in obstetrics and gynecology) and rentgenol. researches (see Peljvimetriya). However, according to nek-ry obstetricians, rentgenol. the research is undesirable even in late durations of gestation because of an adverse effect of X-ray on a fruit. In most cases the doctor can make sufficient idea of anatomic features of a basin, without applying rentgenol. research. During the collecting the anamnesis it is necessary to pay attention on postponed in the childhood inf. diseases with heavy intoxication, rickets, diseases or injuries of bone system, and also on feature of a course of the previous childbirth — duration, operative measures, asphyxia, a birth trauma, weight (weight) of a body of the been born child. At survey of the woman pay attention to a constitution, growth (with a height below 145 cm narrowing of a basin is, as a rule, observed), signs of infantility, a condition of a backbone and the lower extremities (at a rachiocampsis, the lower extremities, unilateral shortening of a leg, ankiloza, dislocations, duck gait, a clubfoot, etc. is often noted changes of a basin). Sharp-pointed stomach at primapara or loose-hanging — at multipara in a standing position, and also high standing of an uterine fundus in a prone position, protrusion of a head over a pubic symphysis or its high standing, mobility of a head over an entrance to a basin at primapara, the wrong provision of a fruit allow to assume existence of the narrowed basin. Some obstetricians do not attach significance to the outside sizes of a basin, believing that essential correlations between the sizes of a big and small pelvis are absent. However most of researchers are guided by the outside sizes of a basin, and not so much by their absolute values how many on their ratios. E.g., proportional reduction of all sizes indicates an obshcheravno-mernosuzhenny basin, reduction of a difference between distantia cristarum and distantia spinarum more than on 3 cm — meets at a ploskorakhitichesky basin. At suspicion on anatomically narrow basin measure the sizes of an exit of a basin; at suspicion on asymmetry determine the slanting and side sizes of a basin (see. Obstetric research). Thickness of pelvic bones and consequently, and its size and capacity can be determined approximately on a circle of a hand in a radiocarpal joint (see Solovyov an index).
At measurement of a basin special attention is paid on a lumbosacral rhombus (see. Obstetric research). At the correct constitution longitudinal and cross its sizes are approximately equal; at a flat basin its longitudinal size decreases, and the rhombus in a form approaches a triangle; on-perechnosuzhenny a basin it is characterized by reduction of cross sectional dimension of a rhombus, at an infantile basin a rhombus also narrow with an acute top and bottom angle. About features of a basin it is possible to judge also by a tilt angle of a basin, height of a pubis and a tilt angle of a pubis.
Vaginal examonation allows to judge the size of a true conjugate, features of a sacrum, size of a pubic corner and corner between a sacrum and a tailbone, existence of the false cape, cross narrowing of a basin (on rapprochement of sidewalls, sciatic awns and hillocks).
Features of the mechanism of childbirth at some forms of a narrow basin. At it is generalravnomernosuzhenny basin in an entrance to a basin there is a considerable bending of a head of a fruit amplifying upon transition from a wide part of a pelvic cavity to narrow. As a result of the leading point there is a small fontanel and thus the head is inserted into this area by the smallest circle. The second feature is that the arrow-shaped seam, as a rule, is located in one of the slanting sizes of an entrance to a basin. Further
childbirth proceeds as well as at a normal basin (see Childbirth). At the unbent predlezhaiiya of a head childbirth is often impossible. At pelvic before lying of a fruit (see) births in time are dangerous to a fruit in connection with extension of a head, a delay of a chin in an entrance to a small pelvis, a stop of childbirth and death of a fruit. Therefore for pelvic presentation even at the I extent of narrowing of a basin it is necessary to expand indications to Cesarean section.
