第二产程时限与妊娠结局的临床研究进展

Advances in Clinical Research on the Time Frame of Second Stage of Labor and Pregnancy Outcome

分娩是指妊娠满28周及以后的胎儿及其附属物,从临产发动至从母体全部娩出的过程。分三个产程,第二产程是母婴面临最大风险的时期,与妊娠结局密切相关。第二产程进展随着时间的变化在演变,第二产程延长的定义被也更新,在第二产程中,应时刻关注产程进展,对胎心监护、胎儿下降程度和宫缩情况等综合评估。目前,对第二产程时间与产后大出血、产妇感染及新生儿死亡风险之间的相关问题,国内外研究者仍存在争议,既要防止在第二产程中实施不必要的干预措施,也要防止在第二产程中因盲目等待而延长可能、增加母儿并发症的风险,从而在最佳的母婴状况下选择适当的分娩时机及方案。本文对第二产程时限与妊娠结局的关系做一综述。

Labor is the process of delivery of the fetus and its appendages at 28 weeks of gestation and beyond, from the onset of labor to the total delivery from the mother. There are three stages of labor, and the second stage of labor is the period of greatest risk to mother and baby, and is closely related to pregnancy outcome. The definition of prolongation of the second stage of labor has been updated as it evolves over time. During the second stage of labor, the progress of labor should be monitored at all times, and a comprehensive assessment of fetal heart monitoring, the degree of fetal descent, and contractions should be performed. At present, the correlation between the duration of the sec-ond stage of labor and the risk of postpartum hemorrhage, maternal infection and neonatal death is still controversial among domestic and foreign researchers, both to prevent the implement- tation of unnecessary interventions in the second stage of labor and to prevent the possible pro- longation and increased risk of maternal and child complications due to blind waiting in the second stage of labor, so as to choose the appropriate timing and protocol of delivery in the best maternal and in-fant condition. This article provides a review of the relationship between the time frame of the sec-ond stage of labor and pregnancy outcome.