肩难产21例回顾性分析

目的　了解肩难产的发生率 ,并发症及处理方法 ,分析肩难产的高危因素 ,探讨其临床价值。方法　回顾性分析 1997年 1月至 2 0 0 1年 12月 5年间的肩难产病例 ,并随机抽取同期阴道分娩病例作为对照 ,比较两组间孕妇在产前、产时指标和胎儿径线等方面有无差别。分析巨大儿、糖尿病、阴道助产、产程异常等高危因素在肩难产中的比率。评价松解胎肩的方法。结果　 5年间分娩总数为 6 4 0 0例 ,肩难产 2 4例 ,其中巨大儿 12例 ,占5 7 10 %。有 6例并发新生儿损伤 ,占 30 0 0 %。肩难产组和对照组在新生儿体重、身长、头围、胸围有显著差异 ,两组孕妇的宫高和腹围有显著差异。结论　肩难产是产科少见的并发症 ,巨大儿发生肩难产的比例最高 ,但根据高危因素仍很难预测肩难产。正确处理肩难产是降低围生儿并发症的重要措施。

Shoulder dystocia:a retrospective analysis of 21 cases

Objective To assess the incidence,treatment and complications of shoulder dystocia and whether the high risk factors could be predicted.Methods Retrospective analysis of shoulder dystocia between 1997 and 2001 was performed to determine whether macrosomia,diabetes,operative vaginal delivery,labor abnormalities could predict shoulder dystocia.The contemporary cases of vaginal delivery were randomly selected as the controls.We assessed whether there were differences between the two groups in the gradivas before and during delivery and the size of fetuses,and we evaluated the techniques of freeing the shoulder.Results There were 24 cases of shoulder dystocia in 6400 births,macrosomia was a feature in 12 infants.The neonatal morbidity rate was 30 00%(6 cases).The two groups had significant difference in the height of uterus,abdomen circumference and neonates' birth weight,body length,head circumference and chest circumference.Conclusion Shoulder dystocia is a rare complication of delivery.The macrosomia shows a high ratio of shoulder dystocia,while the risk factors can not predict shoulder dystocia.Dealing with shoulder dystocia correctly is very important in decreasing the complications of perinatal babies.