กลไกการคลอดปกติ 8 ขั้นตอน

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  • 1. (Mechanism of labor) Presentation Vertex Bregma . Vertex Presentation 1. Engagement 2. Flexion 3. Descent 4. Internal rotation 5. Extension 6. Restitution 7. External rotation 8. Expulsion. Bregma Presentation

2. Engagement () Engagement (Bilateral diameter) ( pelvic inlet) Engagement engagement (lightening subcidence) Engagement (A-P dimeter) . . Promontary of sacrum (sagittal suture) Sacrum Synclitism sacrum Asynclitism Anterior Asynclitism Naegele, s obliquity sacrum 3. Synclitism Anterior Asynclitism (Naegele, s obliquity) Posterior Asynclitism Liztmann s obliquity , Posterior Asynclitism (Liztmann, s obliquity) Engagement Posterior asynclitism Synclitism Engagement Engagement Anterior asynclitism Posterior asynclitism 4. . . Engagement. Engagement Engagement Molding molding Membranous occipital frontal parietal parietal SOB, SOF, OF Biparietal OM molding ( molding , molding ) Molding molding molding molding Engagement 1. (Lightening) 2. Pawlik, s grip Bilateral inquinal grip 3. station Ischial spine Engage 5. . Pawlik, s gripBilateral inquinal grip (Flexion) Flexion (attitude) ( ) OF . . SOB . . . Flexion. Complete Flexion Flexion 1. Fetal axis pressure : . : sacrum (Occiput anterior position) engagement 6. fetal axis pressure. : . : pelvic floor Flexion pelvic floor 7. Complete flexion SOB . . OF Flexion . cephalic prominences Flexion . Flexion (Descent) 1. Fetal axis pressure Occipito vertebral 2. 3. descent 8. 1. 2. 3. Station -, + , + 4. 5. (Internal rotation) (Pelvic floor) (Occiput anterior position) (Sagittal suture) (A-P diameter) ( ) (Persistant occiput posterior : OPP) (Transverse arrest) LOA internal rotation Internal rotation LOA - 9. 1. (LOA ROA) 2. (LOT ROT) LOA ROA OA 3. (LOP ROP) LOT LOA OA ROT ROA OA Internal rotation 1. Pelvic floor Occiput Pelvic floor ( ) 2. Pelvic floor 3. Oblique diameter Antero-posterior diameter Coccyx . ( ) Pelvic floor . . . Internal rotation Internal rotation Engaged - (Extension) Subocciput SOB SOF 10. Biparietal (Crowning) () (Head born)( ) (Crowning) Extension Pelvic inlet (Restitution) LOA restitution 11. Restitution LOA (External rotation) - LOA external rotation External rotation LOA 12. (Expulsion Birth of shoulders , Trunk, Hips , Legs) - (Hypomochlion) Lateral flexion ( ) Pelvic floor Perineum 13. . Engagement : . Occipito frontal . Sub Occipito bregmatic . . . . Flexion . . . Internal Rotation . . . . Extension . SOB, SOF SOM . . Restitution . External rotation: . Expulsion 14. LOA (descent ) - Engagement,Flexion - Internal rotation, Extension - Restitution, External rotation (dystocia)