摘要：妇产科医师与助产士、护士、患者等共同协作，能通过采用较少干预来帮助孕妇顺利分娩。许多产科常用的操作对于低风险孕妇在自然分娩产程中的优势是局限与不确定的。对胎膜早破的孕妇应该早期进行评估，孕妇以及妇产科医师或者其他产科辅助人员应该早期制定出治疗方案。研究数据表明：在处于正常产程，并且胎儿各项体征正常的孕妇中，是没有必要进行人工破膜的。在低风险孕妇中，胎心率检测的广泛使用并没有改善妊娠结局。我们能够采用多种非药物和药物治疗方法来帮助女性消除产程中疼痛。处于自然分娩产程中的女性可能不需要接受肌肉注射和静脉注射。对于采用硬膜外麻醉且没有分娩经验的初产妇，在采取助推之前可能需要给予1-2小时的休息时间。妇产科医师和其他产科护理人员应该熟悉了解和重视对于低风险女性在自然分娩产程中采用较少干预的方式。

 

The American College of Obstetricians andGynecologists (the College) makes the following recommendations and conclusions:

美国妇产科医师学会给出了以下推荐和总结:

 

·        For a woman who is at term in spontaneouslabor with a fetus in vertex presentation, labor management may beindividualized (depending on maternal and fetal condition and risks) to includetechniques such as intermittent auscultation and nonpharmacologic methods ofpain relief.

对于单胎女性在自然分娩产程中，产程管理方案可能需要个体化（依据母胎情况及风险）来采取措施，例如：间断听诊和减轻疼痛的非药物治疗方案。

·        Admission to labor and delivery may bedelayed for women in the latent phase of labor when their status and theirfetuses’ status are reassuring. The women can be offered frequent contact andsupport, as well as nonpharmacologic pain management measures.

在确保母胎安全的前提下，允许产程潜伏期延迟。同时不断地给予孕妇安慰，以及非药物疼痛管理措施。

·        When women are observed or admitted forpain or fatigue in latent labor, techniques such as education and support, oralhydration, positions of comfort, and nonpharmacologic pain managementtechniques such as massage or water immersion may be beneficial.

孕妇处于产程潜伏期时，如果产生疼痛和疲劳，给予安慰支持、水分补充、舒适的体位和非药物疼痛管理措施等，例如按摩会适当缓解疼痛和疲劳。

·        Obstetrician–gynecologists and otherobstetric care providers should inform pregnant women with term prematurerupture of membrane (PROM [also known as prelabor rupture of membranes]) whoare considering a period of expectant care of the potential risks associatedwith expectant management and the limitations of available data. For informedwomen, if concordant with their individual preferences and if there are noother maternal or fetal reasons to expedite delivery, the choice of expectantmanagement for a period of time may be appropriately offered and supported. Forwomen who are group B streptococci (GBS) positive, however, administration ofantibiotics for GBS prophylaxis should not be delayed while awaiting labor. Insuch cases, many patients and obstetrician–gynecologists or other obstetriccare providers may prefer immediate induction.

妇产科医师和其他产科护理人员应该告知胎膜早破（简称PROM）的孕妇关于潜在风险和预期管理与数据有限性相关。

·        Evidence suggests that, in addition toregular nursing care, continuous one-to-one emotional support is associatedwith improved outcomes for women in labor.

证据表明：在产程中，除常规护理之外，给予孕妇心理关怀与安慰对提高产出率很有帮助。

·        For women with normally progressing laborand no evidence of fetal compromise, routine amniotomy need not be undertakenunless required to facilitate monitoring.

在母胎各项体征正常的产程中，没有必要进行人工破膜。

·        To facilitate the option of intermittentauscultation, obstetrician–gynecologists and other obstetric care providers andfacilities should consider adopting protocols and training staff to use ahand-held Doppler device for low-risk women who desire such monitoring duringlabor.

为了帮助低风险孕妇在整个产程中实现不断听诊，妇产科医师和其他产科护理人员的操作应该考虑采用指南或共识与培养助手使用便携式多普勒设备。

·        Use of the coping scale in conjunction withdifferent nonpharmacologic and pharmacologic pain management techniques canhelp obstetrician–gynecologists and other obstetric care providers tailorinterventions to best meet the needs of each woman.

非药物和药物联合应用时，两者量比的多样性能够帮助妇产科医师和其他产科护理人员制定多种干预措施，进而最大程度上满足每一位孕妇的要求。

·        Frequent position changes during labor toenhance maternal comfort and promote optimal fetal positioning can be supportedas long as adopted positions allow appropriate maternal and fetal monitoringand treatments and are not contraindicated by maternal medical or obstetric complications.

在产程中不断地转变体位，能够增强孕妇舒适度和提供最理想的胎方位，只要是满足正确的母胎监测和治疗的体位。

·        When not coached to breathe in a specificway, women push with an open glottis. In consideration of the limited dataregarding outcomes of spontaneous versus Valsalva pushing, each woman should beencouraged to use the technique that she prefers and is most effective for her.

当在特定环境下，无法进行指导呼吸，则采用开放性辅助呼吸。考虑到自主对比Valsalva辅助呼吸结果有限，因此鼓励每一位女性采用自己所偏爱的方式且对她产生最大的疗效。

·        In the absence of an indication forexpeditious delivery, women (particularly those who are nulliparous withepidural analgesia) may be offered a period of rest of 1–2 hours (unless thewoman has an urge to bear down sooner) at the onset of the second stage oflabor.

缺乏正常顺产指征，孕妇（特别是经硬膜外麻醉的初产妇）可能需要在第二产程开始之前给予1-2小时的休息时间（除非孕妇要求立刻进行生产）。

 

 

 

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