劳动的第三阶段:基于证据的实践,预防不良的孕产妇和新生儿的结果
Alyssa R Hersh1, Guillermo Carroli2, G Justus Hofmeyr3
1Oregon Health & Science University, Portland, OR; FUNDARED-MATERNA, Bogotá, Colombia.
American journal of obstetrics and gynecology
|March 10, 2024
概括
劳动第三阶段的积极管理正在被重新评估. 证据支持用于预防产后出血的特殊干预措施,如子宫激动剂和延迟带紧,主张"第三阶段护理"而不是传统的捆绑护理.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 新生儿健康 新生儿健康
背景情况:
- 在胎儿和胎盘分娩之间的第三个分娩阶段,容易出现产后出血.
- 积极管理第三阶段的劳动 (AMTSL) 被实施,以减轻这种风险.
- 最初的AMTSL组件的有效性现在受到质疑,导致指南的变化.
研究的目的:
- 审查劳动第三阶段的生理学.
- 评估预防产后出血和促进母亲/新生儿健康的干预措施的证据.
- 分析当前的全球指导方针并提出未来的研究方向.
主要方法:
- 对劳动第三阶段的干预措施的系统审查.
- 对药理学药物,管管理和刺激技术的证据分析.
- 现行国际指导方针和建议的比较.
主要成果:
- 有效的子宫激活疗法包括催产素/厄戈米特林,催产素/弥苏普罗斯托尔或阴道分娩的卡贝托辛;剖腹产的卡贝托辛或催产素.
- 延迟带紧,早期的皮肤接触和受控的带引得到证据的支持.
- 证据表明,特兰胺酸的附加益处是不一致的.
结论:
- 应该用"第三阶段护理"代替"第三阶段劳动的积极管理"的术语.
- 证据支持个性化,基于证据的干预措施,以确保安全和有益的孕产妇和新生儿结果.
- 预防策略的决策必须考虑患者和系统层面的因素.
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