妇产课件 8-正常分娩

ObstetricsandGynecology

—laboranddelivery

andcomplicationofdelivery赵晓东MD

主任医师

北京医科大学研究生导师laboranddeliveryDefinitionLabor:progressivedilatationoftheuterinecervixinassociationwithrepetitiveuterinecontractions.Delivery:fromonsetoflabortocompleteexpulseoffetusandfacilitatedorgans.laboranddelivery3keyfactorsExpulsiveforceBirthcanal:bonycanal,softtissueofbirthcanalFetus

3keyfactors--expulsiveforceUterinecontraction:rhythm,orientation,retractionAbdominalwallmuscle:thesecondstageoflaborLevatorani:helpinternalrotationandextension3keyfactors--birthcanal

Bonycanal:1)pelvicinletplane:obstetricconjugate(11cm),transverseofpelvicinlet(13cm),obliqueofpelvicinlet(12.75cm2)thegreatestplaneofpelvis:12.5cm3)midplaneofpelvis:anterior-posteriordiameter(11.5cm),bi-ischialdiameter(10cm)4)pelvicoutletplane:anterior-posteriordiameter(11.5cm),transverseoutlet(TO)9cm,anteriorsagittaldiameter(6cm),posteriorsagittaldiameter(8.5cm)5)inclinationofpelvis:60º3keyfactors--birthcanal

Softtissueofbirthcanal1)Lowersegmentofuterus:10cm,physiologicretractionring2)Effacementofcervix:2cm3)Dilationofcervix:10cm4)Vaginaandperiniumbody3keyfactors--fetusThesizeoffetus:

Head:BPD9.3cm,occipito-frontaldiameter11.3cm,sub-occipitalbregmaticdiameter9.5cm,occipito-mentaldiameter13.3cm

Headmolding:

Fetalweight:3keyfactors--fetus

Fetalposition:fetallie,fetalpresentation,fetalpositionAbnormalitisofthefetus:hydrocephalus,conjoinedtwinsNormalmechanismsoflaborThemechanismsoflaborStagesandphasesoflaborThemechanismsoflaborEngagementDescentFlexionInternalrotationExtensionRestitutionandexternalrotationExpulsionStagesandphasesoflaborThreatenedlabor:falselabor,lightening,showInlabor:contraction(30sec/5-6min),accompaniedbydilationofcervixanddescentoffetalheadThefirststageoflabor:tofulldilationofcervix,dividedbylatentphase(to3cm)andactivephase(to10cm),totalneed11-12hoursinnulliparasor6-8hoursinmultiparasThesecondstageoflabor:toexpulsionoffetus,totalneed1-2hoursThethirdstageoflabor:toexpulsionoffetalaffiliatedorgan,suchasplacenta,totalneed5-15minsThefirststageoflaborlatentphase:

1)representation:

contraction(30sec/5-6min—45sec/3-4min),

dilationofcervix:to3cm,1cm/2-3hours

totalneed8-16hours2)treatment:contraction,laborobservation,fetalheartrate,BpThefirststageoflaboractivephase:

1)representation:contraction(50-60sec/2-3min—60sec/1-2min),dilationofcervix3-10cm,1.2-1.5cm/hr,descentoffetalhead:reachthelevelofischialcrestwhendilation4-5cm,0.85cm/hr,ruptureofmembrances

totalneed4-8hours

Prolongedlabor:dilationratebelow1.2cm/hrinnulliparasor1.5cm/hrinmultiparas

Arrestedlabor:cessationoflaborfor2hours2)treatment:contraction,laborobservation,fetalheartrate,BpThesecondstageoflabor1)representation:contraction:60sec/1-2min

descentoffetalhead:1-2cm/hrheadvisibleinvulvagapping,crowningofhead,delivery

totalneed:1-2hours

Prolongedlabor:descentratebelow1cm/hrinnulliparasor2cm/hrinmultiparas

Arrestedlabor:cessationofdescentfor1hours2)Treatment:contraction,laborobservation,fetalheartrate,Bp,directiondelivery:episiotomyThethirdstageoflabor

Thetreatmentofnew-birth:clearbreathcanal,Apgarscore,clampingofcordThesignofplacentaseparationDeliveryofplacenta:manualremovalofplacenta(30mins),adhension,increta,Thefirthstageoflabor:2hoursafterdelivery,observebleeding:postpartumhemorrhage(above500ml),observetheheightofuterinefundusComplic