Abstract：
Pregnancy dating is determined by the patient\'s last menstrual period or an ultrasound measurement. A full-term pregnancy is considered 37 weeks\' gestation or more. Spontaneous labor begins when regular painful uterine contractions result in a cervical change. Active labor begins at 6 cm dilation and is marked by more predictable, accelerated cervical change. In the absence of pregnancy complications, intermittent fetal auscultation may be considered as an alternative to continuous electronic fetal monitoring, which is associated with a high false-positive rate. Intravenous antibiotic prophylaxis is indicated in patients with group B streptococcus colonization or those at high risk to prevent newborn early-onset group B streptococcus. The likelihood of vaginal delivery is increased by providing continuous nonmedical support during labor, encouraging mobility, and using a peanut ball with epidural analgesia. Neuraxial analgesia is more effective for pain control than systemic opioids and is associated with fewer adverse effects. Delayed pushing during the second stage of labor has risks but does not affect the mode of delivery. Routine oropharyngeal suctioning of the newborn is not recommended, even with meconium-stained amniotic fluid. Delayed cord clamping reduces newborn anemia. Prevention of postpartum hemorrhage in patients at risk includes prophylactic uterotonic administration and controlled cord traction. Perineal lacerations that alter anatomy or are not hemostatic should be repaired. (Am Fam Physician. 2024;109(6):525-532.
摘要：
妊娠约会是由患者的最后一次月经期或超声测量确定的。足月妊娠被认为是妊娠37周或以上。当定期疼痛的子宫收缩导致宫颈改变时，自然分娩开始。积极的分娩始于6厘米的扩张，其特点是更可预测，加速宫颈变化。在没有妊娠并发症的情况下，间歇性胎儿听诊可以被认为是连续电子胎儿监护的替代方案，这与高的假阳性率有关。B组链球菌定植的患者或高危患者需要静脉预防抗生素，以预防新生儿早期发作的B组链球菌。通过在分娩期间提供持续的非医疗支持，阴道分娩的可能性增加，鼓励流动性，用花生球硬膜外镇痛.与全身阿片类药物相比，神经轴镇痛对疼痛控制更有效，并且不良反应较少。在第二劳动阶段的延迟推送有风险但不影响分娩方式。不建议对新生儿进行常规口咽吸痰，即使是胎粪污染的羊水.延迟脐带夹闭可减少新生儿贫血。预防有风险患者的产后出血包括预防性子宫收缩给药和控制脐带牵引。改变解剖结构或不止血的会阴撕裂应修复。（我是法姆医生。2024；109（6）：525–532。
