正常分娩(英文)ppt课件

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