Transverse dystocia

Introduction to horizontal dystocia Transverselie is a kind of misplaced position. The longitudinal axis of the carcass is perpendicular or perpendicular to the longitudinal axis of the parent body. Sometimes the longitudinal axis of the carcass is not completely perpendicular to the longitudinal axis of the parent body, forming an acute or oblique position. . The carcass lies horizontally above the entrance of the pelvis, with the exposed part as the shoulder, the fetal head on one side of the mother, and the buttocks on the other side, which may be temporary and finally turned into a vertical or horizontal position. The transverse shoulder is located at the entrance of the pelvis, and the side of the head and hip are concave. Therefore, the shoulders are also exposed first. The front and rear forces and the fetal head are placed on the left and right sides of the mother body, which are called the left shoulder, the left shoulder or the right shoulder and the right shoulder. Full-term cross-production can not be vaginal delivery, threatening the mother and child life, should be diagnosed early, early treatment, can do selective cesarean section surgery. basic knowledge The proportion of the disease: the probability of pregnant women is 0.5% Susceptible people: good for pregnant women Mode of infection: non-infectious Complications: premature rupture of membranes

Cause of dystocia

(1) Causes of the disease

1. Excessive relaxation of the abdominal wall of the mother and excessive amniotic fluid.

2. The fetus of the full term has not yet turned into the first exposure.

3. Uterine malformations or tumors, pelvic stenosis, placenta previa, etc. hinder the longitudinal axis of the carcass parallel to the mother and the fetal head.

4. The fetal head is round and can not be fixed, the basin is blocked, the uterus is not oval, such as pelvic stenosis, pelvic tumor, excessive amniotic fluid, abdominal wall relaxation, multiple pregnancy, uterine malformation, double uterus, premature delivery, placenta previa or lower uterus The posterior wall placenta is caused by the same.

(two) pathogenesis

Cross-production childbirth, because the first exposed part of the high floating in the basin, causing premature rupture of the membrane, weak uterine contractions, sometimes accompanied by umbilical cord prolapse, resulting in fetal death, sometimes after the amniotic fluid outflow, the contractions gradually weakened to stop, after a period of time After that, the uterus contraction becomes intense again. When the strong uterus contracts, the shoulder can be squeezed into the pelvis, or the fetal arm is prolapsed, the carcass is folded into a U shape, the shoulder and the back are lowered, or the fetal neck is elongated, but The fetal head and the carcass are blocked above the entrance of the pelvis. At this time, it becomes a neglected transverse position or an incarcerated transverse position. If the fetus is small, the pelvis is large and the uterus is strong, and the fetus can be delivered in 1811. Douglas described the natural delivery method in the horizontal position: the fetus is small and soft, and is easily deformed. The pelvis is large and the uterus is strong. Occasionally, the arm can be released first (Fig. 1). The fetal head is blocked in the upper pelvis. Under the contraction of the uterus, the neck is stretched and attached to the upper anterior edge of the pelvis, and the chest, abdomen and arms are successively descended along the posterior part of the pelvis (Fig. 2). The lower limbs of the fetus are also delivered, and the upper limbs and the head are finally delivered naturally. 3,4), this horizontal production of the birthing machine, called Douglas natural discharge delivery method, If the fetus is dead, the mother suffers a fatal birth canal injury, neglecting the horizontal production, and the uterine contraction is weak to stop [see Figure 1 Douglas naturally discharges the first step (delivered) protective inhibition of contractions], after a period of time has not been added After treatment, the uterus contraction occurs strongly, becoming a saddle-style repeated contraction, the mother has great fear, the lower abdomen is abnormally painful, the lower part of the uterus is tender, the pulse is fast, the body temperature rises, the uterus is pressed against the carcass, the upper part of the uterus becomes thicker, and the lower part becomes Thin elongation, the inspector can touch the carcass here, but also the pathological narrowing ring, more deep depression, the lower part of the body has obvious tenderness, there is a sign of uterine rupture, if it still can not be resolved, If the contraction is strong, uterine rupture can occur. At this time, if the uterus ruptures, it can cause uterine rupture, and damage, fetal death, such as the horizontal production neglected too long, sometimes the uterus has not broken, can also make the mother Death from shock failure; or infection in the uterine cavity, decomposition and decomposition of gas to produce uterine paralysis, which in turn causes systemic infection, toxic shock and death, if it has reached crisis When conditions while saving treatment, while preparing cesarean section, to be a slight improvement in the patient immediate surgery, not blindly rushed, the case has caused maternal exhaustion is more severe birth trauma.

Horizontal position dystocia prevention

Before 30 weeks of gestation, the gluteal spleen can turn itself to the first exposure, no need to deal with it. If the lap is exposed after 30 weeks of pregnancy, it should be actively corrected. The commonly used correction method is to treat the breech dystocia (pregnancy). .

Horizontal dystocia complications Complications premature rupture of membranes

Difficulty in horizontal position can easily lead to uterine weakness and premature rupture of membranes. After the rupture of the membrane, the amniotic fluid rapidly drains, and the fetal upper limbs and umbilical cord are easily released, resulting in fetal distress and even death. As the labor progresses, part of the shoulder and thorax is squeezed into the pelvic cavity, the carcass folds and bends, the fetal head folds to the ventral side of the carcass, is incarcerated on one side of the armpit, and the fetal buttocks are incarcerated in the contralateral armpit or folded in In the upper part of the uterine cavity, the fetal neck is elongated, and the upper limbs are released into the vagina, forming a neglected shoulder presentation. At this time, the contractions continue to strengthen, and it is easy to cause the uterus to rupture. If not treated in time, uterine rupture will occur.

