Airbag midwifery is one of the “100 projects in ten years” launched by the Ministry of Health in 1994 to promote science and technology nationwide. I was fortunate enough to participate in the "Application and Training of Air Bag Midwifery" held by the Jiangxi Provincial Department of Health at the Provincial Gymnasium from October 19th to October 21st, 2005. The lecturer is Professor Tian Yangshun from the Obstetrics and Gynecology Department of Xijing Hospital of the Fourth Military Medical University. This was the first time I had such close contact with a senior scholar, and it really made me feel the demeanor of a scholar. A very compact and energetic face, a body that is not tall but not strong, showing the typical and familiar posture of a clinician doing table surgery...
The following are the notes.
Air bag assisted delivery and planned delivery:
(1) Causes of delivery
Uterine muscle contraction activity:
(1) Prostate Prostaglandings can simultaneously cause the release of ca2 and a large amount of energy in the tissue, directly participating in the contraction of uterine muscles;
(2) Prostaglandins can also stimulate the release of pituitary oxytocin, which causes uterine contractions. Oxytocin can cause paroxysmal contractions of uterine muscles, and oxytocin, in turn, promotes the release of prostaglandins, which is the start of labor. Once labor officially begins, unless the products of intrauterine pregnancy are eliminated, uterine contractions will not and will not occur. It may stop.
(3) The sensitivity of the pregnant uterus to prostaglandin stimulation: the sensitivity of the full-term uterus is 2 to 20 times that of the first and second trimesters.
Influencing factors of cervical baroreceptors:
When cervical baroreceptors are mechanically stimulated and compressed, such as cervical dilation and rupture of membranes, prostaglandins can be released, which can trigger the onset of labor. .
As can be seen from the above, the factors that initiate labor are: (1) Internal factors: whether the pregnancy is full term; (2) Direct factors: mechanical expansion and compression of the cervix and lower uterine segment to synthesize prostaglandins in the uterus. Applying this principle, the bionic obstetric technology "airbag midwifery" came into being.
(2) Performance and structure of the air bag midwifery device
The TD series fully automatic air bag midwifery device is a new midwifery device developed by Chinese scientific and technological personnel. It is mainly used for dilation of pregnant women. It can reduce the cervix and vagina, shorten the labor process, reduce labor pain, reduce the rate of perineal laceration, perinatal mortality, reduce episiotomy, fetal head suction, forceps and cesarean section, to achieve the purpose of intrapartum eugenics.
The air bag midwifery device is safe to use and easy to operate. It can shorten the labor process by more than 10 hours and ensure the physical recovery of the mother; In order to be effective, reduce the labor intensity of medical staff and achieve planned delivery, it has significantly promoted the development of obstetric technology.
(3) Airbag midwifery stimulates the onset of labor and shortens the labor process
The airbag acts on the cervix, and due to mechanical stimulation, it causes the posterior pituitary gland to reflexively increase endogenous oxytocin and prostate Synthesis of hormones;
After the balloon fully dilates the cervix, it ruptures the membranes in time, increasing the prostaglandins and calcium ions in the serum and amniotic fluid. The prostaglandins cause the contraction of uterine smooth muscles and induce the onset of labor.
After the rupture of membranes, the resistance of the fetal head to descent is reduced, causing the fetal head to be directly close to the cervix. The pressure on the cervix increases, stimulating the parametrial nerve plexus and releasing endogenous oxytocin. Such a virtuous cycle enables primiparous women without vaginal obstruction to have the conditions for multiparous women to give birth in a short period of time.
In general, the latent period of the first stage of labor for first-time mothers takes an average of 6 to 8 hours, from the disappearance and flattening of the cervical canal to the dilation of the cervix of 3 cm. The total labor process averages 12 to 16 hours. During this long labor process , the stimulation of pain puts the mother in a state of anxiety, seriously affects her diet and sleep, causes body fatigue, easily leads to uterine atony, postpartum hemorrhage, and prolonged labor can also lead to fetal distress. By mechanically dilating the cervix, the air bag can dilate the cervix of primiparous women beyond the latent period of the first stage of labor, rapidly dilate the cervix to 5 to 6 cm, and directly enter the end of the active stage. In addition, after dilation of the cervix, the membranes are artificially ruptured, allowing the fetal head to directly It compresses the cervix and lower uterine segment, stimulates effective uterine contractions, and significantly shortens the labor process.
