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Abstract：
During labor mother and fetus are evaluated at intervals to assess their well-being and determine how the labor is progressing. These assessments require skillful physical diagnosis and the ability to translate the acquired information into meaningful prognostic decision-making. We describe a coordinated approach to the assessment of labor. Graphing of serial measurements of cervical dilatation and fetal station creates \"labor curves,\" which provide diagnostic and prognostic information. Based on these curves we recognize nine discrete labor abnormalities. Many may be related to insufficient or disordered contractile mechanisms. Several factors are strongly associated with development of labor disorders, including cephalopelvic disproportion, excess analgesia, fetal malpositions, intrauterine infection, and maternal obesity. Clinical cephalopelvimetry involves assessing pelvic traits and predicting their effects on labor. These observations must be integrated with information derived from the labor curves. Exogenous oxytocin is widely used. It has a high therapeutic index, but is easily misused. Oxytocin treatment should be restricted to situations in which its potential benefits clearly outweigh its risks. This requires there be a documented labor dysfunction or a legitimate medical reason to shorten the labor. Normal labor and delivery pose little risk to a healthy fetus; but dysfunctional labors, especially if stimulated excessively by oxytocin or terminated by complex operative vaginal delivery, have the potential for considerable harm. Conscientiously implemented, the approach to the evaluation of labor outlined in this review will result in a reasonable cesarean rate and minimize risks that may accrue from the labor and delivery process.
摘要：
在分娩期间，每隔一段时间对母亲和胎儿进行评估，以评估他们的健康状况并确定分娩的进展情况。这些评估需要熟练的物理诊断以及将获得的信息转化为有意义的预后决策的能力。我们描述了一种协调的劳动评估方法。宫颈扩张和胎儿站的连续测量的图形创建\“劳动曲线，“提供诊断和预后信息。根据这些曲线，我们可以识别出9种离散的分娩异常。许多可能与收缩机制不足或紊乱有关。几个因素与分娩障碍的发展密切相关，包括头盆比例失调,过量镇痛,胎儿错位,宫内感染,和产妇肥胖。临床头颅测量涉及评估骨盆特征并预测其对分娩的影响。这些观察结果必须与从劳动曲线得出的信息相结合。外源性催产素被广泛使用。它有很高的治疗指数,但很容易被滥用。催产素治疗应仅限于其潜在益处明显超过其风险的情况。这需要有记录的分娩功能障碍或合法的医疗理由来缩短分娩时间。正常的分娩和分娩对健康的胎儿几乎没有风险；但是功能失调的劳动，特别是如果催产素过度刺激或通过复杂的手术阴道分娩终止，有可能造成相当大的伤害。认真执行,本综述概述的分娩评估方法将导致合理的剖宫产率，并将分娩和分娩过程中可能产生的风险降至最低。
