How is bladder catheterization performed depending on gender and age. Bladder catheterization technique in a newborn girl

Tools Used

According to medical standards, when performing catheterization in women, a physician should use the following tools and consumables:

• sterile soft catheters of different sizes;
• tweezers;
• urinal;
• tray for used tools;
• sterile wipes and cotton balls;
• disposable syringes (for the introduction of medicinal solutions);
• medical gloves;
• oilcloth;
• furatsilin in the form of a solution;
• glycerin or vaseline oil.

Consequences and complications of the procedure

There are two most common consequences that appear after catheterization:

• damage to the walls of the urethra and the bladder itself (from minor injuries to ruptures);
• infection in the urinary tract and, as a result, the development

Catheterization - manipulation, access to the cavity of the bladder without violating the integrity skin- introduction under sterile conditions of a tube (catheter made of metal or rubber) into the urethral canal. This allows you to empty the cavity of the bladder.

This method is diagnostic or therapeutic. It allows you to remove all urine from the cavity of the bladder, rinse it and deliver medicines to the emptied cavity, which will improve the process of exposure. chemical to the source of the disease.

The main indications for the procedure

Contraindications

• urethritis of an infectious nature;
• anuria (lack of urine);
• spastic constriction of the sphincter of the urethra.

Types of bladder catheters

In medicine, only soft (most often) and hard catheters are used. What is a soft catheter? Bladder catheterization with a soft catheter is performed with an elastic tube, up to 30 cm long. The outer end has an extension in the form of a funnel or an oblique cut.

Metal or rigid - is a tube, the inner end of which is rounded. It has a beak, a shaft and a handle. Curved catheter that follows the physiological curves of the urethra.

The female catheter differs from the male one in length, it is shorter by 15-17 cm.

Foley flushing is indicated for people who have problems with their ureters (they are inflamed or narrowed).

Insertion technique

The rules of antisepsis and asepsis must be observed to prevent the introduction of infection into the urogenital zone and its penetration higher. For this, the hands of the urologist are treated with special disinfectant solutions. The catheter is pre-sterilized.

Bladder catheterization in women begins with a washing procedure, while men wipe the head of the penis with an antiseptic applied to a cotton ball. During catheterization, the patient lies on his back, spreading his legs.

The procedure is performed by a nurse if a rubber type catheter is used. Metal - enters only the doctor. Because this procedure is more difficult, if it is carried out incorrectly, a number of complications may develop.

Carrying out the procedure in women

Bladder catheterization algorithm in women does not have any particular difficulties.

How to insert a catheter in a woman?

The nurse is located to the right of the patient and treats the genitals with an antiseptic. After that, the inner end of the catheter, lubricated with vaseline oil, is introduced gradually into the opening of the urethral canal. The signal to reach the bladder is the release of urine from the tube.

The urethra is shorter in women, so the procedure is easier with both a rigid and a soft catheter. Urine is discharged into a container placed between the patient's legs.

If the introduction of the catheter causes pain, immediately voice complaints to the medical staff.

Procedure for men

The procedure for men is complicated due to physiological features - a longer urethra - up to 25 cm. As well as two constrictions that prevent the passage of the catheter.

The use of a rigid catheter is carried out only in cases where it is impossible to introduce a soft one. These are diseases of the prostate - adenoma and strictures of the urethra of various etiologies.

How to insert a catheter for a man?

After treatment with an antiseptic, a rubber catheter is introduced, with vaseline oil. The tube is held with tweezers to comply with the principles of sterility. In this case, its gradual advancement is carried out until the appearance of urine output. The procedure using a metal catheter is carried out only by a doctor who inserts it, holding it in one position, to avoid traumatizing the walls of the urethra.

If the instrument has reached the wall, the urine will stop flowing out. Then you need to pull the tube towards you by 1-2 cm.

Why are catheters installed in the bladder for inflammation that occurs acutely or has chronic course? In order to clean the cavity by rinsing it. Sometimes small calculi and elements of the decay of tumor formations are removed in this way. To do this, urine is removed, and then an antiseptic solution is injected. The fluid used for this procedure is filled into an Esmarch cup and connected to a urethral catheter. After that, the washing liquid is removed and the manipulation is repeated.

The result of the procedure should be to obtain a clean washing liquid. According to indications, antibacterial agents or anti-inflammatory agents are administered. After the end of the procedure, the patient should be in a horizontal position for another 40-60 minutes.

