Mechanisms-and-Management-of-Labor--生产的机制和管理.pptVIP

Figure 11 FIGURE 11. (A) Pseudosinusoidal pattern. Note the decreased regularity and the preserved beat-to-beat variability, compared with a true sinusoidal pattern (B). When all else fails…. Enough already!!! If the anterior and posterior shoulders descend together instead of sequentially, the anterior shoulder can become impacted behind the symphysis pubis (or the posterior shoulders on the sacral promontory) If descent of the fetal head continues while the shoulders remain impacted, stretching of the nerves of the brachial plexus can occur. Most brachial plexus injuries resolve on their own, but permanent injury is a often a medicolegal issue. Risks for shoulder dystocia maternal obesity, diabetes, post dates, macrosomic infant, operative delivery Other risks associated with shoulder dystocia: fetal hypoxia and neurologic injury; fractured clavical or humerus, fetal death. Management of Shoulder dystocia Call for help! Suprapubic pressure McRoberts Maneuver Episiotomy Woods screw/ Ruben’s manuevers Deliver posterior arm Fracture clavicles Zavenelli maneuver Mom should not push during maneuvers!! Henry Lerner, MDGraphics Susan Seif, medical graphics After difficult delivery… Careful documentation Explain to patient the events, explanation of problem, steps taken to correct the problem, and what the anticipated sequelae are Fetal Monitoring The following examples of fetal monitoring strips are from… Interpretation of the Electronic Fetal Heart Rate During Labor AMIR SWEHA, M.D., and TREVOR W. HACKER, M.D. Mercy Healthcare Sacramento Sacramento, California NUOVO, M.D. University of California, Davis, School of Medicine Davis, California Used with permission from The American Family Physician Figure 1 Interpreting fetal monitiring Strips; American Academy of Family Physicians May, 1999 Figure 1 Interpretation of Electronic Fetal Heart rate During Labor American Family Physician, May 1999 Figure 1 Reassuring patt