NormalLaborandDelivery

正常分娩

Obs&GynDepartmentof1stClinicalHospitalWuhanUniversityAssociateProfessorMinglei（明蕾）NormalLaborandDelivery

正常1影響分娩的四大因素2FourfactorsforlaborFetusNormalLaborand課件2OutlineDefinition123MechanismoflaborFourfactorsforlabor23（定義）OutlineDefinition123Mechanism3Definition1Deliveryistheprocessbywhichthematureornearlymaturefetusandplacenta

areexpelledfromthematernalbodyafter28weeks分娩是指妊娠滿28周及以后的胎兒及其附屬物從母體排出的過(guò)程（定義）Definition1Deliveryisthepro4Definition1Termdelivery:37-42weeks1足月產(chǎn)Pre-termdelivery:28-37weeks2早產(chǎn)

Post-termdelivery:42weeks3過(guò)期產(chǎn)Abortion:4流產(chǎn)<28weeks（定義）Definition1Termdelivery:5Definition13Mechanismoflabor2FourfactorsforlaborOutline影響分娩的四大因素NormalLaboranddeliveryForceBirthcanalFetusPsychicalfactors

產(chǎn)力

產(chǎn)道

胎兒精神因素Definition13Mechanismoflabor6影響分娩的四大因素2FourfactorsforlaborForceExpulsiveForce產(chǎn)力IntraabdominalpressureThisiscreatedbycontractionoftheabdominalmusclessimutaneouslywithforcedrespiratoryeffortswiththeglottisclose.thisisreferredtoaspushingLevatoranimuscleLevatoranimuscleisthemostimportantpartofpelvicfloorAncillaryForce

輔助產(chǎn)力uterinecontractionArhythmictighteninginlaboroftheupperuterinemusculaturethatcontractsthesizeoftheuterusandpushesthefetustowardthebirthcanalMajorforce子宮收縮力影響分娩的四大因素2Fourfactorsforlab7Rhythm節(jié)律性Symmetry對(duì)稱性Polarity極性Retraction縮復(fù)性intermissionContractioncontraction影響分娩的四大因素2FourfactorsforlaboruterineContractionfeatureForce子宮收縮力的四大特征Rhythm節(jié)律性Symmetry對(duì)稱性Pola8影響分娩的四大因素2FourfactorsforlaborBirthcanalNormalLaboranddeliveryForceFetusPsychicalfactors產(chǎn)力產(chǎn)道胎兒精神因素影響分娩的四大因素2Fourfactorsforlab9影響分娩的四大因素2FourfactorsforlaborBirthcanalBonycanal骨產(chǎn)道Birthcanal

產(chǎn)道Softtissuecanal軟產(chǎn)道重點(diǎn)影響分娩的四大因素2Fourfactorsforlab10影響分娩的四大因素2FourfactorsforlaborBirthcanalBonycanal骨產(chǎn)道PelvicinletplaneSuperiorstraitPelvicoutletplaneInferiorstraitMidpelvisoutletleastpelvicdimensionplanepelvicaxis(骨盆軸):

Ahypotheticallinecurvingthroughthemidpointofthepelvicplanes連接骨盆各平面中點(diǎn)的假想曲線

影響分娩的四大因素2Fourfactorsforlab11影響分娩的四大因素2FourfactorsforlaborFetusNormalLaborand課件12影響分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal軟產(chǎn)道（重點(diǎn)）

Loweruterinesegment

子宮下段Cervix,floorofpelvis,vagina宮頸、陰道、會(huì)陰及盆底Softtissuepartcanal

軟產(chǎn)道影響分娩的四大因素2Fourfactorsforlab13影響分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal軟產(chǎn)道

formationofloweruterinesegment子宮下段形成非孕時(shí)子宮孕足月子宮第一產(chǎn)程子宮子宮峽部isthmus影響分娩的四大因素2Fourfactorsforlab14影響分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal軟產(chǎn)道cervicaleffacementanddilatation宮頸管消失及宮口擴(kuò)張宮頸管影響分娩的四大因素2Fourfactorsforlab15Softcanal軟產(chǎn)道影響分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal影響分娩的四大因素2Fourfacto16影響分娩的四大因素2FourfactorsforlaborFetusNormalLaboranddeliveryForceBirthcanalPsychicalfactors產(chǎn)力產(chǎn)道胎兒精神因素Fetus

