正常分娩英文课件

NormalLabor5/9/20241正常分娩英文课件ObjectiveDefinitionoflabor.DeterminateFactorsofLaborAnatomicalconsiderations:Thefemalepelvis.Thefetalskull.Thestagesoflabor.Themechanismoflabor(vertex,LOA).

Managementofnormallabor.5/9/20242正常分娩英文课件Definitions：Laboristheprocessbywhichcontractionsofthegraviduterusexpelthefetusandtheotherproductsofconceptionafter28weeksfromthelastmenstrualperiod.TermDelivery：Atermdeliveryoccursbetween37and42weeksfromthelastmenstrualperiod.5/9/20243正常分娩英文课件Prematurelabor：Pretermlaboristhatoccurringbefore37weeksofgestationalage.Postdatepregnancy：Postdatepregnancyoccursafter42weeks.5/9/20244正常分娩英文课件Notsure:1、Cervixripendandloweruterinesegmentdevelopmenttheory；2、Endocrineregulatingtheory；3、Mechanicaltheory；4、Neurohumortheory

；5、Immunologictheory；

TheetiologyoflaborMaturationoffetusandchangeofuterusfunctionisnecessary.5/9/20245正常分娩英文课件Theprogressandfinaloutcomeoflaborareinfluencedby4factors.(1)thepowers(2)thepassage(3)thepassenger(4)thepsycheFourDeterminateFactorsofLabor5/9/20246正常分娩英文课件Theexpulsiveforces(Thepowers)

Thepowerthatexpulsethefetusandtheotherproductsofconceptioniscalledtheexpulsiveforces,whichinclude♀

uterinecontraction♀

intra-abdominalpressure

♀levatoranimusclescontractions.

5/9/20247正常分娩英文课件Uterinecontractions

Havethreeuniquecharacteristics:★Rhythm:

increaseinfrequencyandduration,istheimportantmarkerofinlabor。★

Symmetryand

polarity★Retraction5/9/20248正常分娩英文课件Periodsofrelaxationbetweencontractionsareessentialtothewelfareofthefetus.RhythmIncreaseinfrequencyandduration宫缩间歇期宫缩极期进行退行5/9/20249正常分娩英文课件Characteristicofnormaluterineaction5/9/202410正常分娩英文课件★Symmetryand

Polarity

Theintensityoftheuppersegmentoftheuterusisthemoststrong

5/9/202411正常分娩英文课件★Retraction:Themyometriumoftheupperuterinesegmentdoesnotrelaxtoitsoriginallengthaftercontractions;rather,itbecomesrelativefixedatashorterlength.

5/9/202412正常分娩英文课件Theintra-abdominalpressureCreatedbycontractionoftheabdominalmusclessimultaneouslywithforcedrespiratoryeffortswithglottisclosed.＆Itisanecessaryauxiliarytouterinecontractionsinsecondstageoflabor。＆Aftertheplacentahasseparated,itsspontaneousexpulsionisaidedbythemotherincreasingintra-abdominalpressure。5/9/202413正常分娩英文课件腹肌子宫收缩力膈肌肛提肌5/9/202414正常分娩英文课件※FormaV-shapedslingthattendstorotatetheoccipitalanteriorly(internalrotation)。＆

Helpthefetus’extensionanddelivery。＆Helptheexpulsionoftheplacenta。

levatoranimusclescontractions

5/9/202415正常分娩英文课件Passage

Thepassageofthefetusdelivery,including:thebonypelvisandsofttissuesofpelvis骶骨Ossacrum髂骨osilium

耻骨联合Symphysispublis骶尾关节Sacro-iliacjiont尾骨Oscoccyx坐骨结节Osischium5/9/202416正常分娩英文课件The

bonypelvis(thetruepelvis)

PelvicinletplanePelvicmidplanePelvicoutletplaneThreepelvicplane:5/9/202417正常分娩英文课件Pelvicinletplane

Havethreediameters:(1)AnteroposteriordiameterorThetrueconjugate:average11cm.(2)Transversediameter:average13cm.(3)Inclineddiameter:average12.75cm5/9/202418正常分娩英文课件ThetrueconjugateThetransversediameterTheinclineddiameter5/9/202419正常分娩英文课件5/9/202420正常分娩英文课件Threeanteroposteriordiametersof

thepelvicinlet5/9/202421正常分娩英文课件Thesmallestplaneofthepelvis,particularimportanceinobstructedlabor.

Anteroposteriordiameterofmidpelvis：average11.5cm.

