MindMap Gallery Obstetrics and Gynecology (2) - Childbirth and puerperium
About Obstetrics and Gynecology (2) - Childbirth and puerperium mind map, including normal delivery, Abnormal delivery, delivery complications, Puerperium and puerperium diseases, etc.
Edited at 2024-01-12 09:24:45One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
Obstetrics and Gynecology - Childbirth and puerperium
normal delivery
Factors that determine childbirth
productivity
uterine contractility
rhythmicity
Symmetry and polarity
shrinkage
B
fetus
threatened labor
irregular contractions
Can be suppressed by sedatives
Feeling of fetal descent
see red
fetal presentation
Connection ➡️Descent ➡️Bend ➡️Inward selection ➡️Extension (shoulder into basin) ➡️Reduction and external rotation
Abnormal delivery
abnormal labor
definition
first stage of labor
Incubation period (cervix <5cm)
Fetal heart rate monitoring, once every 2 hours
Primipara >20h, abnormal
Multiparous women >14h, abnormal
Active phase (cervix>5cm)
Fetal heart rate monitoring, once every 30 minutes
Active period extended
Speed<0.5cm/h(1cm/2h)
active phase stagnation
The cervix no longer dilates for more than 4 hours
second stage of labor
Delayed fetal head descent
Primipara, cephalic presentation descent speed <1cm/h
Multiparous women, cephalic presentation descent speed <2cm/h
fetal head descent stagnation
Head first, stay in place for >1 hour
Prolonged second stage of labor
primipara
No spinal anesthesia, >3h
Spinal anesthesia, >4h
Multiparous women
No spinal anesthesia, >2h
Spinal anesthesia, >3h
The third stage of labor (5~15min)
reason
abnormal productivity
uterine atony
Classification
Coordination (hypotonic uterine atony)
multiple secondary
clinical manifestations
At the peak of uterine contractions, the uterus does not bulge, but becomes depressed when pressed.
Incoordination (hypertonic uterine atony)
clinical manifestations
Persistent pain in the lower abdomen of the parturient, refusal to press the abdomen, and irritability
Influence
Unable to relax well between contractions➡️Fetal distress
deal with
Determine whether there is obstruction (cephalopelvic disproportion)
have
cesarean section
none
Oxytocin can be administered only if there is no obstruction! ! ! Otherwise, the uterus will rupture! ! !
Artificial membrane rupture (consider first)
Conditions: The cervix is dilated to more than 3cm, and the fetal head is connected
Oxytocin
First and second stages of labor
Intravenous infusion (small dose) to speed up the labor process
third stage of labor
Intravenous injection (large dose) after fetal shoulder delivery to prevent postpartum hemorrhage
incongruity
Pethidine
Regulate uterine contractions, restore polarity, disable oxytocin
strong uterine contractions
Classification
Coordinated uterine hypercontractions
No obstruction
emergency labor
There is obstruction
Pathological contraction ring (also known as threatened uterine rupture)
Does not move up and down with contractions
Uterine rupture
Incoordinated uterine contractions
Tonic uterine contractions (without interruption)
spasmodic ring of uterus
deal with
Suppression of contractions followed by cesarean section
Abnormal birth canal
Narrow entrance plane
Performance
Incoordinated uterine contractions
tonic uterine contractions
localized uterine contractions
Spasmodic narrowing ring of uterus (does not move up and down with contractions)
Affect the basin
Positive cross-stigma sign
Prolonged incubation period
Confirmed
Sacro-pubic outer diameter<=18cm
Diagonal diameter<=11.5cm
Midpelvic plane narrowing
Performance
The mouth can be opened, but the head does not fall
Active period extended
fetal head descent stagnation
Inability to internally rotate (persistent occiputo-transverse, occipito-posterior position)
Confirmed
Ischia interspinous diameter <=10cm
Sciatic notch <2 transverse fingers
Narrow exit plane
Performance
The mouth is fully opened, but the fetal head does not descend
Prolonged and stagnant second stage of labor
Confirmed
Intertubercular diameter ➕ Posterior sagittal diameter <15cm
Fetal abnormalities
Persistent occipito-posterior and occipito-transverse position
Cephalopelvic disproportion
cut open
No obvious cephalopelvic disproportion
trial production
Fetal head reaches S= 2/3
Turning the fetal head by hand, vaginal delivery
Not connected or the descent is blocked after connecting. Midpelvic or exit plane narrowing Failed to turn fetal head
cut open
breech presentation
30 weeks ago
No processing required
After 30 weeks
chest and knee position
Full term
Incomplete breech presentation
cut open
shoulder first
30 weeks ago, same buttock presentation
After 30 weeks, same-breech presentation
Term, cesarean section (if prolapse of limb during delivery is present, indicating shoulder presentation
Puerperium and postpartum diseases
normal puerperium
Maternal changes during puerperium
reproductive system
Uterus (most changed)
uterine muscle fiber contraction
Return to pre-pregnancy size 6 weeks after delivery
endometrial regeneration
Except for placenta attachment site: 3 weeks after delivery
Attachment site: 6 weeks postpartum
uterine vascular changes
Lower uterine segment and cervical changes
vaginal
vulva
pelvic floor tissue
breast
Circulation and blood system
Blood volume, recovery in 2 to 3 weeks
Thrombin and thrombin recover within 2 to 4 weeks after birth
Hb rebounds
ESR returns to normal 3 to 4 weeks after delivery
digestive system
urinary system
Women who are not breastfeeding
Menstruation resumes 6 to 10 weeks after delivery
Ovulation resumes 10 weeks after delivery
breastfeeding women
4 to 6 months after delivery, ovulation resumes
Endocrine System
Clinical manifestations in the puerperium
vital signs
3 to 4 days after delivery, lactation fever
Breathe deeply and slowly
Little change in blood pressure
uterine involution
1 day after delivery, flat navel
After that, it will decrease by 1 to 2cm every day.
