引產與剖腹產之臨床基本觀念

The Modern Concepts in Labor Induction and Cesarean Delivery

黃哲政(Che-Cheng Huang) ； 蘇棋楓(Chi-Feng Su) ； 蔡宏志(Horng-Jyh Tsai)

《北市醫學雜誌》 13卷3期 (2016/09) Pp. 9-16

https://doi.org/10.6200/TCMJ.2016.13.3.02

摘要

引產為產科常見手續，而剖腹生產為產科最常見手術之一；兩者執行情況越來越多。最理想的促進子宮頸成熟改造與企圖引產方式仍未確立，需要討論，通常以前列腺素劑用來促進子宮頸成熟，建議例如以misoprostol；而正式引產以催產素oxytocin使用較有規範。剖腹生產無絕對禁忌，時機為臨床認定有醫學或產科理由即執行，不考慮評估胎兒肺部成熟；但是預定剖腹生產安排應確認懷孕滿39周。醫師不一定要同意配合執行母親要求的選擇性剖腹生產，而台灣的看時剖腹產，其實是個壞習俗。預定剖腹產手術前應一般評估，剖腹生產進行方式非一成不變，但其中有許多新近改變，故給予新知補充建議，而手術後處置同一般下腹部手術。由於危險性與醫療責任索賠問題，前胎剖腹生產孕婦企圖試產而引產少執行了。

關鍵字

引產 ； 前列腺素 ； 剖腹產 ； 催產素

並列摘要

Induction of labor and cesarean delivery are common obstetrical procedure and operation, and both are becoming more frequently conducted. The ideal method for cervical ripening /remodeling toward labor induction has not yet been established, and is in need of discussion. Normally, prostaglandins such as misoprostol are used to promote cervical ripening. Most efforts have been invested in forming the guidelines for oxytocin induction. There are no absolute contraindications when performing cesarean delivery, and can be carried out anytime when a medical or obstetrical indication comes across without considering fetal lung maturity. Elective cesarean delivery should be planned at confirmed 39 weeks gestation. Physicians need not to compromise to do cesarean delivery on maternal request. ＂Timing cesarean＂ in Taiwan is indeed a bad custom. Pre-operative evaluation for planned cesarean delivery is almost the same as lower abdominal surgery, so as the postoperative management. The techniques of performing cesarean delivery are not without changes and new methods have been introduced. Vaginal birth after cesarean delivery has become less common because of its risk, issue of medical liability and lawsuit compensation.

並列關鍵字

cesarean delivery ； induction of labor ； oxytocin ； prostaglandins