Department of Obstetrics and Gynecology, Columbia University Medical Center, NY 10032, USA.
Semin Perinatol. 2012 Oct;36(5):328-35. doi: 10.1053/j.semperi.2012.04.015.
The objective of this review was to assess the evidence that supports cesarean delivery for fetal indications. The main fetal reasons for abdominal delivery include abnormal fetal heart rate patterns in labor, malpresentation, fetal macrosomia, multiple gestation, and both functional and structural fetal abnormalities. Although the level of evidence is not as strong as anticipated, there is sufficient support for cesarean delivery when these fetal conditions complicate pregnancy. Efforts to decrease cesarean delivery for fetal indications in the current medicolegal environment will not be easy; however, the development of more sensitive tools to assess fetal well-being in labor and practices to deliver or reduce fetuses in breech presentation at term have the potential for greatest impact on the overall primary cesarean delivery rate.
本次综述旨在评估支持剖宫产术分娩胎儿指征的证据。行剖宫产术分娩的主要胎儿指征包括产程中胎心监护异常、胎位不正、胎儿巨大儿、多胎妊娠以及胎儿功能和结构异常。尽管证据等级并不像预期的那么高，但当这些胎儿情况使妊娠复杂化时，剖宫产术是有充分依据的。在当前的医疗法律环境下，降低剖宫产术分娩胎儿指征的难度较大；然而，开发更敏感的工具来评估产程中的胎儿状况，以及采取措施在足月时分娩或减少臀位胎儿，可能对整体首次剖宫产率产生最大影响。
