mechanismsandmanagementoflabor生产的机制和管理.pptxVIP

Mechanisms and Management of Labor Definition of LaborLabor is the physiologic process by which the fetus is expelled from the uterus to the outside worldCould also be described as the transition from “contractures” to “contractions” Bottom line defination: Contractions with cervical change. The diagnosis is a clinical one. Gabbe: Obstetrics Normal and Problem pregnancies 4th editionFull term pregnancy is 280 days (40 weeks) or 36 completed weeks.Post term pregnancy is beyond 42 weeksSROM is seen in about 8% of patientsLabor PhysiologyLabor is contractions with cervical change The fetus is in control of the timing of labor The factors responsible for initiating labor are not well-defined…likely an autocrine and/or paracrine event. We do know there is some endocrine maternal/fetal cross talk (eg horses and donkeys indicate that fetal genotype is a factor—365 vs 340 days) Gabbe: Obstetrics Normal and Problem pregnancies 4th edition Labor PhysiologyNo matter what seems to initiate labor it involves regular uterine contractions, mediated through ATP-dependent binding of myosin to actin. Unlike vascular smooth muscle, myometrium has sparse innervation, thus regulation of contractions is hormonal.There is thought to be a parturition cascade. Ultimately, human labor is a multifactorial physiologic process involving an integrated set of changes that occur gradually over days to weeks. Changes include prostaglandin synthesis and release within the uterus, an increase in myometrial gap junction formation, and up-regulation of myometrial oxytocin receptors. At some point labor begins with the activation of the fetal-hypothalamic-pituitary adrenal axis in a way likely common to all species. Gabbe: Obstetrics Normal and Problem pregnancies 4th editionLabor PhysiologyThe regulation of uterine activity can be divided into 4 physiologic phases Phase 0: uterus is quiet due to progesterone, relaxin, prostacyclin I2 (PGI2), parathyroid hormone Phase 1: before term “ac