第一产程干预方法及其必要性探讨

Intervention options and its necessity in the first- stage of labor

社会的发展和生活方式的改变使分娩的自然过程发生了变化。依据有关产程进展的最新研究,国内外的相关学会和学术团体呼吁和倡导大家关注和采纳以第一产程宫口扩张6 cm作为活跃期起点标志的新产程图来管理产程,在充分试产的情况下产程没有进展才能确定潜伏期或活跃期的停滞或延长。随着产程时限标准的更改,有必要重新审视以往在第一产程中常用的一些干预方法如阴道检查、人工破膜、宫缩异常的监护与处理以及胎儿监护等措施,对实施这些方法的必要性进行探讨,有助于科学管理产程,给予充分试产的机会,降低剖宫产率。

There has been a turning point in the course of spontaneous labor with the rapid development of the social economy and the change of the lifestyle. The new partogram, rather than the classical Friedman curve,derived since the advent of the active phase of the first stage of labor, during which more rapid cervical dilation occurs beginning at approximately 6 cm, so far is concerned and admissible. To date, more and more researches have identified the abnormal labor patternsin first-stage, protraction disorder or arrest disorder occur during the latent or active phase. Since then,management options for the first-stage disorders, including vaginal examination, AROM(artificial rupture of membranes), monitoring and management for abnormal uterine contractions, intrapartum fetal surveillance,are controversial. A major goal of this report is to investigate the utilization of the above managements during the first stage, which should be balanced between performing the trial of labor and avoiding the concomitant risk of operative and cesarean delivery.