正常分娩英文

1、2020/4/11,1,Corporate Culture,1,Normal,Labor,2020/4/11,2,Corporate Culture,2,Objective,?,Definition of labor.,?,Determinate Factors of Labor,?,Anatomical considerations:,The female pelvis.,The fetal skull.,?,The stages of labor.,?,The mechanism of labor,(vertex, LOA).,?,Management of normal labor.,2

2、020/4/11,3,Corporate Culture,3,Definitions,：,Labor,is,the,process,by,which,contractions,of,the,gravid,uterus,expel,the,fetus,and,the,other,products,of,conception,after,28,weeks,from,the,last,menstrual,period.,Term Delivery,：,A term delivery occurs,between 37 and 42 weeks from the last,menstrual peri

3、od.,2020/4/11,4,Corporate Culture,4,Premature labor,：,Preterm labor is that,occurring before 37 weeks of gestational,age.,Postdate pregnancy,：,Postdate,pregnancy occurs after 42 weeks,.,2020/4/11,5,Corporate Culture,5,Not sure:,1,、,Cervix ripend and lower uterine segment development,theory,；,2,、,End

4、ocrine regulating theory,；,3,、,Mechanical theory,；,4,、,Neurohumor theory,；,5,、,Immunologic theory,；,The etiology of labor,Maturation of fetus and change of uterus function is necessary.,2020/4/11,6,Corporate Culture,6,The,progress,and,final,outcome,of,labor,are,influenced,by,4,factors,.,(1)the,power

5、s,(2)the,passage,(3)the,passenger,(4)the,psyche,Four Determinate Factors of Labor,2020/4/11,7,Corporate Culture,7,The,expulsive,forces,(The,powers),The,power,that,expulse,the,fetus,and,the,other,products,of,conception,is,called,the,expulsive,forces,which,include,uterine,contraction,intra-abdominal,p

6、ressure,levator,ani,muscles,contractions.,2020/4/11,8,Corporate Culture,8,Uterine contractions,Have three unique characteristics:,Rhythm,:,increase in frequency and duration,is the,important marker of in labor,。,Symmetry and,polarity,Retraction,2020/4/11,9,Corporate Culture,9,Periods of relaxation b

7、etween contractions are essential to the welfare,of the fetus.,Rhythm,Increase in frequency and,duration,宮縮,間歇期,宮縮,極,期,進行,退行,2020/4/11,10,Corporate Culture,10,Characteristic of normal uterine action,2020/4/11,11,Corporate Culture,11,S,ymmetry and,P,olarity,T,he intensity of the upper segment,of the

8、uterus is the most strong,2020/4/11,12,Corporate Culture,12,Retraction:,The myometrium of the upper uterine,segment does not relax to its original length after,contractions;rather, it becomes relative fixed at a shorter,length.,2020/4/11,13,Corporate Culture,13,The intra-abdominal pressure,?,Created

9、 by contraction of the,abdominal muscles,simultaneously with forced,respiratory efforts with glottis,closed.,It is a necessary auxiliary to uterine contractions,in second stage of labor,。,After the placenta has separated,its spontaneous,2020/4/11,14,Corporate Culture,14,腹肌,子宮收縮力,膈肌,肛提肌,2020/4/11,15,

10、Corporate Culture,15,Form a V-shaped sling that tends to,rotate the occipital anteriorly(internal,rotation),。,Help the fetus extension and,delivery,。,Help the expulsion of the placenta,。,levator ani muscles contractions,2020/4/11,16,Corporate Culture,16,Passage,The,passage,of,the,fetus,delivery,incl

11、uding:,the,bony,pelvis,and,soft,tissues,of,pelvis,骶,骨,Os,sacrum,髂,骨,os ilium,恥骨聯(lián)合,Symphysis,publis,骶,尾,關(guān),節(jié),Sacro-,iliac jiont,尾,骨,Os,coccyx,坐骨結(jié)節(jié),Os,ischium,2020/4/11,17,Corporate Culture,17,The,bony,pelvis,(the,true,pelvis),Pelvic,inlet,plane,Pelvic,midplane,Pelvic outlet plane,Three pelvic,plane:,2

