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NormalLabor1ppt精選版ObjectiveDefinitionoflabor.DeterminateFactorsofLaborAnatomicalconsiderations:Thefemalepelvis.Thefetalskull.Thestagesoflabor.Themechanismoflabor(vertex,LOA).
Managementofnormallabor.2ppt精選版Definitions:Laboristheprocessbywhichcontractionsofthegraviduterusexpelthefetusandtheotherproductsofconceptionafter28weeksfromthelastmenstrualperiod.TermDelivery:Atermdeliveryoccursbetween37and42weeksfromthelastmenstrualperiod.3ppt精選版Prematurelabor:Pretermlaboristhatoccurringbefore37weeksofgestationalage.Postdatepregnancy:Postdatepregnancyoccursafter42weeks.4ppt精選版Notsure:1、Cervixripendandloweruterinesegmentdevelopmenttheory;2、Endocrineregulatingtheory;3、Mechanicaltheory;4、Neurohumortheory
;5、Immunologictheory;
TheetiologyoflaborMaturationoffetusandchangeofuterusfunctionisnecessary.5ppt精選版Theprogressandfinaloutcomeoflaborareinfluencedby4factors.(1)thepowers(2)thepassage(3)thepassenger(4)thepsycheFourDeterminateFactorsofLabor6ppt精選版Theexpulsiveforces(Thepowers)
Thepowerthatexpulsethefetusandtheotherproductsofconceptioniscalledtheexpulsiveforces,whichinclude♀
uterinecontraction♀
intra-abdominalpressure
♀levatoranimusclescontractions.
7ppt精選版Uterinecontractions
Havethreeuniquecharacteristics:★Rhythm:
increaseinfrequencyandduration,istheimportantmarkerofinlabor?!?/p>
Symmetryand
polarity★Retraction8ppt精選版Periodsofrelaxationbetweencontractionsareessentialtothewelfareofthefetus.RhythmIncreaseinfrequencyandduration宮縮間歇期宮縮極期進(jìn)行退行9ppt精選版Characteristicofnormaluterineaction10ppt精選版★Symmetryand
Polarity
Theintensityoftheuppersegmentoftheuterusisthemoststrong
11ppt精選版★Retraction:Themyometriumoftheupperuterinesegmentdoesnotrelaxtoitsoriginallengthaftercontractions;rather,itbecomesrelativefixedatashorterlength.
12ppt精選版Theintra-abdominalpressureCreatedbycontractionoftheabdominalmusclessimultaneouslywithforcedrespiratoryeffortswithglottisclosed.&Itisanecessaryauxiliarytouterinecontractionsinsecondstageoflabor。&Aftertheplacentahasseparated,itsspontaneousexpulsionisaidedbythemotherincreasingintra-abdominalpressure。13ppt精選版腹肌子宮收縮力膈肌肛提肌14ppt精選版※FormaV-shapedslingthattendstorotatetheoccipitalanteriorly(internalrotation)。&
Helpthefetus’extensionanddelivery。&Helptheexpulsionoftheplacenta。
levatoranimusclescontractions
15ppt精選版Passage
Thepassageofthefetusdelivery,including:thebonypelvisandsofttissuesofpelvis骶骨Ossacrum髂骨osilium
恥骨聯(lián)合Symphysispublis骶尾關(guān)節(jié)Sacro-iliacjiont尾骨Oscoccyx坐骨結(jié)節(jié)Osischium16ppt精選版The
bonypelvis(thetruepelvis)
PelvicinletplanePelvicmidplanePelvicoutletplaneThreepelvicplane:17ppt精選版Pelvicinletplane
Havethreediameters:(1)AnteroposteriordiameterorThetrueconjugate:average11cm.(2)Transversediameter:average13cm.(3)Inclineddiameter:average12.75cm18ppt精選版ThetrueconjugateThetransversediameterTheinclineddiameter19ppt精選版20ppt精選版Threeanteroposteriordiametersof
thepelvicinlet21ppt精選版Thesmallestplaneofthepelvis,particularimportanceinobstructedlabor.
Anteroposteriordiameterofmidpelvis:average11.5cm.
