正常分娩(英文)

1NormalLabor2ObjectiveDefinitionoflabor.DeterminateFactorsofLaborAnatomicalconsiderations:Thefemalepelvis.Thefetalskull.Thestagesoflabor.Themechanismoflabor(vertex,LOA).Managementofnormallabor.3Definitions：Laboristheprocessbywhichcontractionsofthegraviduterusexpelthefetusandtheotherproductsofconceptionafter28weeksfromthelastmenstrualperiod.TermDelivery：Atermdeliveryoccursbetween37and42weeksfromthelastmenstrualperiod.4Prematurelabor：Pretermlaboristhatoccurringbefore37weeksofgestationalage.Postdatepregnancy：Postdatepregnancyoccursafter42weeks.5Notsure:1、Cervixripendandloweruterinesegmentdevelopmenttheory；2、Endocrineregulatingtheory；3、Mechanicaltheory；4、Neurohumortheory；5、Immunologictheory；TheetiologyoflaborMaturationoffetusandchangeofuterusfunctionisnecessary.6Theprogressandfinaloutcomeoflaborareinfluencedby4factors.(1)thepowers(2)thepassage(3)thepassenger(4)thepsycheFourDeterminateFactorsofLabor7Theexpulsiveforces(Thepowers)Thepowerthatexpulsethefetusandtheotherproductsofconceptioniscalledtheexpulsiveforces,whichinclude♀uterinecontraction♀intra-abdominalpressure♀levatoranimusclescontractions.8UterinecontractionsHavethreeuniquecharacteristics:★Rhythm:increaseinfrequencyandduration,istheimportantmarkerofinlabor。★Symmetryandpolarity★Retraction9Periodsofrelaxationbetweencontractionsareessentialtothewelfareofthefetus.RhythmIncreaseinfrequencyandduration宫缩间歇期宫缩极期进行退行10Characteristicofnormaluterineaction11★SymmetryandPolarityTheintensityoftheuppersegmentoftheuterusisthemoststrong12★Retraction:Themyometriumoftheupperuterinesegmentdoesnotrelaxtoitsoriginallengthaftercontractions;rather,itbecomesrelativefixedatashorterlength.13Theintra-abdominalpressureCreatedbycontractionoftheabdominalmusclessimultaneouslywithforcedrespiratoryeffortswithglottisclosed.＆Itisanecessaryauxiliarytouterinecontractionsinsecondstageoflabor。＆Aftertheplacentahasseparated,itsspontaneousexpulsionisaidedbythemotherincreasingintra-abdominalpressure。14腹肌子宫收缩力膈肌肛提肌15※FormaV-shapedslingthattendstorotatetheoccipitalanteriorly(internalrotation)。＆Helpthefetus’extensionanddelivery。＆Helptheexpulsionoftheplacenta。levatoranimusclescontractions16PassageThepassageofthefetusdelivery,including:thebonypelvisandsofttissuesofpelvis骶骨Ossacrum髂骨osilium耻骨联合Symphysispublis骶尾关节Sacro-iliacjiont尾骨Oscoccyx坐骨结节Osischium17Thebonypelvis(thetruepelvis)PelvicinletplanePelvicmidplanePelvicoutletplaneThreepelvicplane:18PelvicinletplaneHavethreediameters:(1)AnteroposteriordiameterorThetrueconjugate:average11cm.(2)Transversediameter:average13cm.(3)Inclineddiameter:average12.75cm19ThetrueconjugateThetransversediameterTheinclineddiameter2021Threeanteroposteriordiametersofthepelvicinlet22Thesmallestplaneofthepelvis,particularimportanceinobstructedlabor.Anteroposteriordiameterofmidpelvis：average11.5cm.Transversediameterofmidpelvis：alsebecalledinterspinousdiameter,average10cm.Pelvicmidplane23AnteroposteriordiameterofmidpelvisTransversediameterofmidpelvis24Transversediameterofthemidpelvis25Fourdiameters:Anteroposterior:diameterofoutlet：11.5cm。Transverseoutlet：thedistancebetweentheinneredgesoftheischialtuberosities。9cmAnteriorsagittaldiameter：6cm。Posteriorsagittaldiameter：8.5cm。Pelvicoutletplane2641、Transverseoutlet2、Anteriorsagittaldiameter3、Posteriorsagittaldiameter4、Anteroposteriordiameterofoutlet2728PelvicaxisandinclinationofpelvicPelvicaxis：TheaxisofthepelvisreferstothecurveofthebirthcanalasdescribedbyalinedrawnthroughthecenterofeachofthefourplanesInclinationofpelvic:Theangleofthepelvicinletplanewithgroundlevelwhenwomenstand.always60degree。29PelvicaxisInclinationofpelvic3031ThesoftpartofthebirthcanalFormationofloweruterinesegment、cervix、vagina、softtissueinthefloorofpelvis.32TheloweruterinesegmentDevelopedfromtheisthmusoftheuterusofnonpregnantwomen.Physiologicretractionring:Theactivelycontractinguppersegmentbecomesthickeraslaboradvances,theloweruterinesegmentisrelativelythincomparedwiththeuppersegment,betweenthemaphysiologicretractionringappear.3334ChangesofcervixEffacementofcervixdilatationofcervixTheuppersegmentcontracts,retracts,andexpelsthefetus;inresponsetotheforceofthecontractionsoftheuppersegment,theripenedloweruterinesegmentandcervixdilateandtherebyformagreatlyexpanded、thinned-outmuscularandfibromusculartubethroughwhichthefetuscanbeextruded.3536分娩过程中宫颈的变化primigravidamultiparaEffacementofcervixdilatationofcervix37Acrookcanalformedbythevagina、tissueofpelvicfloorandperineumasthefetaldescending.38Fetus(position,presentation,weight)LongaxisofmotherLOALOPLOTROAROPROTEstimationoffetalweight:2500g-4000gPassenger39SizeofthefetusheadVeryimportantfordelivery。Thevaultiscomposedof2frontalbones,2parietalbones,andoneoccipitalbone.Theyareslightlyseparatedfromoneanotheratthemarginsofabutmentandbywiderspaces,theanteriorandposteriorfontanelles.40Fourdiameteroffetushead：Biparietaldiameter：Thegreatesttransversediameterofthehead,whichextendsfromoneparietalbonetoother.Average9.3cm.Occipito-frontaldiameter：Whichfollowsalineextendingfromapointjustabovetherootofthenoseprominentportionoftheocc