Neilson J P, Lavender T, Quenby S, Wray S
Department of Obstetrics & Gynaecology, University of Liverpool, Liverpool, UK.
Br Med Bull. 2003;67:191-204. doi: 10.1093/bmb/ldg018.
Obstructed labour is an important cause of maternal deaths in communities in which undernutrition in childhood is common resulting in small pelves in women, and in which there is no easy access to functioning health facilities with the capability of carrying out operative deliveries. Obstructed labour also causes significant maternal morbidity in the short term (notably infection) and long term (notably obstetric fistulas). Fetal death from asphyxia is also common. There are differences in the behaviour of the uterus during obstructed labour, depending on whether the woman has delivered previously. The pattern in primigravid women (typically diminishing contractility with risk of infection and fistula) may result from tissue acidosis, whereas in parous women, contractility may be maintained with the risk of uterine rupture. Ultimately, tackling the problem of obstructed labour will require universal adequate nutritional intake from childhood and the ability to access adequately equipped and staffed clinical facilities when problems arise in labour. These seem still rather distant aspirations. In the meantime, strategies should be implemented to encourage early recognition of prolonged labour and appropriate clinical responses. The sequelae of obstructed labour can be an enormous source of human misery and the prevention of obstetric fistulas, and skilled treatment if they do occur, are important priorities in regions where obstructed labour is still common.
梗阻性分娩是导致孕产妇死亡的一个重要原因，在儿童期营养不良普遍存在、导致女性骨盆狭小，且难以获得具备实施手术分娩能力的有效运转的医疗设施的社区中尤为如此。梗阻性分娩还会在短期内（尤其是感染）和长期内（尤其是产科瘘）导致严重的孕产妇发病。胎儿窒息死亡也很常见。根据女性既往是否有过分娩经历，梗阻性分娩期间子宫的表现存在差异。初产妇的情况（通常是宫缩力减弱，伴有感染和瘘的风险）可能是由于组织酸中毒所致，而经产妇的宫缩力可能得以维持，但有子宫破裂的风险。最终，解决梗阻性分娩问题需要从儿童期开始普遍摄入充足营养，并在分娩出现问题时能够获得配备齐全、人员充足的临床设施。这些似乎仍是相当遥远的目标。与此同时，应实施相关策略，鼓励尽早识别产程延长并做出适当的临床应对。梗阻性分娩的后遗症可能是巨大的人类痛苦来源，在梗阻性分娩仍然常见的地区，预防产科瘘以及在瘘发生时进行专业治疗是重要的优先事项。