12、020/4/11,18,Corporate Culture,18,Pelvic inlet plane,Have three diameters:,(1)Anteroposterior diameter or The true,conjugate: average,11cm,.,(2)Transverse diameter:average,13cm,.,(3)Inclined diameter:average,12.75cm,2020/4/11,19,Corporate Culture,19,The true,conjugate,The transverse,diameter,The incl

13、ined,diameter,2020/4/11,20,Corporate Culture,20,2020/4/11,21,Corporate Culture,21,Three anteroposterior diameters of,the pelvic inlet,2020/4/11,22,Corporate Culture,22,The,smallest,plane,of,the,pelvis,particular,importance,in,obstructed,labor.,?,Anteroposterior,diameter,of,mid,pelvis,：,average,11.5c

14、m.,?,Transverse,diameter,of,mid,pelvis,：,alse,be,called,interspinous,diameter,average,10cm,.,Pelvic midplane,2020/4/11,23,Corporate Culture,23,Anteroposterior diameter of,mid pelvis,Transverse diameter,of mid pelvis,2020/4/11,24,Corporate Culture,24,Transverse diameter of the midpelvis,2020/4/11,25,

15、Corporate Culture,25,Four,diameters:,?,Anteroposterior:,diameter,of,outlet,：,11.5cm,。,?,Tr,ansverse,outlet,：,the,distance,between,the,inner,edges,of,the,ischial,tuberosities,。,9cm,?,Anterior,sagittal,diameter,：,6cm,。,?,Posterior sagittal diameter,：,8.5cm,。,Pelvic outlet plane,2020/4/11,26,Corporate

16、Culture,26,4,1,、,T,ransverse outlet,2,、,Anterior sagittal,diameter,3,、,Posterior sagittal,diameter,4,、,Anteroposterior,diameter of outlet,2020/4/11,27,Corporate Culture,27,2020/4/11,28,Corporate Culture,28,Pelvic,axis,and,inclination,of,pelvic,Pelvic,axis,：,The,axis,of,the,pelvis,refers,to,the,curve

17、,of,the,birth,canal,as,described,by,a,line,drawn,through,the,center,of,each,of,the,four,planes,Inclination of pelvic,:The angle of the pelvic,inlet plane with ground level when women,stand.always 60 degree,。,2020/4/11,29,Corporate Culture,29,Pelvic axis,Inclination of pelvic,2020/4/11,30,Corporate C

18、ulture,30,2020/4/11,31,Corporate Culture,31,The soft part of the birth canal,Formation of,lower uterine segment,、,cervix,、,vagina,、,soft tissue in the floor of pelvis,.,2020/4/11,32,Corporate Culture,32,The lower uterine segment,?,Developed from the isthmus of the uterus of,nonpregnant women.,?,Phys

19、iologic retraction ring,: The actively,contracting upper segment becomes thicker as,labor advances,the lower uterine segment is,relatively thin compared with the upper,segment,between them a physiologic retraction,ring appear,.,2020/4/11,33,Corporate Culture,33,2020/4/11,34,Corporate Culture,34,Chan

20、ges,of,cervix,Effacement,of,cervix,dilatation,of,cervix,The,upper,segment,contracts,retracts,and,expels,the,fetus;,in,response,to,the,force,of,the,contractions,of,the,upper,segment,the,ripened,lower,uterine,segment,and,cervix,dilate,and,thereby,form,a,greatly,expanded,、,thinned-out,muscular,and,fibr

21、omuscular,tube,through,which,the,fetus,can,be,extruded.,2020/4/11,35,Corporate Culture,35,2020/4/11,36,Corporate Culture,36,分娩過程中宮頸的變化,primigravida,multipara,Effacement of,cervix,dilatation of cervix,2020/4/11,37,Corporate Culture,37,A,crook,canal,formed,by,the,vagina,、,tissue,of,pelvic,floor,and,pe

