发布引产和臀位阴道分娩的管理指南。
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臀位分娩必须在产科病房进行,在产科医生和妇科医生在场的情况下,并在活跃的第二阶段立即提供麻醉师和儿科医生(专业共识)。当符合接受阴道分娩的标准(C级)时,足月臀位不是引产的禁忌症。在这种情况下,可以使用催产素或前列腺素(C级)。在尝试阴道分娩的情况下,应鼓励使用低浓度局部麻醉药的硬膜外镇痛(专业共识)。建议使用CTG的连续监测(专业共识)。不建议使用二线胎儿监护(专业共识)。催产素的给药对于增加分娩是可能的(专业共识)。最好在骨盆挖掘中尽可能低的演示文稿时开始努力(专业共识)。臀位表现不是会阴切开术的指征(专业共识)。由于数据不足,无法就早产臀位的具体情况提出建议。
在计划阴道分娩的情况下,足月臀位胎儿可能引产,即使有不可救药的子宫颈.分娩和阴道分娩管理指南的证据水平较低。
To issue guidelines on management of labour induction and breech vaginal delivery.
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Breech delivery must take place in a maternity ward, in the presence of an obstetrician and gynaecologist and with the immediate availability of an anesthesiologist and a pediatrician during active second stage (Professional consensus). Term breech is not a contraindication to labour induction when the criteria for acceptance of vaginal delivery are met (Grade C). In this case, oxytocin or prostaglandins can be used (Grade C). Epidural analgesia with low concentrations of local anesthetics should be encouraged in case of vaginal delivery attempt (Professional consensus). It is recommended to use continuous monitoring of the CTG (Professional consensus). The use of second-line fetal monitoring is not recommended (Professional consensus). The administration of oxytocin is possible for labour augmentation (Professional consensus). It is better to start the expulsive efforts when the presentation is engaged as low as possible in the pelvic excavation (Professional consensus). Breech presentation is not an indication of episiotomy (Professional consensus). Due to insufficient data, it was not possible to make recommendations on specificities of preterm breech delivery.
In case of planned vaginal delivery, labour induction is possible for term breech fetuses, even with unfarable cervix. Guidelines for labour and vaginal delivery management have a low level of evidence.