Moreover, the balloon dilates the cervix and induces labor in a planned manner, breaking the passive situation of waiting for labor to start naturally. In addition, the dilation of the cervix shortens the labor process, so that labor can start and be completed at a selectable time, forming a good and orderly working state. , which is conducive to the rest of pregnant women and medical staff. This definitely allows obstetric workers to break the past "maternal-centered protection and support natural delivery" model and move into a "doctor-centered medical delivery" model. Here, as an obstetrician, I loudly call for "returning childbirth to nature." Promoting natural childbirth and air bag assisted delivery have brought us to the forefront of obstetrics. Thanks to a group of prophetic obstetrics instructors like Tian Yangshun for their absolute contribution to human women, and to myself for my long-standing attempts at obstetrics.
The author's hospital does not have an air bag midwifery device, but in long-term obstetric clinical practice, he has concluded a set of technologies similar to air bag midwifery - "midwifery technology to promote water sac formation". This set of technology does not have The involvement of instruments and equipment is entirely a matter of clinical practice skills. At that time, I was very shocked when I listened to Tian Yangshun's lectures, because the principle of my "water sac formation midwifery technique" was almost the same as his "air bag midwifery" principle, except that he had instruments and equipment, and various indicators had parameter displays. It can be quantified and can be promoted and popularized throughout the country and even the world as science and technology, but I cannot.
At the training center I saw Tian Yangshun’s air bag midwifery device. The center part of the instrument is a silicone balloon, which is about the size of a broad bean when not inflated. The operation is very simple. You just need to choose single or double dilation according to the size of the cervix, as well as the number of dilations and the time limit.
(1) Single dilation method: When the cervix is ??opened 5 cm, the cervix is ??not dilated, but the upper vagina is dilated twice (set the diameter to 8 cm and held for 3 to 5 minutes), and the lower segment once (set the air bag) The diameter is 6 cm and the holding time is 3 to 5 minutes), which shortens the second half of the first stage of labor and the second stage of labor. This method is simple, safe and reliable, and can be operated by beginners and midwives.
(2) Double dilation method: When the cervix is ??dilated 2 to 4 centimeters, the cervix is ??first dilated, then the membranes are artificially ruptured, and finally the vagina is dilated. Suitable for skilled operators, this can shorten the total labor process to 5 to 8 hours.
This class is very exciting for me. Long-term clinical practice has allowed me to summarize the midwifery method of "promoting water sac formation", but there has never been a complete theoretical system to support my new midwifery technology.
The "midwifery technique to promote water sac formation" is the key technical point:
(1) During intravaginal diagnosis, first separate the fetal membranes from the uterine wall, and then remove the fetal head. Gently push up to turn the posterior amniotic fluid into anterior amniotic fluid, and the effective diameter must be maintained at least 8 cm (similar to Professor Tian's air bag, but the material of this bag is not artificially synthesized but derived from itself, which should be safer and more reliable). Maintain for 30 to 60 minutes;
(2) Artificial membrane rupture, left lateral decubitus position.
