Vinnitsa Nathional Medical University named after n.I. Pyrogov

Head of Obstetrics and Gynaecology department № 2 PhD, prof. Bulavenkо О.V.__________

the «____» ____________of 20___ year

Methodical recommendations for the student’s of stomatological faculty for preparing to practical class

Subject	Obstetrics
Module 1.	Physiological and pathological course of pregnancy, childbirth and the postpartum period. Perinatal complications.
Semantic module 1.	Physiological and pathological course of pregnancy, childbirth and the postpartum period. Perinatal complications.
Subject lessons	Physiology of pregnancy, childbirth and the postpartum period. Survey methods pregnant. Obstetric terminology.
Year of study	4
Faculty	Dental
Author	Assistant, Goncharenko O.M.

Vinnitsa 2013

1.Topicality. The main purpose of antenatal surveillance is the prevention of maternal and perinatal mortality. It is generally accepted the fact that pregnancy is determined considerable number of factors, but the primary importance given to the process of fertilization and development of a fertilized egg, placentation, organogenesis, development prolific membranes, functioning of the new body - the placenta, which connects the mother and the fetus.

Reduction of maternal and perinatal morbidity and mortality contribute to knowledge about the teratogenic and embryotoxic effects chynnnykiv environment on embryo and fetus at a critical time.

To ensure the life, growth and development of the embryo and fetus in the mother's of significant changes regarding almost all body systems. Compensatory changes in the orga ¬ tries and body systems of pregnant homeostasis lead to a state of unstable equilibrium hard. Violation of this balance can lead to changes in homeostasis and implementation of an obstetric or extragenital pathology, what you need to know doctors of all specialties.

Diagnosis of pregnancy in the early period (before 12 weeks) is important in the overall preparation of doctor of any profession, because early detection allows time to diagnose pregnancy obstetric and extragenital pathology and decide on appropriate further pregnancy. Only such an approach is the key to favorable ¬ Volyn end of pregnancy for the mother and fetus.

In recent years the practice obstetrics were a number of changes in direction pereusvidomlenni assist mothers that are based on the principles of evidence-based medicine, more humanistic attitude in postpartum women and to avoid pharmacological and drug aggression, which contributed more physiological partum period, reduce the frequency of complications postpartum period, emergency psychological adaptation of women after childbirth.

Despite the fact that the postpartum period is a physiological process, it requires a doctor's knowledge of all its stages and characteristics, namely the processes of involution in the organs and systems of women after childbirth, lactation, allowing detect the initial signs of diseases and complications that may arise a woman in labor. 2. The student must: Know 1. Physiological changes in women during pregnancy (zina psychological state and the central nervous system, changes in the endocrine system, the changes in the genitals and breasts, changes in the cardiovascular, respiratory system and blood changes in the gastrointestinal tract and kidneys, changes in metabolism. changes in the skin, changes in the musculoskeletal system that occur in pregnant women). 2. Survey methods pregnant. 3. Methods outdoor midwifery examination; 4. Goals and methods of I, II, III, IV techniques Leopold; 5. The method of measuring the height of standing uterus (GMR); 6. Measurement contours of the abdomen; 7. Methods for calculating estimated fetal weight; 8. Methods tazovymiryuvannya; 9. Method of listening to the heartbeat of the fetus; 10. Diagnosis of early pregnancy. 11. Obstetric terminology. Location of the fetus in the uterus (position, positions, types, presentation of the fetus, small and large segments of the head of the fetus). 12. Determination of prenatal vacations (diagnostic methods 30-week pregnancy.) And date of birth. 13. The reasons for the onset of labor, regulation of labor activity. 14. Biomehanizma delivery at the front and rear types occipital presentation. 15. Features involution genital character lohy. 16. The formation and progress of lactation. 17. Features of early and late postpartum period. 18. Measures to prevent complications in the postpartum period. Be able to: 1. Differentiate physiological changes in the body during pregnancy with abnormal. 2. Carry out inspection of the external genitalia and cervix and assess ix condition. 3. Hold vaginal examination and determine the size of the uterus. 4. Make a plan with additional tests for the diagnosis of pregnancy in the early periods. 5. Conduct external (determining the position, position, type of fetal presenting part, calculating estimated fetal weight) obstetric examination. 6. Set of pregnancy in the later periods, to determine the estimated time of childbirth. 7. Conduct internal obstetric examinations of pregnant women, to assess the maturity of the cervix. 8. Hear out fetal and according to instrumental methods to assess functional status and physical development of the fetus during pregnancy. 9. Demonstrate on the phantom biomehanizm delivery at the front and rear types occipital presentation. 10. Identify the beginning of the first stage of labor, objectively assess the dynamics of labor activity (degree of opening of the cervix, duration Rename). 11. Identify and assess fetal heart (auscultatory and hardware method ¬ ladies). 12. Determine the beginning of the second stage of labor, objectively estimate the moving head of the fetus through the birth canal. 13. Assist in the delivery and conduct Psychophysiological anesthesia delivery. 14. Litter inspect and determine its integrity. 15. Determine the total blood loss in childbirth. 16. Assess the state newborn Apgar. 17. Determine the status of mammary glands and lactation character, teach bears a properly feed your baby and express milk. To master practical skills: 1. Methods outdoor midwifery survey of pregnant women using techniques Leopold. 2. Conducting auscultation. 3. Form obstetric diagnosis based obstetric terms. 4. Methods for determination of gestational age (according to history and objective research). 5. Methods for determining the gestational age of the fetus and its mass, determining the estimated delivery. 6. Play biomehanizm births in both types of occipital presentation. 7. Maintaining a normal delivery. 8. Based on the survey data puerperas using laboratory methods, performance rate, blood pressure, body temperature to assess the progress of the postpartum period, to provide guidance on hygiene ne postpartum period. 3. Basic knowledge, skills necessary for studying the topic (interdisciplinary integration)

