正常分娩(英文)課件

NormalLabor1ppt精選版1ppt精選版ObjectiveDefinitionoflabor.DeterminateFactorsofLaborAnatomicalconsiderations:Thefemalepelvis.Thefetalskull.Thestagesoflabor.Themechanismoflabor(vertex,LOA).

Managementofnormallabor.2ppt精選版ObjectiveDefinitionoflabor.2Definitions：Laboristheprocessbywhichcontractionsofthegraviduterusexpelthefetusandtheotherproductsofconceptionafter28weeksfromthelastmenstrualperiod.TermDelivery：Atermdeliveryoccursbetween37and42weeksfromthelastmenstrualperiod.3ppt精選版Definitions：LaboristheprocePrematurelabor：Pretermlaboristhatoccurringbefore37weeksofgestationalage.Postdatepregnancy：Postdatepregnancyoccursafter42weeks.4ppt精選版Prematurelabor：PretermlaborNotsure:1、Cervixripendandloweruterinesegmentdevelopmenttheory；2、Endocrineregulatingtheory；3、Mechanicaltheory；4、Neurohumortheory

；5、Immunologictheory；

TheetiologyoflaborMaturationoffetusandchangeofuterusfunctionisnecessary.5ppt精選版Notsure:TheetiologyoflaboTheprogressandfinaloutcomeoflaborareinfluencedby4factors.(1)thepowers(2)thepassage(3)thepassenger(4)thepsycheFourDeterminateFactorsofLabor6ppt精選版TheprogressandfinaloutcomeTheexpulsiveforces(Thepowers)

Thepowerthatexpulsethefetusandtheotherproductsofconceptioniscalledtheexpulsiveforces,whichinclude♀

uterinecontraction♀

intra-abdominalpressure

♀levatoranimusclescontractions.

7ppt精選版Theexpulsiveforces(ThepowerUterinecontractions

Havethreeuniquecharacteristics:★Rhythm:

increaseinfrequencyandduration,istheimportantmarkerofinlabor?！?/p>

Symmetryand

polarity★Retraction8ppt精選版UterinecontractionsHavethrePeriodsofrelaxationbetweencontractionsareessentialtothewelfareofthefetus.RhythmIncreaseinfrequencyandduration宮縮間歇期宮縮極期進(jìn)行退行9ppt精選版PeriodsofrelaxationbetweenCharacteristicofnormaluterineaction10ppt精選版Characteristicofnormaluteri★Symmetryand

Polarity

Theintensityoftheuppersegmentoftheuterusisthemoststrong

11ppt精選版★SymmetryandPolarity

Thein★Retraction:Themyometriumoftheupperuterinesegmentdoesnotrelaxtoitsoriginallengthaftercontractions;rather,itbecomesrelativefixedatashorterlength.

12ppt精選版★Retraction:ThemyometriumofTheintra-abdominalpressureCreatedbycontractionoftheabdominalmusclessimultaneouslywithforcedrespiratoryeffortswithglottisclosed.＆Itisanecessaryauxiliarytouterinecontractionsinsecondstageoflabor。＆Aftertheplacentahasseparated,itsspontaneousexpulsionisaidedbythemotherincreasingintra-abdominalpressure。13ppt精選版Theintra-abdominalpressureCr腹肌子宮收縮力膈肌肛提肌14ppt精選版腹肌子宮收縮力膈肌肛提肌14ppt精選版※FormaV-shapedslingthattendstorotatetheoccipitalanteriorly(internalrotation)。＆

Helpthefetus’extensionanddelivery。＆Helptheexpulsionoftheplacenta。

levatoranimusclescontractions

15ppt精選版※FormaV-shapedslingthattPassage

Thepassageofthefetusdelivery,including:thebonypelvisandsofttissuesofpelvis骶骨Ossacrum髂骨osilium

恥骨聯(lián)合Symphysispublis骶尾關(guān)節(jié)Sacro-iliacjiont尾骨Oscoccyx坐骨結(jié)節(jié)Osischium16ppt精選版Passage骶骨髂骨恥骨The

bonypelvis(thetruepelvis)

PelvicinletplanePelvicmidplanePelvicoutletplaneThreepelvicplane:17ppt精選版Thebonypelvis(thetruepelvPelvicinletplane

Havethreediameters:(1)AnteroposteriordiameterorThetrueconjugate:average11cm.(2)Transversediameter:average13cm.(3)Inclineddiameter:average12.75cm18ppt精選版Pelvicinletplane

HavethreeThetrueconjugateThetransversediameterTheinclineddiameter19ppt精選版ThetrueconjugateThetransver20ppt精選版20ppt精選版Threeanteroposteriordiametersof

thepelvicinlet21ppt精選版ThreeanteroposteriordiameterThesmallestplaneofthepelvis,particularimportanceinobstructedlabor.Anteroposteriordiameterofmidpelvis：average11.5cm.Transversediameterofmidpelvis：alsebecalledinterspinousdiameter,average10cm.Pelvicmidplane22ppt精選版ThesmallestplaneofthepelvAnteroposteriordiameterofmidpelvisTransversediameterofmidpelvis23ppt精選版AnteroposteriordiameterofmiTransversediameterofthemidpelvis24ppt精選版TransversediameterofthemidFourdiameters:Anteroposterior:diameterofoutlet：11.5cm。Transverseoutlet：thedistancebetweentheinneredgesoftheischialtuberosities。9cmAnteriorsagittaldiameter：6cm。Posteriorsagittaldiameter：8.5cm。

