dystocia
Introduction
Dystocia introduction Dystocia refers to the obvious period of the opening period (first stage) of childbirth, especially the fetal discharge period (second stage) for various reasons. If the artificial assisted childbirth is not used, the maternal body is difficult or unable to discharge the fetus. disease. Dystocia, if not handled properly, can cause not only maternal genital tract disease, but also future fertility, and may endanger the mother and the fetus. basic knowledge The proportion of illness: 10% Susceptible population: pregnant women Mode of infection: non-infectious Complications: postpartum hemorrhagic hemorrhagic shock and encephalopathy syndrome
Cause
Dystocia
Rickets (30%):
Vitamin D deficiency rickets, also known as osteomalacia, is insufficient bone mineralization, is a newly formed bone matrix calcification disorder, and is a disease characterized by vitamin D deficiency leading to disorder of calcium and phosphorus metabolism and clinical calcification of bones. Vitamin D is an essential nutrient for maintaining the life of higher animals. It is one of the most important biological regulators of calcium metabolism. A rickets caused by insufficient vitamin D is a chronic nutritional deficiency.
Pelvic shape (30%):
The shape of the small pelvis pelvis is normal, but the diameter of each can be shortened by more than 2cm compared with the normal value. Therefore, its various planes are reduced to a certain extent, which is more common in short women. The diameters of the funnel-type pelvic pelvic inlet are still normal. Only the middle and outlet diameters are narrow, the pelvic wall is inclined inward, and the pelvis is funnel-shaped.
Pelvic joint tuberculosis (30%):
Deformed pelvic pelvis deformation, left and right asymmetry, seen in sequelae of poliomyelitis, congenital malformation, chronic calcium deficiency, trauma and spinal and pelvic joint tuberculosis.
Prevention
Dystocia prevention
Prenatal examinations are carried out in regular hospitals, and pelvic measurements are performed in the third trimester to allow doctors to have a comprehensive understanding of maternal and child conditions. Generally, about 2 weeks before the expected date of delivery, the doctor must identify the way of delivery of the mother, and inform the mother in advance to let him know that it is possible to give birth naturally or need trial production. If you can only choose cesarean section, you will also tell me. The maternity woman is mentally and materially prepared.
Advanced maternal prevention of dystocia attention:
1. Have a physical examination before pregnancy.
2. Folic acid should be taken orally 1 month before pregnancy.
3. Ensure regular prenatal checkups.
4, pregnancy 16 to 20 weeks, to carry out Down's screening.
5, after 20 weeks of pregnancy to do amniocentesis.
6, more attention to blood sugar, blood pressure and other indicators.
7. Older mothers are more difficult to give birth naturally and need to be prepared in advance.
Complication
Dystocia complications Complications Postpartum hemorrhagic shock and encephalopathy syndrome
1. Fetal inhalation syndrome
The amniotic fluid swallowed by the fetus contains some exfoliated cells, fetal hair, fetal fat and other impurities. When it is close to full term, it gathers in the intestine to form a dark brownish green sticky substance called "fetal stool".
2, shoulder dystocia
Shoulder dystocia often combined with neonatal arm nerve injury or clavicular fracture, and delays of more than a few minutes may be due to umbilical cord compression leading to hypoxia and suffocation.
Symptom
Symptoms of dystocia Common symptoms Intracranial hemorrhage, joint deformity, hip production, weak bone softening, birth canal laceration, pelvic stenosis, flat pelvis, anterior lip edema, osteomalacia, pelvis
Refers to all kinds of abnormal production of fetal delivery difficulties.
1. The pelvic inlet plane is narrow: measuring the outer diameter of the shame <18cm, the anterior and posterior diameter of the pelvic inlet <10cm, the diagonal diameter <11.5cm: (1) the simple flat pelvis (2) the rickety flat pelvis.
2, the middle pelvis and pelvic outlet plane is narrow: (1) funnel pelvis (2) transverse diameter narrow pelvis
3, pelvic three plane stenosis: pelvic shape is a female pelvis, but the pelvic entrance, the middle pelvis and pelvic outlet plane are narrow, each plane diameter is less than the normal value of 2cm or more, known as small pelvis, more common in A short, well-proportioned woman.
4, deformed pelvic pelvis lost normal morphology osteomalacia pelvis (2) skewed pelvis.
The effect of a narrow pelvis on mother and child
1. If the effect on the mother is narrow, the entrance plane of the pelvis is narrow, which affects the connection of the first exposed part of the fetus, which is prone to abnormal fetal position, causing secondary uterine contraction, leading to prolonged or stagnant labor. If the pelvic plane is narrow, it affects the rotation of the fetal head. It is prone to persistent occipital or posterior occipital position. The fetal head is incarcerated in the birth canal for a long time. Compression of soft tissue causes ischemia, edema, necrosis, shedding, formation of genital warts after childbirth; premature rupture of membranes and surgery Increased infection opportunities, severe obstructive dystocia if not treated in time, can lead to uterine rupture of the uterus, and even uterine rupture, endangering maternal life.
2, the impact on the fetus and newborns, the head basin is not commensurate with premature rupture of membranes, umbilical cord prolapse, resulting in fetal distress, and even fetal death; prolonged labor, fetal head compression, ischemic hypoxia is prone to intracranial hemorrhage; Narrow, increased opportunities for surgical midwifery, prone to birth trauma and infection.
Examine
Dystocia check
General examination pay attention to the general development, short stature, abnormal fetal position, primipara women before the birth of the fetal head is not into the basin and (or) with a drooping abdomen, all indicate that the pelvis may be narrow, the walker, the pelvis may be inclined.
The pelvic measurement of the shame outer diameter <17cm, should be suspected as a flat pelvis; each diameter is less than the normal value of 1.5cm or more for the small pelvis; if the ischial nodular diameter is less than 7cm, more than the middle stenosis, should be further pelvic measurement .
Diagnosis
Dystocia diagnosis
According to the symptoms and signs are not difficult to diagnose as dystocia, but need to identify the head position dystocia, shoulder dystocia and so on. The shape of the small pelvis pelvis is normal, but the diameter of each can be shortened by more than 2cm compared with the normal value. Therefore, its various planes are reduced to a certain extent, which is more common in short women. The diameters of the funnel-type pelvic pelvic inlet are still normal. Only the middle and exit diameters are narrow, the pelvic wall is inclined inward, and the pelvis is funnel-shaped, which can lead to dystocia.
