正常分娩(英文)课件

NormalLabor1ppt精选版ObjectiveDefinitionoflabor.DeterminateFactorsofLaborAnatomicalconsiderations:Thefemalepelvis.Thefetalskull.Thestagesoflabor.Themechanismoflabor(vertex,LOA).

Managementofnormallabor.2ppt精选版Definitions：Laboristheprocessbywhichcontractionsofthegraviduterusexpelthefetusandtheotherproductsofconceptionafter28weeksfromthelastmenstrualperiod.TermDelivery：Atermdeliveryoccursbetween37and42weeksfromthelastmenstrualperiod.3ppt精选版Prematurelabor：Pretermlaboristhatoccurringbefore37weeksofgestationalage.Postdatepregnancy：Postdatepregnancyoccursafter42weeks.4ppt精选版Notsure:1、Cervixripendandloweruterinesegmentdevelopmenttheory；2、Endocrineregulatingtheory；3、Mechanicaltheory；4、Neurohumortheory

；5、Immunologictheory；

TheetiologyoflaborMaturationoffetusandchangeofuterusfunctionisnecessary.5ppt精选版Theprogressandfinaloutcomeoflaborareinfluencedby4factors.(1)thepowers(2)thepassage(3)thepassenger(4)thepsycheFourDeterminateFactorsofLabor6ppt精选版Theexpulsiveforces(Thepowers)

Thepowerthatexpulsethefetusandtheotherproductsofconceptioniscalledtheexpulsiveforces,whichinclude♀

uterinecontraction♀

intra-abdominalpressure

♀levatoranimusclescontractions.

7ppt精选版Uterinecontractions

Havethreeuniquecharacteristics:★Rhythm:

increaseinfrequencyandduration,istheimportantmarkerofinlabor。★

Symmetryand

polarity★Retraction8ppt精选版Periodsofrelaxationbetweencontractionsareessentialtothewelfareofthefetus.RhythmIncreaseinfrequencyandduration宫缩间歇期宫缩极期进行退行9ppt精选版Characteristicofnormaluterineaction10ppt精选版★Symmetryand

Polarity

Theintensityoftheuppersegmentoftheuterusisthemoststrong

11ppt精选版★Retraction:Themyometriumoftheupperuterinesegmentdoesnotrelaxtoitsoriginallengthaftercontractions;rather,itbecomesrelativefixedatashorterlength.

12ppt精选版Theintra-abdominalpressureCreatedbycontractionoftheabdominalmusclessimultaneouslywithforcedrespiratoryeffortswithglottisclosed.＆Itisanecessaryauxiliarytouterinecontractionsinsecondstageoflabor。＆Aftertheplacentahasseparated,itsspontaneousexpulsionisaidedbythemotherincreasingintra-abdominalpressure。13ppt精选版腹肌子宫收缩力膈肌肛提肌14ppt精选版※FormaV-shapedslingthattendstorotatetheoccipitalanteriorly(internalrotation)。＆

Helpthefetus’extensionanddelivery。＆Helptheexpulsionoftheplacenta。

levatoranimusclescontractions

15ppt精选版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Osischium16ppt精选版The

bonypelvis(thetruepelvis)

PelvicinletplanePelvicmidplanePelvicoutletplaneThreepelvicplane:17ppt精选版Pelvicinletplane

Havethreediameters:(1)AnteroposteriordiameterorThetrueconjugate:average11cm.(2)Transversediameter:average13cm.(3)Inclineddiameter:average12.75cm18ppt精选版ThetrueconjugateThetransversediameterTheinclineddiameter19ppt精选版20ppt精选版Threeanteroposteriordiametersof

thepelvicinlet21ppt精选版Thesmallestplaneofthepelvis,particularimportanceinobstructedlabor.

Anteroposteriordiameterofmidpelvis：average11.5cm.

