Effective Care Research Unit, University of the Witwatersrand/Fort Hare, Eastern Cape Department of Health, East London, South Africa; Obstetrics and Gynaecology Department, University of Botswana, Gaborone, Botswana.
Effective Care Research Unit, University of the Witwatersrand/Fort Hare, Eastern Cape Department of Health, East London, South Africa.
Best Pract Res Clin Obstet Gynaecol. 2020 Aug;67:53-64. doi: 10.1016/j.bpobgyn.2020.03.012. Epub 2020 Apr 7.
The second stage of labor, from full cervical dilatation to complete birth of the baby or babies, constitutes the time of greatest risk for the baby. Birth attendants at all levels require training in the skills necessary to overcome difficulties that may arise unexpectedly during the second stage, particularly poor progress, shoulder dystocia, and breech birth. The mother should receive emotional support and encouragement to bear down instinctively when she feels the urge to do so, in the position she feels enables her to push most effectively, but not the supine position. The baby's heart rate should be monitored after every second contraction. Recent guidelines such as those of the World Health Organization(WHO) recommend allowing 2-3 h for the second stage of labor. Uterine fundal pressure has not been shown to be effective, and may be dangerous. Choosing between cesarean section and assisted vaginal birth to overcome delayed second stage requires relevant skill and experience.
第二产程，从宫口完全扩张到胎儿或胎儿全部娩出，是婴儿面临最大风险的阶段。各级助产人员都需要接受培训，掌握在第二产程中可能意外出现的困难情况下所需的技能，特别是进展不良、肩难产和臀位分娩。产妇应在感到有便意时，获得情感支持和鼓励，在她感到最有效的用力姿势下本能地用力，而不是仰卧位。胎儿的心率应在每两次宫缩后进行监测。世界卫生组织（WHO）等最近的指南建议第二产程的时间应允许 2-3 小时。子宫底压力并未显示出有效，且可能是危险的。选择剖宫产术和阴道助产术来克服第二产程延长，需要相关的技能和经验。
