正常分娩(英文)PPT课件

.,1,NormalLabor,.,2,Objective,Definitionoflabor.DeterminateFactorsofLaborAnatomicalconsiderations:Thefemalepelvis.Thefetalskull.Thestagesoflabor.Themechanismoflabor(vertex,LOA).Managementofnormallabor.,.,3,Definitions：Laboristheprocessbywhichcontractionsofthegraviduterusexpelthefetusandtheotherproductsofconceptionafter28weeksfromthelastmenstrualperiod.TermDelivery：Atermdeliveryoccursbetween37and42weeksfromthelastmenstrualperiod.,.,4,Prematurelabor：Pretermlaboristhatoccurringbefore37weeksofgestationalage.Postdatepregnancy：Postdatepregnancyoccursafter42weeks.,.,5,Notsure:1、Cervixripendandloweruterinesegmentdevelopmenttheory；2、Endocrineregulatingtheory；3、Mechanicaltheory；4、Neurohumortheory；5、Immunologictheory；,Theetiologyoflabor,Maturationoffetusandchangeofuterusfunctionisnecessary.,.,6,Theprogressandfinaloutcomeoflaborareinfluencedby4factors.(1)thepowers(2)thepassage(3)thepassenger(4)thepsyche,FourDeterminateFactorsofLabor,.,7,Theexpulsiveforces(Thepowers),Thepowerthatexpulsethefetusandtheotherproductsofconceptioniscalledtheexpulsiveforces,whichincludeuterinecontractionintra-abdominalpressurelevatoranimusclescontractions.,.,8,Uterinecontractions,Havethreeuniquecharacteristics:Rhythm:increaseinfrequencyandduration,istheimportantmarkerofinlabor。SymmetryandpolarityRetraction,.,9,Periodsofrelaxationbetweencontractionsareessentialtothewelfareofthefetus.,RhythmIncreaseinfrequencyandduration,宫缩,间歇期,宫缩,极期,进行,退行,.,10,Characteristicofnormaluterineaction,.,11,SymmetryandPolarityTheintensityoftheuppersegmentoftheuterusisthemoststrong,.,12,Retraction:Themyometriumoftheupperuterinesegmentdoesnotrelaxtoitsoriginallengthaftercontractions;rather,itbecomesrelativefixedatashorterlength.,.,13,Theintra-abdominalpressure,Createdbycontractionoftheabdominalmusclessimultaneouslywithforcedrespiratoryeffortswithglottisclosed.Itisanecessaryauxiliarytouterinecontractionsinsecondstageoflabor。Aftertheplacentahasseparated,itsspontaneousexpulsionisaidedbythemotherincreasingintra-abdominalpressure。,.,14,腹肌,子宫收缩力,膈肌,肛提肌,.,15,FormaV-shapedslingthattendstorotatetheoccipitalanteriorly(internalrotation)。Helpthefetusextensionanddelivery。Helptheexpulsionoftheplacenta。,levatoranimusclescontractions,.,16,PassageThepassageofthefetusdelivery,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Osischium,.,17,Thebonypelvis(thetruepelvis)PelvicinletplanePelvicmidplanePelvicoutletplane,Threepelvicplane:,.,18,PelvicinletplaneHavethreediameters:,(1)AnteroposteriordiameterorThetrueconjugate:average11cm.(2)Transversediameter:average13cm.(3)Inclineddiameter:average12.75cm,.,19,Thetrueconjugate,Thetransversediameter,Theinclineddiameter,.,20,.,21,Threeanteroposteriordiametersofthepelvicinlet,.,22,Thesmallestplaneofthepelvis,particularimportanceinobstructedlabor.Anteroposteriordiameterofmidpelvis：average11.5cm.Transversediameterofmidpelvis：alsebecalledinterspinousdiameter,average10cm.,Pelvicmidplane,.,23,Anteroposteriordiameterofmidpelvis,Transversediameterofmidpelvis,.,24,Transversediameterofthemidpelvis,.,25,Fourdiameters:Anteroposterior:diameterofoutlet：11.5cm。Transverseoutlet：thedistancebetweentheinneredgesoftheischialtuberosities。9cmAnteriorsagittaldiameter：6cm。Posteriorsagittaldiameter：8.5cm。