Complications

Sometimes there are complications of catheterization due to a number of reasons:

• the examination was not carried out in full;
• violation of the rules of asepsis;
• violation of the rules for setting a bladder catheter, more often a metal one;
• force catheterization.

Main complications:

• infection with the occurrence of urethritis, cystitis or pyelonephritis of the bladder;
• trauma to the walls of the urethra, including complete rupture of the urethra.

The first type of complications is recorded in both men and women. The second is only for men. The use of a soft catheter reduces the incidence of complications by several times.

Frequently Asked Questions and Answers

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Indications and contraindications

The main indications for catheterization are:

• Urinary retention, which can occur with prostate adenoma, blockage of the urethra with a stone, strictures of the urethra, paralysis or paresis of the bladder, provoked by lesions spinal cord, after surgical interventions, etc.
• The need for laboratory research vesicular urine.
• The condition of the patient in which self-diversion of urine is impossible, for example, comatose.
• Inflammatory diseases, in particular, cystitis. In such cases, washing the bladder through the catheter is indicated.
• The need to inject drugs directly into the bladder.

However, the procedure may not always be performed even if indicated. Most often this prevents acute inflammation urethra, which usually occurs with gonorrhea, spasm or injury of the urinary sphincter.

Attention! Before performing catheterization, the doctor must be sure to report all changes in his condition, without hiding anything.

How is the procedure carried out

Today, doctors have two types of catheters at their disposal:

• soft (rubber), having the form of a flexible thick-walled tube with a length of 25–30 cm;
• rigid (metal), which are a curved tube 12-15 cm long for women and 30 cm for men with a rod, a beak (curved end) and a handle.

In most cases, catheterization of the bladder is performed with a soft catheter, and only if it is impossible to implement it, a metal tube is used. The patient is laid on his back, a small pillow is placed under the buttocks, which can be replaced with a towel folded several times, and the patient is asked to spread apart and bend his knees. A container is placed at the perineum to collect urine.

Typically, the procedure is performed nurse, medical assistance may only be required when inserting a metal catheter for men. She must carefully treat the hands and genitals of the patient in order to avoid infection. The tube is inserted as carefully as possible so as not to injure the delicate walls of the urethra.

Attention! The procedure is performed exclusively with a sterile catheter, the packaging of which has not been prematurely damaged.

During instillation medicine injected through the catheter into the cavity of the bladder, after which the tube is immediately removed. If it is required to flush the bladder in order to remove pus, small stones, tissue decay products and other substances, an antiseptic solution is injected into its cavity through the installed catheter using a Janet syringe or Esmarch's mug. After filling the bladder, its contents are aspirated and a new portion of the solution is injected. Washing is carried out until the sucked liquid is completely clean.

Important: after washing the bladder, the patient should remain in a supine position for half an hour to an hour.

In cases where a permanent catheter is installed in a patient, a urinal is attached to his thigh or by the bed, which is usually required at night or to collect urine from bedridden patients.

Features of conducting in women

Usually, bladder catheterization in women is quick and easy, because the female urethra is short. The procedure is carried out as follows:

1. The nurse stands at the right side of the patient.
2. She spreads her labia with her left hand.
3. Treats the vulva with water and then with an antiseptic solution.
4. Introduces the inner end of the catheter, previously lubricated with vaseline oil, into the external opening of the urethra.
5. Checks for discharge from the tube, which indicates that the procedure was performed correctly and the catheter reached its destination.

Important: about the appearance pain during the manipulation, you must immediately tell the health worker.

Features of conducting in men

Bladder catheterization in men causes more difficulties than manipulation in women. After all, the length of the male urethra reaches 20-25 cm, it is characterized by narrowness and the presence of physiological constrictions that prevent the free introduction of the tube. The procedure is carried out as follows:

1. The nurse stands to the right of the patient.
2. Treats the head of the penis with an antiseptic solution, giving Special attention external opening of the urethra.
3. He takes the catheter with tweezers and inserts the end of the rubber tube, previously lubricated with glycerin or vaseline oil, into the urethra, holding the penis with his left hand.
4. Gradually, without violence, it advances it, resorting to rotational movements as necessary. Upon reaching the sites of physiological narrowing of the urethra, the patient is asked to take several deep breaths. This helps to relax the smooth muscles and make it possible to advance the tube further.
5. If during the manipulation a spasm of the urethra occurs, its execution is suspended until the urethra relaxes.
6. The end of the procedure is indicated by the leakage of urine from the outer end of the device.