On the 10th day after delivery, it dropped into the pelvic cavity and the fundus of the uterus could not be touched during abdominal examination.
Postpartum uterine contraction pain
Multiparous women
1 to 2 days after delivery
Lochia
bloody lochia
3~4 days
serosal lochia
10 days
white lochia
puerperal infection
clinical manifestations
Fever, pain, abnormal lochia
late postpartum hemorrhage
Symptoms and signs
"residual"
10 days after delivery
Sudden bleeding or prolonged bloody lochia
The uterus is large, soft, and has poor dilation and involution.
Placental surface infection or incomplete involution
2 weeks postpartum
Sudden heavy vaginal bleeding
The uterus is large, soft, and has poor dilation and involution.
incision dehiscence
2 to 3 weeks after cesarean section
Sudden heavy vaginal bleeding hemorrhagic shock
childbirth complications
Postpartum hemorrhagePPH
Cause
Uterine atony (most common)
Prolonged labor
uterine factors
Overdistention of the uterus
Uterine muscle wall damage
Uterine lesions
placenta
Insufficient placental detachment
Placenta incarceration (affecting uterine contractions)
placenta accreta
fully implanted
No bleeding
partially implanted
Part of the sinusoids are open and the bleeding doesn’t stop
Retained placenta
Placenta adherent (cannot separate on its own)
soft birth canal injury
coagulopathy
diagnosis
blood loss
Weighing method
volumetric method
area method
Shock index method (shock index = pulse rate/systolic blood pressure)
SI=0.5, normal
SI=1.0, blood loss 10~30% (500~1500ml)
SI=1.5, blood loss 30~50% (1500~2500ml)
SI=2.0, blood loss 50~70% (2500~3500ml)
Diagnosis and treatment of causes of blood loss
placental bleeding before delivery
Bleeding immediately after delivery of the fetus, red in color and may clot
Soft birth canal laceration
suture
Delayed bleeding and intermittent bleeding after the fetus is delivered (related to uterine contractions)
Partial detachment of placenta
Peel off with bare hands and remove the placenta by hand
placental bleeding after delivery
First choice, check whether the placenta is intact
Retained placenta
Placenta removal by hand
Check uterine contractions
uterine atony
Massage uterus, oxytocin
Notice
Whether there is blood clot
Coagulopathy
Replenish coagulation factors and correct shock
Amniotic fluid embolismAFE
inducement
Intra-amniotic pressure is too high
Sinus opening
Rupture of fetal membranes
Pathophysiology
Tangible substances in amniotic fluid
allergic reaction systemic inflammatory response syndrome
Pulmonary embolism (first) pulmonary hypertension
respiratory and circulatory failure
Organ failure kidney failure
DIC
clinical manifestations
Triad: hypoxemia, hypoxia, and coagulopathy
deal with
Obstetric management
first stage of labor
cut open
second stage of labor
Deliver the fetus as soon as possible without using oxytocin
third stage of labor
Remove the placenta as soon as possible to repair birth canal damage
prevention
Uterine rupture
Cause
scarred uterus
obstruction
Strong contractions
Classification
Threatened uterine rupture (pathological contraction ring)
Uterine rupture
incomplete uterine rupture
complete uterine rupture
identify
placental abruption
Dystocia complicated by intrauterine infection
Pregnancy and labor complicated by acute pancreatitis
deal with
threatened uterine rupture
Suppress uterine contractions and cesarean section
Uterine rupture
cut open
breach repair
subtotal hysterectomy
total hysterectomy