正常分娩妇科七年制.ppt

Normal Labor and Delivery(AFE) 正常分娩,Lin Jianhua M.D., Ph.D., Professor Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine,definition,Term delivery(labor): 37-42weeks pre-term delivery: 28- 37 weeks post-term delivery: 42 weeks Abortion: 28 weeks 85% of women spontaneous labor and delivery between 37-42 weeks LMP :last menstrual period EDC: expected date of confinememt,The four factors for labor,Force (contraction) birth canal (bony canal) fetus (lie,position ,presentation,weight) psychical-factors,The contractions,increase in frequency and duration uterus can be felt to harden during contraction lasting about 30-45 seconds interval between contractions to be 5 min the pain of labor is a character,NST CST,Bony pelvis,The planes of pelvis inlet plane (promontory) mid plane of pelvis(ischial spines) outlet plane(two intersecting triangles),Mechanism of labor,Engagement* Flexion Decent Internal rotation Extension External rotation,Symptoms and signs of the onset of the labor,Painful uterine contraction a show effacement and dilation of the cervix rupture of membranes,The show The mucus plug is expelled from the cervix mixing with a little blood the rupture of the membranes at any time during labor effacement and dilation of the cervix to be short,taken up,dilated,Stages of labor,The first stage: onset of labor to full cervical dilation(10cm) the latent phase ( onest to 3cm to 10cm, 8h) The second stage: 10 cm to the delivery of the infant, 2h The third stage: delivery of the infant to delivery of the placenta, 30m The fourth stage: 2 hours after delivery of the placenta,Management of normal labor,The first stage: education, eating, voiding, position(sitting, reclining, recumbent) monitoring of the fetal heart rate , dilation of cervix and frequency severity of uterus contractions(auscultation or electronic monitoring),The second stage,:- 2 hour fetal heart rate maternal conditions: pulse, blood pressure, respiratory rate , temperature, urine output, fluid intake evaluation of progress of labor cervical dilation, station,position of the presenting part, status of membranes, meconium, blood,Pushing: with the onset of each contraction, the mother is encouraged to inhale,hold her breath, and push increase in intra-abdominal pressure aiding in fetal descent through the birth cacal.,Head visible on vulval gapping* Crowning of head* Laceration or Episiotomy Delivery of fetus Deal with umbilical cord,the third stage:,waiting for up to 30 min the uterus decreases in size delivery of placenta(spontaneously, manually inspection of the birth canal evaluated for lacerations,“The fourth stage”,postpartum uterine hemorrhage ,1% uterus palpation through the abdominal wall is repeats the amount of blood on pads are monitored pulse and BP are monitored use of drug : o