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1、Normal Labor and Delivery(AFE)正常分娩正常分娩 Lin Lin J Jianhuaianhua M.D., Ph.D., ProfessorM.D., Ph.D., Professor Department Of Obstetrics & Gynecology Department Of Obstetrics & Gynecology RenjiRenji Hospital Affiliated to SJTU School of Medicine Hospital Affiliated to SJTU School of Medicinedefinitionn
2、nTerm delivery(labor): 37-42weeksn npre-term delivery: 28- 37 weeksn npost-term delivery: 42 weeksn nAbortion: 28 weeksn n85% of women spontaneous labor and delivery between 37-42 weeks n nLMP :last menstrual periodn nEDC: expected date of confinememtThe four factors for laborn nForce (contraction)n
3、 nbirth canal (bony canal)n nfetus (lie,position ,presentation,weight)n npsychical-factorsThe contractionsn n increase in frequency and durationn nuterus can be felt to harden during contraction n nlasting about 30-45 secondsn ninterval between contractions to be 5 minn nthe pain of labor is a chara
4、cterNST CST Bony pelvisn nThe planes of pelvisn n inlet plane (promontory)n n mid plane of pelvis(ischial spines)n n outlet plane(two intersecting triangles)n n Mechanism of laborn nEngagement*n nFlexionn nDecentn nInternal rotationn nExtensionn nExternal rotationSymptoms and signs of the onset of t
5、he laborn nPainful uterine contractionn na shown neffacement and dilation of the cervixn nrupture of membranes The shown nThe mucus plug is expelled from the cervixn nmixing with a little blood the rupture of the membranesn nat any time during laboreffacement and dilation of the cervixn nto be short
6、,taken up,dilatedStages of laborn nThe first stage:The first stage: n n onset of labor to full cervical dilation(10cm) onset of labor to full cervical dilation(10cm)n n the latent phase ( the latent phase ( onestonest to 3cm, 16h) to 3cm, 3cm to 10cm, 3cm to 10cm, 8h)n nThe second stage:The second s
7、tage:n n 10 cm to the delivery of the infant, 2h 10 cm to the delivery of the infant, 2hn nThe third stage:The third stage:n n delivery of the infant to delivery of the delivery of the infant to delivery of the placenta, 30mplacenta, 30mn nThe fourth stage:The fourth stage:n n 2 hours after delivery
8、 of the placenta 2 hours after delivery of the placentaManagement of normal labor n nThe first stage:n neducation, eating, voiding, n nposition(sitting, reclining, recumbent)n nmonitoring of the fetal heart rate ,n ndilation of cervix and frequency n n severity of uterus contractions(auscultation or
9、 electronic monitoring)The second stagen n:- 2 hourn nfetal heart raten nmaternal conditions:n n pulse, blood pressure, respiratory rate , n n temperature, urine output, fluid intaken n evaluation of progress of laborn n cervical dilation, station,position of the n n presenting part, status of membr
10、anes, n n meconium, bloodn nPushing:n nwith the onset of each contraction, the mother is encouraged to inhale,hold her breath, and pushn nincrease in intra-abdominal pressuren naiding in fetal descent through the birth cacal.n nHead visible on vulval gapping*n nCrowning of head*n nLaceration or Epis
11、iotomyn nDelivery of fetusn nDeal with umbilical cordthe third stage:n nwaiting for up to 30 minn nthe uterus decreases in sizen ndelivery of placenta(spontaneously, manuallyn ninspection of the birth canaln nevaluated for lacerations“The fourth stage”n npostpartum uterine hemorrhage ,1%n n uterus p
12、alpation through the abdominal wall is repeatsn nthe amount of blood on pads are monitoredn npulse and BP are monitored n nuse of drug : oxytocinTHANKS FOR YOUR ATTENTION Lin Lin JianhuaJianhua M.D., Ph.D., ProfessorM.D., Ph.D., ProfessorDep. of Dep. of ObstetObstet. & . & GynecolGynecol. .RenjiRenji Hospital Affiliated to SJTU School of Medicine Hospital Affiliated to SJTU School of Medicine
