异常分娩(英文)

1ABNORMALLABORORDYSTOCIA2Defintion：Dystociaisdefinedasdifficultlabor.Itmaybeassociatedwithvariousabnormalitiesthatpreventordeviatefromthenormalcourseoflaboranddelivery.Itistheconsequenceoffourdistinctabnormalitiesthatmayexistsinglyorcombination:thepower,passagepassengerandthepsyche.3CauseofdystociaPowerPassagePassengPsyche4Diagnosis:prolongedcoursesoflabor.Lackofprogressivecervicaldilatationandfetusdescending.prolongedlatentphase16h。prolongedactivephase8hCervicaldilation:Primigravida1.2cm/h，Multipara1.5cm/h。5ProtractedactivephaseThecervicaldilationstopfor2hoursinactivephase。ProlongedsecondstageThesecondstagelastmorethan2hoursforprimigravidaormorethan1hourformultipara。6Prolongeddescent:therateoffetusdescendingindecelerationphaseandthesecondstageoflaborlessthan1.0cm/h(primigravida)，or2.0cm/h(multipara)。Protracteddescent:fetusdescendingindecelerationphasestopformorethan1h。Prolongedlabor:thetotalstagelastmorethan24h。789AbnormaluterineactionTherhythm,symmetry,polarityandretractionofuterinecontractionbecomeabnormal.Include：uterinehypocontractilityuterinehypercontractility10AbnormalitiesofthepowersUterinedysfunctioncoordiantedhypocontractilityUterineUncoordinatedDysfunctioncoordiantedhypercontractilityuncoordinated11Etiologyofuterineaction：CephalopelvicdisproportionorfetalmalpositionPsychologicalfactorsAbnormaluterusEndocrinaldysfunctionOthers12Clinicalmanifestation1.Hypotonicuterineaction(coordianted)★Havenormalrhythm、symmetryandpolarity,★Buttheintensityislow,including:primaryandsecondaryhypotonicuterineaction.132、hypotonicuterineaction(uncoordianted)★lossthenormalrhythm、symmetryandpolarity.★theintensityintheperiodsofrelaxationbetweencontractionsbecomelarger.★Thepregnantwomenwillfellpersistingpain.14EffectonmaternalandfetusmaternalFatigueAcidosisInfectionPostpartumhemorrhageCesareansectionrateincreasingfetusBirthinjurydistressProlapseofumbilicalcordStillbirth15Managemant1.Coordinateddysfunction★VaginalexaminationtoruleoutCephalopelvicdisproportionorfetalmalposition；★Evaluatefetusandmaternalcomplexion.★Oxytocininfusion:16ManagementofcoordinateddysfunctionInthefirststageoflaborRelax,Takegoodcare,Narcoticagent;ImprovethecontractionRupturethemembraneOxytocinstimulationoflabor:fromlowdose.17Insecondstageoflabor★Thereisnocephalopelvicdisproportion：improvetheexpulsiveforce★Fetaldistress:finishthelaborinshortesttime；★Cephalopelvicdisproportion：cesareansectionInthirdstageoflabor：preventionofpostpartumhemorrhage18Uncoordinateddysfunction：★Sedationisgenerallyeffectiveinconvertinguncoordinatedcontractiontonormallaborpatterns.19Hypertonicdysfunction(coordinated)ManifestationanddiagnosisThecontractionhavenormalrhythm、symmetryandpolarity,buttheintensityistoostrong.Precipitatedelivery:Thetotalstageislessthan3hourswhentheratesofcervicaldilationismorethan5cm/h,thecervicaldilationof10cmandexpulsionoffetusoccursinshorttime.20HypertonicofuncoordinatedcontractionConstrictionringofuterusCharacteristic:Localsmoothmuscleinuterusspasmodiclycontracttoformcircularcontraction.Theringislocatedatjuncturebetweenloweruterinesegmentandcorpusuteri.21Tetaniccontractionofuterus:★Lossofrhythmn★Thetitaniccontractionofuteruspersistcontractinganddon’trelax,alwaysappearwhenoxytocinbemisused.22EffectonmaternalandfetusPrecipitatedeliverySoftbirthcanaltraumaRuptureofuterusFetaldistressFetaldeathstillbirth23Management§Preventionismaindoctrine;§Useoxytocin,clysis,artificialruptureofmembranecarefully;§Aspirationoxygen,prohibituterinecontraction—Magnesiumsulfate,pethidine;§Fetaldistress,pathologicretractionring--Cesarean。24AbnormalpassageCausesofabnormalitiesofpassageincludebonyabnormalities(pelvicdystocia),softtissueobstructionofthebirthcanal.Pelvicdystocia,particularlythatduetosmallbonyarchitecture,isthemostcommoncauseofpassageabnormalities.25PelviccontractionTypeofPelvic:femalemaleandropoidpelvisplatypelloidpelvis26inletoutletcavityfemalemale27ContractedpelvicinletplatypelloidiscomonTheplatypelloidpelvisischaracterizedbyatransversediameterthatiswidewithrespecttotheanteroposteriordiameter.SimpleflatpelvisRachiticflatpelvis28MidpelviscontractionMidpelviscontractionisdefinedasvalueslessthan10cmfortheinterspinousdiameter,alwaysoccursinandroidpelvisandanthropoidpelvis.29ContractedpelvicoutletPelvicoutletcontractionisdefinedasvalueslessthan8cmfortheintertuberousdiameterandthesumoftheintertuberousandposteriorsagittaldiameterlessthan15cm.alwaysoccursinandroidpelvis30GenerallycontractedpelvicEachpelvicplaneis2cmlessthannormalvalueormore,whichiscalledgenerallycontractedpelvicandcanbeseeninshapemoreshortandsmall,well-balancedwomenoftypeoffigure.PelvicmalformationThepelviclossthenormalshapeandsymmetry.31ContractedpelvicinletClinicalmanifestation※Abnormalpresentationandlieposition.※Lackofprogressivecervicaldilatationandfetusdescending:prolongedlatentphaseandactivephase.※Prematureruptureofmembraneandumbilicalcordprolapse.32MidpelviscontractionClinicalmanifestation:★AbnormalpositionPersistentocciputposteriorposition,ordeeptransversearrest★Prolongedseco