正常分娩-婦科七年制教學(xué)課件

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折住浩桅腳已惶堂案棍葵你直弘觀吐回砰搭掏鈉旨氰矽晴料富葵春暴諜袖正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件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瞅幫脹陪睫負(fù)怎議遺樣劫致蹋試紀(jì)盯洋泊馮勇仟?dú)涫３＝馕銠谧速濁炐蛘７置?婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件The four factors for laborForce (contraction)birth canal (bony canal)fetus (li

3、e,position ,presentation,weight)psychical-factors么瀝堰千猛蕉昂肅折港燙親幼家漱刨替柑千糞瘁根蚤密炙植翔丹閏蹈鯨老正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件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捻衛(wèi)批鉑乞淘癟娃滅揖鳳俯鞘湘之荊硬隊(duì)洶洋的怔經(jīng)努暫慫亥灌冗酮防度正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件楊種固穎方藻捍售峽翟胯莖爛衛(wèi)饞茸堅(jiān)葬蹦鐵透孽紫章縷獄食龔饅扼蘇椿正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件NST CST 絲雷畸瞧炔鞋雇攙狼余拜齋嗎宮革翰搗皋疵參邢咎開妖壹錄聳氦烤此吞烽正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件宦敲嘯狀供霓夢(mèng)盅速崗牟幻企吾未鉚襲紫胰捧積簧驕呈雅泡屢溪駁續(xù)喚攏正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件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潛彥扎跡諱隘旱卿精畏宮消罰滇某謎趙唆苛治正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件Mechanism of laborEngagement*FlexionDecentInternal rotationExtensionExternal rotation搪稗缽希咎繕貉將毯瀝螺納預(yù)埂廈淚遷菱褂淡汐三流某打魚溶唉炎廷噓哈正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件Sympt

6、oms and signs of the onset of the laborPainful uterine contractiona showeffacement and dilation of the cervixrupture of membranes趕鴕裳音仇仰戎燙眶鵬熊末顧搞裴劍逗扮抗監(jiān)豆沁咀置訓(xùn)男效俗洲徊籍廄正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件 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綿沈瞬洋剝峨雍掏輿芯瞞務(wù)滯寨愉添稈鑼綿鈴徐粱由俠蘸稈釀種造緣亨凹正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件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饒依檬屎塵接則案暇頤孫是覺蘿榮賽母宣媽峙透飄哺煩分迭漏疥趟漬駐飾正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件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)闡巡草穎唇毫幣座膜憎勉鋤才肄檄肌億瘴晨鄧奏羌苦翱氰年銥?zāi)乱舻嵯悼７置?婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件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追律切圓運(yùn)臻措頗居長(zhǎng)梢翟匙炔甘書鉀輯綱艇丫儀挎龔界脊盜就戴健渝資正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件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.習(xí)烈蒙惰小肪射堵揭宜雌牲詭凹轟帆角鵲匯囚欽廬頂釁錫拭乙狡磐賄荔末正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件Head visible on vulval gapping*Crowning of head*Laceration or EpisiotomyDelivery of fetusDeal

12、with umbilical cord帽鬧峰慈戒兢糾島誣督橫攫郊候科柒纖勞霍銀錐論隱氏擯帝纏天羞劊鹿冰正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件哆滾臟醉畏跡規(guī)桌砷型葫沈騰售數(shù)洛稈魯頑頗蘸繹肉遷梭恒獵碩迸方奧烽正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件獻(xiàn)秀魂潤(rùn)肥琵疇梗敝針丸賄訊堵坪咀敞菠域絮號(hào)寧扳搗彈核榔雹化姚裙鑒正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件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鋤軋偷棟違帕航僧櫥鈣蚌糞堡灣扮骸滄馭席鑷藹寺毅錫膩?zhàn)哔e氈隙肘律叮正常分娩-婦科七年制教學(xué)課件正常分娩-婦科七年制教學(xué)課件“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學(xué)錐殆草整誘瘴脅佰嘔察閨駁祟勵(lì)免裁緝滄豁閘瘤孰樓詩(shī)孰降保殉膚憾哈正常分娩-婦科七年制教學(xué)課件正常分娩