妇产科：异常分娩(英文课件)

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ABNORMALLABORORDYSTOCIA

12Defintion：Dystociaisdefinedasdifficultlabor.Itmaybeassociatedwithvariousabnormalitiesthatpreventordeviatefromthenormalcourseoflaboranddelivery.Itistheconsequenceoffourdistinctabnormalitiesthatmayexistsinglyorcombination:thepower,passagepassengerandthepsyche.2Defintion：3CauseofdystociaPowercontractionorintra-abdominalpressure

PassageboneorsoftbirthcanalPassengermalformationPsychetension-anxiety3Causeofdystocia4

AbnormaluterineactionTherhythm,symmetry,polarityandretractionofuterinecontractionbecomeabnormal.Include：uterinehypocontractilityuterinehypercontractility4Abnormaluterineaction5Abnormalitiesofthepowers

Uterinedysfunction

coordianted

hypocontractilityUterineUncoordinatedDysfunctioncoordiantedhypercontractility

uncoordinated5AbnormalitiesofthepowersU6

Etiologyofuterineaction

：Cephalopelvicdisproportionorfetalmalposition

PsychologicalfactorsAbnormaluterus

EndocrinaldysfunctionOthers6

Etiologyofuterineaction：7ClinicalmanifestationHypotonicuterineaction(coordianted)★Havenormalrhythm,symmetryandpolarity.★Theintensityislow.

including:primaryandsecondaryhypotonicuterineaction.7Clinicalmanifestation8Hypotonicuterineaction(uncoordianted)★Lossthenormalrhythm,symmetryandpolarity.★Theintensityintheperiodsofrelaxationbetweencontractionsbecomelarger.★Thepregnantwomenwillfellpersistingpain.

8Hypotonicuterineaction(unco9EffectonmaternalandfetusmaternalFatigueAcidosisInfectionPostpartumhemorrhageCesareansectionrateincreasingfetusBirthinjurydistressProlapseofumbilicalcordStillbirth9Effectonmaternalandfetusm10Managemant

Coordinateddysfunction★VaginalexaminationtoruleoutCephalopelvicdisproportionorfetalmalposition.★Evaluatefetusandmaternalcomplexion.10Managemant11Inthefirststageoflabor

Relax,Takegoodcare

ImprovethecontractionRupturethemembraneOxytocinstimulationoflabor:fromlowdose.Narcoticagentsuchasmorphinesulfateisgivenindoseslargeenoughtoarrestuterinecontractionsandprovidefrom6-12hoursofrest;11Inthefirststageoflabor12Insecondstageoflabor

★Thereisnocephalopelvicdisproportion-----improvetheexpulsiveforce.

★Fetaldistress----finishthelaborinshortesttime.

★Cephalopelvicdisproportion-----cesareansection.

Inthirdstageoflabor----preventionofpostpartumhemorrhage.

12Insecondstageoflabor13Uncoordinateddysfunction：★Sedationisgenerallyeffectiveinconvertinguncoordinatedcontractiontonormallaborpatterns.13Uncoordinateddysfunction：14Hypertonicdysfunction(coordinated)ManifestationanddiagnosisThecontractionhavenormalrhythm,symmetryandpolarity,buttheintensityistoostrong.Precipitatedelivery:

Thetotalstageislessthan3hourswhentheratesofcervicaldilationismorethan5cm/h,thecervicaldilationof10cmandexpulsionoffetusoccursinshorttime.14Hypertonicdysfunction(coord15Hypertonicofuncoordinatedcontraction

Constrictionringofuterus

Characteristic:Local

smooth

muscle

in

uterus

spasmodicly

contract

to

form

circular

contraction.

The

ring

is

located

at

juncture

between

lower

uterine

segment

andcorpusuteri.15Hypertonicofuncoordinated16Tetaniccontractionofuterus:★Lossofrhythmn★Thetitaniccontractionofuteruspersistcontractinganddon’trelax,alwaysappearwhenoxytocinbemisused.16Tetaniccontractionofuteru17EffectonmaternalandfetusPrecipitatedeliverySoftbirthcanaltraumaRuptureofuterusFetaldistressFetaldeathstillbirth17Effectonmaternalandfetus18§Prevention

