dystocia
Introduction
Introduction to abnormal production of dystocia Abnormal productivity refers to abnormal uterine contractility, often caused by dystocia, abnormal uterine contractility can be primary, or secondary to the birth canal due to abnormal birth canal or fetal factors (forming obstructive dystocia) Sexual uterine contractions are weak. The force that forces the fetus and its appendages out of the womb is called productivity. Productivity is the driving force of childbirth. The uterine contraction force is the main factor. The uterine contraction force runs through the whole process of childbirth. It has rhythm, symmetry and polarity. And the characteristics of contraction, it is restricted by the psychological factors of the fetus, birth canal and maternal. During childbirth, the rhythm, symmetry, and polarity of the uterus contraction are abnormal or the intensity and frequency are changed, which is called abnormal uterine contractility. basic knowledge The proportion of illness: 5-10% Susceptible people: women who are pregnant in pregnancy Mode of infection: non-infectious Complications: neonatal asphyxia
Cause
Abnormal labor dystocia
Systemic causes of abnormal uterine contractions (30%):
(1) maternal emotional stress: poor tolerance to pain, irritability and even noisy, interfere with the normal function of the central nervous system and affect uterine contractions.
(2) Endocrine disorders: maternal estrogen, oxytocin, prostaglandins, acetylcholine deficiency, or slow decline in progesterone levels, and decreased sensitivity of the uterus to acetylcholine, can affect the uterine muscle excitation threshold and affect uterine contractions.
(3) Excessive or inappropriate application of drugs such as sedatives can inhibit contractions and contractions.
(4) maternal merger has acute, chronic diseases, or frailty, fatigue, or disease leading to acidosis, water, electrolyte disorders, causing uterine atony.
Local factors of the uterus (30%):
(1) excessive expansion of the uterine wall, the uterine muscle fibers are excessively elongated and the contractility is weakened, such as twin or multiple births, excessive amniotic fluid, and large children.
(2) uterine dysplasia, uterine malformations or uterine fibroids can affect uterine contractions.
(3) Multi-partum women, have a history of uterine infection, etc., causing fibrosis of the uterine muscle wall and affecting the ability of the uterus to contract.
The head basin is not called and the fetal position is abnormal (30%):
The first part can not be close to the lower part of the uterus and the cervix, can not stimulate the uterine vaginal nerve plexus to cause strong reflex uterine contraction, leading to secondary uterine contraction, which is generally more common in the head basin, not the first, the first part of the floating, the first , transverse position, placenta previa, etc. (the bladder can also cause uterine contraction when it is full for a long time).
Abnormal uterine contractility is clinically classified into two types: uterine contraction and uterine contraction.
Prevention
Abnormal productivity dystocia prevention
Prenatal education should be carried out for pregnant women to relieve pregnant women's ideological concerns and eliminate fear, so that pregnant women understand that pregnancy and childbirth are physiological processes, prevent uterine atony caused by nervous tension, encourage more food during childbirth, and supplement nutrients from veins when necessary to avoid Excessive use of sedative drugs, attention to check whether there is a head basin, etc., are effective measures to prevent uterine contraction and fatigue.
Complication
Abnormal productivity dystocia complications Complications, neonatal asphyxia
The phenomenon of hypoxia or distress in the uterus in the uterus stimulates the vagus nerve and causes anal sphincter relaxation. It will prematurely expel the fetus and contaminate the amniotic fluid. The fetus will be more likely to occur in the expired pregnancy, the fetal growth in the uterus is delayed, and the amniotic fluid is too small. Long-term high-risk pregnancy, but prenatal ultrasound examination can not distinguish whether there is fetal fluid in the amniotic fluid, has to wait until the water is broken, the continuous fetal heart rate monitoring can ensure the health of the fetus in the follow-up process, childbirth At the time, you should summon the pediatrician to accompany the patient. Once the fetal head is delivered, immediately expel the nose and mouth foreign body. After the body is delivered, it should be pumped as soon as possible. Don't rush to stimulate the doll to cry, but the fetus is already obvious in the womb. The breathing action, part of the fetus has long existed in the trachea, it is inevitable that it may inhale into the lungs and cause respiratory distress. After birth, it depends on the pediatrician to give active monitoring and treatment, and the prognosis is almost good. A while ago, "shoulder dystocia" is a very popular topic. During the normal delivery process, the body slips out after the fetal head is delivered. Once the fetal shoulder is found stuck in the outlet of the birth canal, the incision will be enlarged and the woman will be raised. With both legs, the uterus is pushed strongly, and the shoulders of the fetus are rotated back and forth. If it is still impossible to deliver, it is necessary to try to interrupt the clavicle of the fetus.
