ABNORMALLABORORDYSTOCIA

Defintion：Dystociaisdefinedasdifficultlabor.Itmaybeassociatedwithvariousabnormalitiesthatpreventordeviatefromthenormalcourseoflaboranddelivery.Itistheconsequenceoffourdistinctabnormalitiesthatmayexistsinglyorcombination:thepower,passagepassengerandthepsyche.CauseofdystociaPowerPassagePassengPsycheDiagnosis:

prolongedcoursesoflabor.Lackofprogressivecervicaldilatationandfetusdescending.

prolongedlatentphase>16h。

prolongedactivephase>8hCervicaldilation:Primigravida<1.2cm/h，Multipara

<1.5cm/h。Clinicalfindinganddiagnosis

ProtractedactivephaseThecervicaldilationstopfor2hoursinactivephase。

ProlongedsecondstageThesecondstagelastmorethan2hoursforprimigravidaormorethan1hourformultipara。

Prolongeddescent:

therateoffetusdescendingindecelerationphaseandthesecondstageoflaborlessthan1.0cm/h(primigravida)，or2.0cm/h(multipara)。

Protracteddescent:

fetusdescendingindecelerationphasestopformorethan1h。

Prolongedlabor:thetotalstagelastmorethan24h。

Treatmentofdystocia★Antepartum

：Regularlyprenatalcare★Duringlabor：Symptoms:abnormalprogressoflabororarrest.Preparatorydivision:ruleoutfalselabor。Dilatationdivision:ruleoutcephalopelvicdisproportion.Pelvicdivision:ruleoutabnormalfetalpresentationandposition.

Pregnantwomencondition.Arrestedfetalheaddescending.Prolongedcervicaldilation.Dysfunctionofuterine.Prematureruptureofmembrane.Abnormaloffetus.PayattentiontoetiologyManagementofvaginaldelivery：Evaluationofuterinecontraction,fetalsizeandposition,pelvicsize,fetopelvicdisproportionornot.Prolongedlatentstage：Sedationmaycauseabsenceofuterinecontractioninfalselabor。。Prolongedactivestage：Observetheprogressoflabor、expulsiveforce、fetalheartrate、fetalpositionfor2～4h,whenruleoutthefetopelvicdisproportion.

Prolongedsecondstageoflabor：Thefirst,performvaginalexaminationtoruleoutfetopelvicdisproportion,correcttheabnormalfetalposition,thencanimprovetheuterinecontractionbyoxytocine.★Ceasreansection

posteriorasynelitism、Anteriorasynelitism)、Browpresentation;

Generalpelviccontract

Fetalmacrosomia;

Shoulderpresentation,Feetpresentation;

Pathologiccontractingring;pelviccontractFetalmacrosomia

uterineinertiaAbnormalfetalposition

Fetaldistress

Threateneduterinerupture

ruputrememberoroxytocineunsuccessprogress

Persistentocciputposteriorposition,ordeeptransversearrest

Cesareansection

AssistedvaginaldeliveryrotatetoLOAorRoA

Vaginaldelivery

AbnormaluterineactionTherhythm,symmetry,polarityandretractionofuterinecontractionbecomeabnormal.Include：uterinehypocontractilityuterinehypercontractilityAbnormalitiesofthepowers

Uterinedysfunction

coordianted

hypocontractility

UterineUncoordinatedDysfunctioncoordianted

hypercontractility

uncoordinated

Etiologyofuterineaction

：Cephalopelvicdisproportionorfetalmalposition

PsychologicalfactorsAbnormaluterus

EndocrinaldysfunctionOthersClinicalmanifestation1.Hypotonicuterineaction(coordianted)★Havenormalrhythm、symmetryandpolarity,★Buttheintensityislow,

including:primaryandsecondaryhypotonicuterineaction.2、Hypotonicuterineaction(uncoordianted)★lossthenormalrhythm、symmetryandpolarity.★

theintensityintheperiodsofrelaxationbetweencontractionsbecomelarger.★Thepregnantwomenwillfellpersistingpain.

