There is a broad range in the rates of operative vaginal deliveries (OVD) worldwide, which reflects the variety of local practice patterns, the number of trained clinicians and the lack of international evidence-based guidelines. The aim of this study was to review and compare the recommendations from published guidelines on OVD. Thus, a descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the American College of Obstetricians and Gynecologists (ACOG) on instrumental vaginal birth was conducted. All the guidelines point out that the use of any instrument should be based on the clinical circumstances and the experience of the operator. The indications, the contraindications, the prerequisites and the classification for OVD are overall very similar in the reviewed guidelines. Further, they all agree that episiotomy should not be performed routinely. The RCOG, the RANZCOG and the SOGC describe some interventions which may promote spontaneous vaginal birth and therefore reduce the need for OVD. They also highlight the importance of adequate postnatal care and counseling. There is no consensus on the actual technique that should be used, including the type of forceps or vacuum cup, the force and duration of traction or the number of detachments allowed. Hence, there is need for international practice protocols, so as to encourage the clinicians to use OVD when indicated, minimize the complications and reduce rates of cesarean delivery.

译文

:世界范围内的阴道手术分娩率(OVD)范围很广,这反映了各种本地实践模式,训练有素的临床医生人数以及缺乏国际循证指南。这项研究的目的是审查和比较已发表的OVD指南中的建议。因此,对皇家妇产科学院(RCOG),澳大利亚皇家新西兰妇产科学院(RANZCOG),加拿大妇产科医师学会(SOGC)和美国妇产科医师(ACOG)进行了阴道阴道分娩。所有指南均指出,任何仪器的使用均应基于临床情况和操作人员的经验。在所审查的指南中,OVD的适应症,禁忌症,前提条件和分类总体上非常相似。此外,他们都同意不应常规进行会阴切开术。 RCOG,RANZCOG和SOGC描述了一些可促进自发性阴道分娩并因此减少对OVD需求的干预措施。他们还强调了适当的产后护理和咨询的重要性。对于应使用的实际技术尚未达成共识,包括镊子或真空杯的类型,牵引力和持续时间或允许的脱离次数。因此,需要国际惯例协议,以鼓励临床医生在指示时使用OVD,最大程度地减少并发症并降低剖宫产率。

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