胎兒Fetalsize胎兒大小Fetallie胎產(chǎn)式Fetalattitude胎姿勢(shì)Fetalstation胎先露高低Fetalpresentation胎先露Fetalposition胎方位影響分娩的四大因素2Fourfactorsforlab17影響分娩的四大因素2FourfactorsforlaborFetusFetallie

胎產(chǎn)式：胎體縱軸與母體縱軸的關(guān)系Relationoflongaxisoffetustothatofthemother.Longitudinal縱產(chǎn)式(99%),transverse橫產(chǎn)式

oroblique影響分娩的四大因素2Fourfactorsforlab18影響分娩的四大因素2FourfactorsforlaborFetus

Fetalpresentation

胎先露：最先進(jìn)入骨盆入 口的胎兒部分FetalpartthatdirectlyoverliespelvicinletCephalic頭先露,breech臀先露,orshoulder肩先露影響分娩的四大因素2Fourfactorsforlab19影響分娩的四大因素2FourfactorsforlaborFetusFetalposition

胎方位：胎兒先露部指示點(diǎn)與母體骨盆的關(guān)系（難點(diǎn)）Therelationofanarbitrarily

chosenportionofthepresentingpartofthefetustotherightorleftsideofthematernalbirthcanal.

Formoreaccurately–anterior,transverse,posterior影響分娩的四大因素2Fourfactorsforlab20影響分娩的四大因素2FourfactorsforlaborFetusLOA(leftoccipito-anterior)ROA(rightoccipito-anterior)枕左前位枕右前位頭先露指示點(diǎn)枕骨影響分娩的四大因素2Fourfactorsforlab21影響分娩的四大因素2FourfactorsforlaborFetus

LOT(leftoccipito-transverse)ROT(rightoccipito-transverse)枕左橫位枕右橫位影響分娩的四大因素2Fourfactorsforlab22影響分娩的四大因素2FourfactorsforlaborFetusLOP(leftoccipito-posterior)ROP(rightoccipito-posterior)

枕左后位枕右后位影響分娩的四大因素2Fourfactorsforlab23影響分娩的四大因素2FourfactorsforlaborFetus影響分娩的四大因素2Fourfactorsforlab24影響分娩的四大因素2FourfactorsforlaborFetusLOAleftoccipito-anterior(枕左前位)影響分娩的四大因素2Fourfactorsforlab25OutlineDefinition13Mechanismoflabor2FourfactorsforlaborOcciputpresentation(枕先露的分娩機(jī)轉(zhuǎn))重難點(diǎn)

1engagement

銜接2descent

下降3flexion

俯屈4internalrotation

內(nèi)旋轉(zhuǎn)5extension

仰伸6externalrotation

外旋轉(zhuǎn)7.expulsion娩出OutlineDefinition13Mechanismo26Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation3Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc27Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation31.Engagement銜接Passageofwidestdiameterofpresentingparttolevelbelowtheplaneofthepelvicinlet胎兒先露部的最大徑線進(jìn)入骨盆入口平面，先露部最低點(diǎn)接近或達(dá)到坐骨棘連線水平ischialspinesMechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc28Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation32、3.

Descent&Flexion下降和俯曲OccipitofrontalDiameter12cmSuboccipitobregmaticDiameter9.5cm枕下前囟徑枕額徑Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc29Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation34.Internalrotation

胎兒內(nèi)旋轉(zhuǎn)Astheheaddescends,thepresentingpart,usuallyinthetransverseposition,isrotatedabout45°toanteroposterior(AP)positionunderthesymphysis.InternalrotationbringstheAPdiameteroftheheadinlinewiththeAPdiameterofthepelvicoutletMechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc30Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation35.Extension仰伸1)Withfurtherdescentandfullflexionofthehead,thebaseoftheocciputcomesincontactwiththeinferiormarginofthepubicsymphysis2)UpwardresistancefromthepelvicfloorandthedownwardforcesfromtheuterinecontractionscausetheocciputtoextendandrotatearoundthesymphysisMechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc31Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation36.ExternalRotation

外旋轉(zhuǎn)Whenthefetus'headisfreeofresistance,ituntwistsabout45°leftorright,returningtoitsoriginalanatomicpositioninrelationtothebodyMechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc32Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation37.Expulsion

胎兒娩出Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc33Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation3MechanismoflaborforleftocciputanteriorpositionMechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc34分娩方式的進(jìn)展

Prospectivefordeliverymethod

Benefits

優(yōu)點(diǎn)increasingchancesofgivingbirthnaturallyandnormallywiththeminimumofinterferenceormedicalintervention.Reducewomen'sperceptionsofpainReduceepisiotomyrates減少會(huì)陰側(cè)切率

