肩难产发生的相关因素及其并发症探索

目的 :了解肩难产发生的相关因素 ,并探讨其臂丛神经麻痹并发症的主要机制。方法 :回顾分析本院 2 5年来 18例肩难产 ,按产前测量宫高、腹围估计胎儿体重 ,据B超测量胎儿双顶径、胸径等 ,结合观察分娩过程 ,测算肩难产的可能性。结果 :(1)上述人体测量法能够发现肩难产的高危因素 ,若经阴道分娩 ,需密切观察产程进展 ,把握剖宫产的时机。 (2 )除肩 -头、胸 -头周径不称外 ,不良肢体位置为产生其并发症的又一重大因素。 (3)胎头娩出后肩解脱时间在 10min以内及超过 10min二组的新生儿并发症发生率及严重程度差异有显著性 (P <0 0 5 ) ,提示内源性分娩力为此类新生儿损伤的主要机制。结论 :人体测量方法的结果异常可以预示会出现肩难产的高危因素。需注意胎儿肢体位置不良这一新的高危因素。内源性分娩力可能是造成新生儿臂丛神经麻痹的主要原因 ,接生者不仅应尽量缩短肩解脱时间 ,还应防止胎头下降过快、过猛。

Clinical Exploration of Factors in Relation to Shoulder Dystocia and Its Complications

Objective: To explore factors in relation to shoulder dystocia and how did the injure of brachial plexus happened. Methods: Eighteen cases diagnosed as shoulder dystocia in our hospital during past 25 years were analyzed retrospectively. To evaluate birth weight by taking mothernal waist measure and the dimensions of biparietal diameter and chest diameter taken by B type ultrasonography, connected with observations of labor course to assess the probability by for shoulder dystocia. Results:(1)Anthropometric measurements described above are able to discover the high risk for shoulder dystocia. In case by vaginal delivery, one must observe labor progress carefully to see if it's the very time to take cesarean operation. (2)Except disproportional shoulder or chest-to-head circumferences, we discovered that distortion of fetal limbs was an additional valuable factor in producing complications. (3)The morbidity and severity of infant's complications differed significantly between duration for shoulder failure to progress in less than or more of ten minutes(P<0.05),and suggested that spontaneous endogenous forces may contribute substantially to this type of neonate trauma. Conclusion:Shoulder dystocia at high risk can be detected by anthropometric measure, and distortion of fetal limbs should be noticed for it may be a new high risk factor. Endogenous force may be a main cause of brachial plexus palsy, the clinician,therefore, not only should do their best to shorten shoulder delivering duration, but also to prevent descending of fetal head too rapid or too strong.