Caism UNICAMP, University of Campinas, Campinas, Brazil.
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Int J Gynaecol Obstet. 2023 Oct;163 Suppl 2:51-56. doi: 10.1002/ijgo.15114.
The goal of induced or spontaneous labor is childbirth by vaginal delivery. Delivery after 37 weeks is desirable and associated with favorable maternal and newborn outcomes. Delivery facilities should have suitable staff and resources on site for antenatal services and delivery care. FIGO's Prep-for-Labor triage method provides rapid diagnostic tools that help define patients as high or low risk to determine whether transfer to a higher-level center is needed. There is often a disconnect between a facility's designation and its ability to achieve safe deliveries. For preplanned labor induction, the designated clinical facility must have the right set-up and prenatal records available to achieve a successful outcome. However, this is often not the case if a patient arrives in labor or needs an induction and the facility has limited patient information and resources, thus requiring rapid management decisions. The practical guidance checklist in this article defines maternal and/or fetal risk factors and delineates approaches and safe practices for labor induction and management, including when antenatal information is limited to maximize safe delivery practices. Guidelines on using the Bishop score (>6 or <6) to manage labor are presented. Evidence supporting successful safe labor induction at 41-42 weeks of gestation in low-risk cases is described. This practice will increase the rate of spontaneous labor and delivery, minimizing intervention and thereby diverting limited clinical resources to those patients in need. In the right setting, this could lead to around 80% of women delivering spontaneously, which remains a desired goal.
引产或自然分娩的目的是经阴道分娩。37 周后分娩是理想的，与产妇和新生儿的良好结局相关。分娩机构应配备有合适的工作人员和现场资源，以提供产前服务和分娩护理。FIGO 的产前分娩分类方法提供了快速诊断工具，有助于将患者定义为高风险或低风险，以确定是否需要转移到更高水平的中心。设施的指定与其实现安全分娩的能力之间经常存在脱节。对于计划中的引产，指定的临床机构必须具备适当的设置和产前记录，以实现成功的结果。然而，如果患者在分娩时到达或需要引产，而该机构的患者信息和资源有限，因此需要快速的管理决策，那么通常情况并非如此。本文中的实用指南清单定义了产妇和/或胎儿的风险因素，并阐述了引产和管理的方法和安全实践，包括在产前信息有限的情况下最大限度地提高安全分娩实践的方法。还介绍了使用 Bishop 评分（>6 或<6）管理分娩的指南。描述了低风险情况下在 41-42 孕周成功安全引产的证据。这种做法将提高自然分娩和分娩的比率，最大限度地减少干预，从而将有限的临床资源转移给需要的患者。在适当的情况下，这可能导致大约 80%的女性自然分娩，这仍然是一个理想的目标。
