正常分娩妇科七年制 .ppt

Normal Labor and Delivery(AFE)正常分娩正常分娩 Lin Lin J Jianhuaianhua M.D.,Ph.D.,ProfessorM.D.,Ph.D.,Professor Department Of Obstetrics&Gynecology Department Of Obstetrics&Gynecology RenjiRenji Hospital Affiliated to SJTU School of Medicine Hospital Affiliated to SJTU School of Medicinedefinitionn nTerm delivery(labor):37-42weeksn npre-term delivery:28-37 weeksn npost-term delivery:42 weeksn nAbortion:28 weeksn n85%of women spontaneous labor and delivery between 37-42 weeks n nLMP:last menstrual periodn nEDC:expected date of confinememtThe four factors for laborn nForce(contraction)n nbirth canal(bony canal)n nfetus(lie,position,presentation,weight)n npsychical-factorsThe contractionsn n increase in frequency and durationn nuterus can be felt to harden during contraction n nlasting about 30-45 secondsn ninterval between contractions to be 5 minn nthe pain of labor is a characterNST CST Bony pelvisn nThe planes of pelvisn n inlet plane(promontory)n n mid plane of pelvis(ischial spines)n n outlet plane(two intersecting triangles)n n Mechanism of laborn nEngagement*n nFlexionn nDecentn nInternal rotationn nExtensionn nExternal rotationSymptoms and signs of the onset of the laborn nPainful uterine contractionn na shown neffacement and dilation of the cervixn nrupture of membranes The shown nThe mucus plug is expelled from the cervixn nmixing with a little blood the rupture of the membranesn nat any time during laboreffacement and dilation of the cervixn nto be short,taken up,dilatedStages of laborn nThe first stage:The first stage:n n onset of labor to full cervical dilation(10cm)onset of labor to full cervical dilation(10cm)n n the latent phase(the latent phase(onestonest to 3cm,16h)to 3cm,3cm to 10cm,3cm to 10cm,8h)n nThe second stage:The second stage:n n 10 cm to the delivery of the infant,2h 10 cm to the delivery of the infant,2hn nThe third stage:The third stage:n n delivery of the infant to delivery of the delivery of the infant to delivery of the placenta,30mplacenta,30mn nThe fourth stage:The fourth stage:n n 2 hours after delivery of the placenta 2 hours after delivery of the placentaManagement of normal labor n nThe first stage:n neducation,eating,voiding,n nposition(sitting,reclining,recumbent)n nmonitoring of the fetal heart rate,n ndilation of cervix and frequency n n severity of uterus contractions(auscultation or electronic monitoring)The second stagen n:-2 hourn nfetal heart raten nmaternal conditions:n n pulse,blood pressure,respiratory rate,n n temperature,urine output,fluid intaken n evaluation of progress of laborn n cervical dilation,station,position of the n n presenting part,status of membranes,n n meconium,bloodn nPushing:n nwith the onset of each contraction,the mother is encouraged to inhale,hold her breath,and pushn nincrease in intra-abdominal pressuren naiding in fetal descent through the birth cacal.n nHead visible on vulval gapping*n nCrowning of head*n nLaceration or Episiotomyn nDelivery of fetusn nDeal with umbilical cordthe third stage:n nwaiting for up to 30 minn nthe uterus decreases in sizen ndelivery of placenta(spontaneously,manuallyn ninspection of the birth canaln nevaluated for lacerations“The fourth stage”n npostpartum uterine hemorrhage,1%n n uterus palpation through the abdominal wall is repeatsn nthe amount of blood on pads are monitoredn npulse and BP are monitored n nuse of drug:oxytocinTHANKS FOR YOUR ATTENTION Lin Lin JianhuaJianhua M.D.,Ph.D.,ProfessorM.D.,Ph.D.,ProfessorDep.of Dep.of ObstetObstet.&.&GynecolGynecol.RenjiRenji Hospital Affiliated to SJTU School of Medicine Hospital Affiliated to SJTU School of Medicine