Limitation局限性NotallwomencantrywaterbirthNeedprofessionalequipmentMoreexpensive水中分娩waterbirth分娩方式的進(jìn)展

Prospectivefordelive35Assignments思考題

Whatistheeffectofpsychicalfactoronthepatientduringthelabor?精神因素對(duì)分娩的影響有哪些？Trytoillustratethemechanismofthelaborof breechpresentation闡述臀先露的分娩機(jī)轉(zhuǎn)Assignments思考題Whatistheef36Thankyou!Haveaniceday!二零零八年十月Thankyou!Haveaniceday!二零零八37NormalLaborandDelivery

正常分娩

Obs&GynDepartmentof1stClinicalHospitalWuhanUniversityAssociateProfessorMinglei（明蕾）NormalLaborandDelivery

正常38影響分娩的四大因素2FourfactorsforlaborFetusNormalLaborand課件39OutlineDefinition123MechanismoflaborFourfactorsforlabor23（定義）OutlineDefinition123Mechanism40Definition1Deliveryistheprocessbywhichthematureornearlymaturefetusandplacenta

areexpelledfromthematernalbodyafter28weeks分娩是指妊娠滿28周及以后的胎兒及其附屬物從母體排出的過(guò)程（定義）Definition1Deliveryisthepro41Definition1Termdelivery:37-42weeks1足月產(chǎn)Pre-termdelivery:28-37weeks2早產(chǎn)

Post-termdelivery:42weeks3過(guò)期產(chǎn)Abortion:4流產(chǎn)<28weeks（定義）Definition1Termdelivery:42Definition13Mechanismoflabor2FourfactorsforlaborOutline影響分娩的四大因素NormalLaboranddeliveryForceBirthcanalFetusPsychicalfactors

產(chǎn)力

產(chǎn)道

胎兒精神因素Definition13Mechanismoflabor43影響分娩的四大因素2FourfactorsforlaborForceExpulsiveForce產(chǎn)力IntraabdominalpressureThisiscreatedbycontractionoftheabdominalmusclessimutaneouslywithforcedrespiratoryeffortswiththeglottisclose.thisisreferredtoaspushingLevatoranimuscleLevatoranimuscleisthemostimportantpartofpelvicfloorAncillaryForce

輔助產(chǎn)力uterinecontractionArhythmictighteninginlaboroftheupperuterinemusculaturethatcontractsthesizeoftheuterusandpushesthefetustowardthebirthcanalMajorforce子宮收縮力影響分娩的四大因素2Fourfactorsforlab44Rhythm節(jié)律性Symmetry對(duì)稱性Polarity極性Retraction縮復(fù)性intermissionContractioncontraction影響分娩的四大因素2FourfactorsforlaboruterineContractionfeatureForce子宮收縮力的四大特征Rhythm節(jié)律性Symmetry對(duì)稱性Pola45影響分娩的四大因素2FourfactorsforlaborBirthcanalNormalLaboranddeliveryForceFetusPsychicalfactors產(chǎn)力產(chǎn)道胎兒精神因素影響分娩的四大因素2Fourfactorsforlab46影響分娩的四大因素2FourfactorsforlaborBirthcanalBonycanal骨產(chǎn)道Birthcanal

產(chǎn)道Softtissuecanal軟產(chǎn)道重點(diǎn)影響分娩的四大因素2Fourfactorsforlab47影響分娩的四大因素2FourfactorsforlaborBirthcanalBonycanal骨產(chǎn)道PelvicinletplaneSuperiorstraitPelvicoutletplaneInferiorstraitMidpelvisoutletleastpelvicdimensionplanepelvicaxis(骨盆軸):

Ahypotheticallinecurvingthroughthemidpointofthepelvicplanes連接骨盆各平面中點(diǎn)的假想曲線

影響分娩的四大因素2Fourfactorsforlab48影響分娩的四大因素2FourfactorsforlaborFetusNormalLaborand課件49影響分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal軟產(chǎn)道（重點(diǎn)）

