Hillemanns H G, Mross F, Schneller H, Steiner H
Geburtshilfe Frauenheilkd. 1977 May;37(5):373-86.
The programming of labor (setting the best possbile time under optimal conditions) was carried out in the University Women's Hospital, Freiburg i. Br. between 1970 and 1975 in 1121 cases. No perinatal mortality was reported. The secondary frequency of cesarean section for this primarily uncomplicated labor was 3.21% (general hospital statistics for this time period: 6.29%). The most important factors for the strict standardized method of induction is the observation of the pelvic score (desired: greater than 6) and a moderate dose of oxytocin or prostaglandin based on the essential amniotomy. In a statistical comparison of three groups of patients (n = 786): programmed labor (n = 427), induction via the same type of method where transference was suspected (n = 158), and uncomplicated spontaneous labor (n=183), the results with induced labor were better than those with spontaneous labor. In addition for the fact that the course of labor could be preplanned and the period of labor shortened intrauterine and partal complications occurred less frequently with programmed labor than with spontaneous labor. Placental complications and the tendency toward postpartum atony must be discussed. Minor complications decreased as the weight, length and gestation period of the newborn increased. Individual palpation until the physiological maturity for birth is reached would, therefore, seem to be required. Observe the conditions and increase antepartal controls. Only by setting the exact time for labor with modern methods of supervision is it theoretically possible to eliminate the danger of active management. The organizational problem involved with a general programming of labor poses the major problem at present.
1970年至1975年间,在弗赖堡大学妇女医院对1121例产妇进行了分娩程序安排(即在最佳条件下设定最佳分娩时间)。未报告围产期死亡情况。此次主要为无并发症分娩的剖宫产二次发生率为3.21%(该时期综合医院统计数据为6.29%)。严格标准化引产方法的最重要因素是观察骨盆评分(理想情况:大于6分)以及在进行必要的人工破膜后给予适量的催产素或前列腺素。在对三组患者(n = 786)进行的统计比较中:计划分娩组(n = 427)、疑似有转诊情况时采用相同方法引产组(n = 158)以及无并发症自然分娩组(n = 183),引产分娩的结果优于自然分娩。此外,由于分娩过程可以预先计划,并且计划分娩时子宫内和分娩期并发症的发生率低于自然分娩,所以还需讨论胎盘并发症和产后子宫收缩乏力的倾向。随着新生儿体重、身长和妊娠期的增加,轻微并发症减少。因此,似乎需要进行个体触诊直至达到生理上的出生成熟度。观察情况并增加产前检查。只有通过采用现代监测方法精确设定分娩时间,从理论上来说才有可能消除积极管理带来的危险。目前,分娩总体程序安排所涉及的组织问题是主要问题。