Effectonmaternalandfetusmaternal

FatigueAcidosisInfectionPostpartumhemorrhageCesareansectionrateincreasing

fetus

Birthinjurydistress

ProlapseofumbilicalcordStillbirthManagemant

1.Coordinateddysfunction★VaginalexaminationtoruleoutCephalopelvicdisproportionorfetalmalposition

；★Evaluatefetusandmaternalcomplexion.★Oxytocininfusion:Inthefirststageoflabor

Relax,Takegoodcare

ImprovethecontractionRupturethemembraneOxytocinstimulationoflabor:fromlowdose.Narcoticagentsuchasmorphinesulfateisgivenindoseslargeenoughtoarrestuterinecontractionsandprovidefrom6-12hoursofrest;Insecondstageoflabor

★Thereisnocephalopelvicdisproportion：improvetheexpulsiveforce

★Fetaldistress:finishthelaborinshortesttime；

★Cephalopelvicdisproportion

：cesareansection

Inthirdstageoflabor

：preventionofpostpartumhemorrhage

Uncoordinateddysfunction：★Sedationisgenerallyeffectiveinconvertinguncoordinatedcontractiontonormallaborpatterns.Hypertonicdysfunction(coordinated)ManifestationanddiagnosisThecontractionhavenormalrhythm、symmetryandpolarity,buttheintensityistoostrong.Precipitatedelivery:

Thetotalstageislessthan3hourswhentheratesofcervicaldilationismorethan5cm/h,thecervicaldilationof10cmandexpulsionoffetusoccursinshorttime.Hypertonicofuncoordinatedcontraction

Constrictionringofuterus

Characteristic:Local

smooth

muscle

in

uterus

spasmodicly

contract

to

form

circular

contraction.

The

ring

is

located

at

juncture

between

lower

uterine

segment

andcorpusuteri.Tetaniccontractionofuterus:★L(fēng)ossofrhythmn★Thetitaniccontractionofuteruspersistcontractinganddon’trelax,alwaysappearwhenoxytocinbemisused.EffectonmaternalandfetusPrecipitatedeliverySoftbirthcanaltraumaRuptureofuterusFetaldistressFetaldeathstillbirth§Prevention

is

main

doctrine;§

Use

oxytocin,

clysis,

artificialrupture

of

membrane

carefully;§

Aspiration

oxygen,

prohibit

uterine

contraction—Magnesium

sulfate,

pethidine;§

Fetaldistress,pathologic

retraction

ring--Cesarean

。Management

Abnormalpassage

Causesofabnormalitiesofpassageincludebonyabnormalities(pelvicdystocia),softtissueobstructionofthebirthcanal.Pelvicdystocia,particularlythatduetosmallbonyarchitecture,isthemostcommoncauseofpassageabnormalities.PelviccontractionTypeofPelvic:

femalemaleandropoidpelvisplatypelloidpelvisinletoutletcavityfemalemaleContractedpelvicinletplatypelloidiscomonTheplatypelloid

pelvisischaracterizedbyatransversediameterthatiswidewithrespecttotheanteroposteriordiameter.SimpleflatpelvisRachiticflatpelvisMidpelviscontraction

Midpelviscontractionisdefinedasvalueslessthan10cmfortheinterspinousdiameter,alwaysoccursinandroidpelvisandanthropoidpelvis.Contractedpelvicoutlet

Pelvicoutletcontractionisdefinedasvalueslessthan8cmfortheintertuberousdiameterandthesumoftheintertuberousandposteriorsagittaldiameterlessthan15cm.alwaysoccursinandroidpelvis

GenerallycontractedpelvicEachpelvicplaneis2cmlessthannormalvalueormore,whichiscalledgenerallycontractedpelvicandcanbeseeninshapemoreshortandsmall,well-balancedwomenoftypeoffigure.PelvicmalformationThepelviclossthenormalshapeandsymmetry.ContractedpelvicinletClinicalmanifestation