Loweruterinesegment

子宮下段Cervix,floorofpelvis,vagina宮頸、陰道、會(huì)陰及盆底Softtissuepartcanal

軟產(chǎn)道影響分娩的四大因素2Fourfactorsforlab50影響分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal軟產(chǎn)道

formationofloweruterinesegment子宮下段形成非孕時(shí)子宮孕足月子宮第一產(chǎn)程子宮子宮峽部isthmus影響分娩的四大因素2Fourfactorsforlab51影響分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal軟產(chǎn)道cervicaleffacementanddilatation宮頸管消失及宮口擴(kuò)張宮頸管影響分娩的四大因素2Fourfactorsforlab52Softcanal軟產(chǎn)道影響分娩的四大因素2FourfactorsforlaborBirthcanalSoftcanal影響分娩的四大因素2Fourfacto53影響分娩的四大因素2FourfactorsforlaborFetusNormalLaboranddeliveryForceBirthcanalPsychicalfactors產(chǎn)力產(chǎn)道胎兒精神因素Fetus

胎兒Fetalsize胎兒大小Fetallie胎產(chǎn)式Fetalattitude胎姿勢(shì)Fetalstation胎先露高低Fetalpresentation胎先露Fetalposition胎方位影響分娩的四大因素2Fourfactorsforlab54影響分娩的四大因素2FourfactorsforlaborFetusFetallie

胎產(chǎn)式：胎體縱軸與母體縱軸的關(guān)系Relationoflongaxisoffetustothatofthemother.Longitudinal縱產(chǎn)式(99%),transverse橫產(chǎn)式

oroblique影響分娩的四大因素2Fourfactorsforlab55影響分娩的四大因素2FourfactorsforlaborFetus

Fetalpresentation

胎先露：最先進(jìn)入骨盆入 口的胎兒部分FetalpartthatdirectlyoverliespelvicinletCephalic頭先露,breech臀先露,orshoulder肩先露影響分娩的四大因素2Fourfactorsforlab56影響分娩的四大因素2FourfactorsforlaborFetusFetalposition

胎方位：胎兒先露部指示點(diǎn)與母體骨盆的關(guān)系（難點(diǎn)）Therelationofanarbitrarily

chosenportionofthepresentingpartofthefetustotherightorleftsideofthematernalbirthcanal.

Formoreaccurately–anterior,transverse,posterior影響分娩的四大因素2Fourfactorsforlab57影響分娩的四大因素2FourfactorsforlaborFetusLOA(leftoccipito-anterior)ROA(rightoccipito-anterior)枕左前位枕右前位頭先露指示點(diǎn)枕骨影響分娩的四大因素2Fourfactorsforlab58影響分娩的四大因素2FourfactorsforlaborFetus

LOT(leftoccipito-transverse)ROT(rightoccipito-transverse)枕左橫位枕右橫位影響分娩的四大因素2Fourfactorsforlab59影響分娩的四大因素2FourfactorsforlaborFetusLOP(leftoccipito-posterior)ROP(rightoccipito-posterior)

枕左后位枕右后位影響分娩的四大因素2Fourfactorsforlab60影響分娩的四大因素2FourfactorsforlaborFetus影響分娩的四大因素2Fourfactorsforlab61影響分娩的四大因素2FourfactorsforlaborFetusLOAleftoccipito-anterior(枕左前位)影響分娩的四大因素2Fourfactorsforlab62OutlineDefinition13Mechanismoflabor2FourfactorsforlaborOcciputpresentation(枕先露的分娩機(jī)轉(zhuǎn))重難點(diǎn)

1engagement

銜接2descent

下降3flexion

俯屈4internalrotation

內(nèi)旋轉(zhuǎn)5extension

仰伸6externalrotation

外旋轉(zhuǎn)7.expulsion娩出OutlineDefinition13Mechanismo63Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation3Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc64Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation31.Engagement銜接Passageofwidestdiameterofpresentingparttolevelbelowtheplaneofthepelvicinlet胎兒先露部的最大徑線進(jìn)入骨盆入口平面，先露部最低點(diǎn)接近或達(dá)到坐骨棘連線水平ischialspinesMechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc65Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation32、3.

Descent&Flexion下降和俯曲OccipitofrontalDiameter12cmSuboccipitobregmaticDiameter9.5cm枕下前囟徑枕額徑Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc66Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation34.Internalrotation

胎兒內(nèi)旋轉(zhuǎn)Astheheaddescends,thepresentingpart,usuallyinthetransverseposition,isrotatedabout45°toanteroposterior(AP)positionunderthesymphysis.InternalrotationbringstheAPdiameteroftheheadinlinewiththeAPdiameterofthepelvicoutletMechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Oc67Mechanismoflabor(枕先露的分娩機(jī)轉(zhuǎn))Occiputpresentation35.Extension仰伸1)Withfu