22、rineum,as,the,fetal,descending.,2020/4/11,38,Corporate Culture,38,Fetus,(,position,presentation,weight),Long axis of mother,LOA LOP LOT ROA ROP ROT,Estimation of fetal weight :2500g -,4000g,Passenger,2020/4/11,39,Corporate Culture,39,Size of the fetus head,?,Very important for delivery,。,?,The,vault

23、,is composed of 2 frontal bones,2 parietal,bones,and one occipital bone. They are slightly,separated from one another at the margins of,abutment and by wider spaces, the anterior and,posterior fontanelles.,2020/4/11,40,Corporate Culture,40,Four,diameter,of,fetus,head,：,Biparietal,diameter,：,The,grea

24、test,transverse,diameter,of,the,head,which,extends,from,one,parietal,bone,to,other.,Average,9.3cm,.,Occipito-frontal,diameter,：,Which,follows,a,line,extending,from,a,point,just,above,the,root,of,the,nose,prominent,portion,of,the,occipital,bone.,Average,11.3cm,.,2020/4/11,41,Corporate Culture,41,Subo

25、ccipito-bregmatic,diameter,.,Which,follows,a,line,drawn,from,the,middle,of,the,large,fontanel,to,the,undersurface,of,the,occipital,bone,just,where,it,joins,the,neck.,Average,9.5cm,Occipito-mental,diameter,：,From,the,chin,to,the,most,prominent,portion,of,the,occiput.,Average,13.3cm,2020/4/11,42,Corpo

26、rate Culture,42,Suboccipito-bregmatic,occipito-frontal,Occipito-mental diameter,2020/4/11,43,Corporate Culture,43,Fetal Skull,?,Vault.,?,Face.,?,Base.,2020/4/11,44,Corporate Culture,44,Position,of,the,fetus,Fetal,position,of,a,particular,presentation,refers,to,the,relationship,of,an,arbitrary,refere

27、nce,point,on,the,fetus,to,a,specific,point,in,the,right,or,left,side,of,the,maternal,pelvis.,2020/4/11,45,Corporate Culture,45,Psychologic Factors,A high level of anxiety during,pregnancy has been associated with,decreased uterine activity and with,longer and dysfunctional labor,。,2020/4/11,46,Corpo

28、rate Culture,46,Diagnosis,of,labor,Threatened,labor,False,labor:,1.,Contractions occur at irregular intervals.;,2.,Intervals remain long;,3.,Intensity remains unchanged;,4.,Discomfort is chiefly in lower abdomen;,5.,Cervix does not dilate;,6.,Discomfort is usually relieved by sedation,.,2020/4/11,47

29、,Corporate Culture,47,Lightenting,The,settling,of,the,fetal,head,into,the,brim,of,the,pelvis.,Bloody Show,The mucus plug is expelled from the cervixmixing,with a little blood,2020/4/11,48,Corporate Culture,48,In,labor,Onset,of,labor,is,spontaneous,uterine,contraction,with,progressive,dilation,of,the

30、,cervix,uterine contraction,interval 5 ,lasting 30,intensity is middle or heavy,2020/4/11,49,Corporate Culture,49,Mechanism of labor,Mechanism of normal labor in occiput,presentation include these cardinal,movements of labor :,engagement,descent,flexion,internal rotation,extension,external rotation,

31、and expulsion.,2020/4/11,50,Corporate Culture,50,Engagement,The,mechanism,by,which,the,biparietal,diameter,the,greatest,transverse,diameter,of,the,fetal,head,in,occiput,presentations,passes,through,the,pelvic,inlet,is,defined,engagement,.,2020/4/11,51,Corporate Culture,51,Descent,Descent continues p

32、rogressively until the,fetus is delivered;the other movements are,superimposed on it.,2020/4/11,52,Corporate Culture,52,Flexion,In,flexion,the chin is brought,into more intimate contact,with the fetal thorax,and the,appreciably shorter,suboccipitobregmatic,diameter,(9.5cm),is,substituted for the lon

33、ger,occipitofrontal,diameter,(11.3cm),.,2020/4/11,53,Corporate Culture,53,Internal,rotation,Internal,rotation,is,a,turning,of,the,fetus,occiput,gradually,moves,from,its,original,position,anteriorly,toward,the,symphysis,pubis,about,45,degrees.,Its,always,finished,in,the,end,of,the,first,stage,of,labo

