11頁的第1頁Englishfirst,simplifiedChineselater先英語,后簡體漢字StepsinloweringbloodlossThereare5steps.Firstistodelivertheheadandbodyofthebabyinstages,meaningtoreducetheuterinevolumeinstages.Thatis,usingasmuchtimeasnecessarytoremovetheamnioticfluid,andusingmoretimethanyounormallyusetodeliverythefetalhead.Therationaleistogivetheuppersegmentashortrestduringvolumereduction,enablingittomakestrongcontractionandretractiontoclosetheinjuredbloodvessels.Secondistorepairtheuterineincisionasquicklyaspossible.Normallytheanteriorwalloftheuterinelowersegmenthasnoopening.Whatthelowersegmentneedsistorepairtheuterineincisionquickly.Theslowstepsofthisoperationtechniqueistoimitatethelengthylabourprocessofavaginaldelivery.Whenapatientisinlabour,1.theamnioticfluidtakesseveralhourstoleavetheuterus,2.thefetalheadtakesseveralhourstodescendtothevulva,3.descentofthefetalheadfromthecervixthroughthevulvatakesalmostanhourormore,4.whenthefetalheadhascomethroughthevulva,allow10ormoresecondsfortheairpassagestobeclearedbeforedeliveringtherestofthebaby,5.lettheplacentawaitfortheobvioussignalthatithasbeenseparatedanddescendedtothetopofthevaginabeforepushingitout.Thisusuallymeansawaitofseveralminutesafterthesecondstage.11頁的第2頁Obviously,ifthese5stagesofactionaretransplantedtoacesareandelivery,firstistomakeasmalluterineincisionattherightplace,andtotake20-90secondstoremovealloftheamnioticfluid,secondistouse4fingersoraMurlessextractorslowlytoliftuptheheadtotheincisionlevel,then,togetherusing30ormoresecondtopulluptheupperuterineflap,thirdisgive20ormoresecondstolifttheheadoutoftheincisionswithoutlaceratingtheincision,andallowingtheincisionssqueezeoutfluidsintheairpassages,fourthistakemorethan10secondstodeliverthebody,allowingtimefortheassistanttocleartheairpassages,fifthistowaitfortheedgeoftheplacentamakingitsappearancebeforeremovingtheplacenta.Bycarryingouttheabove5,bloodlosscancomedowntolessthan300ml.Andifthehighuterineincisionofthistechniqueisused,bloodlosswillbemuchless.HighlowersegmentincisioncanreducebleedingwhileclosingtheuterineincisionPickupinsmallstepstheperitoneumcoveringthelowersegmentfrommiddlepartofthelowersegmenttowardstheuppersegment.Asthetoothedpickupforcepsapproachestheuppersegment,itfindstheperitoneumcanonlybebarelypickedup.And,thespotwheretheperitoneumcannotbepickedup,istheborderoftheserosa.Thelevel3cmcaudaltotheserosaisthelevelofthehighincision.Ahighincisionshouldnotbemade<2cmfromtheserosa.Thisisbecausetheneedleholesontheleftsideofthesuturelikeusuallyoozesblood.Thisnecessitatesseveralstitchestostop.Inthecaseofshoulderpresentation,thelowersegmentappearsasaninvertedstandingtriangle,withemptinessinside.Onlyatoothedpickupcanlocatethecorrectlevelofthehigh11頁的第3頁incision.Thesurgeoninciseslightlythelowersegmentatmidline3cmcaudaltotheserosalborder,pushesawaytheperitonealedges,thenthesuperficialandthenthedeeperlayeruntiltheamnioticmembranesareexposed,puncturesthemembranes,suctionsoutalloftheamnioticfluid.Hethenmakestwoshortuptiltends,andextendsthetwoendstowardstherootsoftheroundligaments.Hethenproceedstouse4fingersoraMurlessretractortodeliverthefetalhead.11頁的第4頁HowtodeliveralargefetalheadwithlittlebloodlossandnolacerationFirstmakethehighuterineincision,thenusetheMurlessextractortoliftupandliftouttheheadslowlyfromtheexistingoccipitalposition.Thefirstassistanthelpsresuscitationofthenewborn,...
VIP
