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在无卵子,单卵子,满期,顶部怀孕中,最佳的分娩方式是什么?
Vincenzo Berghella1, Victoria Adewale2, Tanvi Rana3
1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (Berghella).
与计划性阴道分娩 (VD) 相比,计划性剖腹产 (CD) 对新生儿和母亲有好处,但需要更多的研究. 大规模的随机试验对于比较计划的CD与VD对于无卵性,单卵性,终期,顶部怀孕至关重要.
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
- 新生儿结局的结果.
背景情况:
- 在全球范围内,剖腹产率很高,因此需要对孕产妇和产前期的结果进行评估.
- 计划性CD已经显示出诸如减少新生儿并发症和单子妊娠中产周死亡等好处.
- 计划性阴道分娩 (VD) 提供了诸如较低的伤口感染率和更快的产后恢复等优势.
研究的目的:
- 评估与计划式剖腹产 (CD) 与计划性阴道分娩 (VD) 相关的孕产妇和产周结局.
- 突出需要进行大规模随机试验,比较计划的CD和VD对于无卵性,单卵性,终期,顶部 (NSTV) 怀孕的需求.
主要方法:
- 随机对照试验的元分析,比较计划的CD和VD.
- 建议对NSTV怀孕进行大规模随机试验 (8000多名参与者).
- 长度随访,以评估长期的孕产妇和产周结果,包括非生物因素.
主要成果:
- 计划性CD与动脉pH值降低,出生创伤和低血压相关.
- 计划性CD与单胎妊娠中更低的围产死亡率有关.
- 与静脉疾病相比,计划性CD与较少的膜炎有关,但与更多的伤口感染和类似的长期尿失禁有关.
结论:
- 虽然有计划的CD提供了某些好处,但有计划的VD具有更快的恢复等优势.
- 随着CD风险因素的增加以及对长期风险的担忧,需要进行均衡的评估.
- 迫切需要大型随机试验来比较NSTV怀孕的计划性CD和VD,以告知全球产科护理.
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