After 20 to 30 minutes, instill 5 to 10 units of oxytocin intravenously. When the cervix is ??4 to 5 cm dilated, inject 8 ml of 654-2 injection intravenously. At the same time, inject 8 ml of 654-2 injection into the cervix at 3, 6, 9, and 12 points respectively. Lidocaine 10ml for cervical sealing;
(3) At this time, instill oxytocin intravenously for 5 minutes without controlling the number of drops;
(4) Change to "10GS 100ml VitC" 1g Dx 10mg", continue to lie on the left side;
(5) After the two-drug infusion, continue the infusion of oxytocin. Under normal circumstances, the cervix can be fully opened in about an hour, and the best time is when there is no obstruction. It will not exceed 2 hours
(6) If you continue to lie on your left side for 20 to 30 minutes, the fetal head can usually be exposed, because it has surpassed the long first stage of labor and directly entered the second stage of labor in a short period of time. During the labor process, the mother is generally energetic and has strong labor force. The midwife is active, encouraging, supportive and provides correct labor technical guidance (the mother should know that you are affirming her every effort, and do not attack the mother or scold her for not being able to give birth). It will make the force or comment on her labor useless, which will bring direct trouble to the delivery and increase the chance of episiotomy.) Generally, the second stage of labor will be smoother, and the perineum will generally not be torn to a large extent (because The perineal compression time is not long and will not cause local edema of the perineum, and the newborn's head will not undergo long-term compression in the vagina to form tumors). If there is a tear, it will be easier to suture because there is no perineal edema, there will not be much bleeding, and it can usually heal in the first stage.
Impression: The entire delivery process was very smooth and can be summed up in two words: "beautiful". Everyone felt that my shift workload was heavy, but since it was a planned delivery, the arrangements were orderly and there was basically no labor. Unable to stay up late on the night shift (generally, the remaining deliveries from the day shift will be dealt with before 23:00, and the temporary mothers will be solved in a short time. Even if there are 7 to 8 mothers in one night, their mental state will not be very bad when they hand over the shift in the morning) or That sentence: Tired but not tired, I love my position, I love every mother, I love every sun held in my hands!
The clinical significance of midwifery by promoting water sac formation:
(1) For first-time mothers with a cervix dilation of 4 cm, this treatment usually ends the delivery in about 3 hours, and it is rare. If there is neonatal asphyxia, even if it is asphyxia, it is short-term intrapartum asphyxia. Resuscitation is very easy to succeed, and there will be no sequelae after resuscitation;
(2) First-time mothers with a cervix dilation of 6 cm, Generally, labor ends in about 1.5 hours;
(3) Multiparous women whose cervical canal has disappeared usually end labor within 3 hours without initiating labor;
(4) For expired In pregnancy, crushed misoprostol 0.2 mg can be used after the amniotic fluid is in good condition after the membranes are peeled off and ruptured. Generally, effective uterine contractions occur about 15 minutes after use, and the total labor process generally does not exceed 10 hours, with an average of 6 to 8 hours.
In short, the successful implementation of midwifery technology that promotes the formation of water sacs generally results in an average labor duration of 5 to 6 hours for first-time mothers and 2 hours for multiparous women, and can significantly reduce maternal and infant complications.
The latest domestic and foreign views on planned delivery:
(1) It is better to give birth 1 hour earlier than 5 minutes later;
(2) It is better to give birth a week earlier , and don’t postpone it for a day.
Technical key points:
(1) Successful removal of membranes and artificial rupture of membranes is half the success of planned delivery;
(2) Of course, the cervix should be wide open This operation still needs to be perfected, and it is not without blind spots. Generally, the operation will not be performed if the amniotic fluid has ruptured for the third time after the membranes have ruptured. The operation will not be performed if the fetal heart rate is irregular. The operation will not be performed if the cervix has stress and inflammation, especially if there is a possibility of obstruction. No surgery is required. Surgery can be performed for breech position, but B-ultrasound shows that the biparietal diameter should not be greater than 93mm, and manual membrane stripping and hydrolysis are not allowed. If the fetal position is abnormal (referring to occipital transverse and occiput posterior position), the presentation should be pushed upward at the same time. Try to rotate the fetal head with your bare hands until it reaches the occipitoanterior position.
(3) Midwives should not protect the perineum too early to avoid excessive compression of the perineal body leading to local edema and severe laceration of the perineal body.
(4) It is not recommended that midwives artificially passively expand the perineal body, as this will also lead to severe tearing of the perineal body.