Therefore, this disease is easy to cause neonatal asphyxia, placental retention, uterine contraction and so on.
Symptom
Abnormal labor dystocia symptoms Common symptoms Postpartum poor flexion fatigue Postpartum labor painful paroxysmal uterine contraction abnormality uterine contraction abdomen type pelvis without uterine contraction intermittent anxiety
The uterine contraction is weak, and its main clinical manifestation is uterine contraction, and the duration is short, and the interval is long and irregular. When the uterus contracts the strongest, the abdomen does not become hard, does not bulge, the clinical examination official mouth can not expand as scheduled, the fetus can not gradually decline, resulting in prolonged labor.
Examine
Abnormal productivity 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
Diagnosis of abnormal dystocia
1. False labor: When there is uterine contraction, it should be differentiated from the coordination of uterine contraction fatigue. The characteristics of false labor are pregnant women with no symptoms, or only slight backache or falling abdominal pain, uterine contraction irregular, duration shorter than 30s, intermittent The time is long and irregular, the uterine contraction strength does not gradually increase, often uterine contraction occurs at night, gradually weaken or disappear in the morning, the cervix does not gradually expand with the contraction, most of the vaginal bloodless secretions, intramuscular injection of pethidine, etc. After a strong sedative, the irregular uterine contraction disappeared, and the coordinating uterine contraction was weak. After the intramuscular injection of meperidine, the uterus contraction gradually strengthened after the maternal quiet rest for a period of time. The uterus contraction turned into a rule, and the cervix gradually opened.
2. Uncoordinated uterine contraction: should be differentiated from coordinated uterine contraction.
3. Coordinating uterine contractions are weak.
4. II degree placental abruption: persistent abdominal pain, backache or low back pain, uterine contraction, should be differentiated from the coordination of uterine contraction, but this disease has a history of trauma and hypertension, the uterus is persistent contraction, such as Plate-shaped hard, tenderness, fetal distress signs, if the third-degree placental abruption, hemorrhagic shock symptoms, fetal heart can not hear clearly, fetal position is unclear, fetal death, B-mode ultrasound see post-placental hematoma Easy to identify.
5. Coordinating uterine contraction is too strong: uterine contraction should be differentiated from inconsistent uterine contraction, but uterine contraction when the coordinated uterine contraction is too strong, still rhythmic, symmetrical and polar characteristics, Gongkou Rapid expansion, if the fetus is delivered without resistance, it is prone to emergency production.
6. Intravenous infusion of oxytocin causes tonic uterine contraction; mostly inconsistent uterine contractions, common in the application of oxytocin inducers, after stopping the infusion of oxytocin, uterine contractions gradually weaken or even disappear, the rupture of the membrane Instead, they gradually become more coordinated.
7. The uterine stenosis ring is different from the uterine pathological ring:
(1) Most of the causes are premature rupture of membranes, inappropriate application of uterotonics, intrauterine operations and psychological factors.
(2) can occur in the first, second, and third stages of labor, such as the third stage of labor, the placenta incarceration.
(3) The maternal and fetal outcomes are good.
(4) The ring is in a thinner part of the fetus.
(5) Abdominal palpation is generally not special, only a ring-shaped bulge can be found in the intrauterine diagnosis.
(6) The lower part of the lower uterus below the ring is not elongated and thin and has no tenderness.
(7) The uterus is not thick, and no tonic uterine contractions occur.
(8) The first exposed part of the fetus does not necessarily enter the basin, nor is it squeezed in the cervix and is tightly wrapped by the cervix. The deformation of the fetal head is not obvious. When the uterus contracts, the fetal head drops, the cervix does not expand, and the cervix is even soft and sagging like a cuff.
(9) The round ligament is not tight and there is no tenderness.
(10) Generally, uterine rupture does not occur.