At a flat basin the first moment of the mechanism of childbirth is extension of a head and insertion by its arrow-shaped seam in cross sectional dimension of an entrance to a small pelvis. At the same time small cross sectional dimension of a head matches the smallest (direct) size of an entrance to a small pelvis. As a rule, there is an asynclitic insertion of a head (fig. 3), i.e. the vertical axis of a head costs to a cavity of an entrance to a small pelvis not strictly perpendicularly, and the arrow-shaped seam is located closer or to the cape of a sacrum (a front asynclitism), or to a pubic symphysis (a back asynclitism). It gives the chance
of Fig. 3. The diagrammatic representation of ayein-klitichesky insertion of a head of a fruit at a flat basin: and — a front asynclitism; — a back asynclitism.
to a head of a fruit to overcome an obstacle, passing through an entrance to a small pelvis as if in parts (at first one parietal bone, then another). The front asynclitism is observed more often than back; the last is predictively adverse. At the same time owing to the complicated configuration a head of a fruit it is long costs in an entrance to a small pelvis. After clearing of obstruction the head falls to a cavity of a small pelvis, is bent, the asynclitism disappears and there is internal version of a head. At a ploskorakhitichesky basin, in connection with existence normal or even the increased pelvic cavity, the second and third moments of the mechanism of childbirth (see Childbirth, the mechanism of childbirth) occur quickly enough. At a simple flat basin the second and third moments of the mechanism of childbirth are made more slowly. In some cases in connection with reduction of the direct sizes of a cavity and an exit of a basin of internal version of a head does not occur; at the same time the head of a fruit reaches
a cavity, and sometimes and a bottom of a basin, and the arrow-shaped seam of a head of a fruit still is in cross sectional dimension of a basin (average cross and low cross standing of a head). If in the subsequent the turn of a head a nape of a kpereda (or kzad) does not happen, resort to operational delivery — apply imposing of obstetric nippers (see) or vacuum extraction more often (see).
At the all-narrowed flat basin childbirth happens as childbirth at an obshcheravnomernosuzhenny or flat basin depending on dominance of these or those features of a structure of a basin. At the same time the adverse zadnetemenny insertion of a head of a fruit which is followed by a stop of patrimonial activity is often observed. At childbirth in pelvic presentation the head, as a rule, is late a chin over an entrance to a small pelvis. Delivery in natural patrimonial ways at the term fetus is, as a rule, complicated; in this case Cesarean section is shown.
Slanting asynclitic insertion of a head of a fruit often in a rear view, sometimes (is characteristic of a poperechnosuzhenny basin at the increased true conjugate) there is a high direct standing of a head. The last is favorable at this pathology since gives the chance to a head to be inserted into an entrance to a small pelvis. At good patrimonial activity childbirth comes to an end in natural patrimonial ways.
At an androidny basin in an entrance to a basin conditions for formation of a rear view of occipital presentation (see Childbirth) are often created, at antropoidny — for high direct standing of a head, at Krom the arrow-shaped seam is located in a direct size of an entrance to a small pelvis, owing to space discrepancy the head of a fruit cannot fall by a pelvic bottom. In this case delivery by Cesarean section is shown.
At a long basin owing to a big tilt angle of a basin (a steep entrance) the head «sits down» on a pubic symphysis that leads to high direct standing of a head or to zadnetemenny insertion. The last or amplifies further that leads to a stop of childbirth, or turns into perednetemenny insertion, at Krom the head «slides off» the cape and after a configuration continues progress. At good patrimonial activity childbirth comes to an end in natural patrimonial ways.
Features of a course of pregnancy and childbirth at a narrow basin. A head of a fruit at the end of pregnancy at At. t.
into an entrance of a basin it is not inserted; lack of fixing of a head promotes hypermotility of a fruit, formation of the wrong provisions (slanting, cross) and presentations (extensive, pelvic). High standing of an uterine fundus promotes emergence at a pregnant asthma, tachycardia.
Childbirth at III and IV extents of narrowing of a basin in natural patrimonial ways is impossible. At I and II extents of narrowing the result of childbirth depends on the size of a head of a fruit, features of presentation, ability of a head to a configuration, the nature of patrimonial activity of the woman in labor.
Childbirth at At. t. often become complicated early izlitiy amniotic waters (see. Premature otkhozh - a deniye of waters), arising owing to high standing of a head and lack of a belt of contact (see Childbirth). Premature izli-ty amniotic waters promotes accession of the ascending infection. Lack of a bag of waters at not inserted head leads to the termination of disclosure of a uterine pharynx, and at insertion of a head — to infringement of edges of a uterine pharynx, bladder, rectum and formation of urinogenital, enterosexual, cervical and vulval fistulas (see. Urinogenital fistulas). At At. t. anomalies of patrimonial activity are observed. With primary or secondary weakness of patrimonial forces childbirth gains long character from women that can lead to a hypoxia of a fruit and development of an infection. At a considerable obstacle to exile there can be a rough patrimonial activity, a perera-styazheniye of the lower segment of a uterus and a hysterorrhesis. Sometimes under pressure of a head of a fruit there are ruptures of a pubic symphysis, sacroiliac joints, in mild cases — symphysites (see Childbirth, patrimonial traumatism).
