難產(chǎn)(dystocia)-滕銀成課件(PPT 47頁)

1、Dystocia Teng Yincheng M.D., Ph.D., Professor Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine 第1頁，共47頁。DefinitionDystocia literally means difficult labor and it is characterized by abnormally slow progress of laborIt is the consequence of four distinct abno

2、rmalities that may exist singly or combination2第2頁，共47頁。Abnormal of the powers(uterine contractility and maternal expulsive effort)Abnormalities of passenger(the fetus)Abnormalities of the passage(the birth canal)Categories of dystocia3第3頁，共47頁。Abnormalities of the powersUterine dysfunction hypotoni

3、c primary uterine inertia secondaryUterine hypertonicDysfunction uterine hypercontractility4第4頁，共47頁。Abnormalities of the powers-uterine inertia1.Etiology of uterine inertiaCephalopelvic disproportion or Fetal malposition Abnormal of uterine muscleImbalance of endocrine systemAdministration of analg

4、esiapsychical-factorsOthers fatigue5第5頁，共47頁。Abnormalities of the powers-uterine inertia6第6頁，共47頁。Abnormalities of the powers-uterine inertia2.Clinical findingsFailure to progressLack of progressive cervical dilatation Prolonged latent phase ( 16h) Prolonged active phase ( 8h ; 1.2cm/h or 2h) Prolon

5、ged second phase(2h )Lack of fetal decent Prolonged descent (1cm/h; 1h) Prolonged labor (24h)7第7頁，共47頁。Abnormalities of the powers-uterine inertia3.diagnosisPalpation: strength duration frequencyTocodynamometerVaginal examination8第8頁，共47頁。9第9頁，共47頁。10第10頁，共47頁。11第11頁，共47頁。Abnormalities of the powers

6、-uterine inertia4.Effect on maternal and fetus maternal fatigue acidosis infection postpartum hemorrhage cesarean section rate fetus birth injury distress prolapse of umbilical cord stillbirth12第12頁，共47頁。Abnormalities of the powers-uterine inertia5.managementhypotonic 1) general management 心理護(hù)理 飲食護(hù)理

7、 鎮(zhèn)靜 2) physical methods 導(dǎo)尿 灌腸 人工破膜 針刺穴位 13第13頁，共47頁。14第14頁，共47頁。Abnormalities of the powers-uterine inertia3) Drugs oxytocin 2.5U + 5%GS 500ml 5mU/ml 8滴分開始地西泮10mg iv15第15頁，共47頁。Abnormalities of the powers-uterine inertiaHypertonicSedativeCS16第16頁，共47頁。Abnormalities of the powers- hypercontractility1

8、.Clinical findings and diagnosisPrecipitate deliveryConstriction ring of uterusTetanic contraction of uterus17第17頁，共47頁。Abnormalities of the powers- hypercontractility2.Effect on maternal and fetusPrecipitate deliverysoft birth canal traumaRupture of uterusFetal distressFetal deathstillbirth18第18頁，共

9、47頁。Abnormalities of the powers- hypercontractility3.managementProphylaxisTocolytic therapiesForcepoperation19第19頁，共47頁。Dystocia Part II第20頁，共47頁。 Abnormalities of birth canal1.Bony pelvic1)Contracted pelvic inlet simple flat pelvis rachitic flat pelvis21第21頁，共47頁。2)Contracted midpelvis (anthropoid

10、pelvis)22第22頁，共47頁。3)Contracted pelvic outlet (funnel shaped pelvis)23第23頁，共47頁。4)Generally contracted pelvis5)Disruption of normal female pelvic architecture osteomalacic pelvis obliquely contracted pelvis 24第24頁，共47頁。Clinical signs of contracted pelvisContracted pelvic inletContracted midpelvisCon

11、tracted pelvic outlet25第25頁，共47頁。Diagnosis :HistoryPhysical examinationPelvimetry external pelvimetry internal pelvimetry diagonal conjugate 12.513cm bi-ischial diameter 10cm incisura ischiadica 56cm angle of subpubic arch 9026第26頁，共47頁。27第27頁，共47頁。Effects on maternal and fetusManagement2. Abnormal

12、of soft birth canal28第28頁，共47頁。Abnormalities of the passenger A. malposition and malpresentation a. vertex malposition persistent occiput posterior persistent occiput transverse 5% sincipital presentation 1.08% anterior asynclitism posterior asynclitism 0.5%0.81% b. brow presentation 0.03%0.1% c. fa

13、ce presentation 0.08%0.27% d. breech presentation 3%4% e. abnormal fetal lie transverse or oblique lie 0.25%29第29頁，共47頁。30第30頁，共47頁。31第31頁，共47頁。32第32頁，共47頁。33第33頁，共47頁。Breech presentation complete(mixed) breech presentation frank breech presentation incomplete breech presentation knee or footling pr

14、esentation34第34頁，共47頁。Extraction of breech35第35頁，共47頁。36第36頁，共47頁。37第37頁，共47頁。B. Fetal macrosomia large for gestational age(LGA) 4000g shoulder dystosia38第38頁，共47頁。39第39頁，共47頁。C. Fetal malformation40第40頁，共47頁。Operative delivery1)forceps operations2)Vacuum extractor41第41頁，共47頁。2)Vacuum extractor42第42頁，共47頁。3)Cesarean section43第43頁，共47頁。44第44頁，共47頁。Main point of dystocia managemnet45第45頁，共47頁。思考題:1.The definition and classification of dystosia2.How