Main productivity

Features: Rhythm, symmetry, polarity, abdominal contraction effect

Important auxiliary force in the second stage of labor

Assist the fetal presenting part to flex and internally rotate in the pelvic cavity

Pelvic inlet plane (transverse oval)

Mid-pelvic plane (minimum plane of pelvis, longitudinal oval)

Pelvic outlet plane (composed of two triangles that are not in the same plane)

Pelvic axis and pelvic tilt (60 degrees)

Lower uterine segment, cervix, vagina and pelvic floor soft tissue

formation of lower uterine segment

cervical changes

Changes in vaginal, pelvic tissue, and perineum

Anterior fontanel (large fontanel): in front of the fetal head, diamond-shaped

Posterior fontanel (small fontanel): behind the fetal head, triangular

The fontanel is an important symbol for determining the fetal position.

Biparietal diameter: approximately 9.3cm at term, used to determine fetal size by ultrasound

Occipital and forehead diameter: About 11.3cm at full term

Suboccipital anterior fontanel diameter: about 9.5cm at term, the fetus passes through the birth canal with this diameter

Occipital chin diameter

The biparietal diameter of the fetal head enters the pelvic inlet plane, and the lowest point of the skull is close to or reaches the level of the ischial spine.

Throughout the entire process of childbirth

The degree of fetal head descent is an important marker for judging the progress of labor

Change the occipitofrontal diameter when the fetal head is connected to the suboccipital bregma diameter

Adapt the sagittal suture of the fetal head to align the anteroposterior diameter of the midpelvis and outlet

The first stage of labor is incomplete due to internal rotation of the fetal head

After the fetal head is delivered, the occipital part of the fetal head is rotated 45 degrees to the left to restore the normal relationship between the fetal head and the fetal shoulders, which is called reset.

The fetal shoulder continues to descend in the pelvis, and the front shoulder rotates 45 degrees toward the midline of the mother's pelvis, so that the diameter of the fetal shoulders adapts to the front and rear diameter of the pelvic outlet. At this time, the fetal head and occiput continues to rotate 45 degrees to the left, which is called external rotation.

The uterus becomes hard and spherical, and the fundus of the uterus rises above the umbilicus

Small amount of vaginal bleeding

The umbilical cord leaking from the vaginal opening descends and extends on its own

When you use the ulnar side of your palm to gently press the lower uterine segment above the maternal pubic symphysis, the uterine body will rise and the exposed umbilical cord will no longer retract.

Fetal face delivery (common)

maternal face delivery

general condition

Apgar score: determines whether there is neonatal asphyxia and the severity of asphyxia

Clear respiratory tract (first step)

Dry and keep warm

Treating the umbilical cord

Assist in delivering the placenta

Check the placenta and fetal membranes

Check the soft birth canal

Postpartum 2h care

As labor progresses, the fetal head emerges from the vaginal opening during contractions, and retracts into the vagina during intervals between contractions.

The fetal head no longer retracts during intervals

Listen to the fetal heart rate every 5-10 minutes between contractions

Semi-recumbent position with knees bent is common

Correct use of abdominal pressure is the key to shortening the second stage of labor

When the fetal head of a primiparous woman is exposed by 3-4cm, the cervix of a multiparous woman is nearly fully dilated, and the perineum is bulging and tense, be prepared for delivery.

Only when the perineum is too tight or the fetus is too large, perineal tearing is expected to be inevitable during delivery, or the mother and fetus have pathological conditions that urgently need to end delivery.

Auscultate every hour during the latent period and every 30 minutes during the active period.

Important signs that determine whether vaginal delivery is possible

The degree of fetal head descent is marked by the relationship between the lowest point of the skull and the plane of the ischial spine.

Immediately lie in bed, listen to the fetal heartbeat, observe the characteristics and amount of amniotic fluid, and record the time of membrane rupture

If the membranes have ruptured for more than 12 hours and have not given birth, antibiotics should be used as directed by the doctor.

It usually occurs when the cervix is ​​nearly fully dilated.

diet

Activity

defecation and urination

Promote uterine contractions