肩难产22例临床分析

An analysis from 22 cases of shoulder dystocis

目的探讨肩难产发生的危险因素和处理方法及预后。方法回顾性分析1999年1月至2003年12月11579例头位分娩的产科临床资料,观察22例肩难产的母体相关因素和围生儿情况。结果头位阴道分娩肩难产的发生率为0.19%,巨大儿阴道分娩肩难产发生率为3.53%,显著高于非巨大儿的0.047%(P<0.001),产钳分娩的肩难产发生率为0.57%,显著高于自然分娩的0.14%(P<0.005)。新生儿产伤6例,包括锁骨骨折4例和臂丛神经损伤2例,各种娩肩方法均有产伤发生,围生儿病死率为181.82‰。结论巨大儿、产钳分娩与肩难产发生有关,但肩难产难以预测,处理方法首选屈大腿法,避免暴力牵引有助于改善围生儿预后。

Objective To investigate the risk of shoulder dystocia and fred out the obstetric manenvers to reduce the likelihood of injury. Methods A retrospective analysis of 11579 vaginal deliveries from January , 1999 to December, 2003. 22 cases of shoulder dystocia were reviewed in depth for maternal and infant. Results The should dystoeia represents 0.19% of all vaginal deliveries, and then 3.53% of those with fetal maerosomia, but 0.047% of those without fetal maerosomia （ Χ^2 = 278.9, P 〈 0.001 ）. The incidence of shoulder dystoeia was 0.57% in 1233 forceps deliveries （ Χ^2 = 10.48, P 〈 0.005 ） , which was significantly higher than that of spontaneous delivery （0.14% ） （ P 〈 0.005 ）. There were 6 injuries recorded, 4 fractured clavicles and 2 brachial plexus injuries. There was no statistical differences among the various delivery techniques of shoulder dystoeia with respect to neonatal injury. The perinatal mortality was 181.82‰ in the cases with shoulder dystoeia. Conclusions Shoulder dystoeia was more likely to occur in cases with fetal maerosomia and delivered by forceps, but it is difficult to predict. There was no delivery method without neonatal injury. However, Meroberts maneuver was suggested as the first line method for shoulder dystoeia, and avoiding of violence is helpful to improve the neonatal outcomes.