妇产科学-温医大-正常分娩.ppt

Apgar评分 Apgar Score 意义：有无新生儿窒息/窒息严重程度 10 满分，正常新生儿 ? 7 一般处理 4-7 缺氧较严重/清理呼吸道/人工呼 吸吸氧用药等措施 ? 4 缺氧严重/紧急抢救-行喉镜在直 视下气管内插管+给氧 预防产后出血Prevention of postpartum Hemorrhage 正常分娩出血量多?300ml 既往有产后出血史或易发生宫缩乏力的产妇?胎儿前肩娩出时静注麦角新碱/缩宫素 胎儿已娩出30min，轻轻按压子宫及静注子宫收缩剂后仍不能使胎盘排出时 ?行徒手取胎盘术 检查胎盘胎膜 Maternal side Fetal side 检查软产道Check Soft Birth Canal 分娩镇痛 参考文献 《威廉姆斯产科学》 《头位难产》 思考题 影响分娩的因素有哪些? 子宫收缩力的特点? 衔接的定义 产程的分期及处理 If we hope to create a non-violent world where respect and kindness replace fear and hatred We must begin with how we treat each other at the beginning of life. For that is where our deepest patterns are set. From these roots grow fear and alienation ~or love and trust. ~Suzanne Arms If we want to create a less violent world, we must begin with birth Childbirth is not only a physiologic phenomenon, but a cultural/sociological experience. that most women experience without complication - Intrapartum complications can arise very quickly and unexpectedly.before we learn how to manage abnormal labor we must learn how to handle normal labor. About 30% of hospital deliveries involve an obstetric complication today I will provide you useful information about abruptio placentae, nonreassuring fetal heart rate pattern, shoulder dystocia, need for emergency cesarean delivery, and neonatal depression or abnormality. * * * 骶髂关节 髂耻隆突 * 枕骨隆突胎头颅骨：顶骨 额骨 颞骨 枕骨 胎头径线：双顶径 枕额径 枕下前囟径 枕颏径 * * * * 肛门检查方法：产妇仰卧，两腿屈曲分开。检查者站于产妇右侧，右手示指戴指套蘸肥皂水后，轻轻伸入直肠内，拇指伸直，其余各指屈曲以利示指深入。检查前用消毒纸遮盖阴道口避免粪便污染阴道。检查者在直肠内的示指向后触及尾骨尖端，了解尾骨活动度，再摸两侧坐骨棘是否突出，并确定胎头高低，然后用指端掌侧探查子宫颈口，摸清其四周边缘，估计宫口扩张的厘米数。当宫口近开全时，仅能摸到一个窄边。当宫口开全时，则摸不到宫口边缘。未破膜者，在胎头前方可触到有弹性的胎胞。已破膜者，则能直接触到胎头，若无胎头水肿，还能们清颅缝及囱门的位置，有助于确定胎位。若能触及有血管搏动的索状物。考虑为脐带先露或脐带脱垂，需及时处理。肛门检查方法：产妇仰卧，两腿屈曲分开。检查者站于产妇右侧，右手示指戴指套蘸肥皂水后，轻轻伸入直肠内，拇指伸直，其余各指屈曲以利示指深入。检查前用消毒纸遮盖阴道口避免粪便污染阴道。检查者在直肠内的示指向后触及尾骨尖端，了解尾骨活动度，再摸两侧坐骨棘是否突出，并确定胎头高低，然后用指端掌侧探查子宫颈口，摸清其四周边缘，估计宫口扩张的厘米数。当宫口近开全时，