婦產(chǎn)科學(xué)異常分娩(英文)

1、Abnormal labor and delivery(Dystocia),,Labor and delivery,Uterine Contractions that cause-Progressive effacement of cervix and dilationDescent of fetusExpulsion of fetus and placenta,The four factors for labor,Force

2、(contraction)birth canal (bony canal)fetus (lie,position ,presentation,weight,malformation)psychical-factors,Causes of Dystocia,abnormal uterine action (power)abnormal pelvis(passages)abnormal Passenger (infant size

3、 and fetal presentation,) abnormal psychical-factors,,1. abnormal uterine action (power)Abnormalities of the expulsive forceseither uterine forces insufficiently strong to efface and dilate the cervix (uterine dys

4、function) inadequate voluntary muscle effort during the second stage,,,Common Clinical Findings in Women with Ineffective Labor:Inadequate cervical dilation or fetal descentprotracted labor-slow progressarrested labo

5、r-no progressinadequate expulsive effort-ineffective “pushing”,,Diagnostic criteria for abnormal patterns in active labor,Values represent approximately two standard deviations from the mean,Stages of normal labor,The f

6、irst stage: onset of labor to full cervical dilation(10cm) the latent phase ( onest to 3cm to 10cm, <8h)The second stage: 10 cm to the delivery of the infant, <2hThe third stage: delivery

7、of the infant to delivery of the placenta, <30m’The fourth stage: 2 hours after delivery of the placenta,,Divides 1st stage into latent and active phaseprolonged latent phase(潛伏期延長）: defined as greater than

8、16 hours in a nullipara and greater than 14 hours in a parous woman,active phase（活躍期） disorders: Protraction（延長）: slow rate of cervical dilation or descentFor nulliparas: <1.2 cm dilatation/hr or < 1 cm descent

9、/hrFor multiparas: <1.5 cm dilatation/hr or <2 cm descent/hrTreat with expectant management/oxytocinArrest（停滯）: complete cessation of dilatation or descentArrest of dilatation: 2 hours with no cervical change

10、Arrest of descent: 1 hour without fetal descent,Second Stage : begins when cervical dilation is complete and ends with expulsion of fetusUntil recently, limited to 2 hours without epidural and to 3 hours with epidural

11、Until recently, limited to 1 hour without an epidural and to 2 hours with an epiduralCan be longer with bigger babies and regional anesthesia,,,MANAGEMENT,Poor progression in the first stage  Hypocontractile ute

12、rine activity is treated with oxytocin , which is the only medication approved by the US Food and Drug Administration (FDA) for labor stimulation in the active phase,導(dǎo)樂和陪伴,MANAGEMENT,Other — Other intervention

13、s,ambulationrupture of membrance other medicines,MANAGEMENT,Hypotonic dysfunction Insufficient Irregular Infrequent Response well to oxytocin Most in primigravidas in active phase Hypertonic and uncoordinated

14、 dysfunction Resting tone Dys－synchronous Frequent intense contraction Constriction ring Tocolysis Decrease oxytocin Cesarean section Sedation,MANAGEMENT,Poor progression in the second stage Three options:Conti

15、nued observation Attempt at operative vaginal delivery Cesarean delivery,Forceps Delivery,Forceps,Vacuum,Vacuum,Cesarean Section,,2. abnormal pelvis(passages)abnormalities of the maternal bony pelvisInlet Midpelvic

16、-outlet Generally contracted pelvic Deformed pelvic Soft tissue obstructionCongenital anomalies Scarring of birth canal Pelvic masses Abnormal placenta location,The passages(the pelvis),,Pelvic inlet A-P 11

17、.5 cm transversely 13.6 cmMid cavity all diameters 12 cmPelvic outlet A-P 12.5 cm transverely 10.5 cm,The passages(the pelvis),The clinician's ability to predict maternal pelvis-fet

18、al size discordance (cephalopelvic disproportion) leading to arrest of labor requiring cesarean delivery has been disappointing,Clinical or radiologic assessment of the maternal pelvis (ie, pelvimetry) is associated with

19、 poor predictive value,The passages(the pelvis),,3. Abnormalities of the Passenger Malposition and malpresentation Fetal macrosomia (≥4000g )Shoulder dystocia Fetal malformation,Passenger,,flexedhead,good,,Neutral

20、,OK,,deflexed,,Anterior fontanel,,Posterior fontanel,,OA,,OP,,Occiput Posterior,,ROA,,LOA,,ROT,,LOT,,LOP,,LOP,,Trans lie,,Transverse lie,,,,breech,breech,,breech,,Compound precentationb,,Passenger - Face Presentation,,,,

21、Cesarean Section,WHO target C/S rate is 10-15%C/S rate is about 50% in ChinaDystocia is most common reason for primary C/S,psychical-factors,Doula（導(dǎo)樂）labor analgesia（分娩鎮(zhèn)痛）,Key Words,prolonged latent phaseactive pha