Transversediameterofmidpelvis：alsebecalledinterspinousdiameter,average10cm.Pelvicmidplane22ppt精选版AnteroposteriordiameterofmidpelvisTransversediameterofmidpelvis23ppt精选版Transversediameterofthemidpelvis24ppt精选版Fourdiameters:

Anteroposterior:diameterofoutlet：11.5cm。

Transverseoutlet：thedistancebetweentheinneredgesoftheischialtuberosities。9cm

Anteriorsagittaldiameter：6cm。

Posteriorsagittaldiameter：8.5cm。

Pelvicoutletplane25ppt精选版41、Transverseoutlet2、Anteriorsagittaldiameter3、Posteriorsagittaldiameter4、Anteroposteriordiameterofoutlet

26ppt精选版27ppt精选版PelvicaxisandinclinationofpelvicPelvicaxis：TheaxisofthepelvisreferstothecurveofthebirthcanalasdescribedbyalinedrawnthroughthecenterofeachofthefourplanesInclinationofpelvic:Theangleofthepelvicinletplanewithgroundlevelwhenwomenstand.always60degree。28ppt精选版

Pelvicaxis

骨盆轴Inclinationofpelvic

29ppt精选版30ppt精选版Thesoftpartofthebirthcanal

Formationofloweruterinesegment、cervix、vagina

、softtissueinthefloorofpelvis.31ppt精选版Theloweruterinesegment

Developedfromtheisthmusoftheuterusofnonpregnantwomen.Physiologicretractionring:Theactivelycontractinguppersegmentbecomesthickeraslaboradvances,theloweruterinesegmentisrelativelythincomparedwiththeuppersegment,betweenthemaphysiologicretractionringappear.32ppt精选版33ppt精选版ChangesofcervixEffacementofcervixdilatationofcervixTheuppersegmentcontracts,retracts,andexpelsthefetus;inresponsetotheforceofthecontractionsoftheuppersegment,theripenedloweruterinesegmentandcervixdilateandtherebyformagreatlyexpanded、thinned-outmuscularandfibromusculartubethroughwhichthefetuscanbeextruded.34ppt精选版35ppt精选版分娩过程中宫颈的变化primigravidamultiparaEffacementofcervixdilatationofcervix36ppt精选版Acrookcanalformedbythevagina、tissueofpelvicfloorandperineumasthefetaldescending.37ppt精选版Fetus(position,presentation,weight)LongaxisofmotherLOALOPLOTROAROPROTEstimationoffetalweight:2500g-<4000gPassenger

38ppt精选版SizeofthefetusheadVeryimportantfordelivery。Thevaultiscomposedof2frontalbones,2parietalbones,andoneoccipitalbone.Theyareslightlyseparatedfromoneanotheratthemarginsofabutmentandbywiderspaces,theanteriorandposteriorfontanelles.39ppt精选版Fourdiameteroffetushead：

Biparietaldiameter：Thegreatesttransversediameterofthehead,whichextendsfromoneparietalbonetoother.Average9.3cm.Occipito-frontaldiameter：Whichfollowsalineextendingfromapointjustabovetherootofthenoseprominentportionoftheoccipitalbone.Average11.3cm.40ppt精选版Suboccipito-bregmaticdiameter.Whichfollowsalinedrawnfromthemiddleofthelargefontaneltotheundersurfaceoftheoccipitalbonejustwhereitjoinstheneck.Average9.5cmOccipito-mentaldiameter：Fromthechintothemostprominentportionoftheocciput.Average13.3cm41ppt精选版Suboccipito-bregmaticoccipito-frontalOccipito-mentaldiameter42ppt精选版FetalSkullVault.

Face.Base.43ppt精选版Positionofthefetus

Fetalpositionofaparticularpresentationreferstotherelationshipofanarbitraryreferencepointonthefetustoaspecificpointintherightorleftsideofthematernalpelvis.44ppt精选版PsychologicFactorsAhighlevelofanxietyduringpregnancyhasbeenassociatedwithdecreaseduterineactivityandwithlongeranddysfunctionallabor。45ppt精选版DiagnosisoflaborThreatenedlaborFalselabor:Contractionsoccuratirregularintervals.;Intervalsremainlong;Intensityremainsunchanged;Discomfortischieflyinlowerabdomen;Cervixdoesnotdilate;Discomfortisusuallyrelievedbysedation.46ppt精选版Lightenting

Thesettlingofthefetalheadintothebrimofthepelvis.BloodyShow

Themucusplugisexpelledfromthecervixmixingwithalittleblood47ppt精选版InlaborOnsetoflaborisspontaneousuterinecontractionwithprogressivedilationofthecervix

uterinecontraction

interval<5’lasting>30’’intensityismiddleorheavy48ppt精选版Mechanismoflabor

Mechanismofnormallaborinocciputpresentationincludethesecardinalmovementsoflabor:engagementdescentflexioninternalrotationextensionexternalrotation,andexpulsion.

