Man or machine: who is the last word for?

What helps doctors understand how events develop during delivery: their own observations or data obtained with the help of various instruments? According to experts, one does not exist without the other.

JULIA PISKUNOVA, obstetrician-gynecologist, candidate of medical sciences, maternity hospital № 6 named. AA Abrikosova

"It is difficult to answer this question unambiguously: in some situations it is enough for the doctor to listen to the stethoscope's heartbeat and resort to routine obstetrical examination to understand that at the moment the situation is developing normally and sometimes to confirm the assumptions better with the help of special equipment. Why do I say "for the moment"? The fact is that it is impossible to predict in advance how the birth of a child will take place: several minutes are enough for the picture to change radically - everyone knows that sometimes the well-begun births have to be completed by Caesarean section. By the way, that's why doctors try to give patients as much attention as possible.

What kind of activities do specialists usually use? When a woman comes to the maternity ward, she is weighed in the waiting room, takes a blood test, measures the pressure, and counts the pulse. Then the future mother is laid on the couch and conducts the so-called obstetric study: measure the external dimensions of the pelvis, the abdominal circumference, the height of the standing of the womb, make a conclusion about the position of the baby. With the help of a stethoscope, the doctor listens to the child's heartbeat, determines its frequency, rhythm and sonority. And in the prenatal ward, after certain periods of time, the doctor checks how the cervix opens.

What devices help obstetrician-gynecologists during childbirth? First of all, a cardio monitor. With his help, the doctor watches how the force of fights changes and how the child reacts to it. If childbirth proceeds normally, cardiotocography is resorted to once, if there are any deviations, the cardiomonitor indications may be needed two and three times.

When you are in the maternity hospital, do not be frightened by the devices around you: they are needed in order for a healthy baby to appear.

How is the procedure carried out? The future mother lays down or sits down, two sensors are attached to her stomach, one of which fixes the heart rhythm of the child, and the other - the tone of the uterus. The procedure lasts 40-60 minutes. Due to the received indications, the doctor can understand how the child feels, whether he suffers from a lack of oxygen (hypoxia) and how the labor activity develops. During childbirth, you can use another device - an ultrasound portable device that shows the exact amount of heartbeat of the baby. As for ordinary ultrasound, it can be done in the first stage of childbirth, in order to assess the size of the child, the amount of amniotic fluid, to understand where the placenta was attached, whether the umbilical cord wound around his neck.

In fairness, it must be said that in some situations doctors do not resort to the help of devices: they are about problem-free, physiological births. However, in this case, the expectant mother undergoes a full examination before they begin. If the patient gives birth in a special ward of our maternity hospital, the device of which is close to home conditions, next to her is a midwife. In case of deviations, she invites the doctor, who decides how to proceed further. "

ALEXANDER KONOPLYANNIKOV, obstetrician-gynecologist, Center for Family Planning and Reproduction

"I understand why you ask this question. Indeed, recently it is often discussed whether it is necessary for the future mother, who comes to the hospital, to see the full set of medical equipment. For example, colleagues from St. Petersburg, who recently visited our center, shared their impressions of the western maternity hospitals. There the chambers are more like a good hotel room, but if necessary, the walls move apart, and any medical equipment appears. Why is this necessary? It is easy to imagine what some future mothers feel, far from medicine, getting to the delivery unit: tiled walls, obstetric chair, perfusors (modern "droppers"), squeaking and knocking instruments, sizzling oxygen, equipment intended for the newborn ... But It should not be forgotten that this equipment helps doctors make timely decisions about how to act in the process of the child's birth.

For example, why do our patients during the birth necessarily pass cardiotocography? Because we, the doctors, need to know how the kid feels. And if using a conventional stethoscope, which is used for centuries by doctors, you can listen to the baby's heartbeat every 10 minutes, the data obtained constantly, allow you to make a more objective picture. However, if the birth of a child is normal, without deviations, neither in the equipment, nor even in the physician, there is no special need ... However, since we never know how to begin, and most importantly, how the delivery ends, it is better to keep your hand on the pulse.

The equipment helps us in time to prescribe drugs that enhance labor activity, or to accept the question of surgery if the child suffers from a lack of oxygen.

Now as for ultrasound. This research, most likely, will be necessary in the event that the patient itself gives birth to twins. After the appearance of the first child, we can immediately see what happened to the second baby, whether he decided to take advantage of freedom and turn over. Of course, if there is no ultrasonic device at hand, the doctor will determine this with the help of classical obstetric techniques. However, a more accurate diagnosis is still the device.

Another case: a woman enters the department, whose amniotic fluid has been drained before the time. Using ultrasound, we determine the amount of the remaining amniotic fluid. Why is this necessary? The less water, the more likely the appearance of various deviations in the child. Having determined how he feels, we decide whether to prolong pregnancy or urgent surgery is needed.

On the other hand, thanks to the equipment, we have the opportunity to constantly monitor the condition of the mother. For example, using an instrument that automatically measures pressure every 10-15 minutes, checks the pulse and the level of oxygen saturation of the blood. This is especially important if the patient has severe forms of gestosis. In addition, in complex situations can not do without laboratory research. For example, in case of bleeding, the doctor needs to determine what blood components and how much should be poured. Can a doctor solve this issue without the help of modern equipment? Of course not.

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