Lecture face in obstetrics

2021-03-20 12:00 AM

It is much more difficult with the posterior chin type because the throne can become trapped in the frame, causing the uterus to rupture

General perception

The face is the head facing upwards, the face presented to the upper waist. The landmark of the throne is the chin. The face is a more difficult birthplace than the crown. The previous one is easier to lay than the back one, but there is only one type of face, the chin guard, and the chin cannot.

Rate: 1/50 of births

During labor it is possible to bend over and turn into a forehead.

Reason

The original face is very few. Most secondary facies occur during labor when the throne is tall, poorly aligned, and easy to move.

Factors favorable for the face

Maternal arch: narrow pelvis, uterine malformations, biconcave uterus, uterine deviation or anterior uterine position, uterus with fibroids in the waist, uterus looser due to repeated birth.

On the part of the fetus: fetus is large, not large, lumps in the neck, hunchback of the spine, fetal infarction

About the fetal side: placenta, short lanyard, neck curl, poly amniotic fluid.

Birth mechanism in the face

Pot: diameter of lower chin lower front than 9.5cm. Slipping is not difficult. When the face is completely present in the upper waist. The parrot is symmetrical, the center of the throne is also the center of the upper waist. The anterior chin lower chin diameter coincides with the diagonal diameter (especially left diagonal diameter 12cm) while the horizontal diameter of both cheeks (8.5 - 9cm) easily falls under another diameter. However, the largest diameter of the throne is not right away, it will fall later.

Down and spin: the decisive stage to be able to lay the bottom lane or not. The pre-sterno syncipital 13.5 - 14cm cannot pass through the upper waist, so this diameter must be avoided, but must be down to a small shoulder circumference of 9.5cm. depends on the direction of the head rotation.

Front facing: the head must rotate 45 ° for the former, and 135 ° for the latter. Turn right early to bring the chin under the joint before resting. The slip of the chin under the joint is possible because the maximum length of the contraction is proportional to the length of the joint, allowing the maximum diameter to be eliminated. Using the chin as a prosthesis, the head rotates around the defense, the occipital is in the pit of the sacrum, the head mass does not form a mass. The throne follows the anterior and posterior axes of the lower waist, allowing the top to slide out.

Backward: chin cannot move in the posterior position because the sacral length is greater than the length of the sternum, causing entanglement to the posterior pelvis wall, but the posterior wall is longer than the hip joint compared to the previous position. The throne cannot be descended.

Ledger: chin can be protected, chin cannot be closed because the anterior horn will be fixed below the hip joint, and then gradually tilted until the diameter of the anterior thymus (15cm). chin guard: lower chin fixed under the joint, then head gradually bow down to appear chin lower diameter, lower chin first, lower chin dot. After the number is complete, lower the occipital diameter, the head is completely hollow. However, there is a risk of episiotomy due to the lower chin-dot diameter of 13.5 cm.

Prognosis

Compared with the crown, the prognosis is not as good. Longer labor time, swollen amniotic fluid causes premature rupture of the amniotic fluid, causing an infection of the amniotic fluid. It is much more difficult with the posterior chin type because the throne can become trapped in the frame, causing the uterus to rupture. A good prognosis with a posterior chin pattern is much more difficult because the throne can become trapped in the subframe causing uterine rupture. The prognosis is good with the chin before but when the book is easy to tear the vaginal vagina because the baby's carrying diameter is too large.

The prognosis for the fetus is not good because of long labor, sometimes with √≠orceps, it can easily cause traumatic brain injury. If the child is able to deliver, the fetus has signs of a curvature of the face, purple face, edema, long head, and an arched body.

Diagnose

During pregnancy

Look: nothing special, can still see the head, uterus manifestations.

Lying: is the only method that indicates clearly. Head at the bottom, tucked into the upper waist. Anterior chin type, difficult to discern back, occipital hump and nape groove, sharpening of a horseshoe-shaped chin, and a sharpening of limbs. If it is a posterior chin type, you can see a large, round, solid, occipital hump, between the occipital and back with nape groove, called a sign of shyness (except in the case of infatranial pregnancy).

Hear: nothing special fetal heart, fetal heart position in the area around the navel.

Vaginal examination is unknown because the cervix has not been removed.

X-ray: showing the bent spine image, which can detect fetal malformations, infarction or abnormal tumor in the neck.

