Berghella Vincenzo, Baxter Jason K, Chauhan Suneet P
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Am J Obstet Gynecol. 2008 Nov;199(5):445-54. doi: 10.1016/j.ajog.2008.06.093.
Our objective was to provide evidence-based guidance for management decisions during labor and delivery. We performed MEDLINE, PubMed, and COCHRANE searches with the terms labor, delivery, pregnancy, randomized trials, plus each management aspect of labor and delivery (eg, early admission). Each management step of labor and delivery was reviewed separately. Evidence-based good quality data favor hospital births, delayed admission, support by doula, training birth assistants in developing countries, and upright position in the second stage. Home-like births, enema, shaving, routine vaginal irrigation, early amniotomy, "hands-on" method, fundal pressure, and episiotomy can be associated with complications without sufficient benefits and should probably be avoided. We conclude that labor and delivery interventions supported by good quality data as just described should be routinely performed. All aspects with lower data quality should be researched with adequately powered and designed trials.
我们的目标是为分娩期间的管理决策提供循证指导。我们使用“分娩”“妊娠”“随机试验”以及分娩各管理方面（如提前入院）等术语在MEDLINE、PubMed和COCHRANE数据库进行检索。分娩的每个管理步骤都单独进行了审查。高质量的循证数据支持在医院分娩、延迟入院、由导乐提供支持、在发展中国家培训接生员以及第二产程采用直立位。家庭式分娩、灌肠、剃毛、常规阴道冲洗、早期人工破膜、“手法助产”、按压宫底和会阴切开术可能会引发并发症且益处不足，或许应予以避免。我们得出结论，如上述由高质量数据支持的分娩干预措施应常规实施。所有数据质量较低的方面都应以足够样本量和精心设计的试验进行研究。