34、r.,2020/4/11,54,Corporate Culture,54,Extention,Extention,brings,the,base,of,occiput,into,direct,contact,with,the,inferior,margin,of,the,symphysis,pubis.,2020/4/11,55,Corporate Culture,55,Restitution,:,The fetus head rotates to the position it occupied,at engagement after it deliveried,following this

35、,the shoulders descend in a path similar to that,traced by the head.,External rotation,：,The anterior shoulder rotates internally about 45,degrees to come under the pubic arch for,delivery.The head continutly rotates left about 45,degrees to its position at birth.,2020/4/11,56,Corporate Culture,56,F

36、lowing these maneuvers, the body,legs,and feet are,deliveried.,2020/4/11,57,Corporate Culture,57,Mechanism of Labor,2020/4/11,58,Corporate Culture,58,Total,Stage,of,Labor,and,Treatment,The,total,stage,of,labor,begins,with,the,regular,uterine,contractions,and,ends,when,delivery,of,the,placenta,comple

37、te.,Normal,labor,is,a,continuous,process,which,has,been,divided,into,three,stages,for,purposes,of,study.,2020/4/11,59,Corporate Culture,59,First stage of labor,?,The first stage begins with the onset of,labor and ends when dilation of cervix,(10cm) is complete.,?,The average duration of the first st

38、age,of labor in a primigravida is 11-12,hours;in a multipara 6-8 hours.,2020/4/11,60,Corporate Culture,60,Second,stage,of,labor,The second stage of labor extends from full dilation of,the cervix to the birth of baby and varies from a few,minutes to about two hours depending on both fetal and,materna

39、l factors. primigravida 2h,multipara,1h,Third,stage,of,labor,From,the,birth,of,the,infant,to,delivery,of,the,placenta,5,15min,30min,2020/4/11,61,Corporate Culture,61,Total stage of labor,：,24h,First stage of labor,（,cervical dilation stage,）,primigravida is 11-12,multipara 6-8 hours.,Second stage of

40、 labor,（,fetus expulsive stage,）,primigravida is 1-2 h,multipara few minutes,Third stage of labor,（,placenta expulsive stage,）,5,15min,30min,2020/4/11,62,Corporate Culture,62,Clinical,course,and,treatment,in,first,stage,1,Contraction,and,dilation,of,cervix,Chart of labor stage,the latent phase,( ons

41、et to 3cm, 16h),the active phase,(3cm to 10cm, 8h),2,Decent of presentation,3,Rupture of membranes,2020/4/11,63,Corporate Culture,63,The,active,phase,have,been,divided,into,three,stages,；,?,A,cceleration,phase:cervical,dilation,from,3cm,to,4cm,.,1.5h,；,?,M,aximum,acceleration,phase:,cervical,dilatio

42、n,from,4cm,to,9cm,，,2h;,?,D,eceleration,phase:,cervical,dilation,from,9cm,to,10cm,，,30min,。,2020/4/11,64,Corporate Culture,64,?,The,decent,of,the,fetal,head,is,measured,to,assess,the,progress,of,labor,?,The level of the presenting fetal part in the birth,canal is described in relationship to the isc

43、hial,spines,which are halfway between the pelvic,inlet and the pelvic outlet.,2020/4/11,65,Corporate Culture,65,Management:,B,lood pressure,、,fetal heart rate,、,cervical dilation,、,fetus,descending,、,uterine contraction,；,When the membranes ruptured,please check,the fetal heat rate,fluid colour and

44、amount at,once,Fetal heart rate 120,160bpm,latent stage 1,2h fetal heat rate,active stage 15-30 minute,Need for subsequent vaginal examinations to identify the,status of the cervix and the station and position of,presenting part will vary considerably.,2020/4/11,66,Corporate Culture,66,Management,of,second,stage,of,labor,Manifestation,?,Uterine,contraction,may,last,1.5,minutes,and,recur,at,times,aft