49ppt精选版EngagementThemechanismbywhichthebiparietaldiameter,thegreatesttransversediameterofthefetalheadinocciputpresentations,passesthroughthepelvicinletisdefinedengagement.50ppt精选版DescentDescentcontinuesprogressivelyuntilthefetusisdelivered;theothermovementsaresuperimposedonit.51ppt精选版FlexionInflexion,thechinisbroughtintomoreintimatecontactwiththefetalthorax,andtheappreciablyshortersuboccipitobregmaticdiameter(9.5cm)issubstitutedforthelongeroccipitofrontaldiameter(11.3cm).52ppt精选版Internalrotation

Internalrotationisaturningofthefetusocciputgraduallymovesfromitsoriginalpositionanteriorlytowardthesymphysispubisabout45degrees.It’salwaysfinishedintheendofthefirststageoflabor.

53ppt精选版ExtentionExtentionbringsthebaseofocciputintodirectcontactwiththeinferiormarginofthesymphysispubis.54ppt精选版Restitution

:Thefetusheadrotatestothepositionitoccupiedatengagementafteritdeliveried,followingthistheshouldersdescendinapathsimilartothattracedbythehead.Externalrotation：

Theanteriorshoulderrotatesinternallyabout45degreestocomeunderthepubicarchfordelivery.Theheadcontinutlyrotatesleftabout45degreestoitspositionatbirth.55ppt精选版Flowingthesemaneuvers,thebody,legs,andfeetaredeliveried.56ppt精选版MechanismofLabor57ppt精选版TotalStageofLaborandTreatmentThetotalstageoflaborbeginswiththeregularuterinecontractionsandendswhendeliveryoftheplacentacomplete.Normallaborisacontinuousprocesswhichhasbeendividedintothreestagesforpurposesofstudy.58ppt精选版FirststageoflaborThefirststagebeginswiththeonsetoflaborandendswhendilationofcervix(10cm)iscomplete.Theaveragedurationofthefirststageoflaborinaprimigravidais11-12hours;inamultipara6-8hours.59ppt精选版SecondstageoflaborThesecondstageoflaborextendsfromfulldilationofthecervixtothebirthofbabyandvariesfromafewminutestoabouttwohoursdependingonbothfetalandmaternalfactors.primigravida<2h

multipara

<1hThirdstageoflaborFromthebirthoftheinfanttodeliveryofthe placenta5－15min,<30min60ppt精选版Totalstageoflabor：﹤24hFirststageoflabor（cervicaldilationstage）

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

primigravidais1-2hmultiparafewminutesThirdstageoflabor（placentaexpulsivestage）

5－15min﹤30min61ppt精选版Clinicalcourseandtreatmentinfirststage1,ContractionanddilationofcervixChartoflaborstage

thelatentphase(onsetto<3cm,<16h)

theactivephase(>3cmto10cm,<8h)2,Decentofpresentation3,Ruptureofmembranes62ppt精选版Theactivephasehavebeendividedintothreestages；

Accelerationphase:cervicaldilationfrom3cmto4cm.1.5h；

Maximumaccelerationphase:cervicaldilationfrom4cmto9cm，2h;

Decelerationphase:cervicaldilationfrom9cmto10cm，30min。63ppt精选版Thedecentofthefetalheadismeasuredtoassesstheprogressoflabor

Thelevelofthepresentingfetalpartinthebirthcanalisdescribedinrelationshiptotheischialspines,whicharehalfwaybetweenthepelvicinletandthepelvicoutlet.64ppt精选版Management:⊙Bloodpressure、fetalheartrate、cervicaldilation、fetusdescending、uterinecontraction；⊙

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

Needforsubsequentvaginalexaminationstoidentifythestatusofthecervixandthestationandpositionofpresentingpartwillvaryconsiderably.65ppt精选版ManagementofsecondstageoflaborManifestation

Uterinecontractionmaylast1.5minutesandrecurattimesafteraresti