is

main

doctrine.§

Use

oxytocin,

artificialrupture

of

membrane

carefully.§

Aspiration

oxygen,

prohibit

uterine

contraction—Magnesium

sulfate,

pethidine.§

Fetaldistress,pathologic

retraction

ring—Cesarean.Management18Management19

Abnormalpassage

Causesofabnormalitiesofpassageincludebonyabnormalities(pelvicdystocia),softtissueobstructionofthebirthcanal.Pelvicdystocia,particularlythatduetosmallbonyarchitecture,isthemostcommoncauseofpassageabnormalities.19Abnormalpa20inletoutletcavityfemalemale20inletoutletcavityfemalemale21Contractedpelvicinlet

platypelloidiscomonTheplatypelloid

pelvisischaracterizedbyatransversediameterthatiswidewithrespecttotheanteroposteriordiameter.SimpleflatpelvisRachiticflatpelvis21Contractedpelvicinletpl22Midpelviscontraction

Midpelviscontractionisdefinedasvalueslessthan10cmfortheinterspinousdiameter,alwaysoccursinandroidpelvisandanthropoidpelvis.22Midpelviscontraction23Contractedpelvicoutlet

Pelvicoutletcontractionisdefinedasvalueslessthan8cmfortheintertuberousdiameterandthesumoftheintertuberousandposteriorsagittaldiameterlessthan15cm.alwaysoccursinandroidpelvis.

23Contractedpelvicoutlet

24GenerallycontractedpelvicEachpelvicplaneis2cmlessthannormalvalueormore,whichiscalledgenerallycontractedpelvicandcanbeseeninshapemoreshortandsmall,well-balancedwomenoftypeoffigure.PelvicmalformationThepelviclossthenormalshapeandsymmetry.24Generallycontractedpelvic25ClinicalmanifestationofContractedpelvicinlet※Abnormalpresentationandlieposition.※Lackofprogressivecervicaldilatationandfetusdescending:prolongedlatentphaseandactivephase.※Prematureruptureofmembraneandumbilicalcordprolapse.2526Contractedpelvicinlet

26Contractedpelvicinlet

27ClinicalmanifestationofMidpelviscontraction★AbnormalpositionPersistentocciputposteriorposition,ordeeptransversearrest★

Prolongedlaborstage★Forcepincreasing27ClinicalmanifestationofM28Contractedpelvicoutlet

ClinicalmanifestationSecondaryhypotonicuterineactionandprotractedsecondstageoflabor.Thefetalbiparietaldiametercan’tpassthepelvicoutlet.28ContractedpelvicoutletCli29Managementofpelvicbonycontraction

Consideringtypeofpelvic,power,fetuspositionandfetaldistress.ContractedpelvicinletExternalconjugate16.5～17.5cm,anteroposteriordiameter

8.5～9.5cm.Externalconjugate

<16.0cm,anteroposteriordiameter

<8.0cm,CesareaSection29Managementofpelvicbonyco30Midpelviscontractiontreatment

VaginalexaminationtoruleoutCephalopelvicdisproportionorfetalmalposition.persistentocciputposteriorposition、persistentocciputtransversepositionEnhanceuterinecontractility,oxytocin.VaginaldeliveryorCesareansection.30Midpelviscontractiontreatm31PelvicoutletTreatment

Cesareansectionisthefirstchoice.Whenasumoftheintertuberousdiameterandtheposteriorsagittaldiametergreaterthan15cm,thefetalheadmaypassthebirthcanalusingtheposteriortriangle.31PelvicoutletTreatment32abnormalsoftbirthcanal32abnormalsoftbirthcanal33Abnormalfetalpositionpersistentocciputposteriorposition、persistentocciputtransversepositionDefinition：Duringtheprocessofdelivery,thefetalheadinocciputposterior(transverse)positionengagesinthepelvicinlet,aftervigorousuterinecontraction,theocciputpersistlocatingontheposterior(transverse)portionofmaternalpelvic,whichmayresultindystocia.33Abnormalfetalposition34

persistentocciputposteriorposition、persistentocciputtransverseposition

34persistentocciputposter35Vaginalexamination35Vaginalexamination36Vaginalexamination36Vaginalexamination37LOPROPLOTROTVaginalexamination37LOPROPLOTROTVaginalexaminat38383939404041DiagnosisofAbnormalfetalposition★Clinicalmanifestation：√Engageslaterattheonsetoflabor；√

