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安红敏nomal labor2

安红敏nomal labor2

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Published by sanjivdas
Gynecology
Gynecology

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Published by: sanjivdas on Apr 15, 2009
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05/11/2014

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Good afternoon!

Normal Labor I
正常分娩

Labor Delivery

The mode of expulsion of the futus and placenta The power The passage The futus Psychological factor

Factors affecting labor Mechanism of occipital presentation

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

Normal labor II
• The characteristics of normal labor • Normal labor stages • Clinical management of normal labor

Symptoms and signs of the onset of the labor
• • • •
Painful uterine contraction a show effacement and dilation of the cervix rupture of membranes

The differentiation of labor
In labor:
临产 (sign: regular uterine contraction with cervix
dilatation and descent ) spontaneous uterine contraction with progressive dilation of the cervix interval < 5 ’ lasting >30’’ intensity is middle or heavy

effacement and dilation of the cervix to be short,taken up,dilated the rupture of the membranes at any time during labor

False labor: threatened labor 先兆临 产
1) false labor 假临产 2) lightening 胎儿下降感 3) show 见红
The mucus plug is expelled from the cervix mixing with a little blood

Three Stages of labor
The first stage --- dilatation of the cervical OS • onset of labor to full cervical dilation(10cm) • the latent phase ( onest to <3cm, <16h) • the active phase(>3cm to 10cm, <8h) 初产妇 11 - 12h 经产妇 6 - 8h

Three Stages of labor
The second stage -- expulsion of the fetus
10 cm to the delivery of the infant, <2h

初产妇 1 - 2h 经产妇 数分钟- 1h

Three Stages of labor
The third stage
-- expulsion of the placenta delivery of the infant to delivery of the placenta,

5 - 15min
<30min

Management of normal labor
The first stage: • education, eating, walking, • position(sitting, reclining, recumbent) • monitoring of the fetal heart rate , • Palpation of cervix ( effacement ,dilation) • uterus contractions (palpation or electronic monitoring) • Analgesia and anesthesia

partogram 产程图

Station is expressed in centimeters above or below the level of the ischial spines.

The second stage
• fetal heart rate • maternal conditions:
pulse, blood pressure, respiratory rate , temperature, urine output, fluid intake… • evaluation of progress of labor station, position of the presenting part, status of membranes, meconium, blood

• Pushing: • with the onset of each contraction, the
mother is encouraged to inhale,hold her breath, and push • increase in intra-abdominal pressure • aiding in fetal descent through the birth cacal.

• • • • •

Head visible on vulval gapping Crowning of head Laceration or Episiotomy Delivery of fetus Deal with umbilical cord

Crowning of head

Episiotomy

Clinical course and treatment in third stage 1. Clinical findings 2. treatment

the third stage:
• waiting for up to 30 min • Separation indication of placenta:
the fundus changes to a globular shape and firm consistency A gush of blood appears vaginally The umbilical cord appears to lengthen

• delivery of placenta (spontaneously, manually • inspection of the birth canal • Repair of lacerations or episiotomy

胎盘剥 离

signs of placental separation

Detect placental abnormalities—accessory placenta

Key word and questions
• • • • • • • •
Labor Delivery Engagement Effacement What are the four factors in labor and delivery? What is the mechanisms of labor ? What are the three stages of labor ? Explain the separation indications of placenta.

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