上海市产科临床医学中心 建设规划 - 上海第二医科大学.ppt

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1、dystociaTengYinchengDefinitionDystocialiterallymeansdifficultlaboranditischaracterizedbyabnormallyslowprogressoflaborItistheconsequenceoffourdistinctabnormalitiesthatmayexistsinglyorcombination8/12/20212Abnormalofthepowers(uterinecontractilityandmaternalexpulsiveeffort)Abnormalitie

2、sofpassenger(thefetus)Abnormalitiesofthepassage(thebirthcanal)Categoriesofdystocia8/12/20213AbnormalitiesofthepowersUterinedysfunctionhypotonicprimaryuterineinertiasecondaryUterinehypertonicDysfunctionuterinehypercontractility8/12/20214Abnormalitiesofthepowers8/12/20215Abnormalitie

3、softhepowers-----uterineinertia1.EtiologyofuterineinertiaCephalopelvicdisproportionorFetalmalpositionAbnormalofuterinemuscleImbalanceofendocrinesystemAdministrationofanalgesiapsychical-factorsOthersfatigue8/12/20216Abnormalitiesofthepowers-----uterineinertia2.ClinicalfindingsFail

4、uretoprogressLackofprogressivecervicaldilatationProlongedlatentphaseProlongedactivephaseProtractedactivephaseProlongedsecondphaseLackoffetaldecentProlongeddescentProtracteddescentProlongedlabor8/12/20217Abnormalitiesofthepowers-----uterineinertia3.diagnosisPalpation:strengthdurati

5、onfrequencyTocodynamometerVaginalexamination8/12/202188/12/202198/12/202110Abnormalitiesofthepowers-----uterineinertia4.Effectonmaternalandfetusmaternalfatigueacidosisinfectionpostpartumhemorrhagecesareansectionratefetusbirthinjurydistressprolapseofumbilicalcordstillbirth8/12/2021

6、11Abnormalitiesofthepowers-----uterineinertia5.managementhypotonicgeneralmanagementphysicalmethodsdrugsHypertonicSedative8/12/202112Abnormalitiesofthepowers-----hypercontractility1.ClinicalfindingsanddiagnosisPrecipitatedeliveryConstrictionringofuterusTetaniccontractionofuterus8/

7、12/202113Abnormalitiesofthepowers-----hypercontractility2.EffectonmaternalandfetusPrecipitatedeliverysoftbirthcanaltraumaRuptureofuterusFetaldistressFetaldeathstillbirth8/12/202114Abnormalitiesofthepowers-----hypercontractility3.managementProphylaxisTocolytictherapiesForcepoperat

8、ion8/12/202115