肩难产的高危因素分析

Analysis of risk factors for shoulder dystocia

目的探讨肩难产的高危因素,为临床预防肩难产提供参考。方法收集2009年1月~2018年1月在我院妇产科住院的足月妊娠、单胎、头位并经阴道分娩的产妇共22 665例,其中发生肩难产55例(肩难产组),从其余未发生肩难产者中随机抽取110例(对照组),收集其临床资料,采用Logistic回归检验分析肩难产的危险因素。结果我院2009年1月~2018年1月肩难产率为0.24%。单因素分析显示,宫高、腹围、第一产程、第二产程、合并糖尿病(包括妊娠期糖尿病)、出生体重、身长、胸围是肩难产的影响因素(P<0.05),而年龄、孕次、头围对肩难产无明显影响(P>0.05)。进一步使用Logistic回归检验,显示合并糖尿病(包括妊娠期糖尿病)、第二产程、腹围、体重、宫高、第一产程、身长、胸围是肩难产的危险因素,且其危险程度依次降低(P<0.05)。结论肩难产受产妇和胎儿多种因素的影响,建议临床根据实际情况和肩难产的高危因素,正确预测并处理肩难产的发生。

Objective To analyze the risk factors of shoulder dystocia and provide reference for clinical prevention of shoulder dystocia.Methods A total of 22 665 cases of full-term pregnancy,single fetus,head position and vaginal delivery in the department of obstetrics and gynecology in our hospital from January 2009 to January 2018 were collected,of which 55 cases of shoulder dystocia（shoulder dystocia group） were found.Then,the study randomly selected 110 patients（control groups） from the remaining patients who did not have shoulder dystocia and collected clinical data of all patients.Clinical data were collected and Logistic regression analysis was used to analyze risk factors for shoulder dystocia.Results Form January 2009 and January 2018,the rate of shoulder dystocia in our hospital was 0.24%.Then univariate analysis showed that the factors such as uterine height,abdominal circumference,first stage of labor,second stage of labor,combined with diabetes（including gestational diabetes mellitus）,birth weight,length and chest circumference were the influencing factors of shoulder dystocia（P〈0.05）.Gestational age,head circumference did not affect the shoulder dystocia（P〉0.05）.Further use of Logistic regression test showed that diabetes mellitus（including gestational diabetes mellitus）,second stage of labor,abdominal circumference,body weight,uterine height,first stage of labor,body length and chest circumference were risk factors for shoulder dystocia and their risk decreased in turn（P〈0.05）.Conclusion Due to the multiple factors of maternal and fetal factors,shoulder dystocia is recommended to correctly predict and manage the occurrence of shoulder dystocia according to the actual situation and high risk factors of shoulder dystocia.