Second-stage labor: consensus versus science
Second-stage labor: consensus versus science
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DOI：
10.1016/j.ajog.2019.08.044
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发表时间：
2020-02-01
影响因子：
9.8
通讯作者：
Leveno, Kenneth J.
中科院分区：
文献类型：
--
作者：
Nelson, David B.;McIntire, Donald D.;Leveno, Kenneth J.
由于全国剖腹产率的增加，分娩管理的建议做法最近有了重大的演变。其中最重要的变化是2014年《产科护理共识》颁布的《安全预防初次剖腹产》，该共识建议重新考虑第二阶段和第一阶段的产程长度上限。我们之前发表了2016年临床意见，挑战第二阶段的实践变化。在过去2年中，至少有5份报告和2份国家组织声明支持修订第二产程管理。我们现在重新讨论第二阶段问题，因为我们认为，必须认真澄清协商一致声明所产生的现状以及科学证据不断演变的现状。我们使用问题来构建这个临床意见，以努力记录使用了50多年的第二产程产科戒律如何被取代的故事。我们是怎么到这一步的目前的证据是什么？从这一经验中可以学到什么？美国产科现在是否应该“退回”到先前存在的产科规则，在“向前跳”一个额外的小时后，即延长可接受的第二产程的持续时间到4小时，如产科护理共识所建议的那样？我们认为，自2016年临床意见以来发表的数据支持了我们最初的立场，即第二阶段的延长超出历史戒律是不安全的。
There has been a recent significant evolution in suggested practices for the management of labor because of the increased national cesarean delivery rate. One of the most significant changes was promulgated by the 2014 Obstetric Care Consensus entitled, "Safe Prevention of Primary Cesarean Delivery," which recommended reconsideration of the upper limits of the length of labor in the second stage as well as the first stage. We previously published a 2016 Clinical Opinion challenging the second-stage practice change. Over the past 2 years, there have been at least 5 reports as well as 2 national organization statements supporting revised management of second-stage labor. We now revisit the second-stage issue because we believe that it is important to carefully clarify the current status resulting from consensus statements as well as the evolving current status of scientific evidence. We structured this Clinical Opinion using questions in an effort to chronicle the story of how obstetric precepts on second-stage labor in use for more than 50 years were being replaced. How did we get here? What is the current evidence? What can be learned from this experience? Should American obstetrics now "fall back" to pre-existing obstetric precepts for the management of second-stage labor after having "sprung forward" an additional hour-namely, lengthening the duration of acceptable second-stage labor to 4 hours as recommended by the Obstetric Care Consensus? We believe that the data published since our 2016 Clinical Opinion buttress our original position that prolongation of the second stage beyond historical precepts is unsafe.