The names of the preceding disciplines	The skills
Department of Human Anatomy	determine the anatomical structure of external and internal genitalia.
Department of Biological Chemistry	describe the features of metabolism in pregnant biochemical characterization of amniotic fluid.
Department of histology	describe the structure of germ cells. fertilization and development of the fertilized egg, placentation, organogenesis, development prolific membranes.
Department of Normal and Pathological Physiology	identify features of physiological changes in women during pregnancy, effects on embryo and fetus environmental hazards. Collect material for Gore-monalnoho and biochemical studies
Department of Internal Medicine	medical history, conduct physical examinations ¬ tion, recognition of clinical syndromes and symptoms, determine the required volume and sequence ¬ ARRANGEMENTS methods of examination, evaluation paraclinical methods

Content topics: Critical periods of development of the embryo and fetus. Critical periods of development have the highest sensitivity to adverse environmental factors.

There are 4 main critical periods: 1. Pre embryonic (development and maturation of sex cells). 2. fertilization 3. preimplantation period (from fertilization to 6 days) and implantation (6-9 days after fertilization). 4. Organogenesis (especially the 3.6 week) and placentation (3 - 4 weeks of pregnancy). 5. fetal (fetal) period. starting from the 9th week of pregnancy Effects on embryo and fetus environmental hazards. The main groups teratogenic chynnnykiv: Drugs and chemicals. Ionizing radiation. Infections. Metabolic disorders and bad habits pregnant. The etiological basis distinguish three groups of defects: a) hereditary, b) exogenous c) multychynnykialni.

Physiological changes in a woman's body during pregnancy.

During pregnancy a woman's body there are substantial changes concerning practically all body systems.

Psychological status

Changes psychological condition manifested in the form of emotional feelings: irritability, depression and others. The development of psychological disorders during pregnancy influence following factors:

• hormonal and physiological changes;

• personal property;

• socio-economic status;

• relation in the family;

• unresolved conflicts;

• Genetic peredlehlist (eg, depression);

• physical and mental illness;

• Alcohol and Other Drugs.

Emotional and physical sensations expectant mothers to doctors to consider during surveillance pregnancy, during delivery and in the postpartum period.

Discomfort status

During pregnancy, there are typical quite often uncomfortable condition, with no serious consequences, but lead to significant discomfort and unpleasant sensations in the pregnant woman. These conditions must be taken: fatigue, morning nausea / vomiting, heartburn, constipation, back pain, hemorrhoids, swelling of the legs.

Timely pregnant clarification of the essence of such feelings and professional doctor's advice greatly improve the quality of life of the pregnant woman.