正常分娩英文.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,1,Normal Labor,第1页,2,Objective,Definition of labor.,Determinate Factors of Labor,Anatomical considerations:,The female pelvis.,The fetal skull.,The stages of labor.,The mechanism of labor,(vertex,LOA).,Management of normal labor.,第2页,3,Definitions,：,Labor is the process by which contractions of the gravid uterus expel the fetus,and the other products of conception after,28 weeks,from the last menstrual period.,Term Delivery,：,A term delivery occurs between 37 and 42 weeks from the last menstrual period.,第3页,4,Premature labor,：,Preterm labor is that occurring before 37 weeks of gestational age.,Postdate pregnancy,：,Postdate pregnancy occurs after 42 weeks,.,第4页,5,Not sure:,1,、,Cervix ripend and lower uterine segment development theory,；,2,、,Endocrine regulating theory,；,3,、,Mechanical theory,；,4,、,Neurohumor theory,；,5,、,Immunologic theory,；,The etiology of labor,Maturation of fetus and change of uterus function is necessary.,第5页,6,The progress and final outcome of labor are influenced by 4 factors.,(1)the powers,(2)the passage,(3)the passenger,(4)the psyche,Four Determinate Factors of Labor,第6页7,The expulsive forces,(The powers),The power that expulse the fetus and the other products of conception is called the expulsive forces,which include,uterine contraction,intra-abdominal pressure,levator ani muscles contractions.,第7页,8,Uterine contractions,Have three unique characteristics:,Rhythm,increase in frequency and duration,is the important marker of in labor,。,Symmetry and,polarity,Retraction,第8页,9,Periods of relaxation between contractions are essential to the welfare of the fetus.,Rhythm,Increase in frequency and duration,宫缩,间歇期,宫缩,极,期,进行,退行,第9页,10,Characteristic of normal uterine action,第10页,11,S,ymmetry and,P,olarity,T,he intensity of the upper segment of the uterus is the most strong,第11页,12,Retraction:,The myometrium of the upper uterine segment does not relax to its original length after contractions;rather,it becomes relative fixed at a shorter length.,第12页,13,The intra-abdominal pressure,Created by contraction of the abdominal muscles simultaneously with forced respiratory efforts with glottis closed.,It is a necessary auxiliary to uterine contractions in second stage of labor,。,After the placenta has separated,its spontaneous expulsion is aided by the mother increasing intra-abdominal pressure,。,第13页,14,腹肌,子宫收缩力,膈肌,肛提肌,第14页,15,Form a V-shaped sling that tends to rotate the occipital anteriorly(internal rotation),。,Help the fetus extension and delivery,。,Help the,expulsion of the placenta,。,levator ani muscles contractions,第15页,16,Passage,The passage of the fetus delivery,including:the,bony pelvis,and,soft tissues,of pelvis,骶 骨,Os sacrum,髂 骨,os ilium,耻骨联合,Symphysis publis,骶 尾 关 节,Sacro-iliac jiont,尾 骨,Os coccyx,坐骨结节,Os ischium,第16页,17,The,bony pelvis(the true pelvis),Pelvic inlet plane,Pelvic midplane,Pelvic outlet plane,Three pelvic plane:,第17页,18,Pelvic inlet plane,Have three diameters,:,(1)Anteroposterior diameter or The true conjugate:average,11cm,.,(2)Transverse diameter:average,13cm,.,(3)Inclined diameter:average,12.75cm,第18页,19,The true conjugate,The transverse diameter,The inclined diameter,第19页,20,第20页,21,Three anteroposterior diameters of the pelvic inlet,第21页,22,The smallest plane of the pelvis,particular importance in obstructed labor.,Anteroposterior diameter of mid pelvis,：,average,11.5cm.,Transverse diameter of mid pelvis,：,alse be called interspinous diameter,average,10cm,.,Pelvic midplane,第22页,23,Anteroposterior diameter of mid pelvis,Transverse diameter of mid pelvis,第23页,24,Transverse diameter of the midpelvis,第24页,25,Four diameters:,Anteroposterior:diameter of outlet,：,11.5cm,。,Tr,ansverse outlet,：,the distance between the inner edges of the ischial tuberosities,。,9cm,Anterior sagittal diameter,：,6cm,。,Posterior sagittal diameter,：,8.5cm,。,Pelvic outlet plane,第25页,26,4,1,、,T,ransverse outlet,2,、,A,nterior sagittal diameter,3,、,P,osterior sagittal diameter,4,、,A,nteroposterior diameter of outlet,第26页,27,第27页,28,Pelvic axis and inclination of pelvic,Pelvic axis,：,The axis of the pelvis refers to the curve of the birth canal as described by a line drawn through the center of each of the four planes,Inclination of pelvic,:The angle of the,pelvic inlet plane with ground level when women stand.,always 60 degree,。