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产后保健概述

Author
Pamela Berens, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
葛宝兰, 主管护师

引言

产后期，也被称为产褥期，始于胎儿和胎盘娩出。关于产后期的结束时间界定不是很明确，但通常认为是分娩后6-8周，因为在此时，妊娠对身体多个系统的影响已逐渐恢复，而且这些系统很大程度上已恢复至妊娠前的状态。然而，并非所有的器官系统在此期间都能回到基线水平，而且返回基线水平也不一定随着时间推移呈线性相关。某些研究发现，产褥期可长至分娩后12个月。

医疗保健人员应意识到产后母体的医疗和心理需求，并对有关分娩的文化差异(可涉及特定膳食，以及限制某些活动)持有敏感态度[1]。

产房

产时处理将单独讨论，包括第三产程的处理以及会阴切开术/撕裂伤的修复。 (参见“Management of normal labor and delivery”和“会阴切开术方法概述”)

常规产房保健应配合产妇各自情况进行个体化调整。如果产妇或新生儿均无并发症，应鼓励母亲和婴儿之间进行早期互动。可将精力充沛的足月儿皮肤檫干，赤裸地紧贴母亲裸露的皮肤；将保暖毯同时盖在两个人身上，并给宝宝戴上新生儿帽，以尽可能地减少热量损失。肌肤接触能够改善婴儿的体温调节系统，并使母婴依恋最大化。对于接受剖宫产的女性，手术一完成就进行母婴肌肤接触和尽早开始母乳喂养是可行的，而且也是可取的[2]。一项纳入30项随机和半随机试验、共计1925对参与者(母婴对)的meta分析阐述了婴儿出生后母婴肌肤接触的益处[3]。相比于只接受常规保健的婴儿，进行肌肤接触的婴儿在产后1-4月时更可能进行母乳喂养，并且母乳喂养的总持续时间更长。相比于对照组，肌肤接触组的血糖维持水平也更好。晚期早产儿的热稳定性能够得到显著改善，但在足月儿中这种改善并不具有临床意义。尚未发现短期或长期的不良影响。

新生儿最初的常规处理可以在母亲的床旁进行。若为了确保婴儿情况稳定而需要与母亲分开，则应随时让母亲了解婴儿的状况，并在满足医疗需要的情况下使分离时间最短。针对母亲(如输卵管结扎术)和婴儿(维生素K注射、眼膏、新生儿筛查)的择期操作，通常可延迟到分娩后第1个小时建立初始母婴关系后。 (参见“健康新生儿常规管理的概述”和“新生儿评估”)

                                                                         

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