妇产科学英语课件之屠蕊沁-Abnormal Labor.ppt

Abnormal Labor (dystocia) Tu Rui-qin Department of gynecology and obstetrics Zhongshan Hospital, Fudan University cause of dystocia： （一）abnormalities of powers: uterine contractility and maternal expulsive effort； （二）abnormalities of the passage :the pelvis； （三）abnormalities involving the passenger: fetus； （四）psychological impact。 Review of normal labor definition Dystocia is the conse-quence of four distinct abnormalities above that may exist singly or in combination or not fit for each other. Management of second stage： Vaginal delivery ：augmentation of uterine contraction；episiotomy，vacuum extraction or forceps delivery。 Cesarean delivery：when there is still no progress on birth process or fetal intrauterine distress is shown Management of third stage： prevent postpartum-oxytocin 10~20U＋25%gs20ml iv after delivery of fetal shoulder Abnormal bony pelvi definition: pelvis which of paramorphia or any contraction of the pelvic diameters that makes the capacity of the pelvis too small for fetal presentation to pass and descent and hinder the birth process, is called contracted pelvis. （一）clinical classification 1．Contracted pelvis inlet（platypelloid type pelvis） characteristic ： Shorten anteroposterior diameter of inlet. normal diameter transversa. B. External conjugate＜18cm； C. anteroposterior diameter of inlet ＜10cm； D. Diagonal Conjugate (DC)＜11.5cm。 RACHITIC FLAT PELVIS Combinations of contracted pelvic inlet ,the midpelvis and the pelvic outlet-generally contracte pelvis 2cm less than normal value for each diameters of the three pelvic plane Abnormal fetal position 1. common cause for dystocia 2.Malposition of head in head presentation seen more frequently sincipital presentation：engage by the position without flexion or extention diagnosis： Clinical manifestation Abdomen examination Per vagina examination B ultrasound management：tr