Abstract：
Assisted vaginal birth rates are falling globally with rising cesarean delivery rates. Cesarean delivery is not without consequence, particularly when carried out in the second stage of labor. Cesarean delivery in the second stage is not entirely protective against pelvic floor morbidity and can lead to serious complications in a subsequent pregnancy. It should be acknowledged that the likelihood of morbidity for mother and baby associated with cesarean delivery increases with advancing labor and is greater than spontaneous vaginal birth, irrespective of the method of operative birth in the second stage of labor. In this article, we argue that assisted vaginal birth is a skilled and safe option that should always be considered and be available as an option for women who need assistance in the second stage of labor. Selecting the most appropriate mode of birth at full dilatation requires accurate clinical assessment, supported decision-making, and personalized care with consideration for the woman\'s preferences. Achieving vaginal birth with the primary instrument is more likely with forceps than with vacuum extraction (risk ratio, 0.58; 95% confidence interval, 0.39-0.88). Midcavity forceps are associated with a greater incidence of obstetric anal sphincter injury (odds ratio, 1.83; 95% confidence interval, 1.32-2.55) but no difference in neonatal Apgar score or umbilical artery pH. The risk for adverse outcomes is minimized when the procedure is conducted by a skilled accoucheur who selects the most appropriate instrument likely to achieve vaginal birth with the primary instrument. Anticipation of potential complications and dynamic decision-making are just as important as the technique for safe instrument use. Good communication with the woman and the birthing partner is vital and there are various recommendations on how to achieve this. There have been recent developments (such as OdonAssist) in device innovation, training, and strategies for implementation at a scale that can provide opportunities for both improved outcomes and reinvigoration of an essential skill that can save mothers\' and babies\' lives across the world.
摘要：
随着剖宫产率的上升，辅助阴道分娩率在全球范围内下降。剖腹产并非没有后果，特别是在分娩的第二阶段进行时。第二阶段的剖腹产并不能完全预防盆底疾病，并可能在随后的妊娠中导致严重的并发症。应该承认，与剖宫产相关的母婴发病的可能性随着分娩的推进而增加，并且大于自然阴道分娩。与第二产程的手术分娩方法无关。在这篇文章中,我们认为,辅助阴道分娩是一种技术熟练且安全的选择,对于在第二产程中需要辅助分娩的妇女,应始终加以考虑并作为一种选择.在完全扩张时选择最合适的分娩方式需要准确的临床评估，支持决策，和个性化的照顾，考虑到女人的喜好。使用主要器械实现阴道分娩的可能性比使用真空抽取更高（风险比，0.58；95%置信区间，0.39-0.88）。中腔镊子与产科肛门括约肌损伤的发生率更高(比值比，1.83；95%置信区间，1.32-2.55），但新生儿Apgar评分或脐动脉pH无差异。当手术由熟练的医生进行时，不良结局的风险将降至最低，该医生选择了可能使用主要工具实现阴道分娩的最合适的工具。潜在并发症的预测和动态决策与安全使用仪器的技术同样重要。与女性和分娩伙伴的良好沟通至关重要，关于如何实现这一目标有各种建议。最近在设备创新方面取得了进展（如OdonAssist），培训,和实施战略的规模，可以为改善结果和重振一项能够拯救世界各地母亲和婴儿生命的基本技能提供机会。
