影响分娩的四大因素2FourfactorsforlaborFetusNormalLaborand课件

NormalLaborandDelivery

正常分娩

Obs&GynDepartmentof1stClinicalHospitalWuhanUniversityAssociateProfessorMinglei（明蕾）NormalLaborandDelivery

正常1影响分娩的四大因素2FourfactorsforlaborFetusNormalLaborand课件2OutlineDefinition123MechanismoflaborFourfactorsforlabor23（定义）OutlineDefinition123Mechanism3Definition1Deliveryistheprocessbywhichthematureornearlymaturefetusandplacenta

areexpelledfromthematernalbodyafter28weeks分娩是指妊娠满28周及以后的胎儿及其附属物从母体排出的过程（定义）Definition1Deliveryisthepro4Definition1Termdelivery:37-42weeks1足月产Pre-termdelivery:28-37weeks2早产

Post-termdelivery:42weeks3过期产Abortion:4流产<28weeks（定义）Definition1Termdelivery:5Definition13Mechanismoflabor2FourfactorsforlaborOutline影响分娩的四大因素NormalLaboranddeliveryForceBirthcanalFetusPsychicalfactors

产力

产道

胎儿精神因素Definition13Mechanismoflabor6影响分娩的四大因素2FourfactorsforlaborForceExpulsiveForce产力IntraabdominalpressureThisiscreatedbycontractionoftheabdominalmusclessimutaneouslywithforcedrespiratoryeffortswiththeglottisclose.thisisreferredtoaspushingLevatoranimuscleLevatoranimuscleisthemostimportantpartofpelvicfloorAncillaryForce

辅助产力uterinecontractionArhythmictighteninginlaboroftheupperuterinemusculaturethatcontractsthesizeoftheuterusandpushesthefetustowardthebirthcanalMajorforce子宫收缩力影响分娩的四大因素2Fourfactorsforlab7Rhythm节律性Symmetry对称性Polarity极性Retraction缩复性intermissionContractioncontraction影响分娩的四大因素2FourfactorsforlaboruterineContractionfeatureForce子宫收缩力的四大特征Rhythm节律性Symmetry对称性Pola8影响分娩的四大因素2FourfactorsforlaborBirthcanalNormalLaboranddeliveryForceFetusPsychicalfactors产力产道胎儿精神因素影响分娩的四大因素2Fourfactorsforlab9影响分娩的四大因素2FourfactorsforlaborBirthcanalBonycanal骨产道Birthcanal

产道Softtissuecanal软产道重点影响分娩的四大因素2Fourfactorsforlab10影响分娩的四大因素2FourfactorsforlaborBirthcanalBonycanal骨产道PelvicinletplaneSuperiorstraitPelvicoutletplaneInferiorstraitMidpelvisoutletleastpelvicdimensionplanepelvicaxis(骨盆轴):

Ahypotheticallinecurvingthroughthemidpointofthepelvicplanes连接骨盆各平面中点的假想曲线

影响分娩的四大因素2Fourfactorsforlab11影响分娩的四大因素2FourfactorsforlaborFetusNormalLaborand课件12影响分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal软产道（重点）

Loweruterinesegment

子宫下段Cervix,floorofpelvis,vagina宫颈、阴道、会阴及盆底Softtissuepartcanal

软产道影响分娩的四大因素2Fourfactorsforlab13影响分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal软产道

formationofloweruterinesegment子宫下段形成非孕时子宫孕足月子宫第一产程子宫子宫峡部isthmus影响分娩的四大因素2Fourfactorsforlab14影响分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal软产道cervicaleffacementanddilatation宫颈管消失及宫口扩张宫颈管影响分娩的四大因素2Fourfactorsforlab15Softcanal软产道影响分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal影响分娩的四大因素2Fourfacto16影响分娩的四大因素2FourfactorsforlaborFetusNormalLaboranddeliveryForceBirthcanalPsychicalfactors产力产道胎儿精神因素Fetus

胎儿Fetalsize胎儿大小Fetallie胎产式Fetalattitude胎姿势Fetalstation胎先露高低Fetalpresentation胎先露Fetalposition胎方位影响分娩的四大因素2Fourfactorsforlab17影响分娩的四大因素2FourfactorsforlaborFetusFetallie

