难产(dystocia)-滕银成课件(PPT 47页)

1、Dystocia Teng Yincheng M.D., Ph.D., Professor Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine 第1页，共47页。DefinitionDystocia literally means difficult labor and it is characterized by abnormally slow progress of laborIt is the consequence of four distinct abno

2、rmalities that may exist singly or combination2第2页，共47页。Abnormal of the powers(uterine contractility and maternal expulsive effort)Abnormalities of passenger(the fetus)Abnormalities of the passage(the birth canal)Categories of dystocia3第3页，共47页。Abnormalities of the powersUterine dysfunction hypotoni

3、c primary uterine inertia secondaryUterine hypertonicDysfunction uterine hypercontractility4第4页，共47页。Abnormalities of the powers-uterine inertia1.Etiology of uterine inertiaCephalopelvic disproportion or Fetal malposition Abnormal of uterine muscleImbalance of endocrine systemAdministration of analg

4、esiapsychical-factorsOthers fatigue5第5页，共47页。Abnormalities of the powers-uterine inertia6第6页，共47页。Abnormalities of the powers-uterine inertia2.Clinical findingsFailure to progressLack of progressive cervical dilatation Prolonged latent phase ( 16h) Prolonged active phase ( 8h ; 1.2cm/h or 2h) Prolon

5、ged second phase(2h )Lack of fetal decent Prolonged descent (1cm/h; 1h) Prolonged labor (24h)7第7页，共47页。Abnormalities of the powers-uterine inertia3.diagnosisPalpation: strength duration frequencyTocodynamometerVaginal examination8第8页，共47页。9第9页，共47页。10第10页，共47页。11第11页，共47页。Abnormalities of the powers

6、-uterine inertia4.Effect on maternal and fetus maternal fatigue acidosis infection postpartum hemorrhage cesarean section rate fetus birth injury distress prolapse of umbilical cord stillbirth12第12页，共47页。Abnormalities of the powers-uterine inertia5.managementhypotonic 1) general management 心理护理 饮食护理

7、 镇静 2) physical methods 导尿 灌肠 人工破膜 针刺穴位 13第13页，共47页。14第14页，共47页。Abnormalities of the powers-uterine inertia3) Drugs oxytocin 2.5U + 5%GS 500ml 5mU/ml 8滴分开始地西泮10mg iv15第15页，共47页。Abnormalities of the powers-uterine inertiaHypertonicSedativeCS16第16页，共47页。Abnormalities of the powers- hypercontractility1

8、.Clinical findings and diagnosisPrecipitate deliveryConstriction ring of uterusTetanic contraction of uterus17第17页，共47页。Abnormalities of the powers- hypercontractility2.Effect on maternal and fetusPrecipitate deliverysoft birth canal traumaRupture of uterusFetal distressFetal deathstillbirth18第18页，共

9、47页。Abnormalities of the powers- hypercontractility3.managementProphylaxisTocolytic therapiesForcepoperation19第19页，共47页。Dystocia Part II第20页，共47页。 Abnormalities of birth canal1.Bony pelvic1)Contracted pelvic inlet simple flat pelvis rachitic flat pelvis21第21页，共47页。2)Contracted midpelvis (anthropoid

10、pelvis)22第22页，共47页。3)Contracted pelvic outlet (funnel shaped pelvis)23第23页，共47页。4)Generally contracted pelvis5)Disruption of normal female pelvic architecture osteomalacic pelvis obliquely contracted pelvis 24第24页，共47页。Clinical signs of contracted pelvisContracted pelvic inletContracted midpelvisCon

11、tracted pelvic outlet25第25页，共47页。Diagnosis :HistoryPhysical examinationPelvimetry external pelvimetry internal pelvimetry diagonal conjugate 12.513cm bi-ischial diameter 10cm incisura ischiadica 56cm angle of subpubic arch 9026第26页，共47页。27第27页，共47页。Effects on maternal and fetusManagement2. Abnormal

12、of soft birth canal28第28页，共47页。Abnormalities of the passenger A. malposition and malpresentation a. vertex malposition persistent occiput posterior persistent occiput transverse 5% sincipital presentation 1.08% anterior asynclitism posterior asynclitism 0.5%0.81% b. brow presentation 0.03%0.1% c. fa

13、ce presentation 0.08%0.27% d. breech presentation 3%4% e. abnormal fetal lie transverse or oblique lie 0.25%29第29页，共47页。30第30页，共47页。31第31页，共47页。32第32页，共47页。33第33页，共47页。Breech presentation complete(mixed) breech presentation frank breech presentation incomplete breech presentation knee or footling pr

14、esentation34第34页，共47页。Extraction of breech35第35页，共47页。36第36页，共47页。37第37页，共47页。B. Fetal macrosomia large for gestational age(LGA) 4000g shoulder dystosia38第38页，共47页。39第39页，共47页。C. Fetal malformation40第40页，共47页。Operative delivery1)forceps operations2)Vacuum extractor41第41页，共47页。2)Vacuum extractor42第42页，共47页。3)Cesarean section43第43页，共47页。44第44页，共47页。Main point of dystocia managemnet45第45页，共47页。思考题:1.The definition and classification of dystosia2.How