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九、难产的识别及处理决定是否顺利分娩的主要因素是产力、产道和胎儿。其中任何一个或一个以上的因素异常都会阻碍分娩的顺利进行,本文仅就胎儿因素引起的难产进行讨论。 (一)头位难产 1、未临产时的识别 (1) 病史既往有脊柱或下肢外伤、小儿麻痹症、髋关节结核以及困难分娩史的要考虑头盆不称。 (2) 体检身高145cm以下,骨骼有男性化倾向、两足长短不一以及初产妇有悬垂腹的要考虑头盆不称。 (3) 骨盆测量外测量只提示骨盆概况,并不和真正的骨盆内径线相符。国外有人主张放弃此项检测,除非有绝对狭窄如骶耻外径<16.5cm,坐骨结节间径<6.5cm者才单纯根据外测量作剖腹产术。
Nine, identification and treatment of dystocia The main factors that determine whether the smooth delivery is labor, birth canal and fetus. Any one or more of these factors will hinder the smooth progress of childbirth, this article only to discuss the causes of dystocia caused by fetal factors. (A) the first dystocia 1, the identification of non-labor (1) the history of spinal or lower extremity trauma in history, polio, hip tuberculosis and difficult delivery history to consider the cephalopelvic disproportion. (2) 145cm height below the physical examination, the skeleton has a tendency of masculine, two different lengths and primipara with hanging belly to consider the cephalopelvic disproportion. (3) The measurement of the pelvis outside the pelvis only indicates the general situation, and does not coincide with the true pelvic diameter line. Some foreign advocates to give up this test, unless there is an absolute stenosis such as sacral diameter <16.5cm, ischial tuberosity <6.5cm were only based on external measurements for caesarean section.