1、Obstetrics and Gynecology labor and delivery and complication of delivery,赵晓东 MD 主任医师 北京医科大学研究生导师,labor and delivery,Definition Labor:progressive dilatation of the uterine cervix in association with repetitive uterine contractions. Delivery:from onset of labor to complete expulse of fetus and facili
2、tated organs.,labor and delivery,3 key factors Expulsive force Birth canal: bony canal, soft tissue of birth canal Fetus,3 key factors -expulsive force,Uterine contraction: rhythm, orientation, retraction Abdominal wall muscle: the second stage of labor Levator ani: help internal rotation and extens
3、ion,3 key factors -birth canal,Bony canal: 1)pelvic inlet plane:obstetric conjugate(11cm), transverse of pelvic inlet(13cm), oblique of pelvic inlet(12.75cm 2)the greatest plane of pelvis:12.5cm 3)mid plane of pelvis:anterior-posterior diameter(11.5cm),bi-ischial diameter(10cm) 4)pelvic outlet plane
4、: anterior-posterior diameter(11.5cm), transverse outlet(TO)9cm,anterior sagittal diameter(6cm),posterior sagittal diameter(8.5cm) 5)inclination of pelvis:60,3 key factors -birth canal,Soft tissue of birth canal 1)Lower segment of uterus: 10cm, physiologic retraction ring 2)Effacement of cervix:2cm
5、3)Dilation of cervix:10cm 4)Vagina and perinium body,3 key factors - fetus,The size of fetus: Head: BPD 9.3cm, occipito-frontal diameter 11.3cm, sub-occipital bregmatic diameter 9.5cm, occipito-mental diameter 13.3cm Head molding: Fetal weight:,3 key factors - fetus,Fetal position:fetal lie, fetal p
6、resentation, fetal position Abnormalitis of the fetus: hydrocephalus, conjoined twins,Normal mechanisms of labor,The mechanisms of labor Stages and phases of labor,The mechanisms of labor,Engagement Descent Flexion Internal rotation Extension Restitution and external rotation Expulsion,Stages and ph
7、ases of labor,Threatened labor:false labor, lightening, show In labor: contraction(30sec/5-6min),accompanied by dilation of cervix and descent of fetal head The first stage of labor: to full dilation of cervix, divided by latent phase(to 3cm) and active phase(to 10cm), total need 11-12 hours in null
8、iparas or 6-8 hours in multiparas The second stage of labor: to expulsion of fetus, total need 1-2 hours The third stage of labor: to expulsion of fetal affiliated organ, such as placenta, total need 5-15 mins,The first stage of labor,latent phase: 1)representation: contraction (30sec/5-6min45sec/3-
9、4min), dilation of cervix: to 3cm, 1cm/2-3 hours total need 8-16 hours 2)treatment: contraction, labor observation, fetal heart rate, Bp,The first stage of labor,active phase: 1)representation: contraction (50-60sec/2-3min60sec/1-2min), dilation of cervix 3-10cm, 1.2-1.5cm/hr, descent of fetal head:
10、 reach the level of ischial crest when dilation 4-5cm, 0.85 cm/hr, rupture of membrances total need 4-8 hours Prolonged labor: dilation rate below 1.2cm/hr in nulliparas or 1.5cm/hr in multiparas Arrested labor: cessation of labor for 2 hours 2)treatment: contraction, labor observation, fetal heart
11、rate, Bp,The second stage of labor,1)representation: contraction: 60sec/1-2min descent of fetal head: 1-2cm/hr head visible in vulva gapping, crowning of head, delivery total need: 1-2 hours Prolonged labor: descent rate below 1cm/hr in nulliparas or 2cm/hr in multiparas Arrested labor: cessation of
12、 descent for 1 hours 2)Treatment : contraction, labor observation, fetal heart rate, Bp , direction delivery: episiotomy,The third stage of labor,The treatment of new-birth:clear breath canal, Apgar score, clamping of cord The sign of placenta separation Delivery of placenta:manual removal of placen
13、ta (30 mins), adhension, increta, The firth stage of labor:2 hours after delivery, observe bleeding: postpartum hemorrhage (above 500ml) , observe the height of uterine fundus,Complication of delivery,Dystocia Rupture of uterus Postpartum bleeding Amniotic fluid embolism, AFE Fetal distress,Key problem,The mechanism of labor 3 key factors of labor and delivery The stages and phases of labor,