Pelvicoutletplane25ppt精選版Fourdiameters:Pelvicoutletp41、Transverseoutlet2、Anteriorsagittaldiameter3、Posteriorsagittaldiameter4、Anteroposteriordiameterofoutlet

26ppt精選版41、Transverseoutlet26ppt精選版27ppt精選版27ppt精選版PelvicaxisandinclinationofpelvicPelvicaxis：TheaxisofthepelvisreferstothecurveofthebirthcanalasdescribedbyalinedrawnthroughthecenterofeachofthefourplanesInclinationofpelvic:Theangleofthepelvicinletplanewithgroundlevelwhenwomenstand.always60degree。28ppt精選版Pelvicaxisandinclinationof

Pelvicaxis

骨盆軸Inclinationofpelvic

29ppt精選版Pelvicaxis骨盆軸30ppt精選版30ppt精選版Thesoftpartofthebirthcanal

Formationofloweruterinesegment、cervix、vagina

、softtissueinthefloorofpelvis.31ppt精選版ThesoftpartofthebirthcanTheloweruterinesegment

Developedfromtheisthmusoftheuterusofnonpregnantwomen.Physiologicretractionring:Theactivelycontractinguppersegmentbecomesthickeraslaboradvances,theloweruterinesegmentisrelativelythincomparedwiththeuppersegment,betweenthemaphysiologicretractionringappear.32ppt精選版TheloweruterinesegmentDeve33ppt精選版33ppt精選版ChangesofcervixEffacementofcervixdilatationofcervixTheuppersegmentcontracts,retracts,andexpelsthefetus;inresponsetotheforceofthecontractionsoftheuppersegment,theripenedloweruterinesegmentandcervixdilateandtherebyformagreatlyexpanded、thinned-outmuscularandfibromusculartubethroughwhichthefetuscanbeextruded.34ppt精選版Changesofcervix34ppt精選版35ppt精選版35ppt精選版分娩過(guò)程中宮頸的變化primigravidamultiparaEffacementofcervixdilatationofcervix36ppt精選版分娩過(guò)程中宮頸的變化primigravidamultiparAcrookcanalformedbythevagina、tissueofpelvicfloorandperineumasthefetaldescending.37ppt精選版37ppt精選版Fetus(position,presentation,weight)LongaxisofmotherLOALOPLOTROAROPROTEstimationoffetalweight:2500g-<4000gPassenger

38ppt精選版Fetus(position,presentationSizeofthefetusheadVeryimportantfordelivery。Thevaultiscomposedof2frontalbones,2parietalbones,andoneoccipitalbone.Theyareslightlyseparatedfromoneanotheratthemarginsofabutmentandbywiderspaces,theanteriorandposteriorfontanelles.39ppt精選版SizeofthefetusheadVeryimFourdiameteroffetushead：

Biparietaldiameter：Thegreatesttransversediameterofthehead,whichextendsfromoneparietalbonetoother.Average9.3cm.Occipito-frontaldiameter：Whichfollowsalineextendingfromapointjustabovetherootofthenoseprominentportionoftheoccipitalbone.Average11.3cm.40ppt精選版Fourdiameteroffetushead：4Suboccipito-bregmaticdiameter.Whichfollowsalinedrawnfromthemiddleofthelargefontaneltotheundersurfaceoftheoccipitalbonejustwhereitjoinstheneck.Average9.5cmOccipito-mentaldiameter：Fromthechintothemostprominentportionoftheocciput.Average13.3cm41ppt精選版Suboccipito-bregmaticdiameterSuboccipito-bregmaticoccipito-frontalOccipito-mentaldiameter42ppt精選版Suboccipito-bregmaticoccipito-FetalSkullVault.

Face.Base.43ppt精選版FetalSkullVault.43ppt精選版Positionofthefetus

Fetalpositionofaparticularpresentationreferstotherelationshipofanarbitraryreferencepointonthefetustoaspecificpointintherightorleftsideofthematernalpelvis.44ppt精選版Positionofthefetus44ppt精選版PsychologicFactorsAhighlevelofanxietyduringpregnancyhasbeenassociatedwithdecreaseduterineactivityandwithlongeranddysfunctionallabor。45ppt精選版PsychologicFactors45ppt精選版DiagnosisoflaborThreatenedlaborFalselabor:Contractionsoccuratirregularintervals.;Intervalsremainlong;Intensityremainsunchanged;Discomfortischieflyinlowerabdomen;Cervixdoesnotdilate;Discomfortisusuallyrelievedbysedation.46ppt精選版Diagnosisoflabor46ppt精選版Lightenting

Thesettlingofthefetalheadintothebrimofthepelvis.BloodyShow

Themucusplugisexpelledfromthecervixmixingwithalittleblood47ppt精選版Lightenting47ppt精選版InlaborOnsetoflaborisspontaneousuterinecontractionwithprogressivedilationofthecervix

uterinecontraction

interval<5’lasting>30’’intensityismiddleorheavy48ppt精選版Inlabor48ppt精選版Mechanismoflabor

Mechanismofnormallaborinocciputpresentationincludethesecardinalmovementsoflabor:engagementdescentflexioninternalrotationextensionexternalrotation,andexpulsion.

