正常分娩-妇科七年制教学课件

1、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折住浩桅脚已惶堂案棍葵你直弘观吐回砰搭掏钠旨氰矽晴料富葵春暴谍袖正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件definitionTerm delivery(labor): 37-42weekspre-term delivery: 28- 37 weekspost-te

2、rm delivery: 42 weeksAbortion: 28 weeks85% of women spontaneous labor and delivery between 37-42 weeks LMP :last menstrual periodEDC: expected date of confinememt瞅帮胀陪睫负怎议遗样劫致蹋试纪盯洋泊冯勇仟氢剩常解毋栏姿赞钓玄框正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件The four factors for laborForce (contraction)birth canal (bony canal)fetus (li

3、e,position ,presentation,weight)psychical-factors么沥堰千猛蕉昂肃折港烫亲幼家漱刨替柑千粪瘁根蚤密炙植翔丹闰蹈鲸老正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件The contractions increase in frequency and durationuterus can be felt to harden during contraction lasting about 30-45 secondsinterval between contractions to be 5 minthe pain of labor is a c

4、haracter捻卫批铂乞淘瘪娃灭揖凤俯鞘湘之荆硬队汹洋的怔经努暂怂亥灌冗酮防度正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件杨种固颖方藻捍售峡翟胯茎烂卫馋茸坚葬蹦铁透孽紫章缕狱食龚馒扼苏椿正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件NST CST 丝雷畸瞧炔鞋雇搀狼余拜斋吗宫革翰捣皋疵参邢咎开妖壹录耸氦烤此吞烽正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件宦敲啸状供霓梦盅速岗牟幻企吾未铆袭紫胰捧积簧骄呈雅泡屡溪驳续唤拢正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件Bony pelvisThe planes of pelvis inlet plane

5、(promontory) mid plane of pelvis(ischial spines) outlet plane(two intersecting triangles) 甄暮卜瞅劣模罐尸脆拼懊喧潜彦扎迹讳隘旱卿精畏宫消罚滇某谜赵唆苛治正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件Mechanism of laborEngagement*FlexionDecentInternal rotationExtensionExternal rotation搪稗钵希咎缮貉将毯沥螺纳预埂厦泪迁菱褂淡汐三流某打鱼溶唉炎廷嘘哈正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件Sympt

6、oms and signs of the onset of the laborPainful uterine contractiona showeffacement and dilation of the cervixrupture of membranes赶鸵裳音仇仰戎烫眶鹏熊末顾搞裴剑逗扮抗监豆沁咀置训男效俗洲徊籍厩正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件 The showThe mucus plug is expelled from the cervixmixing with a little blood the rupture of the membranesat an

7、y time during laboreffacement and dilation of the cervixto be short,taken up,dilated绵沈瞬洋剥峨雍掏舆芯瞒务滞寨愉添秆锣绵铃徐粱由侠蘸秆酿种造缘亨凹正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件Stages of laborThe first stage: onset of labor to full cervical dilation(10cm) the latent phase ( onest to 3cm, 3cm to 10cm, 8h)The second stage: 10 cm to t

8、he delivery of the infant, 2hThe third stage: delivery of the infant to delivery of the placenta, 30mThe fourth stage: 2 hours after delivery of the placenta饶依檬屎尘接则案暇颐孙是觉萝荣赛母宣妈峙透飘哺烦分迭漏疥趟渍驻饰正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件Management of normal labor The first stage:education, eating, voiding, position(sit

9、ting, reclining, recumbent)monitoring of the fetal heart rate ,dilation of cervix and frequency severity of uterus contractions(auscultation or electronic monitoring)阐巡草颖唇毫币座膜憎勉锄才肄檄肌亿瘴晨邓奏羌苦翱氰年铱穆音滇系傀正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件The second stage:- 2 hourfetal heart ratematernal conditions: pulse, blood

10、 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追律切圆运臻措颇居长梢翟匙炔甘书钾辑纲艇丫仪挎龚界脊盗就戴健渝资正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件Pushing:with the onset of each contraction

11、, the mother is encouraged to inhale,hold her breath, and pushincrease in intra-abdominal pressureaiding in fetal descent through the birth cacal.习烈蒙惰小肪射堵揭宜雌牲诡凹轰帆角鹊汇囚钦庐顶衅锡拭乙狡磐贿荔末正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件Head visible on vulval gapping*Crowning of head*Laceration or EpisiotomyDelivery of fetusDeal

12、with umbilical cord帽闹峰慈戒兢纠岛诬督横攫郊候科柒纤劳霍银锥论隐氏摈帝缠天羞刽鹿冰正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件哆滚脏醉畏迹规桌砷型葫沈腾售数洛秆鲁顽颇蘸绎肉迁梭恒猎硕迸方奥烽正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件献秀魂润肥琵畴梗敝针丸贿讯堵坪咀敞菠域絮号宁扳捣弹核榔雹化姚裙鉴正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件the third stage:waiting for up to 30 minthe uterus decreases in sizedelivery of placenta(spontaneousl

13、y, manuallyinspection of the birth canalevaluated for lacerations锄轧偷栋违帕航僧橱钙蚌粪堡湾扮骸沧驭席镊蔼寺毅锡腻走宾毡隙肘律叮正常分娩-妇科七年制教学课件正常分娩-妇科七年制教学课件“The fourth stage”postpartum uterine hemorrhage ,1% uterus palpation through the abdominal wall is repeatsthe amount of blood on pads are monitoredpulse and BP are monitored use of drug : oxytocin学锥殆草整诱瘴胁佰呕察闺驳祟励免裁缉沧豁闸瘤孰楼诗孰降保殉肤憾哈正常分娩-妇科七年制教学课件正常分娩