正常分娩(英文)PPT课件

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膈肌
腹肌
子宫收缩力
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肛提肌
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levator ani muscles contractions
※ Form a V-shaped sling that tends to rotate the occipital anteriorly(internal rotation)。 ＆ Help the fetus’ extension and delivery。 ＆Help the expulsion of the placenta。
骶尾关节 Sacro-iliac jiont
耻骨联合 Symphysis publis
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The bony pelvis (the true pelvis)
Pelvic inlet plane Pelvic midplane Pelvic outlet plane
Three pelvic plane:
Normal Labor
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Objective
Definition of labor. Determinate Factors of Labor Anatomical considerations: The female pelvis. The fetal skull. The stages of labor. The mechanism of labor (vertex, LOA). Management of normal labor.
Term Delivery：A term delivery occurs
between 37 and 42 weeks from the last menstrual period.
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Premature labor：Preterm labor is that occurring before 37 weeks of gestational age.
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Changes of cervix
Effacement of cervix
dilatation of cervix
The upper segment contracts, retracts,and expels the fetus; in response to the force of the contractions of the upper segment, the ripened lower uterine segment and cervix dilate and thereby form a greatly expanded、 thinned-out muscular and fibromuscular tube through which the fetus can be extruded.
Postdate pregnancy：Postdate pregnancy occurs after 42 weeks .
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The etiology of labor
Not sure:
1、Cervix ripend and lower uterine segment development theory； 2、Endocrine regulating theory； 3、Mechanical theory； 4、Neurohumor theory ； 5、Immunologic theory；
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Pelvic inlet plane
Have three diameters:
(1)Anteroposterior diameter or The true conjugate: average 11cm.
(2)Transverse diameter:average 13cm. (3)Inclined diameter:average 12.75cm
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The intra-abdominal pressure
Created by contraction of the abdominal muscles simultaneously with forced respiratory efforts with glottis closed.
Four diameters: Anteroposterior: diameter of outlet： 11.5cm。 Transverse outlet： the distance between the inner edges of the ischial tuberosities。9cm Anterior sagittal diameter：6cm。 Posterior sagittal diameter ：8.5cm。
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1、Transverse outlet
2、 Anterior sagittal diameter
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3、 Posterior sagittal
diameter
4、 Anteroposterior diameter of outlet
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Pelvic axis and inclination of pelvic
♀ uterine contraction
♀ intra-abdominal pressure
♀levator ani musclesБайду номын сангаасcontractions.
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Uterine contractions
Have three unique characteristics:
★Rhythm: increase in frequency and duration,is the
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Definitions：Labor is the process by which
contractions of the gravid uterus expel the fetus and the other products of conception after 28 weeks from the last menstrual period.
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★Retraction:The myometrium of the upper uterine
segment does not relax to its original length after contractions;rather, it becomes relative fixed at a shorter length.
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Passage
The passage of the fetus delivery, including: the bony pelvis and soft tissues of pelvis
骶骨 Os sacrum
尾骨 Os coccyx
坐骨结节 Os ischium
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髂骨 os ilium
极期
进行
宫缩
退行
间歇期
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宫缩
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Characteristic of normal uterine action
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★Symmetry and Polarity
The intensity of the upper segment of the uterus is the most strong
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The true conjugate The inclined diameter The transverse diameter
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Three anteroposterior diameters of the pelvic inlet
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＆It is a necessary auxiliary to uterine contractions in second stage of labor。
＆After the placenta has separated,its spontaneous expulsion is aided by the mother increasing intraabdominal pressure。
important marker of in labor。
★ Symmetry and polarity ★ Retraction
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Rhythm
Increase in frequency and duration
Periods of relaxation between contractions are essential to the welfare of the fetus.
Pelvic axis：The axis of the pelvis refers to the curve of the birth canal as described by a line drawn through the center of each of the four planes
Inclination of pelvic :The angle of the pelvic inlet plane with ground level when women stand.always 60 degree。
Maturation of fetus and change of uterus function is necessary.
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Four Determinate Factors of Labor
The progress and final outcome of labor are influenced by 4 factors . (1)the powers (2)the passage (3)the passenger (4)the psyche
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The expulsive forces(The powers)
The power that expulse the fetus and the other products of conception is called the expulsive forces, which include
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Pelvic axis
Inclination of pelvic
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The soft part of the birth canal
Formation of lower uterine segment、cervix、
vagina 、soft tissue in the floor of pelvis.
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The lower uterine segment
Developed from the isthmus of the uterus of nonpregnant women.
Physiologic retraction ring : The actively contracting upper segment becomes thicker as labor advances,the lower uterine segment is relatively thin compared with the upper segment,between them a physiologic retraction ring appear.
Pelvic midplane
The smallest plane of the pelvis, particular importance in obstructed labor. Anteroposterior diameter of mid pelvis：average 11.5cm. Transverse diameter of mid pelvis ： alse be called interspinous diameter,average 10cm.
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Anteroposterior diameter of mid pelvis
Transverse diameter of mid pelvis
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Transverse diameter of the midpelvis
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Pelvic outlet plane