49ppt精選版Mechanismoflabor49ppt精選版EngagementThemechanismbywhichthebiparietaldiameter,thegreatesttransversediameterofthefetalheadinocciputpresentations,passesthroughthepelvicinletisdefinedengagement.50ppt精選版EngagementThemechanismbywhDescentDescentcontinuesprogressivelyuntilthefetusisdelivered;theothermovementsaresuperimposedonit.51ppt精選版Descent51ppt精選版FlexionInflexion,thechinisbroughtintomoreintimatecontactwiththefetalthorax,andtheappreciablyshortersuboccipitobregmaticdiameter(9.5cm)issubstitutedforthelongeroccipitofrontaldiameter(11.3cm).52ppt精選版FlexionInflexion,thechinisInternalrotation

Internalrotationisaturningofthefetusocciputgraduallymovesfromitsoriginalpositionanteriorlytowardthesymphysispubisabout45degrees.It’salwaysfinishedintheendofthefirststageoflabor.

53ppt精選版Internalrotation53ppt精選版ExtentionExtentionbringsthebaseofocciputintodirectcontactwiththeinferiormarginofthesymphysispubis.54ppt精選版Extention54ppt精選版Restitution

:Thefetusheadrotatestothepositionitoccupiedatengagementafteritdeliveried,followingthistheshouldersdescendinapathsimilartothattracedbythehead.Externalrotation：

Theanteriorshoulderrotatesinternallyabout45degreestocomeunderthepubicarchfordelivery.Theheadcontinutlyrotatesleftabout45degreestoitspositionatbirth.55ppt精選版Restitution:55ppt精選版Flowingthesemaneuvers,thebody,legs,andfeetaredeliveried.56ppt精選版56ppt精選版MechanismofLabor57ppt精選版MechanismofLabor57ppt精選版TotalStageofLaborandTreatmentThetotalstageoflaborbeginswiththeregularuterinecontractionsandendswhendeliveryoftheplacentacomplete.Normallaborisacontinuousprocesswhichhasbeendividedintothreestagesforpurposesofstudy.58ppt精選版TotalStageofLaborandTreatFirststageoflaborThefirststagebeginswiththeonsetoflaborandendswhendilationofcervix(10cm)iscomplete.Theaveragedurationofthefirststageoflaborinaprimigravidais11-12hours;inamultipara6-8hours.59ppt精選版Firststageoflabor59ppt精選版SecondstageoflaborThesecondstageoflaborextendsfromfulldilationofthecervixtothebirthofbabyandvariesfromafewminutestoabouttwohoursdependingonbothfetalandmaternalfactors.primigravida<2h

multipara

<1hThirdstageoflaborFromthebirthoftheinfanttodeliveryofthe placenta5－15min,<30min60ppt精選版Secondstageoflabor60ppt精選版Totalstageoflabor：﹤24hFirststageoflabor（cervicaldilationstage）

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

primigravidais1-2hmultiparafewminutesThirdstageoflabor（placentaexpulsivestage）

5－15min﹤30min61ppt精選版Totalstageoflabor：﹤24h61ppClinicalcourseandtreatmentinfirststage1,ContractionanddilationofcervixChartoflaborstage

thelatentphase(onsetto<3cm,<16h)

theactivephase(>3cmto10cm,<8h)2,Decentofpresentation3,Ruptureofmembranes62ppt精選版ClinicalcourseandtreatmentTheactivephasehavebeendividedintothreestages；Accelerationphase:cervicaldilationfrom3cmto4cm.1.5h；Maximumaccelerationphase:cervicaldilationfrom4cmto9cm，2h;Decelerationphase:cervicaldilationfrom9cmto10cm，30min。63ppt精選版TheactivephasehavebeendivThedecentofthefetalheadismeasuredtoassesstheprogressoflaborThelevelofthepresentingfetalpartinthebirthcanalisdescribedinrelationshiptotheischialspines,whicharehalfwaybetweenthepelvicinletandthepelvicoutlet.64ppt精選版ThedecentofthefetalheadiManagement:⊙Bloodpressure、fetalheartrate、cervicaldilation、fetusdescending、uterinecontraction；⊙

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

Needforsubsequentvaginalexaminationstoidentifythestatusofthecervixandthestationandpositionofpresentingpartwillvaryconsiderably.65ppt精選版Management:65ppt精選版ManagementofsecondstageoflaborManifestation

Uterinecontractionmaylast1.5minutesandrecurattimesafterarestingphaseofno