Secondaryhypotonicuterineaction；√

Usetheabdominalpressurebeforethecervixdon’tdilateto10cm；√

Fetalheaddescendslowly；41DiagnosisofAbnormalfetal42TreatmentInthefirststageoflabor：

Ruleoutcephalopelvicdisproportion；Observethebirthprocessseriously；Improveuterinecontraction；Inthesecondstageoflabor：

thevaginalexaminationshouldbecarriedoutandmakeadecisionofdeliverystyle:vaginaldelivery,assisteddelivery,cesareansection.42TreatmentInthesecondstage434344444545464647Sincipitalpresentationoccipitopubicposition;occipitosacralposition;47Sincipitalpresentation48DiagnosisClinicalmanifestation：prolongedactivestageoflabor,persistingpainoftheloweruterinesegment.palpation：cephalopelvicdisproportion.Vaginalexamination：thebregmaticfontalelleandlambdoidsutureareequallyprominent.ManagmentOccipitopubicposition:expectantmanagementforshorttime.Occipitosacralposition：cesareansection.48Diagnosis49AnteriorasynelitismClinicalfinding:49Anteriorasynelitism50Anteriorasynelitism50Anteriorasynelitism51Diagnosis:Clinicalmanifestation：fetaldescendingprotracted；dysuria；palpation：falsesignsoffetalengagement；Vaginalexamination：Management:cesareansectionshouldbeperformed.51Diagnosis:52Includeing:★Completebreechpresentation.★Frankbreechpresentation.★Incompletebreechpresentation

kneeorfootlingpresentationBreechpresentation52Includeing:Breechpresentati53BreechpresentationcompletebreechpresentationFrankbreechpresentationIncompletebreechpresentation53Breechpresentationcomplete54

Classifyofbreechpresentation54Classifyofbreechprese55Diagnosis:Symptoms：Thepregnantwomenfeelthehard,roundfetalheadbelowthecosta.Uterineinertia,slowdilationofcervixoccur,prematureruptureofmembranewilloccurs,whichcauseprolongedstage.Palpationandballottement：55Diagnosis:56ManagementAntepartum：If

breechpresentationpersistsbeyond30weeks,somerectificationmethodshouldbeconsidered:genucubitalposition,externalcephalicversion.56Management57Duringlabor：

Deliverystyleshouldbedeterminedaccordingtomaternalage,fetalsize,fetalmalformationornot,dilationdegreeofcervix,pregnantcomplicationornot.57Duringlabor：58Extractionofbreech58Extractionofbreech595960606161626263Itshouldperformcesareansectionwhen:contractedpelvic,abnormalsoftbirthcanal,estimatedfetalweightof3500gormore,fetaldistress,prematureruptureofmembrane,prolapseofthecord,pregnancycomplications,eldlyprimiparity,dystociahistory,incompletebreechpresentation,etc.63Itshouldperformcesareans64Shoulderpresentation

Shoulderpresentationoccurswhenthelongaxisofthefetusisapproximatelyperpendiculartothatoftheusuallyoverthepelvicinlet,withtheheadlyinginoneiliacfossaandthebreechintheother.64Shoulderpresentation656566Diagnosis:

prolongedcoursesoflabor.Lackofprogressivecervicaldilatationandfetusdescending.Prolongedlatentphase>16h。Prolongedactivephase>8hCervicaldilation:Primigravida<1.2cm/h，Multipara

<1.5cm/h。Clinicalfindinganddiagnosisofabnormallabor66Diagnosis:prolongedcourses67ProtractedactivephaseThecervicaldilationstopfor2hoursinactivephase。ProlongedsecondstageThesecondstagelastmorethan2hoursforprimigravidaormorethan1hourformultipara。67Protractedactivephase68Prolongeddescent:

therateoffetusdescendingindecelerationphaseandthesecondstageoflaborlessthan1.0cm/h(primigravida)，or2.0cm/h(multipara)。Protracteddescent:

fetusdescendingindecelerationphasestopformorethan1h。Prolongedlabor:thetotalstagelastmorethan24h。68Prolongeddescent:therat696970Managementofvaginaldelivery：Evaluationofuterinecontraction,fetalsizeandposition,pelvicsize,fetopelvicdisproportionornot.ProlongedlatentstageSedationmaycauseabsenceofuterinecontractioninfalselabor.。70Managementofvaginaldelive71ProlongedactivestageObservetheprogressoflabor、expulsiveforce、fetalheartrate、fetalpositionfor2～4h,whenruleoutthefetopelvicdisproportion.

