正常分娩与异常分娩
张斌
zhangbinyuan@yahoo.com.cn
Three elements(3P)
? Powers
? Passages
? Passenger
? ----For a normal delivery to take place,each
of these three factors must fulfil its own role,
and interact efficiently with the other two
factors.
The stages of labour
? First stage:full cervical dilatation
? Second stage:delivery of the baby
? Third stage:delivery of the placenta and
membranes.
Cardinal movements in labour
? Fetal head descent and increased flexion
? Internal rotation
? Extention
? Restitution
? External rotation
Partogram
? A composite chart includes the patient’s
identification and helps to pictorially
present the progress in labour
Normal Labour
? Conduct of the Second Stage
– Dorsal position(lithotomy position)
– Episiotomy
– Guards the perineum
– Assist the flexion and extension
Normal Labour
? Conduct of the Third stage
– When the bulk of the placenta is delivered,it
may help to twist the membranes-a manoeuvre
that will strengthen the trailing membranes and
gently aid their separation from the lower
uterine segment.
Shoulder Dystocia
? Exaggerated lithotomy position
? Generous episiotomy
? Suprapubic pressure
? Break one clavicle
Cases
? A 29 year old primigravid patient is
admitted to the labour ward at 01.00
hours.She is at term,having had an
uncomplicated pregnancy,and gives a
history of show and regular painful
contraction-like pain occurring 3:10min.Just
as she was admitted,spontaneous rupture of
membranes occurred,
? On abdominal examination she is found to
have a uterine fundal height compatible
with term;the fetus has a longitudinal lie
and cephalic presentation,On vaginal
examination the cervix is found to be 4cm
dilated,fully effaced with the vertex at O-2
station,at the patient’s requst,epidural
anesthesia is administered for analgesia,
? Some 4 h later,at 05.00hours,she is re-examined
to assess progress in labour,Two- to three-fifths
of th head are palpable abdominally,On vaginal
examination the cervix is found to be 5-6cm
dilated,fully effaced with the fetal head at 0-1
station,The CTG is satisfactory and the epidural
analgesia remains effective,A further 2h later,at
07.00 hours,she is reassessed by the midwife and
found to be 6cm dilated but otherwise the findings
have not changed from the previous assessment.
Question 1
? You are asked to make an assessment of the
situation,What do you consider to be the
differential diagnosis for her slow progress
in labour and how would you manage this?
You examine the patient and find that the presenting
part is the vertex in the left occipitoanterior
position;the cervix is 6cm dilated and the vertex is
1cm above the ischial spines,You prescribe
intravenous oxytocin.Two hours later,you assess
her,She has uterine contractions 3:10 min and
two- to three-fifths of the fetal head are palpable
abdominally,The cervix is 6-7cm dilated,the
vertex remains at 0-1 station and irreducible
overlap of the fetal skull bones is present on two
of the three palpable suture lines.
Question 2
? What is the diagnosis and how should you
deliver the patient?
张斌
zhangbinyuan@yahoo.com.cn
Three elements(3P)
? Powers
? Passages
? Passenger
? ----For a normal delivery to take place,each
of these three factors must fulfil its own role,
and interact efficiently with the other two
factors.
The stages of labour
? First stage:full cervical dilatation
? Second stage:delivery of the baby
? Third stage:delivery of the placenta and
membranes.
Cardinal movements in labour
? Fetal head descent and increased flexion
? Internal rotation
? Extention
? Restitution
? External rotation
Partogram
? A composite chart includes the patient’s
identification and helps to pictorially
present the progress in labour
Normal Labour
? Conduct of the Second Stage
– Dorsal position(lithotomy position)
– Episiotomy
– Guards the perineum
– Assist the flexion and extension
Normal Labour
? Conduct of the Third stage
– When the bulk of the placenta is delivered,it
may help to twist the membranes-a manoeuvre
that will strengthen the trailing membranes and
gently aid their separation from the lower
uterine segment.
Shoulder Dystocia
? Exaggerated lithotomy position
? Generous episiotomy
? Suprapubic pressure
? Break one clavicle
Cases
? A 29 year old primigravid patient is
admitted to the labour ward at 01.00
hours.She is at term,having had an
uncomplicated pregnancy,and gives a
history of show and regular painful
contraction-like pain occurring 3:10min.Just
as she was admitted,spontaneous rupture of
membranes occurred,
? On abdominal examination she is found to
have a uterine fundal height compatible
with term;the fetus has a longitudinal lie
and cephalic presentation,On vaginal
examination the cervix is found to be 4cm
dilated,fully effaced with the vertex at O-2
station,at the patient’s requst,epidural
anesthesia is administered for analgesia,
? Some 4 h later,at 05.00hours,she is re-examined
to assess progress in labour,Two- to three-fifths
of th head are palpable abdominally,On vaginal
examination the cervix is found to be 5-6cm
dilated,fully effaced with the fetal head at 0-1
station,The CTG is satisfactory and the epidural
analgesia remains effective,A further 2h later,at
07.00 hours,she is reassessed by the midwife and
found to be 6cm dilated but otherwise the findings
have not changed from the previous assessment.
Question 1
? You are asked to make an assessment of the
situation,What do you consider to be the
differential diagnosis for her slow progress
in labour and how would you manage this?
You examine the patient and find that the presenting
part is the vertex in the left occipitoanterior
position;the cervix is 6cm dilated and the vertex is
1cm above the ischial spines,You prescribe
intravenous oxytocin.Two hours later,you assess
her,She has uterine contractions 3:10 min and
two- to three-fifths of the fetal head are palpable
abdominally,The cervix is 6-7cm dilated,the
vertex remains at 0-1 station and irreducible
overlap of the fetal skull bones is present on two
of the three palpable suture lines.
Question 2
? What is the diagnosis and how should you
deliver the patient?
