影响分娩的四大因素2FourfactorsforlaborFetusNormalLaborand课件.ppt

1、Normal Labor and Delivery正正 常常 分分 娩娩Obs&Gyn Department of 1st Clinical Hospital Wuhan UniversityAssociate Professor Ming lei（明蕾）（明蕾）OutlineDefinition123Mechanism of laborFour factors for labor23（定义）（定义）Definition1Delivery is the process by which the mature or nearly mature fetus and placenta are exp

2、elled from the maternal body after 28 weeks分娩是指妊娠满28周及以后的胎儿及其附属物从母体排出的过程（定义）（定义）Definition11足月产2早 产3过期产4流 产（定义）（定义）Definition13Mechanism of labor2Four factors for laborOutline影响分娩的四大因素影响分娩的四大因素ForceBirth canalFetusPsychical factors 产产 力力 产产 道道 胎胎 儿儿精神因素精神因素影响分娩的四大因素影响分娩的四大因素2Four factors for laborFo

3、rceExpulsive Force 产力产力This is created by contraction of the abdominal muscles simutaneously with forced respiratory efforts with the glottis close.this is referred to as pushingLevator ani muscleLevator ani muscle is the most important part of pelvic floorAncillaryForce 辅助产力辅助产力uterine contractionA

4、 rhythmic tightening in labor of the upper uterine musculature that contracts the size of the uterus and pushes the fetus toward the birth canalMajor force子子 宫宫收缩力收缩力Retraction 缩复性缩复性intermissionContractioncontraction影响分娩的四大因素影响分娩的四大因素2Four factors for laboruterine ContractionfeatureForce子宫收缩力的四大特征子

5、宫收缩力的四大特征影响分娩的四大因素影响分娩的四大因素2Four factors for laborBirth canalForceFetusPsychical factors产产 力力产产 道道胎胎 儿儿精神因素精神因素影响分娩的四大因素影响分娩的四大因素2Four factors for laborBirth canalBony canal骨产道骨产道Soft tissue canal软产道软产道重点重点影响分娩的四大因素影响分娩的四大因素2Four factors for laborBirth canalBony canal骨产道骨产道Pelvic inlet planeSuperior

6、 straitPelvic outlet planeInferior straitMidpelvis outletleast pelvic dimension planepelvic axis(骨盆轴骨盆轴):A hypothetical line curving through the midpoint of the pelvic planes 连接骨盆各平面中点的假想曲线连接骨盆各平面中点的假想曲线影响分娩的四大因素影响分娩的四大因素2Four factors for laborBirth canalSoft canal软产道软产道（重点）（重点）Lower uterine segment

7、 子宫下段子宫下段Cervix,floor of pelvis,vagina宫颈、阴道、会阴及盆底宫颈、阴道、会阴及盆底Soft tissue part canal 软产道软产道影响分娩的四大因素影响分娩的四大因素2Four factors for laborBirth canalSoft canal软产道软产道 formation of lower uterine segment子宫下段形成子宫下段形成非孕时非孕时子宫子宫 孕足月子宫孕足月子宫 第一产程子宫第一产程子宫子宫峡部子宫峡部isthmusisthmus影响分娩的四大因素影响分娩的四大因素2Four factors for labo

8、rBirth canalSoft canal软产道软产道宫颈管Soft canal软产道软产道影响分娩的四大因素影响分娩的四大因素2Four factors for laborBirth canal影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetusForceBirth canalPsychical factors产产 力力产产 道道胎胎 儿儿精神因素精神因素Fetus 胎儿胎儿Fetal size胎儿大小胎儿大小Fetal lie胎产式胎产式Fetal attitude胎姿势胎姿势Fetal station胎先露高低胎先露高低Fetal present

9、ation胎先露胎先露Fetal position胎方位胎方位影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetusFetal lie 胎产式胎产式：胎体纵轴与母体纵轴的关系胎体纵轴与母体纵轴的关系Relation of long axis of fetus to that of the mother.Longitudinal 纵产式纵产式(99%),transverse横产式横产式 or oblique影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetus Fetal presentation 胎先露胎先露：最先进入

