Quinlan Jeffrey D, Murphy Neil J
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Alaska Native Medical Center, Anchorage, AK, USA.
Am Fam Physician. 2015 Feb 1;91(3):178-84.
Nearly one-third of all deliveries in the United States are cesarean deliveries. Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased maternal and neonatal morbidity and mortality. Interventions that decrease the chance of a cesarean delivery include avoiding non-medically indicated induction of labor, avoiding amniotomy, and having a doula present. In North America, the most common reasons for cesarean delivery include elective repeat cesarean delivery, dystocia or failure to progress, malpresentation, and fetal heart rate tracings that suggest fetal distress. Post-cesarean delivery complications include pain, endomyometritis, wound separation/infection, urinary tract infection, gastrointestinal problems, deep venous thrombosis, and septic thrombophlebitis. Women with no risk factors for deep venous thrombosis other than the postpartum state and the operative delivery do not require thromboembolism prophylaxis other than early ambulation. A pregnant woman's decision to attempt a trial of labor after cesarean delivery or have a planned repeat cesarean delivery involves a balancing of maternal and neonatal risks, as well as personal preference after counseling by her physician. Approximately 75% of attempted trials of labor after cesarean delivery are successful. Provision of advanced maternity care practices by family physicians, including serving as primary surgeons for cesarean deliveries, is consistent with the goals of the patient-centered medical home.
在美国，近三分之一的分娩是剖宫产。与自然阴道分娩相比，剖宫产与孕产妇和新生儿发病率及死亡率增加相关。减少剖宫产几率的干预措施包括避免非医学指征的引产、避免人工破膜以及有导乐陪伴。在北美，剖宫产最常见的原因包括选择性再次剖宫产、难产或产程无进展、胎位异常以及提示胎儿窘迫的胎心监护异常。剖宫产后的并发症包括疼痛、子宫内膜炎、伤口裂开/感染、尿路感染、胃肠道问题、深静脉血栓形成和感染性血栓性静脉炎。除产后状态和手术分娩外无深静脉血栓形成危险因素的女性，除早期活动外不需要进行血栓栓塞预防。剖宫产术后尝试阴道试产或计划再次剖宫产的孕妇决定，涉及权衡孕产妇和新生儿风险以及经医生咨询后的个人偏好。剖宫产术后尝试阴道试产约75%成功。家庭医生提供高级产科护理服务，包括担任剖宫产的主刀医生，符合以患者为中心的医疗之家的目标。
