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產(chǎn)道是什么？產(chǎn)道軟好嘛？

出處：網(wǎng)絡(luò)收集 日期：2024-06-28 10:51:03 編輯：秩名

產(chǎn)道軟好嗎

什么是軟產(chǎn)道？軟產(chǎn)道是由子宮的下段、陰道、宮頸和骨盆底軟組織所構(gòu)成的彎曲管道。我們常說(shuō)的產(chǎn)道是指骨產(chǎn)道，軟產(chǎn)道通常是閉合狀態(tài)，在分娩時(shí)，由于宮縮和孩子的擠壓，軟產(chǎn)道會(huì)被動(dòng)的逐漸擴(kuò)張，只有擴(kuò)張到10cm左右時(shí)，孩子才會(huì)順利通過(guò)，所以軟產(chǎn)道在分娩時(shí)，非常容易發(fā)生撕裂。
 
1.子宮下段形成：子宮下段是沒(méi)懷孕時(shí)長(zhǎng)約1cm的子宮峽部位形成的。臨產(chǎn)后會(huì)出現(xiàn)規(guī)律宮縮，進(jìn)而使子宮下段拉長(zhǎng)，達(dá)到7～10cm之后因?yàn)樽訉m肌纖維縮復(fù)作用，導(dǎo)致子宮上段的肌壁變得越來(lái)越厚。子宮下段的肌壁被拉的越來(lái)越薄。由于子宮上段和子宮下段的肌壁厚薄不同，上下段之間的子宮內(nèi)面會(huì)出現(xiàn)環(huán)狀隆起，醫(yī)學(xué)上稱之為生理縮復(fù)環(huán)。
 
2.宮頸的變化：生產(chǎn)前宮頸管長(zhǎng)2cm左右，生產(chǎn)后由于宮頸內(nèi)口向上或者向外擴(kuò)張，宮頸管會(huì)出現(xiàn)漏斗形，之后宮頸管就逐漸的變短，然后消失，就形成子宮下段。第一次生產(chǎn)的婦女通常宮頸管先消失，宮頸口后擴(kuò)張；第二次生產(chǎn)則通常是兩者同時(shí)進(jìn)行。
 

軟產(chǎn)道異常性難產(chǎn)的表現(xiàn)

軟產(chǎn)道異常導(dǎo)致的難產(chǎn)的臨床表現(xiàn)很多。本文主要介紹以下幾個(gè)方面：
 
1.外陰異常：外陰水腫、外陰狹窄、靜脈瘤、外陰腫瘤、外陰瘢痕 等是造成難產(chǎn)的原因。
 
2.陰道異常：先天性陰道狹窄 雖然妊娠后能夠軟化，但是分娩的時(shí)候，因伸展性較差而引起損傷，陰道手術(shù)瘢痕，如手術(shù)后炎癥形成的瘢痕、宮頸損傷，妊娠時(shí)會(huì)引起瘢痕出血，應(yīng)該進(jìn)行剖宮產(chǎn)，容易造成難產(chǎn)。一般陰道腫瘤在分娩時(shí)才被發(fā)現(xiàn)，腫瘤導(dǎo)致陰道伸展性降低，容易出血感染，建議剖宮產(chǎn)等。
 
3.宮頸病變：宮頸裂傷后感染、宮頸管狹窄 、宮頸口黏合、宮頸口開(kāi)大障礙、宮頸水腫、子宮外口變位、宮頸與胎膜粘連、宮頸肌瘤、宮頸癌、宮頸堅(jiān)硬癥等宮頸病變也會(huì)發(fā)生難產(chǎn)，所以分娩時(shí)建議剖宮產(chǎn)。
 
4.子宮異常：子宮脫垂、子宮扭轉(zhuǎn)、子宮高度前屈固定術(shù)及子宮前腹壁固定術(shù)后、子宮畸形、子宮發(fā)育不全、子宮縮窄環(huán)等造成難產(chǎn)。
 
5.盆腔腫瘤：卵巢囊腫 、盆腔腫塊也會(huì)造成難產(chǎn)。
 

軟產(chǎn)道異常性難產(chǎn)病因

軟產(chǎn)道異常導(dǎo)致的難產(chǎn)幾率比骨產(chǎn)道要少，所以非常容易被忽略而造成漏診。
 
1.發(fā)育異常：如果子宮發(fā)育不良、陰道狹窄、會(huì)陰小或者宮頸長(zhǎng)、窄且硬，缺乏彈性、伸縮困難，生產(chǎn)時(shí)就會(huì)非常困難。
 
