abnormal soft birth canal
Introduction
Introduction The soft birth canal includes the lower uterus, the cervix, the vagina, and the vulva. The lesions of the soft birth canal can cause dystocia, and other parts of the reproductive tract and surrounding lesions can also affect the soft birth canal, making it difficult to deliver, but the former is more common. Dystocia caused by abnormal soft birth canal is far less common than dystocia caused by abnormal bone birth canal, so it is easy to be ignored and cause missed diagnosis. Abnormal soft birth canal refers to the uterus, vagina, and genital stenosis, and the stretch is not enough, so the fetus is difficult to pass.
Cause
Cause
1. Physical dysplasia
Uterine dysplasia, perineal short, small, long, vaginal stenosis, cervical tube length, small, hard, lack of stretch and elasticity, extended difficulty in childbirth.
2. Senior primipara
Maternal women over the age of 35 are senior primiparas. If the 35-year-old marriage is pregnant, it is different from the 35-year-old primipara after 10 years of marriage. The former does not necessarily have dystocia, the latter may have difficulty in giving birth due to genital dysplasia, and the chance of uterine prolapse is generally increased in soft birth canal laceration. Due to the high pelvic floor muscles and dysplasia of the puerperium at the beginning of the high, the pelvic floor muscles and sarcolemma are easily damaged when the fetus passes, and uterine prolapse is easy to form.
Examine
an examination
Related inspection
Obstetric examination
X-ray, B-ultrasound, etc. are selected according to the condition, clinical manifestations, symptoms and signs. Then make a diagnosis.
1. Cervical mouth dilatation degree, thickness, softness (based on the peak of uterine contractions) The cervix has no edema and edema, degree, and whether there is a gap between the cervix and the fetal head at the peak of uterine contractions. These judgments on the type, nature and extent of dystocia are helpful.
2. Find out the position of the sagittal suture and the position of the anterior and posterior iliac crest. Special attention should be paid to the possibility that the anterior and posterior iliac crests are misidentified and the sagittal suture is unclear when the fetal head is severely edematous and the skull overlap is obvious. In the second stage of labor, the vaginal examination before the surgical midwifery often uses the direction of the auricle to help determine whether the fetal position is accurate.
3. Clearly reveal the high and low level. This is extremely important for diagnosing dystocia (including whether the first exposure of the fetus can pass through the bone birth canal) and determining the treatment (vaginal midwifery or cesarean section). There is no obvious error, so those with severe fetal head edema should be dealt with. During the examination, special attention is paid to the lowest point of the skull as the standard for the first exposure of the fetus. Sometimes it is necessary to cooperate with the other hand on the maternal abdomen (the pubic symphysis) to check whether the biparietal diameter of the fetal head has indeed passed the pelvic entrance plane. If the fetal head is severely deformed, sometimes the lowest point of the fetal head is even exposed. However, the double top diameter is also stuck above the pelvic entrance.
Diagnosis
Differential diagnosis
Differential diagnosis of soft birth canal abnormalities:
(a) abnormal uterine neck
1. Older primipara, the neck is tough, the elasticity is poor, the cervical dilation is slow, and the edema is easy, resulting in prolonged labor.
2. Cervical electric ironing, conical resection, partial removal and postoperative formation, scar formation. This type of medical history is clear. If the labor process is stagnant, a vaginal examination can identify the cause.
(two) reproductive organ tumors
1. Cervical cancer: There are many vaginal discharges and irregular bleeding during pregnancy. If it is not found during pregnancy, there may be bleeding or slow expansion of the cervix during labor; if it is not difficult to identify with a speculum.
2. Uterine fibroids: often grow up with the uterus of pregnancy, and the tumor-like mass attached to the uterus is found. If the tumor is located in the interstitial part of the uterus, it can cause the uterine cavity to deform, and some affect the fetal position, and some can cause miscarriage and premature birth. If the fibroids located in the lower part of the uterus or the cervix can block the birth canal, affecting the first exposure of the child or falling. If only under the serosa, general pregnancy
3. Ovarian tumor: If it occupies one part of the small pelvic cavity, it can produce obstruction of the production duct. If the tumor is in the abdomen, it can be used to wrap the outer body of the uterus. If there is no complication such as torsion, there is no feeling. However, there are cases of tumor rupture induced during childbirth, and the symptoms resemble uterine rupture.
4. Vaginal wall cysts or tumors: Anal examination and vaginal examination can find abnormalities and clear diagnosis.
(three) birth canal malformation
1. Vaginal mediastinal, transverse, double vagina, double uterus, etc., due to burns, surgery, inflammation caused by vaginal scarring.
2. Remnant uterine pregnancy, more than auxiliary examination can be confirmed, such as B-mode ultrasound or X-ray photography.
3. The double-horned uterus is pregnant after Strassmann orthopedic surgery.
(4) Perineal toughness, edema of the vulva, venous tumor, etc.
