等待娩肩和俯臥位預(yù)防肩難產(chǎn)課件.ppt

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1、等待娩肩和俯臥位預(yù)防肩難產(chǎn)主要內(nèi)容手膝俯臥位與HELPERR堅(jiān)決禁止腹部擠壓娩胎兒!等待娩肩的意義肩難產(chǎn)危險(xiǎn)因素與預(yù)防肩難產(chǎn)可能導(dǎo)致災(zāi)難性后果?江蘇h?11:12:41前天順產(chǎn)一個(gè)、但是肩難產(chǎn)、立即手術(shù)室、孩子死了、大人切了子宮、20歲重慶-肩難產(chǎn)為什么手術(shù)。?張宏玉海南(582558851)??11:37:33肩難產(chǎn)去手術(shù)室有用嗎,8J不大的,你在哪里醫(yī)院的,跟你們主任交流一下,江蘇?我是鄉(xiāng)鎮(zhèn)的、不是我接的50萬(wàn)賠的肩難產(chǎn)和產(chǎn)傷發(fā)生率?populationstudiesinNorthAmericaandtheUKfounda0.6%incidence.北美和英國(guó)報(bào)告肩難

2、產(chǎn)發(fā)生率0.6%。?Brachialplexusinjuriesareoneofthemostimportantfetalcomplicationsofshoulderdystocia,complicating4–16%ofsuchdeliveries.?肩難產(chǎn)中臂從神經(jīng)損傷的發(fā)生率4–16%產(chǎn)傷也可發(fā)生在非肩難產(chǎn)病例4%發(fā)生在剖宮產(chǎn)術(shù)后一半的肩難產(chǎn)發(fā)生在正常體重的嬰兒Pre-labour產(chǎn)前因素Intrapartum分娩期因素Previousshoulderdystocia前次肩難產(chǎn)史Prolongedfirststageoflabour第一產(chǎn)程延長(zhǎng)Macrosomia

3、>4.5kg估計(jì)大于4.5KGSecondaryarrest繼發(fā)性宮縮乏力Diabetesmellitus糖尿病Prolongedsecondstageoflabour第二產(chǎn)程延長(zhǎng)Maternalbodymassindex>30kg/m2母親肥胖大于30指數(shù)Oxytocinaugmentation縮宮素加強(qiáng)宮縮Inductionoflabour引產(chǎn)Assistedvaginaldelivery陰道助產(chǎn)手術(shù)肩難產(chǎn)的危險(xiǎn)因素Factorsassociatedwithshoulderdystocia如何判斷肩難產(chǎn)?difficultywithdeliveryofthefacea

4、ndchin娩頭時(shí)困難?theheadremainingtightlyappliedtothevulvaorevenretracting龜縮癥?failure?of?restitution?of?the?fetal?head胎頭沒(méi)有自動(dòng)復(fù)位和外旋轉(zhuǎn)?failureoftheshoulderstodescend.肩沒(méi)有下降(有宮縮的時(shí)候才會(huì)旋轉(zhuǎn)下降)肩難產(chǎn)定義---?Shoulderdystociaisdefinedasadeliverythatrequiresadditionalobstetricmanoeuvrestoreleasetheshouldersafterge

5、ntledownwardtractionhasfailed.陰道分娩中，胎頭娩出后，當(dāng)輕柔的向下?tīng)恳『螅枰~外的輔助手段來(lái)娩出胎肩時(shí)，稱為肩難產(chǎn)輕輕的牽拉的定義?Routinetractioninanaxialdirectioncanbeusedtodiagnoseshoulderdystociabutanyothertractionshouldbeavoided.Evidencelevel3?沿軸線方向，與脊柱保持直線，牽引幫助胎體娩出，沒(méi)有側(cè)向的牽引?Axialtractionistractioninlinewiththefetalspinei.e.withou

6、tlateraldeviation肩難產(chǎn)的預(yù)防措施有效性RCOGGreen-topGuidelineNo.423of18?RoyalCollegeofObstetriciansandGynaecologists在非糖尿病孕婦中，應(yīng)用提前引產(chǎn)的方法來(lái)預(yù)防所謂的可疑性巨大兒，沒(méi)有效果D在糖尿病患者，足月時(shí)（大于38周)適時(shí)引產(chǎn)可以減少肩難產(chǎn)的發(fā)生率B5.1.2Shouldelectivecaesareansectionberecommendedforsuspectedfetalmacrosomiatopreventbrachialplexusinjury(BPI)?提前剖宮產(chǎn)

7、術(shù)有效嗎?Electivecaesareansectionshouldbeconsideredtoreducethepotentialmorbidityforpregnanciescomplicatedbypre-existingorgestationaldiabetes,regardlessoftreatment,withanestimatedfetalweightofgreaterthan4.5kg.?對(duì)糖尿病患者，估計(jì)胎兒體重大于4.5KG者，擇期剖宮產(chǎn)（大于38足周），可減少肩難產(chǎn)和臂叢損傷幾率?TheNational