Transversediameterofmidpelvis:alsebecalledinterspinousdiameter,average10cm.Pelvicmidplane22ppt精選版AnteroposteriordiameterofmidpelvisTransversediameterofmidpelvis23ppt精選版Transversediameterofthemidpelvis24ppt精選版Fourdiameters:
Anteroposterior:diameterofoutlet:11.5cm。
Transverseoutlet:thedistancebetweentheinneredgesoftheischialtuberosities。9cm
Anteriorsagittaldiameter:6cm。
Posteriorsagittaldiameter:8.5cm。
Pelvicoutletplane25ppt精選版41、Transverseoutlet2、Anteriorsagittaldiameter3、Posteriorsagittaldiameter4、Anteroposteriordiameterofoutlet
26ppt精選版27ppt精選版PelvicaxisandinclinationofpelvicPelvicaxis:TheaxisofthepelvisreferstothecurveofthebirthcanalasdescribedbyalinedrawnthroughthecenterofeachofthefourplanesInclinationofpelvic:Theangleofthepelvicinletplanewithgroundlevelwhenwomenstand.always60degree。28ppt精選版
Pelvicaxis
骨盆軸Inclinationofpelvic
29ppt精選版30ppt精選版Thesoftpartofthebirthcanal
Formationofloweruterinesegment、cervix、vagina
、softtissueinthefloorofpelvis.31ppt精選版Theloweruterinesegment
Developedfromtheisthmusoftheuterusofnonpregnantwomen.Physiologicretractionring:Theactivelycontractinguppersegmentbecomesthickeraslaboradvances,theloweruterinesegmentisrelativelythincomparedwiththeuppersegment,betweenthemaphysiologicretractionringappear.32ppt精選版33ppt精選版ChangesofcervixEffacementofcervixdilatationofcervixTheuppersegmentcontracts,retracts,andexpelsthefetus;inresponsetotheforceofthecontractionsoftheuppersegment,theripenedloweruterinesegmentandcervixdilateandtherebyformagreatlyexpanded、thinned-outmuscularandfibromusculartubethroughwhichthefetuscanbeextruded.34ppt精選版35ppt精選版分娩過(guò)程中宮頸的變化primigravidamultiparaEffacementofcervixdilatationofcervix36ppt精選版Acrookcanalformedbythevagina、tissueofpelvicfloorandperineumasthefetaldescending.37ppt精選版Fetus(position,presentation,weight)LongaxisofmotherLOALOPLOTROAROPROTEstimationoffetalweight:2500g-<4000gPassenger
38ppt精選版SizeofthefetusheadVeryimportantfordelivery。Thevaultiscomposedof2frontalbones,2parietalbones,andoneoccipitalbone.Theyareslightlyseparatedfromoneanotheratthemarginsofabutmentandbywiderspaces,theanteriorandposteriorfontanelles.39ppt精選版Fourdiameteroffetushead:
Biparietaldiameter:Thegreatesttransversediameterofthehead,whichextendsfromoneparietalbonetoother.Average9.3cm.Occipito-frontaldiameter:Whichfollowsalineextendingfromapointjustabovetherootofthenoseprominentportionoftheoccipitalbone.Average11.3cm.40ppt精選版Suboccipito-bregmaticdiameter.Whichfollowsalinedrawnfromthemiddleofthelargefontaneltotheundersurfaceoftheoccipitalbonejustwhereitjoinstheneck.Average9.5cmOccipito-mentaldiameter:Fromthechintothemostprominentportionoftheocciput.Average13.3cm41ppt精選版Suboccipito-bregmaticoccipito-frontalOccipito-mentaldiameter42ppt精選版FetalSkullVault.
Face.Base.43ppt精選版Positionofthefetus
Fetalpositionofaparticularpresentationreferstotherelationshipofanarbitraryreferencepointonthefetustoaspecificpointintherightorleftsideofthematernalpelvis.44ppt精選版PsychologicFactorsAhighlevelofanxietyduringpregnancyhasbeenassociatedwithdecreaseduterineactivityandwithlongeranddysfunctionallabor。45ppt精選版DiagnosisoflaborThreatenedlaborFalselabor:Contractionsoccuratirregularintervals.;Intervalsremainlong;Intensityremainsunchanged;Discomfortischieflyinlowerabdomen;Cervixdoesnotdilate;Discomfortisusuallyrelievedbysedation.46ppt精選版Lightenting
Thesettlingofthefetalheadintothebrimofthepelvis.BloodyShow
Themucusplugisexpelledfromthecervixmixingwithalittleblood47ppt精選版InlaborOnsetoflaborisspontaneousuterinecontractionwithprogressivedilationofthecervix
uterinecontraction
interval<5’lasting>30’’intensityismiddleorheavy48ppt精選版Mechanismoflabor
Mechanismofnormallaborinocciputpresentationincludethesecardinalmovementsoflabor:engagementdescentflexioninternalrotationextensionexternalrotation,andexpulsion.