Transversediameterofmidpelvis：alsebecalledinterspinousdiameter,average10cm.Pelvicmidplane5/9/202422正常分娩英文课件AnteroposteriordiameterofmidpelvisTransversediameterofmidpelvis5/9/202423正常分娩英文课件Transversediameterofthemidpelvis5/9/202424正常分娩英文课件Fourdiameters:

Anteroposterior:diameterofoutlet：11.5cm。

Transverseoutlet：thedistancebetweentheinneredgesoftheischialtuberosities。9cm

Anteriorsagittaldiameter：6cm。

Posteriorsagittaldiameter：8.5cm。

Pelvicoutletplane5/9/202425正常分娩英文课件41、Transverseoutlet2、Anteriorsagittaldiameter3、Posteriorsagittaldiameter4、Anteroposteriordiameterofoutlet

5/9/202426正常分娩英文课件5/9/202427正常分娩英文课件PelvicaxisandinclinationofpelvicPelvicaxis：TheaxisofthepelvisreferstothecurveofthebirthcanalasdescribedbyalinedrawnthroughthecenterofeachofthefourplanesInclinationofpelvic:Theangleofthepelvicinletplanewithgroundlevelwhenwomenstand.always60degree。5/9/202428正常分娩英文课件

Pelvicaxis

骨盆轴Inclinationofpelvic

5/9/202429正常分娩英文课件5/9/202430正常分娩英文课件Thesoftpartofthebirthcanal

Formationofloweruterinesegment、cervix、vagina

、softtissueinthefloorofpelvis.5/9/202431正常分娩英文课件Theloweruterinesegment

Developedfromtheisthmusoftheuterusofnonpregnantwomen.Physiologicretractionring:Theactivelycontractinguppersegmentbecomesthickeraslaboradvances,theloweruterinesegmentisrelativelythincomparedwiththeuppersegment,betweenthemaphysiologicretractionringappear.5/9/202432正常分娩英文课件5/9/202433正常分娩英文课件ChangesofcervixEffacementofcervixdilatationofcervixTheuppersegmentcontracts,retracts,andexpelsthefetus;inresponsetotheforceofthecontractionsoftheuppersegment,theripenedloweruterinesegmentandcervixdilateandtherebyformagreatlyexpanded、thinned-outmuscularandfibromusculartubethroughwhichthefetuscanbeextruded.5/9/202434正常分娩英文课件5/9/202435正常分娩英文课件分娩过程中宫颈的变化primigravidamultiparaEffacementofcervixdilatationofcervix5/9/202436正常分娩英文课件Acrookcanalformedbythevagina、tissueofpelvicfloorandperineumasthefetaldescending.5/9/202437正常分娩英文课件Fetus(position,presentation,weight)LongaxisofmotherLOALOPLOTROAROPROTEstimationoffetalweight:2500g-<4000gPassenger

5/9/202438正常分娩英文课件SizeofthefetusheadVeryimportantfordelivery。Thevaultiscomposedof2frontalbones,2parietalbones,andoneoccipitalbone.Theyareslightlyseparatedfromoneanotheratthemarginsofabutmentandbywiderspaces,theanteriorandposteriorfontanelles.5/9/202439正常分娩英文课件Fourdiameteroffetushead：

Biparietaldiameter：Thegreatesttransversediameterofthehead,whichextendsfromoneparietalbonetoother.Average9.3cm.Occipito-frontaldiameter：Whichfollowsalineextendingfromapointjustabovetherootofthenoseprominentportionoftheoccipitalbone.Average11.3cm.5/9/202440正常分娩英文课件Suboccipito-bregmaticdiameter.Whichfollowsalinedrawnfromthemiddleofthelargefontaneltotheundersurfaceoftheoccipitalbonejustwhereitjoinstheneck.Average9.5cmOccipito-mentaldiameter：Fromthechintothemostprominentportionoftheocciput.Average13.3cm5/9/202441正常分娩英文课件Suboccipito-bregmaticoccipito-frontalOccipito-mentaldiameter5/9/202442正常分娩英文课件FetalSkullVault.

Face.Base.5/9/202443正常分娩英文课件Positionofthefetus

Fetalpositionofaparticularpresentationreferstotherelationshipofanarbitraryreferencepointonthefetustoaspecificpointintherightorleftsideofthematernalpelvis.5/9/202444正常分娩英文课件PsychologicFactorsAhighlevelofanxietyduringpregnancyhasbeenassociatedwithdecreaseduterineactivityandwithlongeranddysfunctionallabor。5/9/202445正常分娩英文课件DiagnosisoflaborThreatenedlaborFalselabor:Contractionsoccuratirregularintervals.;Intervalsremainlong;Intensityremainsunchanged;Discomfortischieflyinlowerabdomen;Cervixdoesnotdilate;Discomfortisusuallyrelievedbysedation.5/9/202446正常分娩英文课件Lightenting

Thesettlingofthefetalheadintothebrimofthepelvis.BloodyShow

Themucusplugisexpelledfromthecervixmixingwithalittleblood5/9/202447正常分娩英文课件InlaborOnsetoflaborisspontaneousuterinecontractionwithprogressivedilationofthecervix

uterinecontraction

interval<5’lasting>30’’intensityismiddleorheavy5/9/202448正常分娩英文课件Mechanismoflabor

Mechanismofnormallaborinocciputpresentationincludethesecardinalmovementsoflabor:engagementdescentflexioninternalrotationextensionexternalrotation,andexpulsion.