Symptoms of dystocia in the transverse position Common symptoms Weak premature rupture of the membranes of the fungus pelvis After the birth, poor proboureum, abnormal fetal position, abnormal soft floor, abnormal uterine fundus and pubic symphysis... The uterus is transversely elliptical, the uterus is broken, the uterus is lower than the number of weeks of pregnancy.

Symptom

It is easy to cause uterine weakness and premature rupture of membranes. After amniocentesis, the amniotic fluid is rapidly drained. The upper limbs and umbilical cord of the fetus are prone to escape, resulting in fetal distress and even death. As the labor progresses, part of the shoulder and thorax is squeezed into the pelvic cavity. Folding and bending, the fetal head is folded to the ventral side of the carcass, incarcerated on one side of the armpit, the fetal buttocks are incarcerated in the contralateral axilla or folded in the upper part of the uterine cavity, the fetal neck is elongated, and the upper extremity is released into the vagina, forming a neglect Sexual (incarcerated) shoulder (neglected shoulder presentation), at this time the contraction continues to strengthen, prone to aura of uterine rupture, if not treated in time, uterine rupture will occur.

2. Signs

(1) Abdominal examination: The uterus is horizontally elliptical, the uterus height is lower than the number of weeks of pregnancy, and the uterus and pubic symphysis are emptied, touching the fetal head on one side of the abdomen and touching the buttocks on the other side.

(2) Anal examination: the fetal membrane is not broken, the cervix is not open, the anal examination is not easy to touch the exposed part of the tire.

(3) vaginal examination: the membrane has been broken, the uterus is open, the vaginal examination can touch the baby's hand, the arm or shoulder blade, the ribs and the armpit, the tip of the armpit is facing the head of the fetus, according to which the fetal head can be judged to the left of the mother Side or right side.

The shoulder blade is facing the back of the mother's body, and the front is the front of the shoulder. For example, if the fetal head is on the right side of the mother's body and the shoulder blade is facing the rear, it is the shoulder-right position (Fig. 6). If the baby's hand has been removed from the vaginal opening, it can be judged by the handshake method. The left and right hand and fetal position of the fetus, because the examiner can only hold the hand on the same side of the fetus, such as the right hand when the shoulder is in the front position, the examiner is gripped with the right hand; the left hand is taken out when the shoulder is in the front position, and the examiner is holding the left hand; When the back position is out of the right hand, the examiner is gripped with the right hand; when the shoulder is left and left, the left hand is taken out, and the examiner is gripped with the left hand, that is, the shoulder is in the opposite position to the position of the tire, and the back grip is The hand with the same direction of the tire (referred to as the front and back).

Horizontal position dystocia check

According to the condition, he has to choose hematuria.

B-ultrasound can be accurately located.

Ultrasonography.

Vaginal examination.

Diagnosis of lateral dystocia

According to the clinical symptoms and signs, the diagnosis can be generally confirmed. If the diagnosis cannot be confirmed, the ultrasound examination can be used. The ultrasound examination can accurately diagnose the shoulder dew and determine the specific fetal position.

Abdominal clinic

At the end of pregnancy or at the beginning of labor, the abdomen is examined at the bottom of the uterus, which is lower than the position of the uterus at the end of the corresponding gestational age. The uterus loses its normal elliptical shape and is horizontally wide and flat. The fetal head is located on one side of the lower abdomen. If you don't have a fetal head or a baby's hip, you can sometimes touch the depressed fetal abdomen and the fetal limb. In the lower abdomen, you can touch the side of the fetal head and the buttocks. The lower part of the uterus can not touch the fetal part. The pubic symphysis is empty. For example, in front of the shoulder, the back of the tire is forward in the lower abdomen, and the tread of the hard and wide flat surface can be touched; for example, the back of the shoulder, the back of the fetus is backward, the small limb can be touched in the abdomen, and the fetal heart can be left or The umbilical right is the clearest.

2. Vaginal examination

If it is already in labor, the cervix is slack, the first part is high, floating above the entrance of the pelvis, and there is a sense of emptiness in the vaginal canal. If the progress of the labor process has broken the membrane, sometimes it can touch the irregular lumps; if it has been progressing for a long time, it is often in the palace mouth. Touching the shoulders of the fetus, the shoulder blades, the ribs and the armpits, sometimes touching a row of ribs, the fingers reaching into the uterine cavity can touch the armpits and shoulder blades, the axillary apex pointing to the fetal head, and the shoulder blades are forward or backward. The shoulder is on the left or right side of the mother, such as the left shoulder, the axillary tip is to the left, the shoulder is in front, and the clinical findings are negligible transverse position. At this time, a vaginal examination should be performed immediately.

In the case of vaginal examination, if it is a small limb, it should be divided into the hand or foot, elbow or knee, shoulder or hip. If the baby hand is prolapsed in the vagina, it should be recognized as a hand, the fingers are long and not uniform, and the fingers are easy to open. The thumb can be bent to touch the root of the little finger. If the baby's hand comes out of the vagina, the examiner should use the handshake method to identify whether it is the left hand or the right hand. The right hand of the doctor holds the right hand, usually the left hand is the right hand. The left shoulder is the left hand. If it is the right shoulder, the opposite direction is the foot, the toes are short and uniform, the opening degree is small, the toes are not easy to close together, and the heel and the connecting leg are perpendicular to each other, which is easy to identify.

If the progress of the labor process has been long, the fetal back or the abdomen is edema, and it is pressed into the mouth of the basin, so that the examiner can distinguish the difficulty. When checking, pay attention to the presence or absence of uterine rupture, the size of the fetus, and the relationship between the exposed part and the pelvis. In order to decide the mode of delivery.

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