Shields Sara G, Ratcliffe Stephen D, Fontaine Patricia, Leeman Larry
Dept of Family Medicine and Community Health, Family Health Center of Worchester, University of Massachusetts, Massachusetts 01610, USA.
Am Fam Physician. 2007 Jun 1;75(11):1671-8.
Dystocia is common in nulliparous women and is responsible for more than 50 percent of primary cesarean deliveries. Because cesarean delivery rates continue to rise, physicians providing maternity care should be skilled in the diagnosis, management, and prevention of dystocia. If labor is not progressing, inadequate uterine contractions, fetal malposition, or cephalopelvic disproportion may be the cause. Before resorting to operative delivery for arrested labor, physicians should ensure that the patient has had adequate uterine contractions for four hours, using oxytocin infusion for augmentation as needed. For nulliparous women, high-dose oxytocin-infusion protocols for labor augmentation decrease the time to delivery compared with low-dose protocols without causing adverse outcomes. The second stage of labor can be permitted to continue for longer than traditional time limits if fetal monitoring is reassuring and there is progress in descent. Prevention of dystocia includes encouraging the use of trained labor support companions, deferring hospital admission until the active phase of labor when possible, avoiding elective labor induction before 41 weeks' gestation, and using epidural analgesia judiciously.
难产在初产妇中很常见，超过50%的首次剖宫产都与之有关。由于剖宫产率持续上升，提供产科护理的医生应熟练掌握难产的诊断、处理和预防。如果产程没有进展，可能是子宫收缩不足、胎位异常或头盆不称所致。在因产程停滞而采取手术分娩之前，医生应确保患者已经有足够的子宫收缩达4小时，必要时使用缩宫素静脉滴注加强宫缩。对于初产妇，与低剂量方案相比，高剂量缩宫素静脉滴注方案用于加强宫缩可缩短分娩时间且不会导致不良后果。如果胎儿监护情况良好且胎头下降有进展，第二产程可以允许持续超过传统时间限制。难产的预防措施包括鼓励使用经过培训的分娩支持人员，尽可能推迟住院至产程活跃期，避免在妊娠41周前进行选择性引产，以及谨慎使用硬膜外镇痛。
