肩难产紧急处理16例分析

目的分析肩难产发生特点,降低相关母儿并发症。 方法回顾性分析2013年1月至2018年12月陆军军医大学第一附属医院产科收治的紧急发生肩难产病例16例的临床资料,分析指标包括肩难产高危因素、诊断、助娩方式及母儿结局。 结果6年内经阴道分娩共16 252例,肩难产16例,发生率0.1%。高危因素分布为巨大儿3例,妊娠期糖尿病4例,器械助产5例,4例患者无高危因素。7例肩难产确诊表现为胎头娩出后胎肩嵌顿,9例表现为胎头娩出胎肩嵌顿并合并有"乌龟征"的临床表现。16例肩难产病例运用3～5种经阴道最终娩出。母儿结局：产后出血1例,会阴侧切11例,软产道损伤9例,无严重会阴裂伤;14例新生儿健康状况良好,1例新生儿3月龄时发现眼睑下垂,1例失访。 结论肩难产仍是无法预测的产科急症,需要正确判断肩难产的发生,掌握肩难产救治流程,快速施救,从而降低母儿并发症。

Analysis of emergency management of shoulder dystocia in 16 cases

Objective Analyze the characteristics of shoulder dystocia and reduce the complications of maternal and neonatal.Methods Clinical data of 16 cases of shoulder dystocia,who were admitted in the Obstetrics Department of the First Affiliated Hospital of the Army Military Medical University from January 2013 to December 2018,were retrospective analysis.The analysis indicators included high risk factors of shoulder dystocia,diagnosis of shoulder dystocia,assisted delivery methods and the maternal and fetal outcomes.Results There were 16252 cases of raginal delivery and 16 cases of dystocia of shoulder within 6 years,the incidence was 0.1%.Among the 16 patients with shoulder dystocia,3 cases gave birth to giant babies,4 cases were gestational diabetes,5 cases were assisted delivery with instruments,and the other 4 cases had no high risk factors.7 cases of shoulder dystocia were diagnosed as shoulder impaction after delivery of fetal head,9 cases were diagnosed as shoulder impaction after delivery of fetal head and combined with“tortoise sign”.Sixteen cases were treated with 3-5 steps of seven steps in the management of shoulder dystocia and then finally delivered the baby through vagina.Maternal and infant outcomes:1 case were postpartum hemorrhage,11 cases were lateral episiotomy,9 cases were soft birth canal injury,no body had serious perineal laceration;14 newborns were good health,1 newborn were found ptosis at 3 months old and 1 case lost visit.Conclusions Shoulder dystocia is still an unpredictable obstetric emergency.It is necessary to correctly judge the occurrence of shoulder dystocia,master the treatment process of shoulder dystocia,and quickly rescue,so as to reduce the complications of mother and child.