If the patient is diagnosed with urethral strictures or prostate adenoma, insertion of a soft catheter may not be possible. In such cases, a metal device is inserted. For this:

1. The doctor stands to the right of the patient.
2. Treats the head and opening of the urethra with an antiseptic solution.
3. The left hand holds the penis in a vertical position.
4. The catheter is inserted with the right hand so that its rod maintains a strictly horizontal position, and the beak is directed clearly down.
5. Carefully moving the tube with his right hand, as if pulling the penis on it until the beak is completely hidden in the urethra.
6. Tilts the penis to the stomach, lifts the free end of the catheter and, maintaining this position, inserts the tube to the base of the penis.
7. Moves the catheter to a vertical position.
8. Slightly presses the index finger of the left hand on the tip of the tube through the lower surface of the penis.
9. After successfully passing the physiological constriction, the catheter is deflected towards the perineum.
10. As soon as the beak of the device penetrates the bladder, the resistance disappears and urine begins to flow from the outer end of the tube.

Hidden dangers

Although the purpose of bladder catheterization is to alleviate the patient's condition, in some cases the procedure can result in damage or even perforation of the urethra, as well as infection of the urinary organs, that is, the development of:

• cystitis,
• urethritis,
• pyelonephritis, etc.

This may occur if asepsis rules were not followed during the manipulation, errors were made when installing a catheter, especially a metal one, or the patient was insufficiently examined.

But perhaps it is more correct to treat not the consequence, but the cause?

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What is the purpose of catheterization?

The catheter is usually inserted before surgery. It remains in the bladder for some time after the operation.

In some diseases of the urinary system, there is a violation of the outflow of urine.

This may be caused various reasons: obstruction of the urethra by a stone or tumor, a neurogenic disorder of the innervation of the muscles of the bladder and urethral sphincters.

With a critical increase in the volume of the bladder, it is required to immediately insert a catheter to drain urine.

A catheter is also inserted to directly inject drugs into the bladder.

Catheterization is often used for diagnostic purposes. A catheter is inserted to take urine for laboratory testing directly from the bladder, to do retrograde cystography and cystometry.

Cystoscopy examines the internal mucosa of the bladder wall. This method is the main one in the diagnosis of cystitis. Therefore, most often this procedure is carried out by women.

Also, this method allows you to assess the condition of the ureters and treat some diseases of the lower urinary system.

For this manipulation, a special device is used - a cystoscope. It is of three types: catheterization, operating and viewing.

Using a viewing cystoscope, a visual examination of the inner surface of the bladder is carried out. Before this, the bladder is washed from blood clots, if any, urine remains are removed.

Then it is filled with 200 ml of a clear liquid and an optical system with illumination is inserted through the cystoscope. According to the results of such a study, chronic or tuberculous cystitis, bladder cancer can be diagnosed.

Inside the catheterization cystoscope there are special channels for inserting the catheter, and at the end there is an elevator that directs it directly into the ureter.

Through the operating cystoscope, the necessary instruments are inserted into the bladder for biopsy, lipotripsy, electroresection.

Sometimes cystoscopy is performed with the use of a contrast agent.

Cystometry allows you to evaluate the work of the muscles of the inner wall of the bladder and sphincters of the urethra.

Manipulation is carried out as follows. First, a catheter is inserted into the bladder and residual urine is removed, then sterile water or isotonic sodium chloride solution (saline) is injected through it.

The patient is asked to report when the urge to urinate is almost impossible to contain. Then the catheter is connected to a special device called a cystometer.

It records bladder volume and intravesical pressure at maximum filling and subsequent urination.

Types of catheters

They are metal and flexible, made of rubber or silicone. They also vary in length and structure. The diameter is determined by the so-called Charrière scale, there are 30 sizes in total.

Their length is from 24 to 30 cm. Short ones are used for women, long ones for men. The upper end is rounded, there are holes on the side for urine drainage.

In the structure of the catheter, there are:

• straight or curved beak;
• body;
• pavilion, which is connected to a special system, contrasting or medications urine is expelled from the bladder.

The most common types of catheters used in urology are:

• conical Nelaton catheter with one hole, inserted briefly;
• Timman's catheter with a curved end, which facilitates its passage through the urethra;
• Foley catheter with two holes, through one the urine is removed, the other is used to fill a special balloon. Thanks to this balloon, it is firmly held in the urethra;
• the three-way Foley catheter, in addition to the two listed holes, also has a third, through which irrigation with antiseptic drugs is carried out, this procedure is performed after operations on the bladder in women or on the prostate gland in men.