5/9/202449正常分娩英文课件EngagementThemechanismbywhichthebiparietaldiameter,thegreatesttransversediameterofthefetalheadinocciputpresentations,passesthroughthepelvicinletisdefinedengagement.5/9/202450正常分娩英文课件DescentDescentcontinuesprogressivelyuntilthefetusisdelivered;theothermovementsaresuperimposedonit.5/9/202451正常分娩英文课件FlexionInflexion,thechinisbroughtintomoreintimatecontactwiththefetalthorax,andtheappreciablyshortersuboccipitobregmaticdiameter(9.5cm)issubstitutedforthelongeroccipitofrontaldiameter(11.3cm).5/9/202452正常分娩英文课件Internalrotation

Internalrotationisaturningofthefetusocciputgraduallymovesfromitsoriginalpositionanteriorlytowardthesymphysispubisabout45degrees.It’salwaysfinishedintheendofthefirststageoflabor.

5/9/202453正常分娩英文课件ExtentionExtentionbringsthebaseofocciputintodirectcontactwiththeinferiormarginofthesymphysispubis.5/9/202454正常分娩英文课件Restitution

:Thefetusheadrotatestothepositionitoccupiedatengagementafteritdeliveried,followingthistheshouldersdescendinapathsimilartothattracedbythehead.Externalrotation：

Theanteriorshoulderrotatesinternallyabout45degreestocomeunderthepubicarchfordelivery.Theheadcontinutlyrotatesleftabout45degreestoitspositionatbirth.5/9/202455正常分娩英文课件Flowingthesemaneuvers,thebody,legs,andfeetaredeliveried.5/9/202456正常分娩英文课件MechanismofLabor5/9/202457正常分娩英文课件TotalStageofLaborandTreatmentThetotalstageoflaborbeginswiththeregularuterinecontractionsandendswhendeliveryoftheplacentacomplete.Normallaborisacontinuousprocesswhichhasbeendividedintothreestagesforpurposesofstudy.5/9/202458正常分娩英文课件FirststageoflaborThefirststagebeginswiththeonsetoflaborandendswhendilationofcervix(10cm)iscomplete.Theaveragedurationofthefirststageoflaborinaprimigravidais11-12hours;inamultipara6-8hours.5/9/202459正常分娩英文课件SecondstageoflaborThesecondstageoflaborextendsfromfulldilationofthecervixtothebirthofbabyandvariesfromafewminutestoabouttwohoursdependingonbothfetalandmaternalfactors.primigravida<2h

multipara

<1hThirdstageoflaborFromthebirthoftheinfanttodeliveryofthe placenta5－15min,<30min5/9/202460正常分娩英文课件Totalstageoflabor：﹤24hFirststageoflabor（cervicaldilationstage）

primigravidais11-12multipara6-8hours.Secondstageoflabor（fetusexpulsivestage）

primigravidais1-2hmultiparafewminutesThirdstageoflabor（placentaexpulsivestage）

5－15min﹤30min5/9/202461正常分娩英文课件Clinicalcourseandtreatmentinfirststage1,ContractionanddilationofcervixChartoflaborstage

thelatentphase(onsetto<3cm,<16h)

theactivephase(>3cmto10cm,<8h)2,Decentofpresentation3,Ruptureofmembranes5/9/202462正常分娩英文课件Theactivephasehavebeendividedintothreestages；

Accelerationphase:cervicaldilationfrom3cmto4cm.1.5h；

Maximumaccelerationphase:cervicaldilationfrom4cmto9cm，2h;

Decelerationphase:cervicaldilationfrom9cmto10cm，30min。5/9/202463正常分娩英文课件Thedecentofthefetalheadismeasuredtoassesstheprogressoflabor

Thelevelofthepresentingfetalpartinthebirthcanalisdescribedinrelationshiptotheischialspines,whicharehalfwaybetweenthepelvicinletandthepelvicoutlet.5/9/202464正常分娩英文课件Management:⊙Bloodpressure、fetalheartrate、cervicaldilation、fetusdescending、uterinecontraction；⊙

Whenthemembranesruptured,pleasecheckthefetalheatrate,fluidcolourandamountatonceFetalheartrate120～160bpmlatentstage1～2hfetalheatrateactivestage15-30minute⊙

Needforsubsequentvaginalexaminationstoidentifythestatusofthecervixandthestationandpositionofpresentingpartwillvaryconsiderably.5/9/202465正常分娩英文课件ManagementofsecondstageoflaborManifestation

Uterinecontractionmaylast1.5minutesandrecurattimesafterares