正常分娩-妇科七年制教学课件.ppt

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1、Normal Labor and Delivery(AFE)正常分娩正常分娩 Lin JianhuaLin Jianhua M.D.,Ph.D.,ProfessorM.D.,Ph.D.,Professor Department Of Obstetrics&Gynecology Department Of Obstetrics&Gynecology Renji Hospital Affiliated to SJTU School of Medicine Renji Hospital Affiliated to SJTU School of Medicinedefinitionn nTerm de

2、livery(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(bon

3、y 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 pel

4、visn 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 Symptoms and signs of the onset of the laborn nPainful uterine contractionn na shown neffacement and dilation of the cervixn nrupture of membranes The shown nTh

5、e 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,dilatedManagement of normal labor n nThe first stage:n neducation,eating,voiding,n nposition(sitting,reclining,rec

6、umbent)n nmonitoring of the fetal heart rate,n ndilation of cervix and frequency n n severity of uterus contractions(auscultation or electronic monitoring)n nPushing:n nwith the onset of each contraction,the mother is encouraged to inhale,hold her breath,and pushn nincrease in intra-abdominal pressu

7、ren 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,manuall

8、yn 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 JianhuaLin Jianhua M.D.,Ph.D.,ProfessorM.D.,Ph.D.,ProfessorDep.of Obstet.&Gynecol.Dep.of Obstet.&Gynecol.Renji Hospital Affiliated to SJTU School of Medicine Renji Hospital Affiliated to SJTU School of Medicine