Clinical Approach to the Patient DR HISHAM AL HAMMAMI 2020 المقاربة السريرية للمريضة

1. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

2. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫اﻟﺗوﻟﯾدي‬ ‫اﻟﺗﻘﯾﯾم‬
Obstetric evaluation
‫ﻣن‬ ‫اﻟﺗﺄﻛد‬ ‫اﻟطﺑﯾﺔ‬ ‫اﻟرﻋﺎﯾﺔ‬ ‫ﻓرﯾﻖ‬ ‫ﻋﻠﻰ‬ ‫ﯾﺟب‬‫اﻟﻣرﯾﺿﺔ‬ ‫ﺧﺻوﺻﯾﺔ‬ ‫اﺣﺗرام‬.
‫اﻟﺳرﯾري‬ ‫واﻟﻔﺣص‬ ‫اﻟﻘﺻﺔ‬ ‫ﺗﺳﺑب‬ ‫ﻗد‬ً‫ﺎ‬‫إﺣراﺟ‬‫اﻟﻣرﯾﺿﺎت‬ ‫ﻟﺑﻌض‬.
‫اﻟﺳرﯾرﯾﺔ‬ ‫اﻟﻘﺻﺔ‬‫و‬ ‫اﻟدﻗﯾﻘﺔ‬‫اﻟﺳرﯾري‬ ‫اﻟﻔﺣص‬‫ﺗﻘ‬ ‫ﻓﻲ‬ ‫اﻷﺳﺎس‬ ‫ﯾﺷﻛﻼن‬ ‫أن‬ ‫ﯾﺟب‬‫ﯾﯾم‬
‫اﻟﺳرﯾري‬ ‫واﻟﺗدﺑﯾر‬ ‫اﻟﻣرﯾﺿﺔ‬.
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

3. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬‫اﻟﺗوﻟﯾدﯾﺔ‬ ‫اﻟﻘﺻﺔ‬
Obstetric history
ً‫ﺎ‬‫داﺋﻣ‬ ‫اﻟطﺑﯾب‬ ‫ﻋﻠﻰ‬ ‫ﯾﺟب‬:
‫اﻟﻣرﯾﺿﺔ‬ ‫ﻋﻠﻰ‬ ‫اﻟدﺧول‬ ‫ﻗﺑل‬ ‫اﻟﺑﺎب‬ ‫ﻗرع‬
‫ﻧﻔﺳﮫ‬ ‫ﺗﻘدﯾم‬
‫اﻟﺑداﯾﺔ‬ ‫ﻓﻲ‬ ‫اﻟﻣرﯾﺿﺔ‬ ‫ﻣﻘﺎﺑﻠﺔ‬‫ﺎس‬ ‫اﻟﻠ‬ ‫ﺎﻣﻞ‬ ‫وﻫﻲ‬‫أﻣﻛن‬ ‫إن‬
‫اﻟﻣرﯾﺿﺔ‬ ‫ﻣﺧﺎطﺑﺔ‬‫ﺄدب‬‫و‬‫اﺣﺗرام‬
‫واﻟﻣﻘﺎﺑﻠﺔ‬ ‫اﻟﻔﺣص‬ ‫ﺧﻼل‬ ‫اﻟﻣرﯾﺿﺔ‬ ‫وﺣﺷﻣﺔ‬ ‫ﺧﺻوﺻﯾﺔ‬ ‫اﺣﺗرام‬
‫اﻟﻣرﯾﺿﺔ‬ ‫ﻣﻊ‬ ‫اﻟﻠﻘﺎءات‬ ‫ﺟﻣﯾﻊ‬ ‫ﻓﻲ‬ ‫اﻟﺧﻠﻖ‬ ‫وﺣﺳن‬ ،‫اﻟﺟﯾدة‬ ‫اﻟﺷﺧﺻﯾﺔ‬ ‫واﻟﻧظﺎﻓﺔ‬ ‫اﻟﻧظﺎﻓﺔ‬ ‫ﺿﻣﺎن‬.
‫ﺑﺈﺳﻣﮭﺎ‬ ‫اﻟﺑﺎﻟﻐﺔ‬ ‫اﻟﻣرﯾﺿﺔ‬ ‫ﻣﺧﺎطﺑﺔ‬ ‫ﺗﺟﻧب‬ ‫اﻷﻓﺿل‬ ‫ﻣن‬
‫و‬ ‫ﻣﺎت‬ ‫ﻌﻠ‬ ‫اﻟ‬ ‫ﺔ‬ ‫ﺳ‬ ‫ﻋﻠﻰ‬ ‫ﻔﺎ‬ ‫اﻟ‬‫اﻟ‬‫ﺔ‬ ‫اﻟ‬ ‫ﻼت‬‫ﻟ‬‫ﺔ‬ ‫ﻠ‬
‫ﻣرﯾﺿﺔ‬ ‫ﻟﻛل‬ ‫اﻟﺛﻘﺎﻓﯾﺔ‬ ‫اﻟﺧﻠﻔﯾﺔ‬ ‫اﺣﺗرام‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university
BOX 2-1 Approach to the PatientBOX 2-1 Approach to the Patient

4. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫اﻟﺗوﻟﯾدﯾﺔ‬ ‫اﻟﻘﺻﺔ‬
Obstetric history
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

5. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫اﻟﺗوﻟﯾدﯾﺔ‬ ‫اﻟﻘﺻﺔ‬
Obstetric history
1.‫اﻟﺳﺎﺑﻘﺔ‬ ‫اﻟﺣﻣول‬
•‫ﻻدة‬ ‫اﻟ‬ ‫ﺦ‬ ‫ﺗﺎر‬)‫ﻞ‬ ‫اﻟ‬ ‫ﻬﺎء‬ ‫إﻧ‬ ‫أو‬(
•‫ﻻدة‬ ‫اﻟ‬ ‫ﺎن‬ ‫ﻣ‬)‫ﻞ‬ ‫اﻟ‬ ‫ﻬﺎء‬ ‫إﻧ‬ ‫أو‬(
•‫ﻞ‬ ‫اﻟ‬ ‫ة‬ّ‫ﻣ‬)‫ﻊ‬ ‫ﺎﻷﺳﺎﺑ‬ ‫ّﻠﺔ‬ ‫ﻣ‬(.
•‫ﻻدة‬ ‫اﻟ‬ ‫ﻘﺔ‬)‫ﻞ‬ ‫اﻟ‬ ‫ﻬﺎء‬ ‫إﻧ‬ ‫ﻘﺔ‬ ‫أو‬(.
•‫ﺎض‬ ‫اﻟ‬ ‫ة‬ّ‫ﻣ‬)‫ﺎﻋﺎت‬ ‫ﺎﻟ‬ ‫ّﻠﺔ‬ ‫ﻣ‬(
•‫اﻟﺗﺧدﯾر‬ ‫ﻧﻣط‬
•‫ﺔ‬ ‫اﻟ‬ ‫اﻟ‬ ‫ﺎت‬ ‫ﻼ‬ ‫اﻹﺧ‬
•‫اﻟوﻟﯾد‬ ‫وزن‬
•‫اﻟوﻟﯾد‬ ‫ﺟﻧس‬
•‫ﺔ‬ ‫ﻟ‬ ‫اﻟ‬‫و‬ ‫ﺔ‬ ‫اﻟ‬ ‫ﺎت‬ ‫ﻼ‬ ‫اﻹﺧ‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

6. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫اﻟﺗوﻟﯾدﯾﺔ‬ ‫اﻟﻘﺻﺔ‬
Obstetric history
2.‫اﻟﻘﺻﺔاﻟطﻣﺛﯾﺔ‬Menstrual history
‫اﻟـ‬ ‫ﻟﺗﺣدﯾد‬ ‫اﻷﺳﺎس‬ ‫ھﻲ‬EDC
Nägele's
rule
LMP
20/07/2019
EDC
27/04/2020
‫ﺗﻣﺷﯾﺢ‬ ‫أو‬ ‫ﻧزف‬ ‫أي‬
‫اﻟـ‬ ‫ﻣﻧذ‬LMP‫ﯾﺟب‬
‫اﻻﻋﺗﺑﺎر‬ ‫ﺑﻌﯾن‬ ‫أﺧذه‬
‫اﻟـ‬ ‫ﺣﺳﺎب‬ ‫ﻋﻧد‬EDC
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

7. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university
‫اﻟﺗوﻟﯾدﯾﺔ‬ ‫اﻟﻘﺻﺔ‬
Obstetric history
3.‫اﻟﺣﻣل‬ ‫ﻣواﻧﻊ‬ ‫ﻗﺻﺔ‬Contraceptive history
‫ﻣﮭﻣﺔ‬‫اﻟﺧطورة‬ ‫ﻟﺗﻘدﯾر‬
OCPs)( Oral Contraceptive Pill:
•‫ﺧﻠﻘﯾﺔ‬ ‫ﻋﯾوب‬
‫اﻟرﺣم‬ ‫داﺧل‬ ‫اﻟﻣﺣﺗﺑس‬ ‫اﻟﻠوﻟب‬IUDs)intrauterine device: (
•‫ﺑ‬ ‫اﺟﮭﺎض‬‫ﺎ‬‫ﻛر‬.
•‫اﻧﺗﺎن‬.
•‫وﻻدة‬‫ﺑﺎﻛرة‬

8. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
4.‫اﻟﻘﺻﺔ‬‫اﻟطﺑﯾﺔ‬Medical history
‫اﻟﺣﻣل‬ ‫ﻧﺗﯾﺟﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺑﺗﺄﺛﯾرھﺎ‬ ‫اﻟﻣﻌروﻓﺔ‬ ‫اﻟﺷﺎﺋﻌﺔ‬ ‫اﻻﺿطراﺑﺎت‬:
•‫اﻟﺳﻛري‬ ‫اﻟداء‬.
•‫اﻟدم‬ ‫ﺿﻐط‬ ‫ارﺗﻔﺎع‬
•‫اﻟﻛﻠﯾﺔ‬ ‫أﻣراض‬
‫اﻟﺧطﯾرة‬ ‫اﻟطﺑﯾﺔ‬ ‫اﻟﺣﺎﻻت‬ ‫ﻛل‬ ‫ﺗﺳﺟﯾل‬ ‫ﯾﺟب‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university
‫اﻟﺗوﻟﯾدﯾﺔ‬ ‫اﻟﻘﺻﺔ‬
Obstetric history

9. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
•‫اﻟﺟراﺣﯾﺔ‬ ‫اﻟﻌﻣﻠﯾﺎت‬
•‫اﻟرﺿوض‬)‫اﻟﺣوض‬ ‫ﻛﺳر‬(
5.‫اﻟﺟراﺣﯾﺔ‬ ‫اﻟﺳواﺑﻖ‬
•‫اﻟﻌﺎدات‬)‫أﺧرى‬ ‫ﻣواد‬ ‫أي‬ ‫وادﻣﺎن‬ ، ‫اﻟﻛﺣول‬ ، ‫اﻟﺗدﺧﯾن‬. (...
•‫اﻷﻟﯾﻔﺔ‬ ‫ﻟﻠﺣﯾواﻧﺎت‬ ‫اﻟﺗﻌرض‬ ‫أو‬ ‫اﻟﺗﻣﺎس‬)‫اﻟﺗوﻛﺳوﺑﻼﺳﻣ‬‫وز‬(
•‫اﻟﺣﯾﺎة‬ ‫وﻧﻣط‬ ‫اﻟﻌﻣل‬)‫ﻟﻠﻛﺑد‬ ‫ﺳﺎﻣﺔ‬ ‫أو‬ ‫ﻣﺎﺳﺧﺔ‬ ‫ﻣواد‬. (
6.‫اﻻﺟﺗﻣﺎﻋﯾﺔ‬ ‫اﻟﻘﺻﺔ‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university
‫اﻟﺗوﻟﯾدﯾﺔ‬ ‫اﻟﻘﺻﺔ‬
Obstetric history

10. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
B.‫اﻟﺗوﻟﯾدي‬ ‫اﻟﺳرﯾري‬ ‫اﻟﻔﺣص‬
Obstetric physical examination
‫اﻷﺳﺎس‬ ‫ﺧط‬ ‫ﻣﺳﺗوﯾﺎت‬ ‫وﺿﻊ‬ ‫ﯾﺟب‬baseline levels‫اﻟطﺑﯾﻌﯾﺔ‬
‫اﻟوزن‬‫اﻟدم‬ ‫ﺿﻐط‬‫اﻟﻌﯾن‬ ‫ﻗﻌر‬ ‫ﻓﺣص‬‫اﻟﻘﻠﺑﯾﺔ‬ ‫اﻟﺣﺎﻟﺔ‬
‫وﺷﺎﻣﻠﺔ‬ ‫ﻣﻧﮭﺟﯾﺔ‬ ‫ﺗﻛون‬ ‫أن‬ ‫ﯾﺟب‬ ‫اﻻﺟراءات‬
1-‫اﻟﻌﺎم‬ ‫اﻟﺳرﯾري‬ ‫اﻟﻔﺣص‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

11. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university
B.‫اﻟﺗوﻟﯾدي‬ ‫اﻟﺳرﯾري‬ ‫اﻟﻔﺣص‬
Obstetric physical examination

12. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
c.‫اﻟﺣﻣل‬ ‫ﺗﺷﺧﯾص‬
Diagnosis of pregnancy
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

13. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫ھﻲ‬ ‫اﻟﺣﻣل‬ ‫ﻣن‬ ‫اﻷوﻟﻰ‬ ‫اﻷﺷﮭر‬ ‫ﻓﻲ‬ ‫اﻷﻋراض‬ ‫أﺷﯾﻊ‬
‫اﻟطﻣث‬ ‫اﻧﻘطﺎع‬‫ﻼت‬ ‫اﻟﺒ‬ ‫ﺗﻌﺪد‬‫اﻟﺛدﯾﯾ‬ ‫اﺣﺗﻘﺎن‬‫ن‬‫اﻟﻐﺛﯾﺎن‬
‫اﻻرھﺎق‬
Tiredness
‫ﺳ‬‫رﻋﺔ‬‫اﻟﺗﻌب‬
easy
fatigability
1-‫اﻟﺣﻣل‬ ‫أﻋراض‬Symptoms of pregnancy
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university
c.‫اﻟﺣﻣل‬ ‫ﺗﺷﺧﯾص‬
Diagnosis of pregnancy

14. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
c.‫اﻟﺣﻣل‬ ‫ﺗﺷﺧﯾص‬
Diagnosis of pregnancy
2.‫اﻟﺣﻣل‬ ‫ﻋﻼﻣﺎت‬signs of pregnancy
A-‫اﻻﻓﺗراﺿﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬
Presumptive
signs
A-‫اﻻﻓﺗراﺿﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬
Presumptive
signs
‫ﻂ‬ ‫ﺗﺮﺗ‬‫ﺪﻻت‬ ‫ﺑ‬‫اﻟﻣﺧﺎطﯾﺔ‬ ‫واﻷﻏﺷﯾﺔ‬ ‫اﻟﺟﻠد‬:
•‫وزرﻗﺔ‬ ‫ﺗﺻﺑﻎ‬‫اﻟرﺣم‬ ‫وﻋﻧﻖ‬ ‫اﻟﻣﮭﺑل‬ ، ‫اﻟﻔرج‬.
•‫اﻟﺣوﺿﯾﺔ‬ ‫اﻷﻋﺿﺎء‬ ‫ﻓﻲ‬ ‫ﻣﻌﻣم‬ ‫اﺣﺗﻘﺎن‬)‫ﻧوﻋﯾﺔ‬ ‫ﻏﯾر‬.(
•‫ﺷﺎدوﯾك‬ ‫ﻋﻼﻣﺔ‬chadwick's sign:‫اﻟﻔرج‬ ‫ﻓﻲ‬ ‫داﻛن‬ ‫ﺗﺻﺑﻎ‬
‫اﻟﻣﮭﺑل‬ ‫وﺟدران‬.
•‫اﻟﺑطﻧﯾﺔ‬ ‫واﻟﺗﺷﻘﻘﺎت‬ ‫اﻟﺟﻠد‬ ‫ﺗﺻﺑﻎ‬‫وﻏﯾرﻣو‬ ‫ﻧوﻋﯾﺔ‬ ‫ﻏﯾر‬ ‫ﻋﻼﻣﺎت‬‫ﺛوﻗﺔ‬.
•‫اﻷﺳﻣر‬ ‫اﻟﺧط‬linea nigra.
•‫اﻟﺣﻣﻠﻲ‬ ‫اﻟﻘﻧﺎع‬Chloasma(OCP).
‫ﻂ‬ ‫ﺗﺮﺗ‬‫ﺪﻻت‬ ‫ﺑ‬‫اﻟﻣﺧﺎطﯾﺔ‬ ‫واﻷﻏﺷﯾﺔ‬ ‫اﻟﺟﻠد‬:
•‫وزرﻗﺔ‬ ‫ﺗﺻﺑﻎ‬‫اﻟرﺣم‬ ‫وﻋﻧﻖ‬ ‫اﻟﻣﮭﺑل‬ ، ‫اﻟﻔرج‬.
•‫اﻟﺣوﺿﯾﺔ‬ ‫اﻷﻋﺿﺎء‬ ‫ﻓﻲ‬ ‫ﻣﻌﻣم‬ ‫اﺣﺗﻘﺎن‬)‫ﻧوﻋﯾﺔ‬ ‫ﻏﯾر‬.(
•‫ﺷﺎدوﯾك‬ ‫ﻋﻼﻣﺔ‬chadwick's sign:‫اﻟﻔرج‬ ‫ﻓﻲ‬ ‫داﻛن‬ ‫ﺗﺻﺑﻎ‬
‫اﻟﻣﮭﺑل‬ ‫وﺟدران‬.
•‫اﻟﺑطﻧﯾﺔ‬ ‫واﻟﺗﺷﻘﻘﺎت‬ ‫اﻟﺟﻠد‬ ‫ﺗﺻﺑﻎ‬‫وﻏﯾرﻣو‬ ‫ﻧوﻋﯾﺔ‬ ‫ﻏﯾر‬ ‫ﻋﻼﻣﺎت‬‫ﺛوﻗﺔ‬.
•‫اﻷﺳﻣر‬ ‫اﻟﺧط‬linea nigra.
•‫اﻟﺣﻣﻠﻲ‬ ‫اﻟﻘﻧﺎع‬Chloasma(OCP).
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

15. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

16. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫اﻻﻓﺗراﺿﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

17. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫اﻻﻓﺗراﺿﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

18. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫اﻻﻓﺗراﺿﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

19. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
c.‫اﻟﺣﻣل‬ ‫ﺗﺷﺧﯾص‬
Diagnosis of pregnancy
2.‫اﻟﺣﻣل‬ ‫ﻋﻼﻣﺎت‬signs of pregnancy
B.‫اﻻﺣﺗﻣﺎﻟﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬Probable signs
‫ﺑﺎﻟﺗﺑدﻻت‬ ‫ﺗرﺗﺑط‬
‫اﻟﻔﯾزﯾﺎﺋﯾﺔ‬‫ا‬‫ﻟﺮﺣﻢ‬‫اﻟرﺣم‬ ‫وﻗوام‬ ‫وﺷﻛل‬ ‫ﺣﺟم‬ ‫ﯾﺗﺑدل‬
‫ﻛروي‬ ‫اﻟرﺣم‬ ‫ﯾﺻﺑﺢ‬
Globular
‫ﻋﻼﻣﺔ‬Piskacek
‫أﻛﺛر‬ ‫اﻟرﺣم‬ ‫ﻗوام‬ ‫ﯾﺻﺑﺢ‬
‫ﻟﯾوﻧﺔ‬
)‫ھﯾﻐﺎر‬ ‫ﻋﻼﻣﺔ‬Hegar.(
‫اﻟرﺣم‬ ‫ﻋﻧﻖ‬ ‫ﯾﺑدأ‬
‫ﺑﺎﻟﺗﻠﯾن‬‫ﻓﻲ‬‫ﺑداﯾ‬‫ﺔ‬
‫اﻟﺣﻣل‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

20. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫ﻋﻼﻣﺔ‬Piskacek
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

21. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
‫اﻻﺣﺗﻣﺎﻟﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

22. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
c.‫اﻟﺣﻣل‬ ‫ﺗﺷﺧﯾص‬
Diagnosis of pregnancy
2.‫اﻟﺣﻣل‬ ‫ﻋﻼﻣﺎت‬signs of pregnancy
C.‫اﻟﯾﻘﯾﻧﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬Positive signs
‫اﻟﺟﻧﯾن‬ ‫ﺣرﻛﺎت‬
‫ﺑﺎﻷﺳﺑو‬ ‫اﻟوﻟودات‬‫ع‬
15-17
‫اﻟﺧروﺳﺎت‬
‫ﺑﺎﻷﺳﺑوع‬18-20
‫اﻟﺟﻧﯾن‬ ‫ﻗﻠب‬ ‫دﻗﺎت‬
‫اﻟدوﺑﻠر‬
‫اﻷﺳﺑوع‬9-12
‫اﻟﺟﻧﯾن‬ ‫ﻣﺳﻣﻊ‬
‫ﺑﺎﻷﺳﺑوع‬16-20
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

23. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
3.‫ﻟﻠﺣﻣل‬ ‫اﻟﻣﺧﺑري‬ ‫اﻟﺗﺷﺧﯾص‬Laboratory tests for pregnancy
•1.‫اﻟﺣﻣل‬ ‫اﺧﺗﺑﺎرات‬Pregnancy Tests:
•‫ﻋﻼﻣﺔ‬‫اﺣﺗﻣﺎﻟﯾﺔ‬probable‫ﻟﻠﺣﻣل‬.
•‫اﻟدﻗﺔ‬‫ﺟدا‬ ‫ﺟﯾدة‬.
•‫ﺗﺣري‬ ‫ﻋﻠﻰ‬ ‫ﺗﻌﺗﻣد‬HCGβ‫اﻟﺑول‬ ‫أو‬ ‫اﻟﻣﺻل‬ ‫ﻓﻲ‬.
•‫اﻟط‬ ‫اﻧﻘطﺎع‬ ‫ﻗﺑل‬ ‫ﺣﺗﻰ‬ ‫اﻟﺣﻣل‬ ‫ﺑﺣدوث‬ ‫اﻻﺷﺗﺑﺎه‬ ‫ﯾﻣﻛن‬‫ﻣث‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university
c.‫اﻟﺣﻣل‬ ‫ﺗﺷﺧﯾص‬
Diagnosis of pregnancy

24. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
3.‫ﻟﻠﺣﻣل‬ ‫اﻟﻣﺧﺑري‬ ‫اﻟﺗﺷﺧﯾص‬Laboratory tests for pregnancy
•‫ﯾﺷﺎھد‬GS‫ﺑﺎﻷﺳﺑوع‬5.
•‫ﺗﺷﺎھد‬‫اﻟﻣﺿﻐﺔ‬‫اﻷﺳﺑوع‬ ‫ﻓﻲ‬6–7.
•‫ﺗﺷﺎھد‬‫اﻟﺣﻧﯾن‬ ‫ﻗﻠب‬ ‫دﻗﺎت‬‫اﻷﺳﺑوع‬ ‫ﻓﻲ‬8.
•‫ﯾﻌﺗﻣد‬‫اﻟﺷﻌﺎﻋﻲ‬ ‫اﻟﺗﺻوﯾر‬‫ﻟ‬ ‫اﻟﻌظﻣﻲ‬ ‫اﻟﮭﯾﻛل‬ ‫ﺗﺣري‬ ‫ﻋﻠﻰ‬‫ﻠﺟﻧﯾن‬
‫اﻷﺳﺑوع‬ ‫ﻓﻲ‬16)‫اﻟﺣﻣل‬ ‫ﺑداﯾﺔ‬ ‫ﻓﻲ‬ ‫ﺗﺟﻧﺑﮫ‬ ‫ﯾﺟب‬. (
2.‫اﻟﺻوﺗﯾﺔ‬ ‫ﻓوق‬ ‫ﺑﺎﻷﻣواج‬ ‫اﻟﺗﺷﺧﯾص‬Diagnostic ultrasonography
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university
c.‫اﻟﺣﻣل‬ ‫ﺗﺷﺧﯾص‬
Diagnosis of pregnancy

25. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

26. ‫اﻟﺗوﻟﯾد‬ ‫طب‬–‫اﻟراﺑﻌﺔ‬ ‫اﻟﺳﻧﺔ‬
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university