正常分娩循证护理PPT课件

1、正常分娩循证护理助产士节-5-5 世界需要助产士现在比以前更甚教学目标1、明确正常分娩护理原则2、找出工作中可能存在的不合理措施3、制定可行的、可操作性的、具体的实施计划调查表观看电影请找出电影中你认为不恰当的护理措施内容提要正常分娩的定义正常分娩的特征正常分娩的服务原则循证护理自然的生理性分娩（natural physiological birth）自然的生理性分娩自然是来自天然而非来自人工。在自发性宫缩开始后，没有人工干预，胎儿经阴道自然娩出者，称为自然的生理性分娩，简称自然分娩。促进自然的生理性分娩是助产人员的基本工作目标。正常分娩（Normal labor）WHO分娩指导中正常分娩（N

2、ormal labor）的定义为，低危产妇，胎儿单胎、头位，在37孕周和42孕周之间自然的发动宫缩，胎儿经阴道自然娩出，产后母亲与胎儿情况均良好。产科分娩有专家建议将正常分娩，应用了干涉措施，如促宫颈成熟、引产、缩宫素应用、人工破膜等后，经阴道自然娩出的分娩，归为产科分娩，以与自然的未加干涉措施的分娩相区分。应努力促进自然的产程，尽可能减少不必要的干涉措施 the best outcomes, the least interventions正常分娩的特征自然生理本能-分娩的最基本特征分娩是自然的生理过程，而不是疾病正常分娩的基本服务原则being with rather than doing

3、to and can provide continuous care正常分娩第一原则：产妇是正常分娩的主动者！观察、关爱、支持正常分娩循证护理问题1、产程的起点：一个从来都不准确的概念潜伏期延长：一个从来都是错误的诊断活跃期起点：？为什么是3CM？活跃期延长：时间延长？母儿情况异常？睡， 忍痛， 慢临盆耐心等待自然的宫缩正常分娩最重要的一步 人为早产的教训有多少因素在妨碍正常生理性分娩的节律？入院-肛诊胎监 输液交接班什么时候入院 低危产妇的临产诊断评估晚入院，活跃期入院，一个重要的管理措施）临产的评估-一个漫长的等待临产与假临产，需要助产专业人员的耐心指导（案例-漫长的等待）2.Mobili

4、ty and Posture in Labour产床？一个可怕的难产工具Laboring women must have the freedom to move around, change position,and work with gravity, along with enjoying physical space, privacy, and even a sense of connection to the earth.倡议产房内至少有一把产妇专用的坐椅-不管什么材质、便宜或昂贵的-产妇能坐的地方产妇能进食-饮水机3. 第二产程 directed, or coached pushin

5、g, a practice that persists without any supporting scientific evidence！用力！不用力什么时间用力（被动的下降期、主动期）第二产程延长（-有争议的问题）4. Care of the Perineumepisiotomy be restricted to fetal indications onlystudies do not show that the pelvic floor is injured by vaginal birth. Antenatal pelvic floor exercises are heartily

6、recommended.WHO 分娩指导原则对产妇及胎儿有害需要禁止的措施1.Routine episiotomy is associated with poor healing, and longer hospital stays. Episiotomies should only be done where clinically required. 常规的会阴切开术带来愈合不良、住院时间延长等。只有在有医学指征时才能应用会阴切开。http:/www.liv.ac.uk/选择性（限制应用）会阴切开术结果分析No increase in incidence of major outcomes

7、(e.g., severe vaginal or perineal trauma nor in pain, dyspareunia or urinary incontinence) 不增加会阴裂伤、排尿困难，尿失禁（会阴松驰表现） Incidence of 3rd degree tear reduced (1.2% with episiotomy, 0.4% without)会阴三度裂伤在常规会阴切开者为1.2% ，在选择性应用中为0.4% (Carroli and Belizan 2000.Eason et al 2000; WHO 1999.)对产妇及胎儿有害需要禁止的措施2.Routin

8、e enemas. They are uncomfortable, make a mess, and are of no benefit. Enemas should be used only if requested. 常规的灌肠。对产妇及胎儿有害需要禁止的措施3.Perineal shaving. This is degrading and of no demonstrable benefit. 剃除阴毛。没有益处，使产妇感到不舒适。4.Withholding oral fluids. This is uncomfortable and unjustified. 分娩过程中限制喝水。这使产

9、妇不舒适并没有证据。对产妇及胎儿有害需要禁止的措施5.Routine artificial rupture of the membranes (AROM). Painful, and of no value unless progress in labor is abnormal. 常规人工破膜。带来疼痛，对正常分娩无益。6.Supine position for delivery. Affects blood flow in the uterus and interferes with progress of second stage of labor. 仰卧位分娩。这减少子宫血流供给并妨碍

10、第二产程进 展不恰当应当避免的措施7.Routinely moving laboring woman to a different room at onset of second stage在第二产程常规的搬动产妇到另一房间（产房）8.Encouraging woman to push when full dilation or nearly full dilation of cervix has been diagnosed, before woman feels urge to bear down 在产妇还不想用力时就指导产妇屏气用力有利应提倡的措施1.Companionship prov

11、ided by a family member or lay carer during labour. This improves maternal satisfaction, shortens labour and improves breastfeeding. It also reduces the need for pain relief and assisted delivery. 由家庭成员或专业人员提供陪伴分娩。这增加产妇满意度，缩短产程并增加母乳喂养成功率。减轻分娩时疼痛，并减少助产手术。有利应提倡的措施2.Being mobile during labour. This sho

12、rtens labour and reduces the need for pain relief and assisted deliveries. 产妇在产程中可自由活动。可缩短产程，减轻疼痛，减少助产手术。有利应提倡的措施3.Routine antibiotics for preterm, prelabour rupture of membranes. They improve maternal and neonatal outcomes早产儿常规应用抗菌素。. 4.Keeping the umbilical cord clean at delivery. Poor hygiene is

13、associated with neonatal tetanus and sepsis. 无菌断脐有利应提倡的措施应用一次性无菌用物或重复消毒用品手套，隔离衣，鞋，围裙，眼镜（防水，防血）洗 手Wash womans perineum with soap and water and keep it clean用肥皂和清水清洗会阴部保持清洁Ensure that surface on which newborn is delivered is kept clean 保持新生儿娩出后在洁净的地方High-level disinfect instruments, gauze and ties for

14、 cutting cord严格无菌断脐WHO 2006版1、较充分的依据支持晚断脐（等待脐带搏动停止后，60-90秒（一个平均的脐带搏动停止的参数，不是一个严格的时间限制！）2、水中待产：是有循证依据 水中分娩：依据不足，可以采用3、脐带护理：无菌断脐，DRY AND CLEAN清洁干燥，不包扎，不用消毒剂，（不剪！）（专项推广项目）案例分析4CM常规人工破膜平卧？2小时后检查？（宫口评估标准、宫缩时？间歇时？一个人？多个人？）无痛分娩（宣传）输液持续静脉留置？会阴侧切产后常规探查宫腔？产后常规缩宫素？产后断脐时间？总结有益的措施Have a skilled attendant present 专业人员Use partograph 应用产程图Use specific criteria to diagnose active labor 正确的判断活跃期（3CM？4CM？一个点？一段时间？WHO 新版产程图）-临产诊断评估Restrict use of unnecessary interventions 限制不必要的措施（如会阴切开）Support womans choice for position during