49ppt精選版EngagementThemechanismbywhichthebiparietaldiameter,thegreatesttransversediameterofthefetalheadinocciputpresentations,passesthroughthepelvicinletisdefinedengagement.50ppt精選版DescentDescentcontinuesprogressivelyuntilthefetusisdelivered;theothermovementsaresuperimposedonit.51ppt精選版FlexionInflexion,thechinisbroughtintomoreintimatecontactwiththefetalthorax,andtheappreciablyshortersuboccipitobregmaticdiameter(9.5cm)issubstitutedforthelongeroccipitofrontaldiameter(11.3cm).52ppt精選版Internalrotation
Internalrotationisaturningofthefetusocciputgraduallymovesfromitsoriginalpositionanteriorlytowardthesymphysispubisabout45degrees.It’salwaysfinishedintheendofthefirststageoflabor.
53ppt精選版ExtentionExtentionbringsthebaseofocciputintodirectcontactwiththeinferiormarginofthesymphysispubis.54ppt精選版Restitution
:Thefetusheadrotatestothepositionitoccupiedatengagementafteritdeliveried,followingthistheshouldersdescendinapathsimilartothattracedbythehead.Externalrotation:
Theanteriorshoulderrotatesinternallyabout45degreestocomeunderthepubicarchfordelivery.Theheadcontinutlyrotatesleftabout45degreestoitspositionatbirth.55ppt精選版Flowingthesemaneuvers,thebody,legs,andfeetaredeliveried.56ppt精選版MechanismofLabor57ppt精選版TotalStageofLaborandTreatmentThetotalstageoflaborbeginswiththeregularuterinecontractionsandendswhendeliveryoftheplacentacomplete.Normallaborisacontinuousprocesswhichhasbeendividedintothreestagesforpurposesofstudy.58ppt精選版FirststageoflaborThefirststagebeginswiththeonsetoflaborandendswhendilationofcervix(10cm)iscomplete.Theaveragedurationofthefirststageoflaborinaprimigravidais11-12hours;inamultipara6-8hours.59ppt精選版SecondstageoflaborThesecondstageoflaborextendsfromfulldilationofthecervixtothebirthofbabyandvariesfromafewminutestoabouttwohoursdependingonbothfetalandmaternalfactors.primigravida<2h
multipara
<1hThirdstageoflaborFromthebirthoftheinfanttodeliveryofthe placenta5-15min,<30min60ppt精選版Totalstageoflabor:﹤24hFirststageoflabor(cervicaldilationstage)
primigravidais11-12multipara6-8hours.Secondstageoflabor(fetusexpulsivestage)
primigravidais1-2hmultiparafewminutesThirdstageoflabor(placentaexpulsivestage)
5-15min﹤30min61ppt精選版Clinicalcourseandtreatmentinfirststage1,ContractionanddilationofcervixChartoflaborstage
thelatentphase(onsetto<3cm,<16h)
theactivephase(>3cmto10cm,<8h)2,Decentofpresentation3,Ruptureofmembranes62ppt精選版Theactivephasehavebeendividedintothreestages;
Accelerationphase:cervicaldilationfrom3cmto4cm.1.5h;
Maximumaccelerationphase:cervicaldilationfrom4cmto9cm,2h;
Decelerationphase:cervicaldilationfrom9cmto10cm,30min。63ppt精選版Thedecentofthefetalheadismeasuredtoassesstheprogressoflabor
Thelevelofthepresentingfetalpartinthebirthcanalisdescribedinrelationshiptotheischialspines,whicharehalfwaybetweenthepelvicinletandthepelvicoutlet.64ppt精選版Management:⊙Bloodpressure、fetalheartrate、cervicaldilation、fetusdescending、uterinecontraction;⊙
Whenthemembranesruptured,pleasecheckthefetalheatrate,fluidcolourandamountatonceFetalheartrate120~160bpmlatentstage1~2hfetalheatrateactivestage15-30minute⊙
Needforsubsequentvaginalexaminationstoidentifythestatusofthecervixandthestationandpositionofpresentingpartwillvaryconsiderably.65ppt精選版ManagementofsecondstageoflaborManifestation
Uterinecontractionmaylast1.5minutesandrecurattimesafteraresti
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