,第28页,29,Pelvic axis,骨盆轴,Inclination of pelvic,第29页,30,第30页,31,The soft part of the birth canalFormation of,lower uterine segment,、,cervix,、,vagina,、,soft tissue in the floor of pelvis,.,第31页,32,The,lower uterine segment,Developed from the isthmus of the uterus of nonpregnant women.,Physiologic retraction ring,:The actively contracting upper segment becomes thicker as labor advances,the lower uterine segment is relatively thin compared with the upper segment,between them a physiologic retraction ring appear,.,第32页,33,第33页,34,Changes of cervix,Effacement of cervix,dilatation of cervix,The upper segment contracts,retracts,and expels the fetus;in response to the force of the contractions of the upper segment,the ripened lower uterine segment and cervix dilate and thereby form a greatly expanded,、,thinned-out muscular and fibromuscular tube through which the fetus can be extruded.,第34页,35,第35页,36,分娩过程中宫颈旳变化,primigravida,multipara,Effacement of cervix,dilatation of cervix,第36页,37,A crook canal formed by the vagina,、,tissue of pelvic floor and perineum as the fetal descending.,第37页,38,F,etus(position,presentation,weight),Long axis of mother,LOA LOP LOT ROA ROP ROT,Estimation of fetal weight:2500g-4000g,Passenger,第38页,39,Size of the fetus head,Very important for delivery,。,The,vault,is composed of 2 frontal bones,2 parietal bones,and one occipital bone.They are slightly separated from one another at the margins of abutment and by wider spaces,the anterior and posterior fontanelles.,第39页,40,Four diameter of fetus head,：,Biparietal diameter,：,The greatest transverse diameter of the head,which extends from one parietal bone to other.,Average,9.3cm,.,Occipito-frontal diameter,：,Which follows a line extending from a point just above the root of the nose prominent portion of the occipital bone.Average,11.3cm,.,第40页,41,Suboccipito-bregmatic diameter,.,Which follows a line drawn from the middle of the large fontanel to the undersurface of the occipital bone just where it joins the neck.Average,9.5cm,Occipito-mental diameter,：,From the chin to the most prominent portion of the occiput.Average,13.3cm,第41页,42,Suboccipito-bregmatic,occipito-frontal,Occipito-mental diameter,第42页,43,Fetal Skull,Vault.,Face.,Base.,第43页,44,P,osition of the fetus,Fetal position of a particular presentation refers to the relationship of an arbitrary reference point on the fetus to a specific point in the right or left side of the maternal pelvis.,第44页,45,Psychologic Factors,A high level of anxiety during pregnancy has been associated with decreased uterine activity and with longer and dysfunctional labor,。,第45页,46,Diagnosis of labor,Threatened labor,False labor,:,Contractions occur at irregular intervals.;,Intervals remain long;,Intensity remains unchanged;,Discomfort is chiefly in lower abdomen;,Cervix does not dilate;,Discomfort is usually relieved by sedation,.,第46页,47,Lightenting,The settling of the fetal head into the brim of the pelvis.,Bloody Show,The mucus plug is expelled from the cervixmixing with a little blood,第47页,48,In labor,Onset of labor,is spontaneous uterine contraction with progressive dilation of the cervix,uterine contraction,interval 30,intensity is middle or heavy,第48页,49,Mechanism of labor,Mechanism of normal labor in occiput presentation include these cardinal movements of labor:,engagement,descent,flexion,internal rotation,extension,external rotation,and expulsion.,第49页,50,Engagement,The mechanism by which the biparietal diameter,the greatest transverse diameter of the fetal head in occiput presentations,passes through the pelvic inlet is defined,engagement,.,第50页,51,Descent,Descent continues progressively until the fetus is delivered;the other movements are superimposed on it.,第51页,52,Flexion,In,flexion,the chin is brought into more intimate contact with the fetal thorax,and the appreciably shorter suboccipitobregmatic diameter,(9.5cm),is substituted for the longer occipitofrontal diameter,(11.3cm),.,第52页,53,Internal rotation,Internal rotation,is a turning of the fetus occiput gradually moves from its original position anteriorly toward the symphysis pubis about 45 degrees.Its always finished in the end of the first stage of labor.,第53页,54,Extention,Extention,brings