扬州大学：《妇产科学》课程教学课件（PPT讲稿）24 难产 dystocia

?dystocia

仁济医院 RENJI HOSPITAL dystocia

DefinitionDystocia literally means difficultlabor and it is characterized byabnormally slow progress of laborIt is the consequence of four distinctabnormalities that may existsingly orcombinationRENJIHOSPITAL

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 dystociaAbnormal of the powers(uterine contractilityand maternal expulsive effort)Abnormalities of passenger(the fetus)Abnormalities of the passage(the birth canal)RENJIHOSPITAL

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 powersUterine dysfunctionhypotonic-primaryuterine inertiasecondaryUterinehypertonicDysfunctionuterine hypercontractilityRENJIHOSPITAL

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

Abnormalities of the powersTable 1. Clinical Criteria for the Differentiation of the Two Types of DysfunctionHYPOTONICHYPERTONICOccurrence rate4% of labors1% of laborsPhase of laborActiveLatentClinical symptomPainlessPainfulFetal distressLateEarlyReaction to oxytocinFavorableUnfavorableLitleValueof sedationGreatRENJIHOSPITAL

5 RENJI HOSPITAL Abnormalities of the powers

Abnormalities of the powers-----uterine inertia1.Etiology of uterine inertiaCephalopelvic disproportion orFetalmalpositionAbnormal of uterine muscleImbalance of endocrine systemAdministrationof analgesiapsychical-factorsOthers fatigueRENJIHOSPITAL

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 inertia2.Clinical findingsFailure to progressLack of progressive cervical dilatationProlonged latent phaseProlongedactive phaseProtracted activephaseProlonged second phaseLackoffetaldecentProlonged descentProtracted descentProlonged laborRENJIHOSPITAL

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 inertiaExternalUltrasoundDopplerMonitoringUterinecontractionfrequencyand durationTocodynamometer3.diagnosisPalpation:FetalhearratestrengthUterinecontractionfrequencyanddurationuterinecontractionstrength-millimetersdurationStrain gaugeofmercuryrestinguterinetoneInternalIntrauterinepressure(pressure)MonitoringcatheterfrequencyTocodynamometerFetal heartrateVaginalexaminationand variability,long-andshort-termFetalscalpelectrode(FSE)JRE7.1.Tocodynamometers and intrauterine pressure catheters

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

10min49mmHg44mmHg50mmHg47mmHg52mmHg国鸟2图11-3宫缩强度Montevideo单位监测维·商请L5

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410-98一正常(o）7异常(3)(1)潜伏期延长6(2)活跃期延长5(3)活跃期停滞4-(4)第二产程延长(1)3-2106842102022242614161812产程时间(h)2产程延缓及停滞示意图图11-2

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