正常分娩婦科七年制教學

NormalLaborandDelivery(AFE)

正常分娩definitionTermdelivery(labor):37-42weekspre-termdelivery:28-<37weekspost-termdelivery:42weeksAbortion:<28weeks85%ofwomenspontaneouslaboranddeliverybetween37-42weeksLMP:lastmenstrualperiodEDC:expecteddateofconfinememtThefourfactorsforlaborForce(contraction)birthcanal(bonycanal)fetus(lie,position,presentation,weight)psychical-factorsThecontractionsincreaseinfrequencyanddurationuteruscanbefelttohardenduringcontractionlastingabout30-45secondsintervalbetweencontractionstobe5min’thepainoflaborisacharacterNSTCSTBonypelvisTheplanesofpelvisinletplane(promontory)midplaneofpelvis(ischialspines)outletplane(twointersectingtriangles)

MechanismoflaborEngagement*FlexionDecentInternalrotationExtensionExternalrotationSymptomsandsignsoftheonsetofthelaborPainfuluterinecontractionashoweffacementanddilationofthecervixruptureofmembranesTheshowThemucusplugisexpelledfromthecervixmixingwithalittlebloodtheruptureofthemembranesatanytimeduringlaboreffacementanddilationofthecervixtobeshort,takenup,dilatedStagesoflaborThefirststage:

onsetoflabortofullcervicaldilation(10cm)thelatentphase(onestto<3cm,<16h)theactivephase(>3cmto10cm,<8h)Thesecondstage:10cmtothedeliveryoftheinfant,<2hThethirdstage:deliveryoftheinfanttodeliveryoftheplacenta,<30m’Thefourthstage:2hoursafterdeliveryoftheplacentaManagementofnormallaborThefirststage:education,eating,voiding,position(sitting,reclining,recumbent)monitoringofthefetalheartrate,dilationofcervixandfrequencyseverityofuteruscontractions(auscultationorelectronicmonitoring)Thesecondstage:---<2hourfetalheartratematernalconditions:pulse,bloodpressure,respiratoryrate,temperature,urineoutput,fluidintake…evaluationofprogressoflaborcervicaldilation,station,positionofthepresentingpart,statusofmembranes,meconium,bloodPushing:withtheonsetofeachcontraction,themotherisencouragedtoinhale,holdherbreath,andpushincreaseinintra-abdominalpressureaidinginfetaldescentthroughthebirthcacal.Headvisibleonvulvalgapping*Crowningofhead*LacerationorEpisiotomyDeliveryoffetusDealwithumbilicalcordthethirdstage:

waitingforupto30min’theuterusdecreasesinsizedeliveryofplacenta(spontaneously,manuallyinspectionofthebirthcanalevaluatedforlacerations“Thefourthstage”

postpartumuterinehemorrhage,1%uteruspalpationthroughtheabdominalwallisrepeatstheamountofbloodonpadsaremonitoredpulseandBParemonitoreduseofdrug:oxytoc