正常分娩婦科七年制

1、Normal Labor and Delivery(AFE)正常分娩,Lin Jianhua M.D., Ph.D., Professor Department Of Obstetrics & Gynecology Renji Hospi

2、tal Affiliated to SJTU School of Medicine,definition,Term delivery(labor): 37-42weekspre-term delivery: 28- <37 weekspost-term delivery:? 42 weeksAbortion: <28 weeks85% of women spontaneous labor and delivery b

3、etween 37-42 weeks LMP :last menstrual periodEDC: expected date of confinememt,The four factors for labor,Force (contraction)birth canal (bony canal)fetus (lie,position ,presentation,weight)psychical-factors,The con

4、tractions,increase in frequency and durationuterus can be felt to harden during contraction lasting about 30-45 secondsinterval between contractions to be 5 min’the pain of labor is a character,NST C

5、ST,,Bony pelvis,The planes of pelvis inlet plane (promontory) mid plane of pelvis(ischial spines) outlet plane(two intersecting triangles),Mechanism of labor,Engagement*FlexionDecentInternal ro

6、tationExtensionExternal rotation,Symptoms and signs of the onset of the labor,Painful uterine contractiona showeffacement and dilation of the cervixrupture of membranes,,The showThe mucus plug is expelled from the

7、 cervixmixing with a little blood the rupture of the membranesat any time during laboreffacement and dilation of the cervixto be short,taken up,dilated,Stages of labor,The first stage: onset of labor to full ce

8、rvical 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 of the infant to delivery of the placent

9、a, <30m’The fourth stage: 2 hours after delivery of the placenta,Management of normal labor,The first stage:education, eating, voiding, position(sitting, reclining, recumbent)monitoring of the fetal heart

10、rate ,dilation of cervix and frequency severity of uterus contractions(auscultation or electronic monitoring),The second stage,:--- < 2 hourfetal heart ratematernal conditions: pulse, blood pressure, respir

11、atory rate , temperature, urine output, fluid intake… evaluation of progress of labor cervical dilation, station,position of the presenting part, status of membranes, meconium, blood,,Pushing:

12、with the onset of each contraction, the mother is encouraged to inhale,hold her breath, and pushincrease in intra-abdominal pressureaiding in fetal descent through the birth cacal.,,Head visible on vulval gapping*Crow

13、ning of head*Laceration or EpisiotomyDelivery of fetusDeal with umbilical cord,,,the third stage:,waiting for up to 30 min’the uterus decreases in sizedelivery of placenta(spontaneously, manuallyinspection of th

14、e birth canalevaluated for lacerations,“The fourth stage”,postpartum uterine hemorrhage ,1% uterus palpation through the abdominal wall is repeatsthe amount of blood on pads are monitoredpulse and BP are monitored u