关键词: complications diagnosis prevention shoulder dystocia

来  源:   DOI:10.3390/jpm14060586   PDF(Pubmed)

Abstract:
The term dystocia refers to labor characterized by a slow progression with delayed rates or even pauses in the dilation of the cervix or the descent of the fetus. Dystocia describes the deviation from the limits that define a normal birth and is often used as a synonym for the term pathological birth. Shoulder dystocia, also known as the manual exit of the shoulders during vaginal delivery on cephalic presentation, is defined as the \"failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head\". This means that obstetric interventions are necessary to deliver the fetus\'s body after the head has been delivered, as gentle traction has failed. Abnormal labor (dystocia) is expressed and represented in partograms or by the prolongation of the latent phase or by slowing and pausing in the phases of cervical dilatation and fetal descent. While partograms are helpful in visualizing the progress of labor, regular use of them has not been shown to enhance obstetric outcomes considerably, and no partogram has been shown to be superior to others in comparative trials. Dystocia can, therefore, appear in any phase of the evolution of childbirth, so it is necessary to simultaneously assess all the factors that may contribute to its abnormal evolution, that is, the forces exerted, the weight, the shape, the presentation and position of the fetus, the integrity and morphology of the pelvis, and its relation to the fetus. When this complication occurs, it can result in an increased incidence of maternal morbidity, as well as an increased incidence of neonatal morbidity and mortality. Although several risk factors are associated with shoulder dystocia, it has proven impossible to recognize individual cases of shoulder dystocia in practice before they occur during labor. Various guidelines have been published for the management of shoulder dystocia, with the primary goal of educating the obstetrician and midwife on the importance of a preplanned sequence of maneuvers, thereby reducing maternal and neonatal morbidity and mortality.
摘要:
术语“难产”是指以缓慢进展为特征的分娩,其速度延迟,甚至在子宫颈扩张或胎儿下降中暂停。难产描述了与定义正常分娩的界限的偏差,通常被用作术语病理性分娩的同义词。肩难产,也称为阴道分娩过程中头部表现的肩部手动退出,定义为“胎头分娩后,肩膀自发穿过骨盆的失败”。这意味着产科干预是必要的,以在胎儿头部分娩后分娩胎儿的身体,因为温和的牵引失败了。异常分娩(难产)以段图或潜伏期的延长或通过在宫颈扩张和胎儿下降阶段的减慢和暂停来表示和表示。虽然部分图有助于可视化劳动的进展,定期使用它们并没有显着提高产科结果,并且在比较试验中没有显示出优于其他的句型图。难产可以,因此,出现在分娩演变的任何阶段,因此有必要同时评估可能导致其异常演变的所有因素,也就是说,施加的力量,重量,形状,胎儿的外观和位置,骨盆的完整性和形态,以及它与胎儿的关系.当这种并发症发生时,它会导致产妇发病率增加,以及新生儿发病率和死亡率的增加。尽管有几个危险因素与肩难产有关,事实证明,在分娩过程中发生肩难产之前,在实践中不可能识别出个别病例。肩难产的管理已经发布了各种指南,主要目标是教育产科医生和助产士预先计划的一系列演习的重要性,从而降低孕产妇和新生儿的发病率和死亡率。
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