阴道分娩中肩难产发生的危险因素及旋后肩法的干预效果评价

Risk factors of shoulder dystocia during maternal delivery and the evaluation of the intervention effect of posterior shoulder rotation

目的探究产妇生产中肩难产发生的危险因素及旋后肩法的干预效果。方法收集宁波市妇女儿童医2019年1月—2020年1月行阴道分娩的5 812例产妇相关资料,其中发生肩难产59例(病例组),未发生肩难产5 753例(对照组),单因素及多因素logistic回归分析肩难产发生的危险因素。另59例肩难产产妇中接受常规压前肩法促分娩27例(病例1组),行旋后肩法促分娩32例(病例2组),比较各组妊娠结局。结果单因素可见病例组、对照组在年龄、体重指数(BMI)、妊娠期糖尿病(GDM)、宫缩乏力、巨大儿上对比差异有统计学意义(均P<0.05);多因素logistic分析得出BMI>27、GDM、宫缩乏力、巨大儿是产妇生产中肩难产发生的独立危险因素(均P<0.05)。病例组产妇、新生儿不良结局总发生率分别为20.34%、13.56%,均显著高于对照组的6.67%、0.42%(均P<0.05);病例1组产妇不良结局总发生率为25.93%,与病例2组的15.62%对比差异无统计学意义(P>0.05),病例1组新生儿不良结局总发生率为25.93%,显著高于病例2组的3.13%(P<0.05)。结论产妇生产中肩难产发生危险因素较多,需针对性管理以预防肩难产;而对肩难产发生后,旋后肩法相对常规压前肩法,其不良母婴结局发生率低。

Objective To explore the risk factors of shoulder dystocia during maternal delivery and the intervention effect of posterior shoulder rotation. Methods Data of 5 812 women who underwent vaginal delivery in Ningbo Women’s and Children’s Hospital from January 2019 to January 2020 were collected, including 59 women with shoulder dystocia(case group) and 5 753 women without shoulder dystocia(control group). Univariate and multivariate logistic regression analyses were conducted on the risk factors of shoulder dystocia. Among the 59 women with shoulder dystocia, 27 cases received conventional forearm pressure(case group 1), and 32 cases received posterior shoulder rotation(case group 2). The pregnancy outcomes of the groups were compared. Results Statistically significant differences in age, body mass index(BMI), gestational diabetes mellitus(GDM), uterine inertia and macrosomia were found between the case and control groups(all P<0.05). Multivariate logistic analysis showed that BMI>27, GDM, uterine inertia and macrosomia were independent risk factors for shoulder dystocia(all P< 0.05). The total incidence rates of maternal and neonatal adverse outcomes in the case group were 20.34% and 13.56%, respectively, which were higher than those in the control group(6.67% and 0.42%, respectively;all P<0.05). The total incidence rate of maternal and neonatal adverse outcomes in the case group 1 was 25.93%, which was not significantly different from at in case group 2(15.62%, P>0.05). The total incidence rate of adverse neonatal outcomes in case group 1 was 25.93%, which was significantly higher than that in case group 2(3.13%;P<0.05). Conclusion Shoulder dystocia in maternal delivery have numerous risk factors, and thus targeted management is necessary to the prevention of shoulder dystocia. The incidence rates of adverse maternal and infant outcomes when the posterior shoulder rotation method is used are lower than those when the conventional shoulder pressing method is used for treating shoulder dystocia.