71Prolongedactivestage72ProlongedsecondstageoflaborThefirst,performvaginalexaminationtoruleoutfetopelvicdisproportion,correcttheabnormalfetalposition,thencanimprovetheuterinecontractionbyoxytocine.72Prolongedsecondstageofla73★Ceasreansectionposteriorasynelitism、Anteriorasynelitism)、Browpresentation;GeneralpelviccontractFetalmacrosomia;Shoulderpresentation,Feetpresentation;Pathologiccontractingring;73★Ceasreansection74潜伏期有延长倾向或已经延长强烈镇静剂无进展催产素剖宫产术无进展有进展宫颈扩张活跃期无进展有进展有进展人工破膜潜伏期延长的处理方案排除CPD排除胎窘74潜伏期有延长倾向或已经延长强烈镇静剂无进展催产素剖宫产术75延缓阻滞胎儿娩出无明显CPD人工破膜

2小时无进展严重胎头位置异常剖宫产术无严重胎头位置异常催产素无进展剖宫产术有进展明显CPD剖宫产术有进展活跃期宫颈扩张延缓及阻滞处理75延缓阻滞胎儿娩出无明显CPD人工破膜无进展严重胎头位置异76胎头下降延缓阻滞明显CPD剖宫产无明显CPD加强宫缩（人工破膜，催产素）儿头最大横径位于或低于坐骨棘以下儿头最大横径位于或低于坐骨棘以上阴道分娩徒手内旋双顶径降至坐骨棘以下阴道分娩失效剖宫产活跃期胎头下降延缓阻滞及胎头娩出期延长的处理76胎头下降延缓阻滞明显CPD剖宫产无明显CPD加强宫缩（人777778

ABNORMALLABORORDYSTOCIA

179Defintion：Dystociaisdefinedasdifficultlabor.Itmaybeassociatedwithvariousabnormalitiesthatpreventordeviatefromthenormalcourseoflaboranddelivery.Itistheconsequenceoffourdistinctabnormalitiesthatmayexistsinglyorcombination:thepower,passagepassengerandthepsyche.2Defintion：80CauseofdystociaPowercontractionorintra-abdominalpressure

PassageboneorsoftbirthcanalPassengermalformationPsychetension-anxiety3Causeofdystocia81

AbnormaluterineactionTherhythm,symmetry,polarityandretractionofuterinecontractionbecomeabnormal.Include：uterinehypocontractilityuterinehypercontractility4Abnormaluterineaction82Abnormalitiesofthepowers

Uterinedysfunction

coordianted

hypocontractilityUterineUncoordinatedDysfunctioncoordiantedhypercontractility

uncoordinated5AbnormalitiesofthepowersU83

Etiologyofuterineaction

：Cephalopelvicdisproportionorfetalmalposition

PsychologicalfactorsAbnormaluterus

EndocrinaldysfunctionOthers6

Etiologyofuterineaction：84ClinicalmanifestationHypotonicuterineaction(coordianted)★Havenormalrhythm,symmetryandpolarity.★Theintensityislow.

including:primaryandsecondaryhypotonicuterineaction.7Clinicalmanifestation85Hypotonicuterineaction(uncoordianted)★Lossthenormalrhythm,symmetryandpolarity.★Theintensityintheperiodsofrelaxationbetweencontractionsbecomelarger.★Thepregnantwomenwillfellpersistingpain.

8Hypotonicuterineaction(unco86EffectonmaternalandfetusmaternalFatigueAcidosisInfectionPostpartumhemorrhageCesareansectionrateincreasingfetusBirthinjurydistressProlapseofumbilicalcordStillbirth9Effectonmaternalandfetusm87Managemant

Coordinateddysfunction★VaginalexaminationtoruleoutCephalopelvicdisproportionorfetalmalposition.★Evaluatefetusandmaternalcomplexion.10Managemant88Inthefirststageoflabor

Relax,Takegoodcare

ImprovethecontractionRupturethemembraneOxytocinstimulationoflabor:fromlowdose.Narcoticagentsuchasmorphinesulfateisgivenindoseslargeenoughtoarrestuterinecontractionsandprovidefrom6-12hoursofrest;11Inthefirststageoflabor89Insecondstageoflabor

★Thereisnocephalopelvicdisproportion-----improvetheexpulsiveforce.

