Safe prevention of the primary cesarean delivery
Safe prevention of the primary cesarean delivery
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DOI：
10.1016/j.ajog.2014.01.026
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发表时间：
2014-03-01
影响因子：
9.8
通讯作者：
Rouse, Dwight J.
中科院分区：
文献类型：
--
作者：
Caughey, Aaron B.;Cahill, Alison G.;Rouse, Dwight J.
2011年，在美国分娩的妇女中有三分之一是通过剖腹产分娩的。在某些情况下，剖腹产可以挽救胎儿、母亲或两者的生命。然而，从1996年到2011年，剖腹产率迅速增加，但没有明确的证据表明产妇或新生儿发病率或死亡率随之下降，这引起了人们对过度使用剖腹产的严重关注。未产妇，足月，单胎，头位剖宫产率的变化也表明，临床实践模式影响剖宫产的数量进行。初次剖宫产最常见的指征包括：产程难产、胎心率描记异常或不确定（以前称为不确定）、胎儿先露不良、多胎妊娠和疑似巨大儿。安全地降低初次剖宫产率需要对这些适应症以及其他适应症采取不同的方法。例如，可能有必要重新审视分娩难产的定义，因为最近的数据显示，当代分娩的进展速度远远低于历史上所教导的。此外，改进和标准化的胎儿心率解释和管理可能会产生影响。增加妇女在分娩过程中获得非医疗干预的机会，如连续分娩和分娩支持，也被证明可以降低剖腹产率。臀先露的头外转位和第一胎头先露时双胎妊娠妇女的试产是其他几个有助于安全降低初次剖宫产率的干预措施的例子。
In 2011, 1 in 3 women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be lifesaving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 through 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.