劳动的被动第二阶段:第四个小时是否会增加产妇患病率,在无产期的患者中,随着外围注射?
Hélène Collinot1, Anna Miloradovic Klein2, Camille Guihard2
1Maternité Port-Royal, AP-HP, APHP Centre, Université Paris Cité, FHU PREMA, Paris, France; Université Paris Cité, INSERM U1016, CNRS UMR 8104, Institut Cochin, Equipe "From Gamete To Birth", Paris, France.
Journal of gynecology obstetrics and human reproduction
|June 27, 2024
概括
与3小时相比,将被动第二阶段的分娩延长到4小时,并没有增加无产妇妇女的孕产妇发病率. 这种延长的持续时间也显示出高的阴道分娩率与低的并发症发生率.
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
- 生殖健康 生殖健康
背景情况:
- 劳动的被动第二阶段的最佳持续时间受到争论.
- 延长分娩可能会增加阴道分娩率,但也会引起对孕产妇和胎儿并发症的担忧.
- 法国指导方针没有明确的被动第二阶段的最大持续时间.
研究的目的:
- 评估是否延长被动分娩的第二阶段到完全扩张后4小时,而不是3小时,会增加孕产妇的死亡率.
- 评估对阴道分娩率和并发症发生率的影响.
主要方法:
- 在第三级产妇病房进行了回顾性观察队列研究 (2020年1月至12月).
- 包括经过外周麻醉并没有病态胎儿心率的无产期妇女,其被动第二阶段至少为3小时.
- 对比的孕产妇发病率在一个之间.
- 3小时的小组时间为3小时.
- 和一个和一个和一个.
- 4小时的小组时间为4小时.
- 根据被动第二阶段的持续时间.
主要成果:
- 在4小时组 (18.9%) 和3小时组 (17.5%; p = 0.73) 之间,母婴综合发病率相似.
- 这两组新生儿的发病率在两组之间是可比的.
- 在4小时组中,82%的患者实现了阴道分娩,55.9%是自发分娩,26.1%是仪器分娩.
结论:
- 允许4小时的被动第二阶段的分娩对精选的绝育妇女有益.
- 这种方法与高的阴道分娩率和低的孕产妇和胎儿并发症发生率有关.
- 在被动的第二阶段扩展期望管理可以是一个安全的选择.
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