异 常 分 娩-第8版教材.ppt

异 常 分 娩  Dystocia 湘雅医院 姚若进 Although the definition of dystocia is “difficult childbirth”, the term is used interchangeably with dysfunction labor and characterizes labor that does not progress normally. The problem may be caused by (1) ineffective uterine expulsive forces; (2) an abnormal lie; presentation, position, or fetal structure; (3) disproportion between the size of the fetus and pelvis, resulting in mechanical interference with the passage of the fetus through the birth canal. It is important that the cause or causes of abnormal labor be determined as accurately as possible so that an effective and safe management plan may be developed. 定义 Definition 决定分娩的四因素是产力、产道、胎儿及精神心理因素。若各因素正常并能相互适应，胎儿能顺利经阴道自然娩出，为正常分娩 任何一个或一个以上的因素异常，或各因素间相互不能适应,而使分娩进展受到阻碍，称异常分娩 Dystocia Table 1 China United States before 1949 1997 1900 1997 Maternal 1500/ 61.9/ 1000/ 7.7/ mortality (per 100,000 ) (per 100,000 ) Infant 200/ 17.5/ 100/ 7.2/ (1 year) (per 1000 ) ( per 1000 ) mortality 第一节 产力异常 产力是分娩的动力，只有有效的产力，才能使宫口扩张和先露下降 产力包括子宫收缩力、腹壁肌和膈肌收缩力以及肛提肌收缩力，其中以子宫收缩力为主,并贯穿于分娩全过程 在分娩过程中，子宫收缩的节律性、对称性及极性不正常, 或强度、频率有改变，称为子宫收缩力异常 ，简称产力异常 abnormal uterine action 一、子宫收缩乏力 Uterine inertia 【病因 Etiology 】 1.头盆不称或胎位异常 cephalopelvic disproportion or abnormal presentation 先露下降受阻，不能紧贴子宫下段及宫颈 内口，局部不能引起反射性子宫收缩，导致 继发性宫缩乏力 2.子宫局部因素 uterine factor ①子宫壁过度膨胀，肌纤维失去正常收缩能力 ②经产妇（multipara）子宫肌纤维变性，结缔组 织增生，影响子宫收缩 ③子宫发育不良、子宫畸形、子宫肌瘤等，均可引起宫缩乏力 3 .精神因素 psychical factor 初产妇（primipara）,尤其35岁以上的高龄初产妇（elderly primipara）,过度紧张、担忧，至睡眠减少，临产后进食不足，过度体力消耗，水、电解质紊乱，均可致宫缩乏力 4.内分泌失调 endocrine dy