第二产程异常:原因和处理

Abnormalities of second stage of labor:cause and management

世界卫生组织(WHO)将第二产程定义为从子宫颈完全扩张至胎儿娩出之间的一段时间,又称胎儿娩出期,在此期间产妇出现非自主屏气用力而将胎儿娩出,是产程管理的重要阶段。即使第一产程过程顺利,第二产程胎儿和母亲的情况均有可能急速变化,主要表现为先露旋转和下降失败,产程延长或停滞,中转剖宫产或阴道助产率升高,产后出血、产道损伤等风险明显增高。因此,对第二产程的研究一直都是产科领域的焦点问题。准确识别胎儿下降模式的变化对于评估第二产程进展和做出最佳判断给予相应干预非常必要。

The World Health Organization(WHO)defines the second stage of labor as the period of time between the complete expansion of the cervix and the delivery of the fetus,also known as the fetal delivery period.During this perid the mother appears involuntary breath-holding force and delivers the fetus,which is an important stage of labor management.Even if the first stage of labor is smooth,the situation of the fetus and the mother may change rapidly in the second stage of labor,mainly manifested by failure of rotation and descent of the anterior part,prolonged and stagnation of labor,followed by a caesarean section,an increased rate of vaginal midwifery,which significantly increases the risk of postpartum hemorrhage,and birth canal injury.Therefore,the study of the second stage of labor has always been the focus of the field of obstetrics.Accurate recognition of the changes in descent mode of fetus is of great sinificance for evaluating the progress of second stage of labor,making good judgment and giving corresponding interventions.