2.高齡初產(chǎn)婦：35歲以上婦女生產(chǎn)稱為高齡產(chǎn)婦。35歲結(jié)婚妊娠與結(jié)婚十年后才35歲的產(chǎn)婦第一次生產(chǎn)相比難產(chǎn)的幾率是不同的。前者不一定會(huì)發(fā)生難產(chǎn)的情況，后者可能會(huì)因?yàn)樯称鞴俚陌l(fā)育不良而發(fā)生分娩困難。一般，軟產(chǎn)道發(fā)生裂傷而形成子宮脫垂的機(jī)會(huì)增多。由于高齡初產(chǎn)婦的盆底肌肉群與肌膜伸展性不好，胎兒通過(guò)產(chǎn)道時(shí)容易造成盆底肌肉和肌膜損傷，從而形成子宮脫垂。
 
3.檢查：（1）實(shí)驗(yàn)室檢查，是根據(jù)產(chǎn)婦病情、臨床表現(xiàn)及癥狀和體征做血常規(guī)等相關(guān)檢查。（2）其他輔助檢查，如根據(jù)產(chǎn)婦病情、臨床表現(xiàn)及癥狀和體征選擇做B超、X線等相關(guān)檢查。
 

軟產(chǎn)道異常性難產(chǎn)的診斷

軟產(chǎn)道異常診斷有以下幾個(gè)方面：
 
1.宮頸口的厚度、軟硬度及擴(kuò)張程度，胎頭與宮頸之間在發(fā)生宮縮高峰時(shí)有沒(méi)有空隙，宮頸是否有水腫以及水腫的部位和程度等。
 
2.查清胎方位：比如矢狀縫走向和前后囟門位置。尤其要注意的是當(dāng)胎頭嚴(yán)重水腫時(shí)，會(huì)導(dǎo)致前囟、后囟摸不清楚的可能。在助產(chǎn)之前的陰道檢查時(shí)，要以捫清耳郭方向的方法，來(lái)協(xié)助判斷胎兒方位檢查的是否有誤。
 
3.明確先露高低：這胎兒是否能通過(guò)骨產(chǎn)道和陰道助產(chǎn)還是剖宮產(chǎn)的判斷都非常重要，不容易出現(xiàn)差錯(cuò)。所以那些嚴(yán)重胎頭水腫的人，在檢查時(shí)，要以顱骨的最低點(diǎn)為標(biāo)準(zhǔn)，有的時(shí)候，還需要用另一手在產(chǎn)婦恥骨聯(lián)合上檢查胎兒頭部是否已經(jīng)通過(guò)骨盆入口。有時(shí)胎頭最低點(diǎn)已經(jīng)撥露，但雙頂徑仍然卡在骨盆的入口之上。
 

軟產(chǎn)道異常性難產(chǎn)的治療

當(dāng)診斷是軟產(chǎn)道異常時(shí)，不要慌張，應(yīng)積極治療和預(yù)后。
 
1.軟產(chǎn)道異常除了生殖器性病變引起的改變外，還有孕足月時(shí)宮頸不成熟，產(chǎn)程延長(zhǎng)，使產(chǎn)婦非常痛苦，最后導(dǎo)致難產(chǎn)發(fā)生或新生兒窒息等。所以，軟產(chǎn)道異常的程度的不同，處理方法也不同，如單純瘢痕的產(chǎn)婦切除即可。如宮頸不成熟則需先促宮頸成熟，然后催產(chǎn)。對(duì)于宮頸堅(jiān)硬的患者已經(jīng)臨產(chǎn)，產(chǎn)程如果進(jìn)展很慢者易做剖宮產(chǎn)。如果出現(xiàn)影響母子健康的情況，應(yīng)盡早結(jié)束分娩。
 
2.宮頸堅(jiān)硬者不能以小水囊引產(chǎn)。如出現(xiàn)縮窄環(huán)的情況，可以用麻醉劑解除痙攣，如果胎兒存活，盡早進(jìn)行剖宮產(chǎn)，否則結(jié)束分娩。
 
3.對(duì)于胎膜粘連的患者，若胎兒存活，盡早做剖宮產(chǎn)。
 
4.會(huì)陰、外陰異常狹窄，骨盆出口小，應(yīng)做剖宮產(chǎn)。
 
5.軟產(chǎn)道異常時(shí)，產(chǎn)程延長(zhǎng)，引起胎兒缺氧、宮內(nèi)窒息。檢查過(guò)多，包括陰道檢查和肛門檢查，會(huì)引起子宮內(nèi)感染而對(duì)胎兒不利。
 
6.分娩時(shí)間延長(zhǎng)，手術(shù)產(chǎn)率增加，如胎位異常，分娩停滯，導(dǎo)致難產(chǎn)和產(chǎn)傷，胎膜早破，引起宮內(nèi)感染，軟產(chǎn)道擴(kuò)展受阻，不利于分娩。
 
以上就是有關(guān)軟產(chǎn)道好不好的一些介紹，希望能幫助到大家，提高自我保護(hù)意識(shí)。

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