10、骨盆入最先进入骨盆入 口的胎儿部分口的胎儿部分Fetal part that directly overlies pelvic inletCephalic 头先露头先露,breech 臀先露臀先露,or shoulder肩先露肩先露影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetusFetal position 胎方位胎方位：胎儿先露部指示点与胎儿先露部指示点与母体骨盆的关系母体骨盆的关系（难点）（难点）影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetusLOA(left occipito-anterior)ROA

11、(right occipito-anterior)枕左前位枕左前位 枕右前位枕右前位头先露指示点头先露指示点枕骨枕骨影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetus LOT(left occipito-transverse)ROT(right occipito-transverse)枕左横位枕左横位 枕右横位枕右横位影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetusLOP(left occipito-posterior)ROP(right occipito-posterior)枕左后位枕左后位 枕右后位枕右后

12、位影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetus影响分娩的四大因素影响分娩的四大因素2Four factors for laborFetusLOA left occipito-anterior(枕左前位枕左前位)OutlineDefinition13Mechanism of labor2Four factors for laborOcciput presentation(枕先露的分娩机转枕先露的分娩机转)重难点重难点 1engagement 衔衔 接接2descent 下下 降降3flexion 俯俯 屈屈4internal rotation 内内

13、 旋旋 转转5extension 仰仰 伸伸6external rotation 外外 旋旋 转转7.expulsion 娩出娩出Mechanism of labor(枕先露的分娩机转枕先露的分娩机转)Occiput presentation3Mechanism of labor(枕先露的分娩机转枕先露的分娩机转)Occiput presentation31.Engagement 衔接衔接Passage of widest diameter of presenting part to level below the plane of the pelvic inlet胎儿先露部的最大径线进胎儿先

14、露部的最大径线进入骨盆入口平面，先露部入骨盆入口平面，先露部最低点接近或达到坐骨棘最低点接近或达到坐骨棘连线水平连线水平ischial spinesMechanism of labor(枕先露的分娩机转枕先露的分娩机转)Occiput presentation32、3.Descent&Flexion下降和俯曲下降和俯曲Occipitofrontal Diameter 12cmSuboccipitobregmatic Diameter 9.5cm枕下前囟枕下前囟径径枕额径枕额径Mechanism of labor(枕先露的分娩机转枕先露的分娩机转)Occiput presentation34.I

15、nternal rotation 胎儿内旋转胎儿内旋转As the head descends,the presenting part,usually in the transverse position,is rotated about 45to anteroposterior(AP)position under the symphysis.Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outletMechanism of labor(枕先露的分娩

16、机转枕先露的分娩机转)Occiput presentation35.Extension 仰伸仰伸1)With further descent and fullflexion of the head,the baseof the occiput comes in contactwith the inferior margin of thepubic symphysis2)Upward resistance from thepelvic floor and the downwardforces from the uterine contractions cause the occiput to e

17、xtend and rotate around the symphysis Mechanism of labor(枕先露的分娩机转枕先露的分娩机转)Occiput presentation36.External Rotation 外旋转外旋转When the fetus head is free of resistance,it untwists about 45left or right,returning to its original anatomic position in relation to the bodyMechanism of labor(枕先露的分娩机转枕先露的分娩机转)

18、Occiput presentation37.Expulsion 胎儿娩出胎儿娩出Mechanism of labor(枕先露的分娩机转枕先露的分娩机转)Occiput presentation3Mechanism of labor for left occiput anterior position分娩方式的进展分娩方式的进展Prospective for delivery methodBenefits 优点优点increasing chances of giving birth naturally and normally with the minimum of interference

19、or medical intervention.Reduce womens perceptions of painReduce episiotomy rates 减少会阴侧切率减少会阴侧切率 Limitation 局限性局限性Not all women can try water birthNeed professional equipmentMore expensiveAssignments 思考题思考题 What is the effect of psychical factor on the patient during the labor?精神因素对分娩的影响精神因素对分娩的影响有哪些有哪些？Try to illustrate the mechanism of the labor of breech presentation 阐述臀先露的分娩机转阐述臀先露的分娩机转Thank you!Have a nice day!二零零八年十月二零零八年十月