What are the items of postpartum pelvic examination?
It is best to evaluate pelvic floor muscles 42 days after delivery, which is the best time for postpartum pelvic floor muscle rehabilitation training. Women who have given birth and are over 30 years old should undergo pelvic floor muscle rehabilitation training under the guidance of a doctor as soon as possible to prevent future troubles. In postpartum rehabilitation training, the doctor will evaluate the physical condition of the parturient, and if necessary, the machine can be used for corresponding rehabilitation training.
Usually, routine examinations mainly include perineum and general gynecological examination 1. Perineal examination: mainly check whether there is a wound in perineum, the wound healing, the elasticity of perineum, whether the vaginal opening can be closed, the downward movement of perineum plane when the maximum screen force is downward and its relationship with the plane of ischial tubercle. Check the pain and temperature sensation in the distribution area of perineal sacral nerve to find out whether there is nerve injury. 2, general gynecological examination: understand the position and recovery of the uterus.
Pelvic floor evaluation and biofeedback training therapy are guided by the measurement of surface electromyography and urethral systolic pressure, and the feedback shows EMG or pressure curve. By influencing the display and sound prompts, patients can understand their pelvic floor muscle function more clearly and intuitively and participate in the treatment. Combined with individualized electrical stimulation therapy, it can awaken and activate pelvic floor muscles, and accelerate the recovery of tension and elasticity of vaginal and pelvic floor muscles after delivery, which has a good effect on preventing and treating postpartum pelvic floor diseases such as vaginal prolapse, relaxation and urinary incontinence.
Extrapelvic measurement
Pelvic outlet measurer is used for extrapelvic measurement. When measuring, the inspector faces the vulva of pregnant women, and mainly measures and records the following items.
(1) Inter-iliac spine diameter (IS): pregnant women straighten their legs on the examination table, measure the distance between the lateral edges of the anterior superior iliac spine on both sides, and record the data. The normal value is 23 ~ 26 cm.
(2) Inter-iliac crest diameter (IC): Pregnant women stretch their legs and lie on the examination bed, measure the widest distance between the outer edges of bilateral iliac crests, and record the data. Measuring the above two items can indirectly understand the transverse diameter length of pelvic entrance. The normal value is 23 ~ 26 cm.
(3) External diameter of sacrum (EC): pregnant woman lies on her left side, with her right leg straight and her left leg flexed; Measured as the distance from the midpoint of the upper margin of pubic symphysis to the subspinous depression of the fifth lumbar vertebra; This radial line can indirectly estimate the anteroposterior radial length of pelvic entrance, and it is the most important radial line in extrapelvic measurement. The outer diameter of sacrum is related to the thickness of bone. The measured sacrum external diameter minus the radial diameter of 1/2 feet is equivalent to the anteroposterior diameter of the pelvic entrance. The normal value is 18 ~ 20 cm.
(4) Transverse diameter of outlet (diameter between ischial tubercles): supine position, legs bent, hands clasping knees, so that hip and knee joints can fully flex; Measure the distance between the inner edges of two ischial tubercles. The normal value is 8.5 ~ 9.5 cm.
(5) Sagittal diameter after exit: pregnant women take knee chest or left lateral position; The examiner puts a finger cuff on the index finger of his right hand, and after applying lubricating oil, he extends into the anus, with his finger abdomen facing the sacrum and his thumb cooperating to find the sacrococcygeal joint and mark it; Measure the distance from the mark to the midpoint of the transverse diameter of the outlet, that is, the posterior sagittal diameter. The normal value is 8 ~ 9 ㎝.
(6) Angle of pubic arch: supine position, legs bent, hands clasped knees; Use the fingertips of the left and right thumb to approach each other obliquely, put them on the lower edge of the pubic symphysis, and lay them flat on the lower side of the pubic branch. Measure and record the angle between two thumbs. The normal value is 90.