Smith Andrew, Barr Wendy B, Bassett-Novoa Erin, LeFevre Nicholas
Lawrence Family Medicine Residency, 34 Haverhill St, Lawrence, MA 01841.
John Peter Smith Hospital Family Medicine Residency, 1500 South Main St 4th Floor OPC, Fort Worth, TX 76104.
FP Essent. 2018 Apr;467:25-32.
Labor is defined as contractions with cervical change and active labor starts when the cervix is dilated 6 cm. Updated labor curves and definitions should be used to define labor dystocia. Oxytocin and amniotomy have important roles in the management of labor dystocia. Structured intermittent fetal monitoring should be considered for women with low-risk pregnancies but continuous electronic fetal monitoring still is used most commonly. Moderate fetal heart rate variability is the most reliable marker of fetal well-being. Epidural analgesia is used in more than half of all births in the United States. It is not associated with an increase in the rate of cesarean deliveries but is associated with a longer second stage of labor. Interventions that may reduce the need for cesarean delivery include use of the new definitions of labor dystocia, a trial of manual rotation of occiput posterior presentations, use of cervical ripening agents for induction of labor with an unfavorable cervix, and encouragement of women with previous cesarean deliveries to attempt vaginal delivery.
分娩被定义为伴有宫颈变化的宫缩，当宫颈扩张至6厘米时进入活跃期分娩。应使用更新后的分娩曲线和定义来界定产程异常。缩宫素和人工破膜在产程异常的处理中发挥着重要作用。对于低风险妊娠的女性，应考虑采用结构化间歇性胎儿监护，但目前仍最常使用连续电子胎儿监护。中等程度的胎心率变异是胎儿健康最可靠的指标。在美国，超过半数的分娩采用硬膜外镇痛。它与剖宫产率的增加无关，但与第二产程延长有关。可能减少剖宫产需求的干预措施包括采用新的产程异常定义、尝试手动旋转枕后位、对宫颈条件不佳者使用宫颈成熟剂引产，以及鼓励有剖宫产史的女性尝试阴道分娩。