★Fetaldistress----finishthelaborinshortesttime.

★Cephalopelvicdisproportion-----cesareansection.

Inthirdstageoflabor----preventionofpostpartumhemorrhage.

12Insecondstageoflabor90Uncoordinateddysfunction：★Sedationisgenerallyeffectiveinconvertinguncoordinatedcontractiontonormallaborpatterns.13Uncoordinateddysfunction：91Hypertonicdysfunction(coordinated)ManifestationanddiagnosisThecontractionhavenormalrhythm,symmetryandpolarity,buttheintensityistoostrong.Precipitatedelivery:

Thetotalstageislessthan3hourswhentheratesofcervicaldilationismorethan5cm/h,thecervicaldilationof10cmandexpulsionoffetusoccursinshorttime.14Hypertonicdysfunction(coord92Hypertonicofuncoordinatedcontraction

Constrictionringofuterus

Characteristic:Local

smooth

muscle

in

uterus

spasmodicly

contract

to

form

circular

contraction.

The

ring

is

located

at

juncture

between

lower

uterine

segment

andcorpusuteri.15Hypertonicofuncoordinated93Tetaniccontractionofuterus:★Lossofrhythmn★Thetitaniccontractionofuteruspersistcontractinganddon’trelax,alwaysappearwhenoxytocinbemisused.16Tetaniccontractionofuteru94EffectonmaternalandfetusPrecipitatedeliverySoftbirthcanaltraumaRuptureofuterusFetaldistressFetaldeathstillbirth17Effectonmaternalandfetus95§Prevention

is

main

doctrine.§

Use

oxytocin,

artificialrupture

of

membrane

carefully.§

Aspiration

oxygen,

prohibit

uterine

contraction—Magnesium

sulfate,

pethidine.§

Fetaldistress,pathologic

retraction

ring—Cesarean.Management18Management96

Abnormalpassage

Causesofabnormalitiesofpassageincludebonyabnormalities(pelvicdystocia),softtissueobstructionofthebirthcanal.Pelvicdystocia,particularlythatduetosmallbonyarchitecture,isthemostcommoncauseofpassageabnormalities.19Abnormalpa97inletoutletcavityfemalemale20inletoutletcavityfemalemale98Contractedpelvicinlet

platypelloidiscomonTheplatypelloid

pelvisischaracterizedbyatransversediameterthatiswidewithrespecttotheanteroposteriordiameter.SimpleflatpelvisRachiticflatpelvis21Contractedpelvicinletpl99Midpelviscontraction

Midpelviscontractionisdefinedasvalueslessthan10cmfortheinterspinousdiameter,alwaysoccursinandroidpelvisandanthropoidpelvis.22Midpelviscontraction100Contractedpelvicoutlet

Pelvicoutletcontractionisdefinedasvalueslessthan8cmfortheintertuberousdiameterandthesumoftheintertuberousandposteriorsagittaldiameterlessthan15cm.alwaysoccursinandroidpelvis.

23Contractedpelvicoutlet

101GenerallycontractedpelvicEachpelvicplaneis2cmlessthannormalvalueormore,whichiscalledgenerallycontractedpelvicandcanbeseeninshapemoreshortandsmall,well-balancedwomenoftypeoffigure.PelvicmalformationThepelviclossthenormalshapeandsymmetry.24Generallycontractedpelvic102ClinicalmanifestationofContractedpelvicinlet※Abnormalpresentationandlieposition.※Lackofprogressivecervicaldilatationandfetusdescending:prolongedlatentphaseandactivephase.※Prematureruptureofmembraneandumbilicalcordprolapse.25103Contractedpelvicinlet

26Contractedpelvicinlet

104ClinicalmanifestationofMidpelviscontraction★AbnormalpositionPersistentocciputposteriorposition,ordeeptransversearrest★

Prolongedlaborstage★Forcepincreasing27ClinicalmanifestationofM105Contractedpelvicoutlet

ClinicalmanifestationSecondaryhypotonicuterineactionandprotractedsecondstageoflabor.Thefetalbiparietaldiametercan’tpassthepelvicoutlet.28ContractedpelvicoutletCli106Managementofpelvicbonycontraction

