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1、正常分娩(英文),2,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 period.,3,Premature labor：Pre
2、term labor is that occurring before 37 weeks of gestational age.Postdate pregnancy：Postdate pregnancy occurs after 42 weeks.,4,Not sure:1、Cervix ripend and lower uterine segment development theory；2、Endocrine regulating theory；3、Mechanical theory；4、Neurohumor theory；5、Immunologic theory；,The etiolog
3、y of labor,Maturation of fetus and change of uterus function is necessary.,5,The progress and final outcome of labor are influenced by 4 factors.(1)the powers(2)the passage(3)the passenger(4)the psyche,Four Determinate Factors of Labor,6,The expulsive forces(The powers),The power that expulse the fe
4、tus and the other products of conception is called the expulsive forces,which include uterine contraction intra-abdominal pressure levator ani muscles contractions.,7,Uterine contractions,Have three unique characteristics:Rhythm:increase in frequency and duration,is the important marker of in labor。
5、Symmetry and polarity Retraction,8,Periods of relaxation between contractions are essential to the welfare of the fetus.,RhythmIncrease in frequency and duration,宫缩,间歇期,宫缩,极期,进行,退行,9,Characteristic of normal uterine action,10,Symmetry and Polarity The intensity of the upper segment of the uterus is
6、the most strong,11,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.,12,The intra-abdominal pressure,Created by contraction of the abdominal muscles simultaneously with forced respirat
7、ory efforts with glottis closed.It is a necessary auxiliary to uterine contractions in second stage of labor。After the placenta has separated,its spontaneous expulsion is aided by the mother increasing intra-abdominal pressure。,13,腹肌,子宫收缩力,膈肌,肛提肌,14,Form a V-shaped sling that tends to rotate the occ
8、ipital anteriorly(internal rotation)。Help the fetus extension and delivery。Help the expulsion of the placenta。,levator ani muscles contractions,15,Passage The passage of the fetus delivery,including:the bony pelvis and soft tissues of pelvis,骶 骨Os sacrum,髂 骨 os ilium,耻骨联合Symphysis publis,骶 尾 关 节Sacr
9、o-iliac jiont,尾 骨Os coccyx,坐骨结节Os ischium,16,The bony pelvis(the true pelvis)Pelvic inlet plane Pelvic midplane Pelvic outlet plane,Three pelvic plane:,17,Pelvic inlet plane Have three diameters:,(1)Anteroposterior diameter or The true conjugate:average 11cm.(2)Transverse diameter:average 13cm.(3)In
10、clined diameter:average 12.75cm,18,The true conjugate,The transverse diameter,The inclined diameter,19,20,Three anteroposterior diameters of the pelvic inlet,21,The smallest plane of the pelvis,particular importance in obstructed labor.Anteroposterior diameter of mid pelvis：average 11.5cm.Transverse
11、 diameter of mid pelvis：alse be called interspinous diameter,average 10cm.,Pelvic midplane,22,Anteroposterior diameter of mid pelvis,Transverse diameter of mid pelvis,23,Transverse diameter of the midpelvis,24,Four diameters:Anteroposterior:diameter of outlet：11.5cm。Transverse outlet：the distance be
12、tween the inner edges of the ischial tuberosities。9cmAnterior sagittal diameter：6cm。Posterior sagittal diameter：8.5cm。,Pelvic outlet plane,25,4,1、Transverse outlet2、Anterior sagittal diameter3、Posterior sagittal diameter4、Anteroposterior diameter of outlet,26,27,Pelvic axis and inclination of pelvic
13、Pelvic axis：The axis of the pelvis refers to the curve of the birth canal as described by a line drawn through the center of each of the four planesInclination of pelvic:The angle of the pelvic inlet plane with ground level when women stand.always 60 degree。,28,Pelvic axis,骨盆轴,Inclination of pelvic,
14、29,30,The soft part of the birth canal Formation of lower uterine segment、cervix、vagina、soft tissue in the floor of pelvis.,31,The lower uterine segment,Developed from the isthmus of the uterus of nonpregnant women.Physiologic retraction ring:The actively contracting upper segment becomes thicker as
15、 labor advances,the lower uterine segment is relatively thin compared with the upper segment,between them a physiologic retraction ring appear.,32,33,Changes of cervixEffacement of cervixdilatation of cervixThe upper segment contracts,retracts,and expels the fetus;in response to the force of the con
16、tractions of the upper segment,the ripened lower uterine segment and cervix dilate and thereby form a greatly expanded、thinned-out muscular and fibromuscular tube through which the fetus can be extruded.,34,35,分娩过程中宫颈的变化,primigravida,multipara,Effacement of cervix,dilatation of cervix,36,A crook can
17、al formed by the vagina、tissue of pelvic floor and perineum as the fetal descending.,37,Fetus(position,presentation,weight)Long axis of motherLOA LOP LOT ROA ROP ROTEstimation of fetal weight:2500g-4000g,Passenger,38,Size of the fetus head,Very important for delivery。The vault is composed of 2 front
18、al 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.,39,Four diameter of fetus head：Biparietal diameter：The greatest transverse diameter of the head,which extends from one
19、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.,40,Suboccipito-bregmatic diameter.Which follows a line drawn from the middle of the large fontanel to the
20、 undersurface of the occipital bone just where it joins the neck.Average 9.5cmOccipito-mental diameter：From the chin to the most prominent portion of the occiput.Average 13.3cm,41,Suboccipito-bregmatic,occipito-frontal,Occipito-mental diameter,42,Fetal Skull,Vault.Face.Base.,43,Position of the fetus