Technique for catheterization

The installation of a catheter in a woman is as follows.

The procedure is performed on a couch, bed or a special urological chair. The woman is asked to lie on her back, bend and spread her legs.

Then the nurse spreads the woman's labia, takes a cotton swab with an antiseptic with forceps and treats the area around the external opening of the urethra.

For easier catheter insertion and reduced discomfort its beak is wetted with sterile vaseline oil.

The catheter is then inserted into the woman's urethra a few centimeters.

If urine comes out of the catheter, it means that it has entered the bladder.

Its free end is inserted into a container for collecting urine or connected to a device for supplying a medicinal solution.

Contraindications and prevention of complications

During catheterization, the likelihood of infection and the onset of bacterial inflammation is very high. Therefore, a prophylactic course of antibiotics is prescribed a few days before the procedure.

Fluoroquinolones (eg, levofloxacin or sparfloxacin) or protected penicillins (eg, augmentin or amoxiclav) are commonly prescribed.

Absolute contraindications to catheterization for both women and men are:

• damage and inflammation of the urethra;
• cystitis in the acute phase;
• bleeding from trauma to the urethra.

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Indications for the procedure

Most often, women receive a referral for catheterization in the following cases:

• for taking urine for analysis (unlike the usual collection of morning urine in a container, this method of taking urine allows you to get more "clean" biological material for research without impurities);
• to fill the bladder with medications in the treatment of various diseases of the urinary system;
• for washing and disinfecting the urinary tract (catheterization will help remove pus, sand, crushed small stones, etc.) from the organ;
• to study the volume of residual urine filling the urinary bladder;
• to empty or fill the pelvic organ before an X-ray examination (during the diagnosis, the urinary bladder must be empty or filled with a special contrast agent, which, when X-rayed, will stain the internal organs and tissues, so that the doctor will be able to get a more accurate picture of the state of the urinary tract);
• to remove urine when it is impossible to empty itself (urine retention, acute or chronic violation of normal urination, etc.)

Bladder catheterization with a soft catheter in women is done during surgical operations on internal organs under local or general anesthesia. Also, catheters in the urinary bladder are installed for paralyzed people, patients who cannot move, are in a coma, etc.

Algorithm for bladder catheterization in women

The technique of catheterization of the bladder of men and women, of course, is very different. Installing a catheter in the female urethra will not cause any significant difficulties for an experienced doctor or nurse. Due to the fact that women have a short urethra, the introduction of the catheter and its passage through the urinary tract is very fast and in most cases painless.

The correct technique for catheterization of the bladder in women is as follows:

• the patient lies on a special chair or couch, bends her knees and spreads them apart, a sterile diaper is placed under her hips, and a sterile container for collecting urine is installed next to her (the external genitalia must be pre-washed);
• the doctor, whose hands are wearing sterile rubber gloves, gently pushes the woman's labia apart and treats the entrance to the urethra with furatsilin disinfectant (when processing the movement, the hands should be directed from top to bottom);
• after antiseptic treatment, the doctor should take a sterile catheter with tweezers, moisten its tip in vaseline oil or glycerin, and then insert it into the female urethra by about 4-5 cm with light circular movements, the second end of the catheter should be lowered into a container for receiving urine;
• if the whole procedure was carried out correctly, and the catheter was completely inserted into the urinary bladder, urine should flow into the urinal;
• if the purpose of catheterization was to collect urine, then when filling the urinal, the catheter must be removed, and the urine should be poured into a sterile test tube or container with a printed scale showing the volume of liquid;
• if necessary, rinse or fill the bladder through the catheter, pre-prepared preparations are introduced into the urinary tract, after which the device is removed from the urethra;
• after emptying the bladder with urinary retention, the catheter must also be removed from the urethra;
• it is necessary to remove the catheter with smooth circular movements, after it is removed, the urethra must be re-treated with furacilin, and the perineum should be blotted with a napkin;
• it is best to remove the catheter from the urethra at a time when there is still a little fluid left in the bladder, because. residual urine should wash out the urinary tract after removal of the catheter.

After catheterization, the doctor must place all used instruments in a disinfectant solution; reuse of untreated devices is unacceptable.

Tools Used

According to medical standards, when performing catheterization in women, a physician should use the following tools and consumables:

• sterile soft catheters of different sizes;
• tweezers;
• urinal;
• tray for used tools;
• sterile wipes and cotton balls;
• disposable syringes (for the introduction of medicinal solutions);
• medical gloves;
• oilcloth;
• furatsilin in the form of a solution;
• glycerin or vaseline oil.