Consideringtypeofpelvic,power,fetuspositionandfetaldistress.ContractedpelvicinletExternalconjugate16.5～17.5cm,anteroposteriordiameter

8.5～9.5cm.Externalconjugate

<16.0cm,anteroposteriordiameter

<8.0cm,CesareaSection29Managementofpelvicbonyco107Midpelviscontractiontreatment

VaginalexaminationtoruleoutCephalopelvicdisproportionorfetalmalposition.persistentocciputposteriorposition、persistentocciputtransversepositionEnhanceuterinecontractility,oxytocin.VaginaldeliveryorCesareansection.30Midpelviscontractiontreatm108PelvicoutletTreatment

Cesareansectionisthefirstchoice.Whenasumoftheintertuberousdiameterandtheposteriorsagittaldiametergreaterthan15cm,thefetalheadmaypassthebirthcanalusingtheposteriortriangle.31PelvicoutletTreatment109abnormalsoftbirthcanal32abnormalsoftbirthcanal110Abnormalfetalpositionpersistentocciputposteriorposition、persistentocciputtransversepositionDefinition：Duringtheprocessofdelivery,thefetalheadinocciputposterior(transverse)positionengagesinthepelvicinlet,aftervigorousuterinecontraction,theocciputpersistlocatingontheposterior(transverse)portionofmaternalpelvic,whichmayresultindystocia.33Abnormalfetalposition111

persistentocciputposteriorposition、persistentocciputtransverseposition

34persistentocciputposter112Vaginalexamination35Vaginalexamination113Vaginalexamination36Vaginalexamination114LOPROPLOTROTVaginalexamination37LOPROPLOTROTVaginalexaminat115381163911740118DiagnosisofAbnormalfetalposition★Clinicalmanifestation：√Engageslaterattheonsetoflabor；√

Secondaryhypotonicuterineaction；√

Usetheabdominalpressurebeforethecervixdon’tdilateto10cm；√

Fetalheaddescendslowly；41DiagnosisofAbnormalfetal119TreatmentInthefirststageoflabor：

Ruleoutcephalopelvicdisproportion；Observethebirthprocessseriously；Improveuterinecontraction；Inthesecondstageoflabor：

thevaginalexaminationshouldbecarriedoutandmakeadecisionofdeliverystyle:vaginaldelivery,assisteddelivery,cesareansection.42TreatmentInthesecondstage12043121441224512346124Sincipitalpresentationoccipitopubicposition;occipitosacralposition;47Sincipitalpresentation125DiagnosisClinicalmanifestation：prolongedactivestageoflabor,persistingpainoftheloweruterinesegment.palpation：cephalopelvicdisproportion.Vaginalexamination：thebregmaticfontalelleandlambdoidsutureareequallyprominent.ManagmentOccipitopubicposition:expectantmanagementforshorttime.Occipitosacralposition：cesareansection.48Diagnosis126AnteriorasynelitismClinicalfinding:49Anteriorasynelitism127Anteriorasynelitism50Anteriorasynelitism128Diagnosis:Clinicalmanifestation：fetaldescendingprotracted；dysuria；palpation：falsesignsoffetalengagement；Vaginalexamination：Management:cesareansectionshouldbeperformed.51Diagnosis:129Includeing:★Completebreechpresentation.★Frankbreechpresentation.★Incompletebreechpresentation

kneeorfootlingpresentationBreechpresentation52Includeing:Breechpresentati130BreechpresentationcompletebreechpresentationFrankbreechpresentationIncompletebreechpresentation53Breechpresentationcomplete131

Classifyofbreechpresentation54Classifyofbreechprese132Diagnosis:Symptoms：Thepregnantwomenfeelthehard,roundfetalheadbelowthecosta.Uterineinertia,slowdilationofcervixoccur,prematureruptureofmembranewilloccurs,whichcauseprolongedstage.Palpationandballottement：55Diagnosis:133ManagementAntepartum：If

breechpresentationpersistsbeyond30weeks,somerectificationmethodshouldbeconsidered:genucubitalposition,externalcephalicversion.56Management134Duringlabor：

Deliverystyleshouldbedeterminedaccordingtomaternalage,fetalsize,fetalmalformationornot,dilationdegreeofcervix,pregnantcomplicationornot.57Duringlabor：135Extractionofbreech58Extractionofbreech13659137601386113962140Itshouldperformcesareansectionwhen:contractedpelvic,abno