胎产式：胎体纵轴与母体纵轴的关系Relationoflongaxisoffetustothatofthemother.Longitudinal纵产式(99%),transverse横产式

oroblique影响分娩的四大因素2Fourfactorsforlab18影响分娩的四大因素2FourfactorsforlaborFetus

Fetalpresentation

胎先露：最先进入骨盆入 口的胎儿部分FetalpartthatdirectlyoverliespelvicinletCephalic头先露,breech臀先露,orshoulder肩先露影响分娩的四大因素2Fourfactorsforlab19影响分娩的四大因素2FourfactorsforlaborFetusFetalposition

胎方位：胎儿先露部指示点与母体骨盆的关系（难点）Therelationofanarbitrarily

chosenportionofthepresentingpartofthefetustotherightorleftsideofthematernalbirthcanal.

Formoreaccurately–anterior,transverse,posterior影响分娩的四大因素2Fourfactorsforlab20影响分娩的四大因素2FourfactorsforlaborFetusLOA(leftoccipito-anterior)ROA(rightoccipito-anterior)枕左前位枕右前位头先露指示点枕骨影响分娩的四大因素2Fourfactorsforlab21影响分娩的四大因素2FourfactorsforlaborFetus

LOT(leftoccipito-transverse)ROT(rightoccipito-transverse)枕左横位枕右横位影响分娩的四大因素2Fourfactorsforlab22影响分娩的四大因素2FourfactorsforlaborFetusLOP(leftoccipito-posterior)ROP(rightoccipito-posterior)

枕左后位枕右后位影响分娩的四大因素2Fourfactorsforlab23影响分娩的四大因素2FourfactorsforlaborFetus影响分娩的四大因素2Fourfactorsforlab24影响分娩的四大因素2FourfactorsforlaborFetusLOAleftoccipito-anterior(枕左前位)影响分娩的四大因素2Fourfactorsforlab25OutlineDefinition13Mechanismoflabor2FourfactorsforlaborOcciputpresentation(枕先露的分娩机转)重难点

1engagement

衔接2descent

下降3flexion

俯屈4internalrotation

内旋转5extension

仰伸6externalrotation

外旋转7.expulsion娩出OutlineDefinition13Mechanismo26Mechanismoflabor(枕先露的分娩机转)Occiputpresentation3Mechanismoflabor(枕先露的分娩机转)Oc27Mechanismoflabor(枕先露的分娩机转)Occiputpresentation31.Engagement衔接Passageofwidestdiameterofpresentingparttolevelbelowtheplaneofthepelvicinlet胎儿先露部的最大径线进入骨盆入口平面，先露部最低点接近或达到坐骨棘连线水平ischialspinesMechanismoflabor(枕先露的分娩机转)Oc28Mechanismoflabor(枕先露的分娩机转)Occiputpresentation32、3.

Descent&Flexion下降和俯曲OccipitofrontalDiameter12cmSuboccipitobregmaticDiameter9.5cm枕下前囟径枕额径Mechanismoflabor(枕先露的分娩机转)Oc29Mechanismoflabor(枕先露的分娩机转)Occiputpresentation34.Internalrotation

胎儿内旋转Astheheaddescends,thepresentingpart,usuallyinthetransverseposition,isrotatedabout45°toanteroposterior(AP)positionunderthesymphysis.InternalrotationbringstheAPdiameteroftheheadinlinewiththeAPdiameterofthepelvicoutletMechanismoflabor(枕先露的分娩机转)Oc30Mechanismoflabor(枕先露的分娩机转)Occiputpresentation35.Extension仰伸1)Withfurtherdescentandfullflexionofthehead,thebaseoftheocciputcomesincontactwiththeinferiormarginofthepubicsymphysis2)UpwardresistancefromthepelvicfloorandthedownwardforcesfromtheuterinecontractionscausetheocciputtoextendandrotatearoundthesymphysisMechanismoflabor(枕先露的分娩机转)Oc31Mechanismoflabor(枕先露的分娩机转)Occiputpresentation36.ExternalRotation

外旋转Whenthefetus'headisfreeofresistance,ituntwistsabout45°leftorright,returningtoitsoriginalanatomicpositioninrelationtothebodyMechanismoflabor(枕先露的分娩机转)Oc32Mechanismoflabor(枕先露的分娩机转)Occiputpresentation37.Expulsion

胎儿娩出Mechanismoflabor(枕先露的分娩机转)Oc33Mechanismoflabor(枕先露的分娩机转)Occiputpresentation3Mechanism