The fruit is threatened most often by a hypoxia (see Asphyxia of a fruit and the newborn) as a result of disturbance of uteroplacental blood circulation, a prolapse of the umbilical cord and small parts of a fruit, and also che - a turnip and brain injury (see. Birth trauma) caused by a prelum of a head with the excessive shift of bones of a skull.
Conducting childbirth at a narrow basin. Pregnant women with At. t. hospitalize for 2 weeks before estimated childbirth. At arrival of the woman in labor in a maternity home collect the anamnesis, make the general survey and inspection, measurement of a basin of the woman in labor and size discrimination of a fruit, in particular heads; define the provision of a fruit and the relation of a head to an entrance to a small pelvis, osoben-
to Nosta of its insertion in a basin. For definition of compliance of the sizes of a head of a fruit and a basin of mother use Vasten's sign — Genkelya and Tsangemeyster's size. Vasten's sign — Genkel is defined at the woman in labor at the head of a fruit (fig. 4) which is densely pressed or fixed in an entrance to a small pelvis. The obstetrician puts a palm (or two fingers) on area of a pubic symphysis of the woman in labor and gradually moves it on an abdominal wall up. If at this movement a palm, encountering a vystoyashchy head of a fruit and pe-
Fig. 4. The diagrammatic representation of a ratio of a head of a fruit and pubic symphysis of the woman in labor (Vasten's sign — Genkelya): and — the pubic symphysis is an obstacle for a head of a fruit (a sign positive); — the head of a fruit is in one plane with a pubic symphysis (Vasten's sign — Genkelya «level with»); in — the pubic symphysis is not an obstacle for a head of a fruit (Vasten's sign — Genkelya negative). the Fat line designated a trajectory of the movement of an obstetrical hand.
rekhodya on it, Vasten's sign — Genkelya positive rises up. In this case childbirth in natural ways is complicated or impossible. If at the movement of a hand it turns out that the head of a fruit is in one plane with a pubic symphysis (Vasten's sign — Genkelya «level with»),
childbirth is possible at good patrimonial activity and a sufficient configuration of a head of a fruit. If the palm of the obstetrician at the described movement falls from top to bottom, Vasten's sign — Genkelya negative and the sizes of a head of a fruit correspond to an entrance to a basin; childbirth in this case usually comes to an end independently. Tsangemeyster's size — distance from the most vystoyashchy knaruzha of a point of a front circle of a head of a fruit to a suprasacral pole of the woman in labor — is measured by the gasmeter. Normal Tsangemeyster's size is 3 — 4 cm less than outside conjugate. If Tsangemeyster's size more outside conjugate, therefore, is available discrepancy between the size of a head and the sizes of an entrance to a small pelvis; in this case Cesarean section is shown. At Tsangemeyster's size equal to an outside conjugate, discrepancy is expressed slightly therefore at good patrimonial activity and a good configuration of a head of a fruit childbirth in natural patrimonial ways is possible; at from
a sutstviya of these conditions
Cesarean section is shown.
At III and IV extents of narrowing of a basin, and also at women with any degree anatomically of a narrow basin at anomalies of provision of a fruit, a large fruit, heavy late toxicosis of pregnant women (see), placental presentation (see), a hem on
a uterus make planned Cesarean section.
At I and II extent of narrowing of a basin and good patrimonial activity, the correct insertion of a head of a fruit in an entrance to a small pelvis, its sufficient ability to a configuration
twisted childbirth as a pra, come to the end in natural patrimonial ways. Tactics of conducting childbirth active and waiting. Make the plan of conducting childbirth and make careful monitor overseeing the nature of patrimonial activity and a condition of a fruit, and also watch the mechanism of childbirth and emergence of complications.
