中国医科大学：《妇产科学》课程教学资源（PPT课件讲稿，英文版）Abnormal Labour

Abnormal labour

Abnormal Labour

Normal labour ◆3 elements a expulsive force a birth canal fetus

Normal labour 3 elements : ◼ expulsive force ◼ birth canal ◼ fetus

Abnormal labour o Abnormalities of the expulsive forces exPulsive force aBnormalities of the fetus o Abnormalities of the maternal pelvis

Abnormal labour Abnormalities of the expulsive forces Abnormalities of the fetus Abnormalities of the maternal pelvis

Abnormal expulsive force ◆ Uterine dysfunction hypotonic uterine dysfunction hypertonic uterine dysfunction

Abnormal expulsive force Uterine dysfunction  hypotonic uterine dysfunction  hypertonic uterine dysfunction

Hypotonic uterine dysfunction Effective contraction uterine activity is sufficient to make the cervix effacement and dilatation fetus descent

Hypotonic uterine dysfunction Effective contraction: ◼ uterine activity is sufficient to make the cervix effacement and dilatation, fetus descent

Etiology o Cephalopelvic disproportion or fetal mal position ◆ abnormal uterus psychological factors Endocrinal dysfunction excessive sedation or conduction analgesia

Etiology Cephalopelvic disproportion or fetal malposition abnormal uterus psychological factors endocrinal dysfunction excessive sedation or conduction analgesia

Clinical manifestation Coordinate hypotonic uterine dysfunction Incoordinate hypotonic uterine dysfunction partogram: World Health Organization partograph

Clinical manifestation Coordinate hypotonic uterine dysfunction incoordinate hypotonic uterine dysfunction partogram: World Health Organization partograph

o World Health Organization pantograph o A partogram was designed for use in developing countries(1992). Labour is divided into a latent phase which should last no longer than 8hours, and an active phase starting at 3cm dilatation the rate of which should be no slower than 1cm per hour. A4- hour wait is recommended before intervention when the active phase is slow. Labor is graphed and analysis includs use of alert and action lines. The protocol was found to be beneficial in Southeast Asia (WHO, 1994

World Health Organization partograph A partogram was designed for use in developing countries (1992).Labour is divided into a latent phase ,which should last no longer than 8hours, and an active phase starting at 3cm dilatation, the rate of which should be no slower than 1cm per hour. A 4- hour wait is recommended before intervention when the active phase is slow. Labor is graphed and analysis includs use of alert and action lines. The protocol was found to be beneficial in Southeast Asia.(WHO,1994)

7 concepts o Prolonged latent phase: 16 hr prolonged active phase: 8 hr Arrest active phase: Ocm/2hr prolonged second-stage labor: 2hr/ihr Arrest second-stage labor: Ocm/ihr delayed descent: =0cm/hr

7 concepts Prolonged latent phase:16 hr prolonged active phase:8 hr arrest active phase:0cm/2hr prolonged second-stage labor:2hr/1hr arrest second-stage labor:0cm/1hr delayed descent:=0cm/hr

Treatment Enhance the uterine contractibili ity othe goal is to affect uterine activity that is sufficient to produce cervical change and fetal descent while avoiding uterine hyperstimulation and fetal distress

Treatment Enhance the uterine contractibility the goal is to affect uterine activity that is sufficient to produce cervical change and fetal descent while avoiding uterine hyperstimulation and fetal distress