宫缩乏力

2016-09-09 13:38 阅读: 编辑:sunyoung 来源:
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内容简介:子宫收缩乏力属产力异常 ,按发生时间可分为原发性 宫缩乏力 (产程开始就出现)和继发性宫缩乏力(宫口开大3cm进入活跃期后出现)。
?       随着产程进展,子宫收缩逐渐增强,收缩时间变长,间隔时间变短,强有力的宫缩促使分娩继续进行。但是有的准妈妈宫缩并不是随着产程而增强,就必然使产程时间拖长,这种状况被称作宫缩乏力,分为原发性和继发性两种。
 
宫缩乏力

?       一、产生原因

?       1.原发性宫缩乏力的原因
?       
?       从一开始子宫肌肉的收缩力就很弱,或子宫肌肉水肿而妨碍收缩,多胎、羊水过多等原因也会造成宫缩乏力。

?       2.继发性宫缩乏力的原因

?       如果骨盆狭窄、胎头位置不正,致使分娩无法正常进行,产妇就会感到疲惫,宫缩也会变得不协调。除此之外,产妇心里紧张,呼疼不止,也使产程时间拖长导致宫缩乏力。

?       二、临床特征

?       1.子宫收缩力弱而无力,产程长。

?       2.原发性宫缩乏力,指产程开始时就出现的子宫收缩乏力;

?       3.继发性宫缩乏力,指产程进展到某一阶段方出现子宫收缩乏力。

?       4.宫腔内压力少于4KPa。

宫缩乏力

?       胎盘娩出前发生的产后出血称为第三产程出血。胎盘娩出前的出血,可能不会是突发性大量出血,而是较为稳定的流血,此种流血在任一时间点都属适量,但是会持续至发生严重低血容为止。但需特别注意的是胎盘娩出后的出血情形,由于胎盘剥离处需子宫的收缩以压迫血管并堵住管腔来止血,当子宫乏力时会立即且大量失血,若止血或输血太慢,使病人陷入昏迷、器宫衰竭时,将危及产妇生命。

?       三、解决办法

?       凡准备自然分娩的产妇,一定要树立克服困难的信心,决心自己分娩,听从医生和助产士的指导,解除心理压力,会使宫缩协调而迅速分娩,因此心理因素是决定自产成功的关键。不论何种原因,如果宫缩一直很微弱,可以用宫缩剂加强宫缩,如果是因为准妈妈身体疲惫而导致宫缩乏力,可给药休息,或散散步调节心情,吃点东西恢复体力,这样强有力的宫缩就会再次来临。

?       如果子宫口全开,宫缩逐渐减弱,这时可以适当滴些催产素,使宫缩加强。同时鼓励产妇尽量吃好吸收的饮料或巧克力,提起精神尽快分娩。

宫缩乏力

?       四、治疗用药原则

?       
(一)治疗原则

?       1.排除产道、胎儿性难产制定分娩方式。

?       2.预计能从阴道分娩者增强产妇体力,加强子宫收缩。

?       3.有头盆不称,胎儿窘迫,胎位异常,前置胎盘,子宫过度膨胀,高龄产妇,子宫过度膨胀有子宫和子宫颈手术者慎用。

?       4.情况改善后预防产后出血和感染。

?       (二)用药原则

?       1.如胎膜未破宫口开大3cm以下者宜先用温热肥皂水灌肠,排便后行人工破膜。

?       2.如经上述处理无效或继发性宫缩乏力者可选用维生素B1穴位注射,催产素静脉滴注。

?       3.精神紧张体力差者予以休息必要时予以杜冷丁或安定调整后加强宫缩。

      4.进食少脱水者酌情补液。
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