Cyr R M, Usher R H, McLean F H
Am J Obstet Gynecol. 1984 Mar 1;148(5):490-8. doi: 10.1016/0002-9378(84)90733-6.
Comparison of birth asphyxia and trauma in the same obstetric service during periods 18 years apart shows some reassuring and some disquieting findings. Liberalized cesarean sections, electronic monitoring of fetal heart in labor, and replacement of opiate sedation by epidural anesthesia have had their effect. There has been dramatic reduction in perinatal death and neonatal encephalopathy due to birth asphyxia and trauma and only rarely do affected infants now develop permanent cerebral injury. Severe birth asphyxia, defined by need for prolonged ventilation, has, however, remained unchanged in frequency. Unexpectedly, fractures and paralyses have dramatically increased. The major hazard today for the term infant is the use of midforceps, which has become much more common in parallel with the increased use of pain relief by continuous epidural anesthesia.
对间隔18年的同一产科服务中出生窒息和产伤情况的比较显示出一些令人欣慰和一些令人不安的发现。剖宫产的放宽、分娩时胎儿心率的电子监测以及硬膜外麻醉取代阿片类镇静剂都产生了效果。由于出生窒息和产伤导致的围产期死亡和新生儿脑病显著减少，现在受影响的婴儿很少会发展为永久性脑损伤。然而，需要长时间通气定义的严重出生窒息的发生率保持不变。出乎意料的是，骨折和麻痹显著增加。如今足月儿面临的主要风险是中位产钳的使用，这与持续硬膜外麻醉用于缓解疼痛的使用增加同时变得更加普遍。
