Head fitting - General examination of the ante-natal patients

 Head fitting 

From the 36 week onwards, it is essential to assess the pelvic capacity in every pregnant woman. In a normal pelvic brim inclination of 600 the head should engage from 36 week, but in some African women with pelvic inclination of over 80 the head does not engage until labour has been in progress for some hours.

 

The following methods of assessments are considered


1. Sitting the patient up.

 

Ensure that the bladder is empty while patient lies on the couch, grasp the fetal head with the right hand as in pawlik’s grip. Rest the ulna border of the examining hand, with the 4th and last fingers on the symphysis pubis. The woman is asked to sit up without assistant and to lean forwards for a short time. Her diaphragm and abdominal muscles tend to press the fetus downwards. The thumb, index and middle fingers feel the head go through the pelvis. Any overlap (which is suggestive of cephalo – pelvic disproportion will be felt by the fingers on the symphysis pubis)

 

2. With the Patient Standing: Let the patient stand up with herfeet slightly apart. Face her and grasp fetal head gently. Let her lean forward slightly holding the edge of the couch with both hands. Push the head backward and downward gently. The titled pelvis makes the entry through the pelvic brim ‘direct’ in the absence of cephalo -pelvic disproportion.

Comments

Post a Comment

Popular posts from this blog

Methods of placental separation

  Methods of placental separation There are two methods of separation and expulsion of the placenta.   Shultze Method: 80%:  This is the most common method. Inthis method separation starts from the centre of the placenta and with the aid of Retroplacenta clot the placenta drop into the lower uterine segment or into the vagina. During delivery the fetal surface appears first at the vulva followed by the membranes. There is minimal blood loss with this method. The 3 rd  stage is neat   Mathews Duncan Method 20%:  In this method separationstarts at the edge and slides down sideways. It comes through the vulva with the lateral border first, like a button through a button hole. The maternal surface is seen first at the vulva. There is trickling of blood throughout the third stage. The third stage .is messier.   Control of bleeding:  the Contraction and retraction of theuterine muscle fibers that bring about separation of the placenta also act as “livin...
Read more

Amniocentesis

  Amniocentesis   This is withdrawing of fluid from the amniotic sac through abdominal wall using a transabdominal needle. With the aid of ultrasound the location of the placenta can be seen. It is performed between 16 to 18 week to diagnosis fetal abnormality. It may be performed later for ;   1.             Polyhydramnios   2.             Intrauterine transfusion   Dangers 1.             Abortion in early pregnancy.   2.             Abruptio Placenta – APH.   3.             Damage to fetal vessels   4.             Trauma to the fetus.   5.             Rhesus isoi...
Read more

Measurements of the fetal skull

Image
  Measurements of the fetal skull-   1. Diameter of the fetal skull   These are the diameter the birth canal must stretch to allow the head to pass during labour. The lagest being mento vertical 13.5cm.   1.             Sub-Occipito Bregmatic (9.5cm) 2.             Sub-Occipito Frontal (10cm) 3.             Occipito Frontal (11.5m) 4.             Mento Vertical (13.5cm) 5.             Sub Mento Vertical(11.5) 6.             Sub-mento Bregmatic (9.5cm) 7.             Biparieta (9.5cm) 8.             Bitemporal (8.2cm). 2. Circumferences...
Read more