正常分娩婦科七年制教學(xué)

正常分娩婦科七年制教學(xué)第1頁/共22頁definitionTermdelivery(labor):37-42weekspre-termdelivery:28-<37weekspost-termdelivery:42weeksAbortion:<28weeks85%ofwomenspontaneouslaboranddeliverybetween37-42weeksLMP:lastmenstrualperiodEDC:expecteddateofconfinememt第2頁/共22頁ThefourfactorsforlaborForce(contraction)birthcanal(bonycanal)fetus(lie,position,presentation,weight)psychical-factors第3頁/共22頁Thecontractionsincreaseinfrequencyanddurationuteruscanbefelttohardenduringcontractionlastingabout30-45secondsintervalbetweencontractionstobe5min’thepainoflaborisacharacter第4頁/共22頁第5頁/共22頁NSTCST第6頁/共22頁第7頁/共22頁BonypelvisTheplanesofpelvisinletplane(promontory)midplaneofpelvis(ischialspines)outletplane(twointersectingtriangles)

第8頁/共22頁MechanismoflaborEngagement*FlexionDecentInternalrotationExtensionExternalrotation第9頁/共22頁SymptomsandsignsoftheonsetofthelaborPainfuluterinecontractionashoweffacementanddilationofthecervixruptureofmembranes第10頁/共22頁TheshowThemucusplugisexpelledfromthecervixmixingwithalittlebloodtheruptureofthemembranesatanytimeduringlaboreffacementanddilationofthecervixtobeshort,takenup,dilated第11頁/共22頁StagesoflaborThefirststage:

onsetoflabortofullcervicaldilation(10cm)thelatentphase(onestto<3cm,<16h)theactivephase(>3cmto10cm,<8h)Thesecondstage:10cmtothedeliveryoftheinfant,<2hThethirdstage:deliveryoftheinfanttodeliveryoftheplacenta,<30m’Thefourthstage:2hoursafterdeliveryoftheplacenta第12頁/共22頁ManagementofnormallaborThefirststage:education,eating,voiding,position(sitting,reclining,recumbent)monitoringofthefetalheartrate,dilationofcervixandfrequencyseverityofuteruscontractions(auscultationorelectronicmonitoring)第13頁/共22頁Thesecondstage:---<2hourfetalheartratematernalconditions:pulse,bloodpressure,respiratoryrate,temperature,urineoutput,fluidintake…evaluationofprogressoflaborcervicaldilation,station,positionofthepresentingpart,statusofmembranes,meconium,blood第14頁/共22頁P(yáng)ushing:withtheonsetofeachcontraction,themotherisencouragedtoinhale,holdherbreath,andpushincreaseinintra-abdominalpressureaidinginfetaldescentthroughthebirthcacal.第15頁/共22頁Headvisibleonvulvalgapping*Crowningofhead*LacerationorEpisiotomyDeliveryoffetusDealwithumbilicalcord第16頁/共22頁第17頁/共22頁第18頁/共22頁thethirdstage:

waitingforupto30min’theuterusdecreasesinsizedeliveryofplacenta(spontaneously,manuallyinspectionofthebirthcanalevaluatedforlacerations第19頁/共22頁“Thefourthstage”

postpartumuterinehemorrhage,1%uteruspalpationthroughtheabdominalwallisrepeatstheamountofbloodonpadsaremonitoredpulseandBParemonitoreduseofdrug:oxytocin第20頁/共22頁THANKSFORYOURAT