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1、NormalLaborandDelivery(AFE)正常分娩LinJianhuaM.D.,Ph.D.,ProfessorDepartmentOfObstetrics&GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicinedefinitionTermdelivery(labor):37-42weekspre-termdelivery:28-<37weekspost-termdelivery:42weeksAbortion:<28weeks8
2、5%ofwomenspontaneouslaboranddeliverybetween37-42weeksLMP:lastmenstrualperiodEDC:expecteddateofconfinememtThefourfactorsforlaborForce(contraction)birthcanal(bonycanal)fetus(lie,position,presentation,weight)psychical-factorsThecontractionsincreaseinfreq
3、uencyanddurationuteruscanbefelttohardenduringcontractionlastingabout30-45secondsintervalbetweencontractionstobe5min’thepainoflaborisacharacterNSTCSTBonypelvisTheplanesofpelvisinletplane(promontory)midplaneofpelvis(ischialspines)outletplane(twointersec
4、tingtriangles)MechanismoflaborEngagement*FlexionDecentInternalrotationExtensionExternalrotationSymptomsandsignsoftheonsetofthelaborPainfuluterinecontractionashoweffacementanddilationofthecervixruptureofmembranesTheshowThemucusplugisexpelledfromthecerv
5、ixmixingwithalittlebloodtheruptureofthemembranesatanytimeduringlaboreffacementanddilationofthecervixtobeshort,takenup,dilatedStagesoflaborThefirststage:onsetoflabortofullcervicaldilation(10cm)thelatentphase(onestto<3cm,<16h)theactivephase(>3cmto10cm,<
6、8h)Thesecondstage:10cmtothedeliveryoftheinfant,<2hThethirdstage:deliveryoftheinfanttodeliveryoftheplacenta,<30m’Thefourthstage:2hoursafterdeliveryoftheplacentaManagementofnormallaborThefirststage:education,eating,voiding,position(sitting,reclining,rec
7、umbent)monitoringofthefetalheartrate,dilationofcervixandfrequencyseverityofuteruscontractions(auscultationorelectronicmonitoring)Thesecondstage:---<2hourfetalheartratematernalconditions:pulse,bloodpressure,respiratoryrate,temperature,urineoutput,fluid
8、intake…evaluationofprogressoflaborcervicaldilation,station,positionofthepresentingpart,statusofmembranes,meconium,bloodPushing:withtheonsetofeachcontraction,themotherisencouragedtoinhale,holdherbreath,andpushincreaseinintra-abdominalpressureai