During labor

Seeing, manipulating and hearing is the same as during pregnancy but more difficult because of uterine contractions. You can see signs that suggest a bad head bow.

Vaginal examination requires a gentle, non-traumatic examination (eg face). Is the main sign of detection of the face. When unbroken amniotic fluid is difficult to examine because the amniotic fluid is swollen, the throne is high. Be careful to avoid rupture of the amniotic fluid, and examine when there is no uterine contraction. When amniotic fluid has ruptured uterus, always feel the joint line between the frontal bones, the bridge of the nose and the two-eye fossa, the nostrils, the upper jaw, and the lower jaw in the shape of a horseshoe. Identify the chin is to identify the throne. Never a cockle is squashed first.

Diagnosis of posture and pattern

The landmark of the face is the chin:

Thê: If the back is left, we will be better than the other because the chin is facing the back.

The type of position of the chin relative to the pelvic parts.

There are 4 types of leaks:

Left anterior pelvic chin (AD) 20%.

Right posterior pelvic chin (CaCFS) 30%.

Right anterior pelvic chin (CaCFT) 27%.

Left posterior chin (CaCTS) 10%.

Only the previous posture types to turn forward to become the chin guard can lay the excess sugar.

Differential diagnosis

The forehead: can never be confused with the frontal throne because it is a throne without a lower-laying mechanism. In the forehead, the mouth and chin cannot be touched.

Buttock: when there is a big, tired, buttock, it is mistaken for an incomplete buttock. Easy to confuse cheeks with buttocks. Distinguish by external examination to see the head on the ribs, vaginal exploration to distinguish the mouth from the anus (by giving fingers to probe if the mouth has a sucking reflex, if the anus has poop, pay attention only especially when the amniotic fluid has ruptured).

Treatment attitude

Must rely on the progress of the throne

In the face must exclude malformations: fetus shaped "canal" (deformed head, elongated back, edema lips and eyelids). Intracranial pregnancy to lay natural lower sugar.

If the throne is chin-type first, when labor holds the amniotic fluid until the end, wait for the cervix to fully open, the throne is well progressed, the head is fully tilted and down, back to the chin, to the chin, when the fetus is in pregnancy, a wide episiotomy is required.

If the face is like that, follow the labor closely, protect the amniotic fluid. If the amniotic fluid ruptures, the throne has not returned to the chin before the cesarean section is required.

The face if the pelvis is not proportionate to the fetus, accompanied by difficult delivery factors (the older child, the history of heavy obstetrics, rupture of the amniotic fluid) should caesarean section.

The fetal face died, aborting the fetus by crushing the base of the skull and taking a vaginal pregnancy.

If there are signs of rupture of the uterus, a cesarean section is required.

Upper jaw fixed the lower margin of the joint, the head gradually bowed so that the nose, forehead, front tip, dot, lower dot gradually, then head tilted, leaning on the two branches of vulva, head tilted gradually to mouth and chin out. When the episiotomy must be maximally stretched and indicated for extensive episiotomy. It is also indicative of preterm pregnancy and fetus. The part after giving birth is normal.

Symptom

During pregnancy

While pregnant, the forehead cannot be diagnosed because this throne only occurs in labor.

During labor

Vaginal examination: only the frontal throne is diagnosed when it is found that the throne has been fixed to the subframe. When examining the vagina, you can feel the forehead in the middle of the subframe with the joint line between the two frontal bones, the anterior lobe shape with 4 edges, 4 corners, the two eye sockets, the base of the nose and the two nostrils can be seen, the upper jaw can be seen. Back, mouth and chin are not palpable.

The landmark of the forehead is the pus-shaped base, it rises up, is pyramidal, hard, never oedema even when there is a serious tumor, the sides of the eye socket are palpable, the eyebrows above are.

Implementing the quadrants

Mainly based on clinical symptoms as described, in combination with subclinical tests.

X-ray and ultrasound allow to identify the difficult to diagnose fetus when the head is tilted, increasing the hollow part of the subframe. In addition, it is possible to eliminate malformed fetuses such as infarction, hydrocephalus to avoid unnecessary caesarean section.

Diagnosis of stereotype

Based on the landmark of the anterior chamber is the anterior tubule in the mother's position to make a diagnosis.

The anterior left pelvic nose and posterior right pelvic nose fall diagonally to the left.