21、 Fetal position of a particular presentation refers to the relationship of an arbitrary reference point on the fetus to a specific point in the right or left side of the maternal pelvis.,44,Psychologic Factors A high level of anxiety during pregnancy has been associated with decreased uterine activi
22、ty and with longer and dysfunctional labor。,45,Diagnosis of laborThreatened laborFalse labor:Contractions occur at irregular intervals.;Intervals remain long;Intensity remains unchanged;Discomfort is chiefly in lower abdomen;Cervix does not dilate;Discomfort is usually relieved by sedation.,46,Light
23、enting 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,47,In laborOnset of labor is spontaneous uterine contraction with progressive dilation of the cervix uterine contraction interval 30 intensity is middle
24、or heavy,48,Mechanism of labor Mechanism of normal labor in occiput presentation include these cardinal movements of labor:engagement descentflexioninternal rotationextensionexternal rotation,and expulsion.,49,Engagement The mechanism by which the biparietal diameter,the greatest transverse diameter
25、 of the fetal head in occiput presentations,passes through the pelvic inlet is defined engagement.,50,Descent Descent continues progressively until the fetus is delivered;the other movements are superimposed on it.,51,Flexion,In flexion,the chin is brought into more intimate contact with the fetal t
26、horax,and the appreciably shorter suboccipitobregmatic diameter(9.5cm)is substituted for the longer occipitofrontal diameter(11.3cm).,52,Internal rotation Internal rotation is a turning of the fetus occiput gradually moves from its original position anteriorly toward the symphysis pubis about 45 deg
27、rees.Its always finished in the end of the first stage of labor.,53,ExtentionExtention brings the base of occiput into direct contact with the inferior margin of the symphysis pubis.,54,Restitution:The fetus head rotates to the position it occupied at engagement after it deliveried,following this th
28、e 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.,55,Flowing these maneuvers,the body,legs,
29、and feet are deliveried.,56,Mechanism of Labor,57,Total Stage of Labor and Treatment The total stage of labor begins with the regular uterine contractions and ends when delivery of the placenta complete.Normal labor is a continuous process which has been divided into three stages for purposes of stu
30、dy.,58,First stage of laborThe first stage begins with the onset of labor and ends when dilation of cervix(10cm)is complete.The average duration of the first stage of labor in a primigravida is 11-12 hours;in a multipara 6-8 hours.,59,Second stage of labor The second stage of labor extends from full
31、 dilation of the cervix to the birth of baby and varies from a few minutes to about two hours depending on both fetal and maternal factors.primigravida 2h multipara 1hThird stage of laborFrom the birth of the infant to delivery of the placenta 515min,30min,60,Total stage of labor：24hFirst stage of l
32、abor（cervical dilation stage）primigravida is 11-12 multipara 6-8 hours.Second stage of labor（fetus expulsive stage）primigravida is 1-2 h multipara few minutesThird stage of labor（placenta expulsive stage）515min 30min,61,Clinical course and treatment in first stage1,Contraction and dilation of cervix
33、,Chart of labor stage the latent phase(onset to 3cm to 10cm,8h)2,Decent of presentation3,Rupture of membranes,62,The active phase have been divided into three stages；Acceleration phase:cervical dilation from 3cm to 4cm.1.5h；Maximum acceleration phase:cervical dilation from 4cm to 9cm，2h;Deceleration
34、 phase:cervical dilation from 9cm to 10cm，30min。,63,The decent of the fetal head is measured to assess the progress of laborThe level of the presenting fetal part in the birth canal is described in relationship to the ischial spines,which are halfway between the pelvic inlet and the pelvic outlet.,6
35、4,Management:Blood pressure、fetal heart rate、cervical dilation、fetus descending、uterine contraction；When the membranes ruptured,please check the fetal heat rate,fluid colour and amount at onceFetal heart rate 120160bpm latent stage 12h fetal heat rate active stage 15-30 minute Need for subsequent va
36、ginal examinations to identify the status of the cervix and the station and position of presenting part will vary considerably.,65,Management of second stage of laborManifestation Uterine contraction may last 1.5 minutes and recur at times after a resting phase of no more than a minute.The woman typ
37、ically begins to bear down The perineum begins to bulge and the overlying skin becomes tense and glistening.,66,Head visible on vulva gappingCrowning of headBetween uterine contractions the presenting part tends to recede slightly,but“crowing”occurs when the head is visible at the vaginal introitus
38、and not receding in between contractions.,67,Management of the second stageFetal heart rate:should be auscultated at least every 510min.Maternal expulsive efforts.Preparation for delivery primigravida from cervical dilation completed multipara from cervical dilation 4cm,68,Management of third stage
39、of labor.Clinical courseAfter delivery of the infant,the height of the uterine fundus and its consistency are ascertained.Uterine contraction reappear after stopping for few minutes.Placental separation,69,Signs of placental separation：a.the uterus becomes globular and firmer.b.The umbilical cord le
40、ngthened outside the vagina c.A fresh show of blood from vaginad.the uterus fundus rises up.,70,Pay attention to:Examine the placenta to ensure complete removal.Examine the soft part of the birth canal.Prevention of excessive postpartum bleeding.Uterine contraction、bladder distension,71,thankyou,此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢,