,Pelvicoutletplane,.,26,4,1、Transverseoutlet2、Anteriorsagittaldiameter3、Posteriorsagittaldiameter4、Anteroposteriordiameterofoutlet,.,27,.,28,PelvicaxisandinclinationofpelvicPelvicaxis：TheaxisofthepelvisreferstothecurveofthebirthcanalasdescribedbyalinedrawnthroughthecenterofeachofthefourplanesInclinationofpelvic:Theangleofthepelvicinletplanewithgroundlevelwhenwomenstand.always60degree。,.,29,Pelvicaxis,骨盆轴,Inclinationofpelvic,.,30,.,31,ThesoftpartofthebirthcanalFormationofloweruterinesegment、cervix、vagina、softtissueinthefloorofpelvis.,.,32,Theloweruterinesegment,Developedfromtheisthmusoftheuterusofnonpregnantwomen.Physiologicretractionring:Theactivelycontractinguppersegmentbecomesthickeraslaboradvances,theloweruterinesegmentisrelativelythincomparedwiththeuppersegment,betweenthemaphysiologicretractionringappear.,.,33,.,34,ChangesofcervixEffacementofcervixdilatationofcervixTheuppersegmentcontracts,retracts,andexpelsthefetus;inresponsetotheforceofthecontractionsoftheuppersegment,theripenedloweruterinesegmentandcervixdilateandtherebyformagreatlyexpanded、thinned-outmuscularandfibromusculartubethroughwhichthefetuscanbeextruded.,.,35,.,36,分娩过程中宫颈的变化,primigravida,multipara,Effacementofcervix,dilatationofcervix,.,37,Acrookcanalformedbythevagina、tissueofpelvicfloorandperineumasthefetaldescending.,.,38,Fetus(position,presentation,weight)LongaxisofmotherLOALOPLOTROAROPROTEstimationoffetalweight:2500g-4000g,Passenger,.,39,Sizeofthefetushead,Veryimportantfordelivery。Thevaultiscomposedof2frontalbones,2parietalbones,andoneoccipitalbone.Theyareslightlyseparatedfromoneanotheratthemarginsofabutmentandbywiderspaces,theanteriorandposteriorfontanelles.,.,40,Fourdiameteroffetushead：Biparietaldiameter：Thegreatesttransversediameterofthehead,whichextendsfromoneparietalbonetoother.Average9.3cm.Occipito-frontaldiameter：Whichfollowsalineextendingfromapointjustabovetherootofthenoseprominentportionoftheoccipitalbone.Average11.3cm.,.,41,Suboccipito-bregmaticdiameter.Whichfollowsalinedrawnfromthemiddleofthelargefontaneltotheundersurfaceoftheoccipitalbonejustwhereitjoinstheneck.Average9.5cmOccipito-mentaldiameter：Fromthechintothemostprominentportionoftheocciput.Average13.3cm,.,42,Suboccipito-bregmatic,occipito-frontal,Occipito-mentaldiameter,.,43,FetalSkull,Vault.Face.Base.,.,44,PositionofthefetusFetalpositionofaparticularpresentationreferstotherelationshipofanarbitraryreferencepointonthefetustoaspecificpointintherightorleftsideofthematernalpelvis.,.,45,PsychologicFactorsAhighlevelofanxietyduringpregnancyhasbeenassociatedwithdecreaseduterineactivityandwithlongeranddysfunctionallabor。,.,46,DiagnosisoflaborThreatenedlaborFalselabor:Contractionsoccuratirregularintervals.;Intervalsremainlong;Intensityremainsunchanged;Discomfortischieflyinlowerabdomen;Cervixdoesnotdilate;Discomfortisusuallyrelievedbysedation.,.,47,LightentingThesettlingofthefetalheadintothebrimofthepelvis.BloodyShowThemucusplugisexpelledfromthecervixmixingwithalittleblood,.,48,InlaborOnsetoflaborisspontaneousuterinecontractionwithprogressivedilationofthecervixuterinecontractioninterval30intensityismiddleorheavy,.,49,MechanismoflaborMechanismofnormallaborinocciputpresentationincludethesecardinalmovementsoflabor:engagementdescentflexioninternalrotationextensionexternalrotation,andexpulsion.,.,50,EngagementThemechanismbywhichthebiparietaldiameter,thegreatesttransversediameterofthefetalheadinocciputpresentations,passesthroughthepelvicinletisdefinedengagement.,.,51,DescentDescentcontinuesprogressivelyuntilthefetusisdelivered;theothermovementsaresuperimposedonit.,.,52,Flexion,Inflexion,thechinisbroughtintomoreintimatecontactwiththefetalthorax,andtheappreciablyshortersuboccipitobregmaticdiameter(9.5cm)issubstitutedforthelongeroccipitofrontaldiameter(11.3cm).,.,53,InternalrotationInternalrotationisaturningofthefetusocciputgraduallymovesfromitsoriginalpositionanteriorlytowardthesymphysispubisabout45degrees.Itsalwaysfinishedintheendofthefirststageoflabor.,.,54,ExtentionExtentionbringsthebaseofocciputintodirectcontactwiththeinferiormarginofthesymphysispubis.,.,55,Restitution:Thefetusheadrotatestothepositionitoccupiedatengagementafteritdeliveried,followingthistheshouldersdescendinapathsimilartothattracedbythehead.Externalrotation：Theanteriorshoulderrotatesinternallyabout45degreestocomeunderthepubicarchfordelivery.Theheadcontinutlyrotatesleftabout45degreestoitspositionatbirth.,.,56,Flowingthesemaneuvers,thebody,legs,andfeetaredeliveried.,.,57,MechanismofLabor,.,58,TotalStageofLaborandTreatmentThetotalstageoflaborbeginswiththeregularuterinecontractionsandendswhendeliveryoftheplacentacomplete.Normallaborisacontinuousprocesswhichhasbeendividedintothreestagesforpurposesofstudy.,.,59,FirststageoflaborThefirststagebeginswiththeonsetoflaborandendswhendilationofcervix(10cm)iscomplete.Theaveragedurationofthefirststageoflaborinaprimigravidais11-12hours;inamultipara6-8hours.,.,60,SecondstageoflaborThesecondstageoflaborextendsfromfulldilationofthecervixtothebirthofbabyandvariesfromafewminutestoabouttwohoursdependingonbothfetalandmaternalfactors.primigravida2hmultipara1hThirdstageoflaborFromthebirthoftheinfanttodeliveryoftheplacenta515min,30min,.,61,Totalstageoflabor：24hFirststageoflabor（cervicaldilationstage）primigravidais11-12multipara6-8hours.Secondstageoflabor（fetusexpulsivestage）primigravidais1-2hmultiparafewminutesThirdstageoflabor（placentaexpulsivestage）515min30min,.,62,Clinicalcourseandtreatmentinfirststage1,Contractionanddilationofcervix,Chartoflaborstagethelatentphase(onsetto3cmto10cm,8h)2,Decentofpresentation3,Ruptureofmembranes,.,63,Theactivephasehavebeendividedintothreestages；Accelerationphase:cervicaldilationfrom3cmto4cm.1.5h；Maximumaccelerationphase:cervicaldilationfrom4cmto9cm，2h;Decelerationphase:cervicaldilationfrom9cmto10cm，30min。,.,64,ThedecentofthefetalheadismeasuredtoassesstheprogressoflaborThelevelofthepresentingfetalpartinthebirthcanalisdescribedinrelationshiptotheischialspines,whicharehalfwaybetweenthepelvicinletandthepelvicoutlet.,.,65,Management:Bloodpressure、fetalheartrate、cervicaldilation、fetusdescending、uterinecontraction；Whenthemembranesruptured,pleasecheckthefetalheatrate,fluidcolourandamountatonceFetalheartrate120160bpmlatentstage12hfetalheatrateactivestage15-30minuteNeedforsubsequentvaginalexaminationstoidentifythestatusofthecervixandthestationandpositionofpresentingpartwillvaryconsiderably.,.,66,ManagementofsecondstageoflaborManifestationUterinecontractionmaylast1.5minutesandrecurattimesafterarestingphaseofnomoretha