Obstructed labour
Obstructed labour
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DOI：
10.1093/bmb/ldg018
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发表时间：
2003-01-01
影响因子：
6.7
通讯作者：
Wray, S
中科院分区：
文献类型：
--
作者：
Neilson, JP;Lavender, T;Wray, S
在一些社区，难产是导致孕产妇死亡的一个重要原因，在这些社区中，儿童期营养不良很常见，导致妇女骨盆过小，而且不易获得能够进行手术分娩的正常运转的卫生设施。难产还会导致短期（尤其是感染）和长期（尤其是产科瘘管病）显着的孕产妇发病率。胎儿窒息死亡也很常见。难产期间子宫的行为存在差异，具体取决于女性之前是否分娩过。初产妇的这种模式（通常收缩力减弱，有感染和瘘管的风险）可能是由组织酸中毒引起的，而在经产女性中，收缩力可能会维持，但有子宫破裂的风险。最终，解决难产问题需要从儿童时期开始普遍摄入充足的营养，并在产程出现问题时能够获得设备齐全、人员配备充足的临床设施。这些似乎仍然是相当遥远的愿望。与此同时，应采取策略鼓励及早识别产程延长和适当的临床反应。难产的后遗症可能是人类痛苦的一个巨大根源，在难产仍然常见的地区，预防产科瘘以及在发生产科瘘时进行熟练治疗是重要的优先事项。
Obstructed labour is an important cause of maternal deaths in communities in which undernutrition in childhood is common resulting in small pelves in women, and in which there is no easy access to functioning health facilities with the capability of carrying out operative deliveries. Obstructed labour also causes significant maternal morbidity in the short term (notably infection) and long term (notably obstetric fistulas). Fetal death from asphyxia is also common. There are differences in the behaviour of the uterus during obstructed labour, depending on whether the woman has delivered previously. The pattern in primigravid women (typically diminishing contractility with risk of infection and fistula) may result from tissue acidosis, whereas in parous women, contractility may be maintained with the risk of uterine rupture. Ultimately, tackling the problem of obstructed labour will require universal adequate nutritional intake from childhood and the ability to access adequately equipped and staffed clinical facilities when problems arise in labour. These seem still rather distant aspirations. In the meantime, strategies should be implemented to encourage early recognition of prolonged labour and appropriate clinical responses. The sequelae of obstructed labour can be an enormous source of human misery and the prevention of obstetric fistulas, and skilled treatment if they do occur, are important priorities in regions where obstructed labour is still common.