I. Observation Obvious abnormal fetal position, abnormal fetal development, abnormal soft or bony birth canal are easily diagnosed before delivery. Most of the abnormal deliveries occur during labor, so we must carefully observe the labor process, draw the labor chart, combine with medical history, physical examination and comprehensive analysis in order to timely detect the following abnormalities: maternal systemic failure symptoms Due to prolonged labor, maternal agitation, physical exhaustion, serious cases of dehydration, metabolic acidosis and electrolyte disorders. Weak bowel movement and bladder smooth muscle weakness due to autonomic dysfunction, leading to intestinal distention and urinary retention, which should be detected and corrected in time. Obstruction of fetal head descent After delivery, when the fetal head descent is obstructed, we should think of pelvic stenosis, abnormal fetal position, weak uterine contraction, abnormal soft birth canal, oversized fetal head, fetal malformation, uterine spasm and narrow ring, etc. If the fetal head is delayed to enter the pelvis during the latent period, it should be alerted to weak contraction and cephalopelvic disproportion, and the fetal head should be checked for trans-pubic sign. In the active phase and second stage of labor, the fetal head descends less than 1cm/h or stays in the same place, most commonly seen in mid-pelvic stenosis and persistent posterior occipital and transverse occipital position. Delayed or stagnant cervical dilation After the clinical period, there is a clear pattern of cervical dilation in primiparous women, i.e. the latent period takes about 8 hours to dilate the cervical opening to 3 cm and the active period takes about 4 hours to fully open the cervical opening. If the rate of cervical opening dilatation is less than 1.2 cm/h in primiparous women or less than 1.5 cm/h in transmaternal women and the cervical opening is stagnant for more than 2 hours without progression of labor, this suggests that there may be ineffective uterine contractions or weak uterine contractions, cervical edema, cervical toughness and cervical scarring, cephalopelvic disproportion, abnormal fetal position, giant baby, and narrowing of the mid-pelvis or pelvic outlet plane. Uterine contraction abnormalities The first distinction is between coordinated or uncoordinated weak or excessive uterine contractions. Then distinguish between simple lack of uterine contractions or caused by other causes. The most common clinical condition is secondary contraction weakness, when the pelvis is narrow, cephalopelvic disproportion or abnormal fetal position, the contractions are normal at the beginning of labor for a period of time, and as labor progresses, the fetal head is obstructed from descending, so that the fetal head cannot fit tightly into the lower uterine segment and the inner cervical opening, resulting in secondary uterine contraction weakness. Uncoordinated uterine contractions can occur due to maternal stress or inappropriate application of contractin. For example, in twin pregnancies and excessive amniotic fluid, the uterine wall is overstretched resulting in weak uterine contractions, which can prolong the labor if not treated in time. If the uterus contraction is too strong and the fetal head is obstructed from descending, a precursory uterine rupture or even uterine rupture may occur. Therefore, it is important to detect abnormal uterine contraction, identify the cause and deal with it in time. Premature rupture of fetal membranes When the cephalopelvic disproportion or fetal position is abnormal, there is a gap between the first dewlap and the pelvis, and the front and back amniotic fluid traffic, resulting in uneven pressure in the front amniotic sac, when contractions, the fetal membranes bear too much pressure and rupture. Premature rupture of the fetal membranes is often a precursor to abnormal delivery, so it is important to find out whether there is cephalopelvic disproportion or abnormal fetal position. Fetal distress Due to prolonged labor, resulting in fetal hypoxia, fetal compensatory capacity may be reduced or lost, and the signs of fetal distress may appear (fetal heart rate greater than 160bpm or less than 120bpm, irregular heart rate, amniotic fluid contamination, fetal scalp blood pH less than 7.24), the cause of fetal distress should be investigated and dealt with in time. General treatment Firstly, relieve maternal fear and mental tension, provide adequate nutrition, encourage feeding, give 10% glucose solution, vitamin C and electrolyte supplementation if necessary. Give warm soapy water enema to cleanse the stool and catheterize if urinary retention occurs. Obstetric management Caesarean section should be considered in cases of preterm uterine rupture, obvious pelvic stenosis or obvious deformity, shoulder previa, chin posterior position, high straight posterior position, anterior uneven tilt position, mixed breech or full position in primigravida, breech position with pelvic stenosis, giant fetus, conjoined fetus, etc. In case of mild cephalopelvic disproportion, especially critical stenosis of the pelvic inlet, full trial of labor should be given, taking into account the conditions of labor, fetal position and fetal size. In the case of cephalopelvic asymmetry in the middle pelvis and exit plane and with pregnancy complications, caution should be exercised. If there is obvious cephalopelvic disproportion, high straight posterior position, chin posterior position and anterior uneven tilt position, cesarean section should be performed. The fetal head may be obstructed at the mid-bone and exit planes if there is delayed or stagnant fetal head descent at the end of the first stage of labor and the second stage of labor. If it is persistent occipito-transverse or occipito-posterior position, we can consider rotating the fetal head to occipito-anterior position by hand, and the fetal head will continue to descend, when S is greater than or equal to +3, spontaneous delivery or low forceps and fetal head suction can be performed to assist delivery, if S is less than or equal to +2, cesarean section should be performed. During the trial of labor, the fetal heart must be checked. If the fetal heart rate becomes faster, slower or irregular, especially if there is frequent heavy variation deceleration or late deceleration, the fetal heart variation decreases, etc., it is a manifestation of fetal distress, the cause should be found and treated symptomatically, if the fetal heart still does not improve and the opening of the uterus has been fully opened, vaginal assisted delivery should be performed, if it is estimated that vaginal delivery cannot be performed in a short time, a cesarean section should be performed to save the fetus. During the trial of labor, we must strictly observe the labor force, fetal heartbeat, dilatation of the uterus and the descent of the fetal previa. The trial of labor should not be too long, usually 2~4 hours, and not more than 2 hours after manual rupture of membranes. If abnormalities such as prolonged latent period or active period, delayed or stalled dilatation of the uterine orifice and delayed or stalled descent of the fetal head are found during the trial of labor, vaginal examination should be performed first, and if obvious cephalopelvic disproportion should be performed; if there is no cephalopelvic disproportion and the latent period is prolonged, the sedative pethidine 100mg or diazepam 10mg should be used for intravenous pushing, which can also be transferred to the active period soon, such as after the application of sedation or transfer to the If the uterine contractions are weak after the application of sedation or after the transition to the active phase, the uterine contractions can be strengthened by the use of contractin. 2.5u of contractin is commonly added to 500ml of 5% glucose solution, and the number of drops is adjusted so that the contractions are 2~3 minutes apart and last about 1 minute. If the fetal head descends smoothly, vaginal delivery is possible; if the fetal head still does not descend obviously after 2 hours of applying contractions and artificially breaking the membranes, the reason should be identified, and if there is obvious cephalopelvic disproportion and obvious abnormal fetal position, cesarean section is still needed.