Consequences and complications of the procedure

With the wrong choice of catheter size, its abrupt installation, or non-compliance with the rules, serious complications can occur in a woman's body.

There are two most common consequences that appear after catheterization:

• damage to the walls of the urethra and the bladder itself (from minor injuries to ruptures);
• infection in the urinary tract and, as a result, the development of cystitis, urethritis and other similar diseases.

With a sharp rise in temperature, symptoms of intoxication and pain in the lower abdomen that occurred after catheterization, a woman needs to urgently seek medical help.

INDICATIONS

Urine excretion for therapeutic and diagnostic purposes, control of diuresis, bladder lavage, administration of drugs.

CONTRAINDICATIONS

No evidence.

LOCATION

Neonatal pathology departments, neonatal intensive care unit (NICU) of maternity hospitals, resuscitation and intensive care unit (ICU).

COMPOSITION OF THE TEAM

Nurse.

EQUIPMENT

Hat, glasses, sterile masks and gloves, sterile wipes or diapers, mask, sterile urinary catheters (for premature babies - 5 Fr, for full-term babies - 8 Fr), vaseline oil, antiseptic solution, disinfectant solution (furatsilina solution), urinal, sterile oil .

PREPARATION

Clean your hands with a disinfectant solution. The position of the patient on the back with slightly bent at the knees and legs apart.

TECHNIQUE OF PERFORMANCE

Catheterization in girls .

● With one hand, spread the labia, with the other hand from top to bottom (towards the anus), carefully wipe the genitals and the opening of the urethra with a disinfectant solution.

● Put on sterile gloves, cover the labia with sterile wipes.

● Dip the catheter in sterile vaseline oil and gently insert the catheter into the opening of the urethra. The appearance of urine from the external opening of the catheter indicates its presence in the bladder.

● Secure the catheter if necessary.

Catheterization in boys.

● Lay the child on his back.

● Penis (glans, foreskin and the opening of the urethra) treat with a disinfectant solution.

● Put on gloves, cover the penis with sterile wipes, diapers.

● Spread the lips of the external opening of the urethra with one hand, and insert the catheter with the other hand with a slight effort (Fig. 2).

● If the catheter must be left in the bladder, secure it. The catheter should be changed every 48-72 hours.

Rice. 2. Introduction of a catheter.

COMPLICATIONS

Infection of the bladder and urinary tract, trauma, hematuria, urethral stricture.

3. Setting enemas

Enemas are cleansing, siphon, hypertonic and nourishing. The most common are cleansing enemas. A common point for all types of enemas is the method of inserting the tip into the rectum. It is believed that it is better to insert the enema tip in the position on the side with the legs bent at the hip joints. However, the tip can also be inserted in the supine position, with the legs brought to the abdomen. The tip is introduced carefully, without violence, after having generously lubricated it with vaseline oil. The tip is inserted into the rectum in newborns by 3 cm, in one year old baby- by 4 cm, in older children - by 5 cm. The tip of the tip should be directed towards the sacrum after it has passed the anal sphincter.

Cleansing enemas

Cleansing enemas in children under 5 years old can be done with pear-shaped balloons. In older children, Esmarch's mug or special rubber tanks are used, usually an enema is given from boiled water with a temperature of 28-30 ° C. Use according to the age of the child ny volume of liquid: in newborns - 30 ml, in 6 months - 90-100 ml, at 1 year - 200 ml, at 5 years - 300 ml, at 10 years old -400 ml, at 14 years old -500 ml. Reducing the water temperature to 22-24 °C enhances the laxative effect of the enema. In the presence of steep and dense feces, it is useful after the first cleansing enema to give an enema of paraffin oil (about 30-50 ml) and then a second cleansing enema. In addition to vaseline oil, you can use sunflower, linseed, hemp, corn, etc. An enema from vaseline oil is used, as a rule, for very steep feces. The amount of oil solution, if a pure oil enema is given, is approximately 2 times less than with a cleansing enema with water.

The enema is provided by a nurse on the order of a doctor.

EQUIPMENT

Pear-shaped rubber balloon or Esmarch's mug. Vaseline oil. Boiled water at room temperature. Diaper. Pot. Rubber gloves.

Indications:

Acute urinary retention

Surgical intervention lasting more than 2 hours,

Medical and diagnostic procedures,

Control of diuresis in critically ill patients.

