Abnormal Birth Canal
What is Abnormal Birth Canal
Birth canal birth canal of bone and soft birth canal, the fetus channel. The abnormal birth canal can fetus blocked, including abnormal bony birth canal and abnormal soft birth canal clinically abnormal bony birth canal more common, narrow pelvis, can often lead to abnormal childbirth. Narrow pelvis is the the pelvic diameter line is too short or abnormal shape, resulting in less than the Ministry of fetal limits by pelvic hinder the Ministry of fetal decline, affecting the progress of the production schedule has. Narrow pelvis can to a diameter line is too short or the plurality of radial line at the same time is too short, can also be a flat narrow or narrow plurality of planes at the same time.
Symptoms of Abnormal Birth Canal
Clinical manifestations of abnormal birth canal
Narrow pelvic inlet plane.
Even though they have the the perinatal fetal head yet Rupen, shame and positive signs cross inspected fetal head, fetal head blocked. Narrow inlet plane increased incidence of abnormal fetal umbilical cord prolapse. If you labor, pelvic stenosis, the strength of the productive forces, the size of the fetus and the fetal position is different, different clinical manifestations.
(1) pelvis critical stenosis
If the fetal position, fetal size and productivity normal fetal head often before the sagittal suture in the pelvis population transverse diameter of convergence uneven tilt potential to take on more, that after the first Rupen parietal bone, after parietal bone gradually into the sacral recess, and then make The parietal bone 入盆 the sagittal suture in the transverse diameter of the pelvis population was all the trends in the first basin. Abnormal clinical manifestations of the birth canal to extend the incubation period and active period early, late active phase of labor progress smoothly. Fetal head delay Rupen, premature rupture of membranes, mother and child increased the probability of infection. Fetal head is not close to the mouth of the cervix induced reflex contractions, often secondary uterine inertia. Latency, slow cervical dilatation.
(2) pelvic absolute narrow
Obstructive dystocia often occurs, a pathological reduction of complex ring, and even uterine rupture. Extend the production process can cause urogenital fistula. The contractions cause skull overlap, severe skull fracture and intracranial bleeding.
2 narrow pelvis plane
Convergence normal incubation period and the active period of the early progress smoothly. When the fetal head to the pelvis, internal rotation blocked fetal head biparietal diameter was blocked in the pelvis above the stenosis, often persistent occiput transverse or posterior position. Secondary uterine inertia, the active period of the late and prolonged second stage or even stagnation. The fetal head got bogged down in the pelvis, forming Succedaneum, the birth canal is unusually severe brain tissue damage can occur, intracranial hemorrhage and fetal embarrassed chase. Stenosis is severe contractions stronger, threatened uterine rupture and uterine rupture can also occur. Forced vaginal delivery can cause serious soft birth canal laceration, neonatal birth trauma.
Narrow pelvic outlet plane.
Narrow pelvic outlet plane with pelvic plane narrow often coexist.
What Causes Abnormal Birth Canal
Tests and Diagnosis for Abnormal Birth Canal
The diagnosis of abnormal birth canal
Narrow pelvis affect fetal position and the decline of the fetal head, internal rotation, also affect the contractions. During pregnancy should be investigated whether the abnormal pelvis, with or without head basin do not call as soon as possible to make a diagnosis, to determine the appropriate mode of delivery.
l. history of abnormal birth canal
Understanding pregnant women with or without rickets, a history of a history of trauma, polio, spinal and hip tuberculosis. Parous, you should be aware of the past history and whether the newborn birth trauma with or without dystocia.
2. Systemic examination of abnormal birth canal
Pregnant women Height <145 cm should be alert to both the small pelvis. The observed maternal body, whether lameness, the presence or absence of spine and hip deformity, Michaelis rhomboid fossa symmetry.
3. Abnormal abdominal examination of the birth canal
Observed abdominal type, whether the tip of the abdomen and overhanging belly, feet measured uterine length and abdominal circumference, whether the fetal position abnormal. Correctly estimate the head pots relations, to fully determine fetal head is able to or have already Rupen: Under normal circumstances, primigravida mostly in 1 to 2 weeks before the expected date, maternal labor Rupen. If you labor, fetal head Rupen yet, you should check first basin of proportionality, specific methods are as follows: pregnant women emptying the bladder, supine, legs straight. The exception checking birth canal hand on top of the pubic symphysis, floating fetal head is pushed to the pelvis direction, if the fetal head above the symphysis pubis front surface, said first basin is obviously not said, saying the the fetal head cross shame levy positive; if the tire The front surface of the head and pubic symphysis suspected cephalopelvic disproportion said to said fetal head cross shame levy suspicious positive; if the fetal head below the pubic symphysis front surface, said fetal head can Rupen, head basin commensurate, said the fetal head in the same plane, negative cross shame levy.
