上海交通大学医学院：《妇产科学》（双语） 5 dystocia

★ dystocia Teng Yincheng H证

仁济医院 RENJI HOSPITAL dystocia Teng Yincheng

★ X Definition Dystocia literally means difficult labor and it is characterized by abnormally slow progress of labor It is the consequence of four distinct abnormalities that may exist singly or combination RENJI HOSPITAL

2 RENJI HOSPITAL Definition Dystocia literally means difficult labor and it is characterized by abnormally slow progress of labor It is the consequence of four distinct abnormalities that may exist singly or combination

★ Categories of dystocia Abnormal of the powers(uterine contractility and matenal expulsive effort Abnormalities of passenger(the fetus o Abnormalities of the passage(the birth canal) RENJI HOSPITAL

3 RENJI HOSPITAL uAbnormal of the powers(uterine contractility and maternal expulsive effort) uAbnormalities of passenger(the fetus) uAbnormalities of the passage(the birth canal) Categories of dystocia

★ Abnormalities of the powers Uterine dysfunction hy potonic-primary uterine inertia secondary Uterine hypertonic Dysfunction uterine hypercontractility RENJI HOSPITAL

4 RENJI HOSPITAL Abnormalities of the powers Uterine dysfunction hypotonic primary uterine inertia secondary Uterine hypertonic Dysfunction uterine hypercontractility

★ Abnormalities of the powers Table 1. Clinical Criteria for the Differentiation of the Two Types of Dysfunction HYPOTONIC HYPERTONIC Occurrence rate 4 of labors 1% of labors Phase of labor Active Latent Clinical symptom Fetal distress Reaction to oxytocin Favorable Unfavorable value of sedation great RENJI HOSPITAL

5 RENJI HOSPITAL Abnormalities of the powers

Abnormalities of the powers uterine inertia 1.Etiology of uterine inertia Cephalopelvic disproportion or Fetal malposition Abnormal of uterine muscle Imbalance of endocrine system Administration of analgesia psychical-factors Others fatigue RENJI HOSPITAL

6 RENJI HOSPITAL Abnormalities of the powers -----uterine inertia 1.Etiology of uterine inertia uCephalopelvic disproportion or Fetal malposition uAbnormal of uterine muscle uImbalance of endocrine system uAdministration of analgesia upsychical-factors uOthers fatigue

Abnormalities of the powers uterine inertia 2. Clinical findings Failure to progress Lack of progressive cervical dilatation Prolonged latent phase Prolonged active phase Protracted active phase Prolonged second phase e Lack of fetal decent Prolonged descent Protracted descent Prolonged labor RENJI HOSPITAL

7 RENJI HOSPITAL Abnormalities of the powers -----uterine inertia 2.Clinical findings Failure to progress v Lack of progressive cervical dilatation Prolonged latent phase Prolonged active phase Protracted active phase Prolonged second phase v Lack of fetal decent Prolonged descent Protracted descent Prolonged labor

Abnormalities of the powers uterine inertia Ultrasound Doppler Uterine contraction frequency 3.diagnosis Palpation: Fetal heart strength Uterine contraction frequency and duration duration strength-millimeters Strain gauge resting uterine tone Internal ntrauterine pressure (pressure) Monitoring catheter frequency ocodynamometer Vaginal examination Fetal heart rate long- and short-term Fetal scalp JRE 7.1- Tocodynamometers and intrauterine pressure catheters

8 RENJI HOSPITAL Abnormalities of the powers -----uterine inertia 3.diagnosis Palpation: strength duration frequency Tocodynamometer Vaginal examination

10min ■ □■■■■■■■ ■■国国■■■ ■■■■圈■ ■■ ■■■■■■ 口■■■ ■■■■■■ 52mmHg 50mmHg 47mmHg 44mmHg 491 mm 图113宫官缩强度 Montevideo单位监测

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10 正常 异常 潜伏期延长 2)活跃期延长 (3活跃期停滞 (4第二产程延长 2468101214161820222426 产程时间h) 图112产程延缓及停滞示意图

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