Contraindications:

urethral injury,

Acute inflammatory diseases of the urethra and bladder.

Equipment:

- sterile tray,

- sterile disposable soft catheter of the appropriate diameter,

Sterile tweezers - 2 pcs,

Antiseptic solution (for example, chlorhexidine solution),

gauze napkins,

Sterile vaseline oil,

Sterile gloves,

Sterile urine collection tube

Oilcloth, diaper,

Capacities with dez. solution,

Waste tray.

Execution algorithm:

1. Introduce the child / mother to the course of manipulation, establish friendly relations.

2. Put the child on his back with legs bent and spread apart at the hips.

3. Treat hands at a hygienic level, put on a mask and gloves.

4. Treat the area of ​​the urethra twice, using sterile wipes and an antiseptic solution (for girls, the opening of the urethra and the entrance to the vagina are treated, then the small and large labia, inguinal folds from top to bottom, for boys, the opening of the urethra is treated in a circular motion, then the head of the penis).

5. With the first sterile tweezers, grab a napkin and wrap it around the head of the penis 2 cm above the urethra; for girls, cover the labia with a napkin.

6. Reset tweezers.

7. Remove gloves, throw them into a container with a disinfectant.

8. Treat hands at a hygienic level, put on sterile gloves.

9. Grab the catheter with the second sterile tweezers, stepping back from the blind end of 5 cm, take the outer end of the catheter with your left hand and fix it between the 4th and 5th fingers of the right hand.

10. Moisten the end of the catheter with sterile vaseline oil, in girls, spread the labia with the 1st and 2nd fingers of the left hand, freeing the opening of the urethra. In boys, take the head of the penis with the left hand, slightly squeezing it to open the opening of the urethra, to straighten the urethra and remove the obstruction when inserting the catheter, hold the penis perpendicular to the body.

11. With your right hand, carefully insert the catheter into the opening of the urethra until urine appears, the approximate depth of insertion of the catheter in girls is 1-4 cm, in boys 5-15 cm, if an obstacle is felt during the introduction of the catheter, you should not overcome it forcibly in order to avoid damage to the urethra channel.

12. Lower the outer end of the catheter into the tray (sterile tube).

13. Shortly before the cessation of urine output from the catheter, press on the bladder area and slowly withdraw the catheter. If the catheter should be left on long time, it should be fixed, for this, a narrow strip of adhesive plaster is used (fixation of the catheter to the glans penis or clitoris is unacceptable).

End of procedure:

1. Place the catheter in a disinfectant solution.

2. Remove gloves and place in a disinfectant solution.

3. Treat hands at a hygienic level.

4. Make sure the patient is comfortable.

12. Methods of external examination of a pregnant woman .

Equipment:

Disposable gloves;

- couch,

- phantom doll;

- disinfectant container.

Target: diagnostic

Execution of the procedure:

1. Wash your hands at a hygienic level, put on a mask, put on disposable gloves.

2. Lay the pregnant woman on her back, her legs should be bent at the hip and knee joints. Stand on the right side of the pregnant woman.

3. The first reception of an external obstetric examination:

The palms of both hands are located on the bottom of the uterus, the fingers are approaching. Careful downward pressure determines the level of standing of the uterine fundus, which is used to judge the gestational age and the part of the fetus located in the uterine fundus.

4. Second reception of external obstetric examination:

Both hands from the bottom of the uterus are moved downwards, located on its lateral surfaces. Palpation of parts of the fetus is carried out gradually with the right and left hand, which makes it possible to determine in which direction the back of the fetus and its small parts are facing.

5. The third reception of an external obstetric examination (performed with one hand): - put right hand slightly above the pubic joint so that thumb was on one side, and the other four were on the other side of the lower segment of the uterus. With a slow and careful movement, the fingers plunge deep into, covering the part of the fetus located above the bosom.

6. The fourth reception of an external obstetric examination (performed with two hands):

Stand with your back to the face of a pregnant woman, the palms of both hands are placed on the lower segment of the uterus on the right and left, while the ends of the fingers reach the symphysis, with curved fingers carefully slide inward, towards the pelvic cavity, specifying the nature of the presentation of the fetal part and the height of its standing.

Note:- with a longitudinal position of the fetus, the uterus has an ovoid shape; with head presentation, childbirth is possible with minimal complications;

- with breech presentation, childbirth through the birth canal is possible, but they are accompanied by severe complications.

End of procedure:

1. Remove gloves, throw them into a container with a disinfectant.

2. Treat hands at a hygienic level.