Pelvis measuring diameters less than the normal value for the average small pelvis 2 cm or more. The sacral shame outer diameter <18 cm flat pelvis. Ischial tuberosity diameter <8 cm, suprapubic angle <90. , Funnel-shaped pelvis. The distance between the upper spine pelvis on both sides of the oblique diameter (distance to the side of the anterior superior iliac spine to the contralateral iliac spine) and ipsilateral (from the anterior superior iliac spine to the ipsilateral iliac diameter) difference of> 1 cm To skew the pelvis. The pelvic measurements abnormal, the measurement should be carried out within the pelvis. Diagonal diameter <11.5 cm the sacral promontory highlights pelvic inlet plane narrow are flat pelvis. Pelvic plane narrow and narrow pelvic outlet plane often exist, should be measured the sacrum front bend diameter between the ischial spine, sciatic notch width (the width of the sacral spine ligament). Ischial spine diameter <10 cm, sciatic notch width <2 cross-refers to a narrow plane for the pelvis. If the ischial tuberosity diameter <8 cm, sagittal diameter should be measured export and check sacrococcygeal joint activity, it is estimated that the degree of stenosis of the pelvic outlet plane. Ischial tuberosity diameter and export sagittal diameter of <15 cm, narrow pelvic outlet plane.
5. B-ultrasound abnormalities of the birth canal
Observed tire first exposed parts of the pelvis relationship should be measuring the fetal head biparietal diameter, diameter at breast height, abdominal diameter, femur length, estimating fetal weight, to determine whether through bone and birth canal.
Treatments of Abnormal Birth Canal
Abnormal processing of the birth canal
Should first clear the a narrow pelvis type and degree of stenosis, understand the fetal position, fetal size, fetal heart rate and strength of contractions, cervical dilation, fetal dew drop of rupture or not combined with age, parity, previous birth History is a comprehensive judgment to determine the mode of delivery.
1. General treatment of abnormal birth canal
To encourage maternal mental relaxation, adequate nutrition and water intake, rehydration necessary. Monitoring the strength of contractions, ground to listen to the fetal heart rate, check the Ministry of fetal loss and the degree of cervical dilation.
2 abnormal birth canal entrance plane narrow processing
Absolutely narrow the fetal head cross shame and positive signs, full-term live births not Rupen, elective cesarean termination of pregnancy; Once labor, cesarean section to ensure parent child safety should be immediately. Relatively narrow, the fetal head cross shame levy suspicious positive, the normal full-term live birth weight <000 g, the fetal heart rate and productivity, trial production in intensive care. Cervical dilation 3 cm when the line of artificial rupture of membranes strong contractions, if after rupture of membranes, labor progressed smoothly, most vaginal delivery. The uterine atony available oxytocin infusion. Trial production time is normally 2 ~ 4 h, fetal membranes have been broken, in order to reduce the infection should be appropriate to shorten the the trial production time, trial postpartum fetal head still has not people basins, cervical dilation slow, or fetal distress, should be timely cesarean section.
3 in the pelvis and pelvic outlet a narrow plane's handling
Pelvic plane narrow the fetal head flexion and internal rotation hindered, prone to persistent occiput transverse or posterior position. Maternal multi-performance active period or prolonged second stage and stagnation, secondary uterine inertia. If the whole cervix and fetal head biparietal diameter of the ischial spine level or less, freehand rotation of fetal head is the anterior wait until the natural childbirth, surgery or line of forceps or vacuum extraction midwifery. If the fetal head biparietal diameter less than the level of the ischial spine, or the signs of fetal distress, cesarean section. Diagnosed as narrow pelvic outlet, should not be carried out trial production. Found exports transverse diameter of narrow pubic arch angle sharp, the suprapubic triangular gap can not use, the Ministry of fetal backward exports after the triangular gap expulsion. Sagittal diameter of the birth canal abnormal clinical commonly export transverse diameter and export and estimated export size. Two and> 15 cm, most via vaginal delivery, sometimes need to use fetal head aspiration or forceps midwifery should be made to the rear side of the large perineal incision, in order to avoid severe perineal laceration. Two and <15 cm, full-term fetus is not easy by vaginal delivery, cesarean section.
4 the abnormal pelvic birth canal three planes narrow processing
Mainly are small pelvis. If it is estimated that the fetus is not normal fetal position, head basin commensurate contractions, trial production. If the fetus is larger, obviously cephalopelvic disproportion, cesarean section as soon as possible.
Birth canal treatment of abnormal deformed pelvis
If the deformity is severe, it is obviously cephalopelvic disproportion said, should early cesarean section.