肩难产的预防及处理

我院1984年～1991年期间3747次头位阴道分娩中肩难产12例,发生率0.3％;同期阴道分娩巨大儿103例,肩难产9例,巨大儿肩难产发生率8.47％。作者认为肩难产是一种少见的急症性难产,如处理不当,有极高的母婴并发症发生率。巨大儿、骨盆狭窄和困难阴道助产术是其发生的主要因素。提高巨大儿产前诊断水平,对可疑者行胎儿多径线的B超测量,避免困难阴道助产术,有助于肩难产的预防。麦克手法为处理肩难产的首选方法,如失败,旋肩法及后肩娩出法亦行之有效。

Prevention and Management of Shoulder Dystocia

From 1984 to 1991 there were 3 747 cases of vaginal deliveries of head presentation in our hospital,of which 12 cases were shoulder dystocia with an incidence of 0. 3%,in the meantime,the number of fetal macrosomia from vagina was 103,among which 9 cases were shoulder dystocia with an incidence of 8. 74%. In our opinion,shoulder dystocia is a rare kind of emergence dystocia and has higher complications of mothers and infants if not treated property. The main factors that cause shoulder dystocia are fetal macrosomia, contracted pelvis and difficult vaginal operation. To raise the diagnostic level of fetal macrosomia,conduct some fetal measuremets with B-ultrasonic examination for a suspect and avoid difficult vaginal operation are helpful to prevent shoulder dystocia. The means of Mckoberts is the first management chosen for shoulder dystocia,however,if there is a failure the ways of Morris-Woods and posterior shoulder delivery will also be effective.