During disclosure of a neck of uterus for the prevention early poured out amniotic waters to the woman in labor do not allow to rise and recommend to lie on one side, corresponding to the provision of that part of a fruit, edges shall the first enter an entrance to a small pelvis. Kolygeyriz (see) for prevention of a precocious rupture of a bag of waters, a prolapse of the umbilical cord and small parts of a fruit in a crust, time do not use because of its small efficiency and danger of the ascending infection. It is necessary to watch closely a condition of external genitals (puffiness, cyanosis), the nature of allocations from a genital tract, possible emergence of impurity of blood in urine (burrowing), not to allow overflow of a bladder. At the whole bag of waters even in case of weak patrimonial activity it is not necessary to resort to its excitement. After an izlitiya of amniotic waters according to indications (the proceeding weakness of patrimonial activity) at insignificant discrepancy of the sizes of a head of a fruit and a basin of the woman in labor it is possible to apply the means (oxytocin, prostaglandin) stimulating patrimonial activity. The drugs should be administered with care in connection with a possibility of development of excessive patrimonial activity and a hysterorrhesis, and also a hypoxia of a fruit.
At emergence of weakness of patrimonial forces after good patrimonial activity, in case of insignificant discrepancy of the sizes of a head
of a fruit and a basin of the woman in labor and lack of symptoms of the ascending infection, rest (short-term medication sleep) can be presented to the woman in labor. The persistent weakness of patrimonial activity which is not giving in to therapy, especially at emergence of signs of disturbance of life activity of a fruit is the indication to Cesarean section. At emergence of the rough patrimonial activity menacing with a hysterorrhesis apply a deep anesthesia then make delivery by Cesarean section.
In the period of an expulsion of the fetus the main attention is paid to features of insertion and a configuration of a head of a fruit. If in the period of exile the head of a fruit rather well adapts to an entrance to a small pelvis and overcomes it, its further advance is controlled by means of outside receptions (see. Obstetric manual receptions) and vaginal examonation. Insertion of a head in a basin can be promoted by a podkladyvaniye under a sacrum and a waist of the woman in labor of the roller and reduction of knees to a stomach during the pains (for change of a tilt angle of a basin).
At emergence in the period of exile of symptoms of restretching of the lower segment of a uterus, puffiness of a neck of uterus and external genitals, impurity of blood in urine, and also symptoms of an acute hypoxia of a fruit (see Asphyxia of a fruit and the newborn) it is necessary to finish childbirth immediately. Thus resort to Cesarean section more often. Imposing of obstetric nippers (see) and vacuum extraction (see) at At. t. it is necessary to make extremely carefully in connection with danger of an injury to mother and a fruit and only under a condition if the head is in a narrow part of a pelvic cavity or in its exit.
The forecast of childbirth at At. t. for mother and a fruit at the correct tactics of conducting childbirth favorable.
Bibliography: To and l of and N about in and R. I.
A narrow basin in modern obstetrics, M., 1965; Novikova 3. B. A narrow basin in modern obstetrics, Akush. and ginek., No. 6, page 3, 1979; Won - with to and y against N. M., etc. Radiodiagnosis of forms of a narrow basin, in the same place, page 8; The II lunch and N with to both y N. M. and d river. A current and the result of childbirth at poperechnosuzhen-number a basin, in the same place, No. 5, page 39, * 1981; H e r epan about in V. of II. About a ratio of outside and internal dimensions of a female basin, in the same place, No. 6, page 45, 197 1; Barton J. J., Garbaciak’. J. And! a. R at a n G. M of The efficacy of X-ray pelvimetry, Amer. J. Obstet. Gvnee. v. 143, p. 304, 1982; Engstroni L.
Of a g e r q u i s t M. Herbs t:
I. Mid-pelvis contraction, Acta obstet, gynec. strand., suppl. 93, p. 51, 1980; To i of with till about f f H. Das «Enge Becken», Z. Geburtsh. Pennat., Bd 180, S. 95, 1976; M about
e r-m a n M. L. Growth of the birth canal in adolescent girls, Amer. J. Obstet. Gvnec. v. 143, p. 528, 1982, Steer With h*. M.’
Evaluation of the pelvis in obsl.et.rics, N. Y., 1975, V. I. Alipov