减少娩儿失血的五缓慢步骤(精).doc

13頁的第13頁 English first, simplified Chinese later 先英語, 后簡體漢字 Steps in lowering blood loss There are 5 steps. First is to deliver the head and body of the baby in stages, meaning to reduce the uterine volume in stages. That is, using as much time as necessary to remove the amniotic fluid, and using more time than you normally use to delivery the fetal head. The rationale is to give the upper segment a short rest during volume reduction, enabling it to make strong contraction and retraction to close the injured blood vessels. Second is to repair the uterine incision as quickly as possible. Normally the anterior wall of the uterine lower segment has no opening. What the lower segment needs is to repair the uterine incision quickly. The slow steps of this operation technique is to imitate the lengthy labour process of a vaginal delivery. When a patient is in labour, 1. the amniotic fluid takes several hours to leave the uterus, 2. the fetal head takes several hours to descend to the vulva, 3. descent of the fetal head from the cervix through the vulva takes almost an hour or more, 4.when the fetal head has come through the vulva, allow 10 or more seconds for the air passages to be cleared before delivering the rest of the baby, 5.let the placenta wait for the obvious signal that it has been separated and descended to the top of the vagina before pushing it out. This usually means a wait of several minutes after the second stage. Obviously, if these 5 stages of action are transplanted to a cesarean delivery, first is to make a small uterine incision at the right place, and to take 20-90 seconds to remove all of the amniotic fluid, second is to use 4 fingers or a Murless extractor slowly to lift up the head to the incision level, then, together using 30 or more second to pull up the upper uterine flap, third is give 20 or more seconds to lift the head out of the incisions without lacerating the incision, and allowing the incisions squeeze out fluids in the air passages, fourth is take more than 10 seconds to deliver the body, allowing time for the assistant to clear the air passages, fifth is to wait for the edge of the placenta making its appearance before removing the placenta. By carrying out the above 5, blood loss can come down to less than 300ml. And if the high uterine incision of this technique is used, blood loss will be much less. High lower segment incision can reduce bleeding while closing the uterine incision Pick up in small steps the peritoneum covering the lower segment from middle part of the lower segment towards the upper segment. As the toothed pickup forceps approaches the upper segment, it finds the peritoneum can only be barely picked up. And, the spot where the peritoneum cannot be picked up, is the border of the serosa. The level 3 cm caudal to the serosa is the level of the high incision. A high incision should not be made <2cm from the serosa. This is because the needle holes on the left side of the suture like usually oozes blood. This necessitates several stitches to stop. In the case of shoulder presentation, the lower segment appears as an inverted standing triangle, with emptiness inside. Only a toothed pickup can locate the correct level of the high incision. The surgeon incises lightly the lower segment at midline 3cm caudal to the serosal border, pushes away the peritoneal edges, then the superficial and then the deeper layer until the amniotic membranes are exposed, punctures the membranes, suctions out all of the amniotic fluid. He then makes two short uptilt ends, and extends the two ends towards the roots of the round ligaments. He then proceeds to use 4 fingers or a Murless retractor to deliver the fetal head. How to deliver a large fetal head with little blood loss and no laceration First make the high uterine incision, then use the Murless extractor to lift up and lift out the head slowly from the existing occipital position. The first assistant helps resuscitation of the new born, the surgeon cuts the umbilical cord, and apply clamps to stop bleeding on the incision edges when necessary. 減少娩兒失血的五緩慢步驟 7頁內容: (一) 模仿經陰分娩步驟達成失血少 (二) “緩慢” 操作減少失血 (三) 但是, “緩慢” 操作只適用于高位水平宮切口 (四) 娩巨大兒, 如何保持高位宮切口完整及失血少 取法 “經陰分娩” 的兩個步驟調整之至適用於剖宮產 傳統足月剖宮產失血多於經陰分娩, 均因沒有取法經陰產時失血少的步驟。 本產術摸清經陰分娩有兩個步驟值得模仿,遂將該兩步驟作適當調整, 移用于剖宮產、達成實現經陰分娩失血少的效果。 下述是調整好的兩個經陰分娩步驟。 (一)經陰分娩是通過產時分時段削減宮腔容積, 調整好的步驟應用于本剖宮產的是 “用足夠時間吸干羊水、用超過您願意用的時間娩胎頭”。 (二)經陰分娩的子宮宮下段是沒有缺口的, 應用于本剖宮產時的調整是娩兒后立馬手取胎盤及急速修復宮切口哄騙子宮其宮下段無缺口。 “緩慢” 操作有利患者 剖宮產期間五個時段逐步減縮宮腔容積至零, 每一個時段僅削減宮腔一部分容積, 每一個時段都要緩慢地完成, 緩慢完成使到宮體尚未進行下一個操作之前獲得短暫歇息, 因而達成實現吸干羊水娩頭娩兒身娩盤后(即縫合宮切口后)、宮體強勢收縮、縮復及結扎受傷血管。 本剖宮產術的緩慢操作是模擬經陰分娩步驟的五個漫長的時段, 例如: 經陰分娩時(一)破羊膜流出羊水的時間是需要數小時的, (二)胎頭需要經過數小時下降至接近陰戶外口, (三)娩胎頭的第二產程, 時間是一小時或超過一小時, (四)胎頭娩出陰戶后, 使用適當時間吸出兒口鼻積液后纔娩兒身也就說明娩兒身是等待抽出腔液后纔完成, 娩兒身絕對不是一兩秒鐘完成的,(五)娩胎盤也要等待宮體擠壓胎盤至陰道頂然后動手的, 亦即是說娩兒后等待3數分腫然后進行的。 可見, 假如模擬和調整好的經陰分娩五個時段步驟和搬它們到剖宮產術: (一