the base of occiput into direct contact with the inferior margin of the symphysis pubis.,第54页,55,Restitution,:,The fetus head rotates to the position it occupied at engagement after it deliveried,following this the shoulders descend in a path similar to that traced by the head.,External rotation,：,The anterior shoulder rotates internally about 45 degrees to come under the pubic arch for delivery.The head continutly rotates left about 45 degrees to its position at birth.,第55页,56,Flowing these maneuvers,the body,legs,and feet are deliveried.,第56页,57,Mechanism of Labor,第57页,58,Total Stage of Labor and Treatment,The total stage of labor begins with the regular uterine contractions and ends when delivery of the placenta complete.,Normal labor is a continuous process which has been divided into,three,stages for purposes of study.,第58页,59,First stage of labor,The first stage begins with the onset of labor and ends when,dilation of cervix(10cm)is complete.,The average duration of the first stage of labor in a primigravida is 11-12 hours;in a multipara 6-8 hours.,第59页,60,Second stage of labor,The second stage of labor extends from full dilation of the cervix to the birth of baby and varies from a few minutes to about two hours depending on both fetal and maternal factors.primigravida 2h,multipara,1h,Third stage of labor,From the birth of the infant to delivery of the placenta 5,15min,30min,第60页,61,Total stage of labor,：,24h,First stage of labor,（,cervical dilation stage,）,primigravida is 11-12,multipara 6-8 hours.,Second stage of labor,（,fetus expulsive stage,）,primigravida is 1-2 h,multipara few minutes,Third stage of labor,（,placenta expulsive stage,）,5,15min 30min,第61页,62,Clinical course and treatment in first stage,1,Contraction and dilation of cervix,Chart of labor stage,the latent phase,(onset to 3cm,3cm to 10cm,8h),2,Decent of presentation,3,Rupture of membranes,第62页,63,The active phase have been divided into three stages,；,A,cceleration phase:cervical dilation from,3cm to 4cm,.,1.5h,；,M,aximum acceleration phase:cervical dilation from,4cm to 9cm,，,2h;,D,eceleration phase:cervical dilation from,9cm to 10cm,，,30min,。,第63页,64,The decent of the fetal head is measured to assess the progress of labor,The level of the presenting fetal part in the birth canal is described in relationship to the ischial spines,which are halfway between the pelvic inlet and the pelvic outlet.,第64页,65,Management:,B,lood pressure,、,fetal heart rate,、cervical dilation,、,fetus descending,、,uterine contraction,；,When the membranes ruptured,please check the fetal heat rate,fluid colour and amount at once,Fetal heart rate 120,160bpm,latent stage 1,2h fetal heat rate,active stage 15-30 minute,Need for subsequent vaginal examinations to identify the status of the cervix and the station and position of presenting part will vary considerably.,第65页,66,Management of second stage of labor,Manifestation,Uterine contraction may last 1.5 minutes and recur at times after a resting phase of no more than a minute.,The woman typically begins to bear down,The perineum begins to bulge and the overlying skin becomes tense and glistening.,第66页,67,Head visible on vulva gapping,Crowning of head,Between uterine contractions the presenting part tends to recede slightly,but“crowing”occurs when the head is visible at the vaginal introitus and not receding in between contractions,.,第67页,68,Management of the second stage,Fetal heart rate:should be auscultated at least every,5,10min.,Maternal expulsive efforts.,Preparation for delivery,primigravida from,cervical dilation completed,multipara from,cervical dilation 4cm,第68页,69,Management of third stage of labor.,Clinical course,After delivery of the infant,the height of the uterine fundus and its consistency are ascertained.,U,terine contraction reappear after stopping for few minutes.,P,lacental separation,第69页,70,S,igns of placental separation,：,a.,the uterus becomes globular and firmer.,b.,The umbilical cord lengthened outside the vagina,c.A fresh show of blood from vagina,d.the uterus fundus rises up.,第70页,71,Pay attention to:,Examine the placenta to ensure complete removal.,Examine the soft part of the birth canal.,Prevention of excessive postpartum bleeding.,Uterine contraction,、,bladder distension,第71页,72,thankyou,第72页,