安红敏nomal Labor1

Good

afternoon ！

医生，请 帮帮 忙！！

Help me,doctor

• 在开 往沈 阳的一列 特快

On a train to Shenyang, you have just left the home town,watching the beautiful scenery .suddenly,broadcasting stop the train of your thought:a pregnant woman will bear child,if you are a doctor ,please go to No.8 coach...

列车 上， 探亲归来 的你 正在 欣赏 着沿途美 丽的 风光 ，列 车广播员 急切 的声 音打 断了你的 思绪 ：“ 列车 上有一位 孕妇 临产 ，医 生同志请 尽快 赶到 8 号车厢 ……”

问题

Questions???

• 你首先怎么办？ Your first step… • 如何判断胎儿能否娩出？ Could the child be born out ? • 如何处理才能保证母子平安？ How to make the

mother and the child safe?

Normal Labor 正常分娩

Key Words • • • • • • • • • • •

Retraction uterine segment fontanels engagement descent delivery show partogram lateral episiotomy dilatation of cervix dystocia

缩复性 子宫下段 囟门 衔接 下降 分娩 见红 产程图 会阴侧切术 宫颈口扩张 难产

Ⅰ . Definition Delivery is the process by which the mature or nearly mature (fetus and placenta) are expelled from the maternal body. • Premature delivery: 28GW – 37GW • Term delivery: 37GW – 42GW • Postterm delivery: after 42 GW

• Abortion : <28 week

• 85% of women spontaneous labor and delivery between 37-42 weeks

• Labor : the process by which contractions of uterus expel the fetus.

• Delivery : receive the neonate

• 2. Factors affecting labor. There are four factors affecting labor: expulsive force, the fetus (lie, position and presentation of fetus), passage (the bony pelvis and soft tissue), and psychological factors. If the four factors accommodate each other, the fetus may be easily delivery, otherwise difficult delivery may occur.

The four factors for labor • • • •

Force ( uterine contraction) birth canal (bony canal) fetus (lie,position ,presentation,weight) psychical-factors

1. The powers 产力 1) uterine contraction rhythm 节律性

symmetry 对称性 polarity 极性 retraction 缩复作用

Contractions onset, frequency, duration, intensity • increase in frequency and duration • uterus can be felt to harden during contraction • lasting about 30-45 seconds • interval between contractions to be 5 min’ • Intensity (slight, middle, heavy) • the pain of labor is a character

2) abdominal muscles and diaphragm 腹肌、膈肌 3) levator 肛提肌

2. Birth canal 产道 1) bony pelvis 骨产道 pelvic inlet plane 骨盆入口平面 ( 前 后 11cm, 横 13cm, 斜 12.75cm)

Mid plane of pelvis 中骨盆平面

中骨盆平面 前后径： 11.5cm 横径（坐骨棘间径 ） lOcm 与分娩机制关系密切

骨盆出口平面 １出口前后径 :11.5cm ２出口横径 : ９ cm ３出口前矢状径 :6cm ４出口后矢状径 :8.5cm 2+4﹥ 15cm

一般大小的妊娠足月胎头可 通过后三角区经阴道娩出。

2) the soft part of the birth canal 软产道 formation of lower segment changes in the cervix changes in the floor of pelvis, vagina and perineum

3. The fetus 胎儿 1) size of the fetus

胎儿颅骨

2) position of the fetus 胎位 3) abnormality of the fetus 胎儿畸形 4. Psychological factors 精神心理因 素

The mechanism of normal labor in vertex presentation 1. Engagement 衔接 2. Descent 下降 3. Flexion 俯屈 4. Internal rotation 内旋转 5. Extension 仰伸 6. Restitution and external rotation 复位、外旋转 7. Expulsion of fetus 胎儿娩出

Mechanism of labor • The process of labor and delivery is marked by change in fetal position in relation to the maternal pelvis

• Engagement (BPD decent to a level below the pelvic inlet An occiput below the ischial spines is engaged) • Flexion • Decent • Internal rotation • Extension • External rotation