※Abnormalpresentationandlieposition.※Lackofprogressivecervicaldilatationandfetusdescending:prolongedlatentphaseandactivephase.※Prematureruptureofmembraneandumbilicalcordprolapse.MidpelviscontractionClinicalmanifestation:★AbnormalpositionPersistentocciputposteriorposition,ordeeptransversearrest★

Prolongedsecondstage★ForcepincreasingForcepsdeliveryContractedpelvicoutlet

Clinicalmanifestation:

Secondaryhypotonicuterineactionandprotractedsecondstageoflabor.

Thefetalbiparietaldiametercan’tpassthepelvicoutlet.Managementofpelvicbonycontraction:

Consideringtypeofpelvic,power,fetuspositionandfetaldistress.ContractedpelvicinletExternalconjugate16.5～17.5cm、anteroposteriordiameter

8.5～9.5cm.Externalconjugate

<16.0cm、anteroposteriordiameter

<8.0cm、CesareaSectionMidpelviscontractiontreatment

VaginalexaminationtoruleoutCephalopelvicdisproportionorfetalmalposition

；

Enhanceuterinecontractility:oxytocinVaginaldeliveryorCesareansectionPelvicoutletTreatment

Cesareansectionisthefirstchoice.

Whenasumoftheintertuberousdiameterandtheposteriorsagittaldiametergreaterthan15cm,thefetalheadmaypassthebirthcanalusingtheposteriortriangle.Abnormalfetalpositionpersistentocciputposteriorposition、persistentocciputtransversepositionDefinition：Duringtheprocessofdelivery,thefetalheadinocciputposterior(transverse)positionengagesinthepelvicinlet,aftervigorousuterinecontraction,theocciputpersistlocatingontheposterior(transverse)portionofmaternalpelvic,whichmayresultindystocia.persistentocciputposteriorposition、persistentocciputtransverseposition

persistentocciputposteriorposition、persistentocciputtransverseposition

LOPROPLOTROTVaginalexaminationDiagnosisofAbnormalfetalposition★Clinicalmanifestation：√Engageslaterattheonsetoflabor；√

Secondaryhypotonicuterineaction；√

Usetheabdominalpressurebeforethecervixdon’tdilateto10cm；√

Fetalheaddescendslowly；TreatmentInthefirststageoflabor：

Ruleoutcephalopelvicdisproportion；Observethebirthprocessseriously；Improveuterinecontraction；Inthesecondstageoflabor：

thevaginalexaminationshouldbecarriedoutandmakeadecisionofdeliverystyle:vaginaldelivery,assisteddelivery,cesareansection.Sincipitalpresentationoccipitopubicposition;occipitosacralposition;DiagnosisClinicalmanifestation：prolongedactivestageoflabor,persistingpainoftheloweruterinesegment.palpation：cephalopelvicdisproportion.Vaginalexamination：thebregmaticfontalelleandlambdoidsutureareequallyprominent.ManagmentOccipitopubicposition:expectantmanagementforshorttime.Occipitosacralposition：cesareansection.AnteriorasynelitismClinicalfinding:Diagnosis:Clinicalmanifestation：fetaldescendingprotracted；dysuria；palpation：falsesignsoffetalengagement；Vaginalexamination：Management:cesareansectionshouldbeperformed.Includeing:★Completebreechpresentation.★Frankbreechpresentation.★Incompletebreechpresentation

kneeorfootlingpresentationBreechpresentationBreechpresentationIncompletebreechpresentationFrankbreechpresentationIncompletebreechpresentation

ClassifyofbreechpresentationDiagnosis:Symptoms：Thepregnantwomenfeelthehard,roundfetalheadbelowthecosta.Uterineinertia,slowdilationofcervixoccur,prematureruptureofmembranewilloc