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,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Normal Labor and Delivery(AFE)正常分娩,Lin J,ianhua,M.D.,Ph.D.,Professor,Department Of Obstetrics&Gynecology,Renji Hospital Affiliated to SJTU School of Medicine,definition,Term delivery(labor):37-42weeks,pre-term delivery:28-37 weeks,post-term delivery:,42 weeks,Abortion:,28 weeks,85%of women spontaneous labor and delivery between 37-42 weeks,LMP:last menstrual period,EDC:expected date of confinememt,The four factors for labor,Force(contraction),birth canal(bony canal),fetus(lie,position,presentation,weight),psychical-factors,The contractions,increase in frequency and duration,uterus can be felt to harden during contraction,lasting about 30-45 seconds,interval between contractions to be 5 min,the pain of labor is a character,NST CST,Bony pelvis,The planes of pelvis,inlet plane(promontory),mid plane of pelvis(ischial spines),outlet plane(two intersecting triangles),Mechanism of labor,Engagement*,Flexion,Decent,Internal rotation,Extension,External rotation,Symptoms and signs of the onset of the labor,Painful uterine contraction,a show,effacement and dilation of the cervix,rupture of membranes,The show,The mucus plug is expelled from the cervix,mixing with a little blood,the rupture of the membranes,at any time during labor,effacement and dilation of the cervix,to be short,taken up,dilated,Stages of labor,The first stage:,onset of labor to full cervical dilation(10cm),the latent phase(onest to 3cm,3cm to 10cm,8h),The second stage:,10 cm to the delivery of the infant,2h,The third stage:,delivery of the infant to delivery of the placenta,30m,The fourth stage:,2 hours after delivery of the placenta,Management of normal labor,The first stage,:,education,eating,voiding,position(sitting,reclining,recumbent),monitoring of the fetal heart rate,dilation of cervix and frequency,severity of uterus contractions(auscultation or electronic monitoring),The second stage,:-2 hour,fetal heart rate,maternal conditions:,pulse,blood pressure,respiratory rate,temperature,urine output,fluid intake,evaluation of progress of labor,cervical dilation,station,position of the,presenting part,status of membranes,meconium,blood,Pushing:,with the onset of each contraction,the mother is encouraged to inhale,hold her breath,and push,increase in intra-abdominal pressure,aiding in fetal descent through the birth cacal.,Head visible on vulval gapping*,Crowning of head*,Laceration or Episiotomy,Delivery of fetus,Deal with umbilical cord,the third stage:,waiting for up to 30 min,the uterus decreases in size,delivery of placenta(spontaneously,manually,inspection of the birth canal,evaluated for lacerations,“The fourth stage,postpartum uterine hemorrhage,1%,uterus palpation through the abdominal wall is repeats,the amount of blood on pads are monitored,pulse and BP are monitored,use of drug:oxytocin,THANKS FOR YOUR ATTENTION,Lin Jianhua,M.D.,Ph.D.,Professor,Dep.of Obstet.&Gynecol.,Renji Hospital Affiliated to SJTU School of Medicine,
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