McRoberts手法及Woods手法处理肩难产效果的评价

目的 对McRoberts手法及Woods手法处理肩难产的效果进行评价。方法 对1996年1月至2004年12月的48例肩难产患者的临床资料进行回顾性分析。结果 按肩难产发生后首先采用的处理方法分为2组：A组28例，采用单一McRoberts手法；B组20例，采用McRoberts手法联合Woods手法。单一手法及联合手法的成功率分别为46％和95％，差异有统计学意义（P〈0．01）。单用McRoberts手法处理非巨大儿及巨大儿肩难产的成功率分别为75％和25％，差异有统计学意义（P〈0．01）。McRoberts手法联合Woods手法处理非巨大儿及巨大儿肩难产的成功率差异无统计学意义（P〉0．05）。在A组失败的病例中，13例改用McRoberts手法联合Woods手法后全部阴道分娩成功。结论 McRoberts手法及Woods手法是处理肩难产简便易行的方法。肩难产发生时，尤其是预计胎儿体重≥4000g者，宜采用McRoberts手法联合Woods手法；若估计胎儿体重〈4000g，可采用单一McRoberts手法。采用单一McRoberts手法失败时应及时联合采用Woods手法。

Evaluation of effectiveness of McRoberts maneuver and Woods maneuver in the management of shoulder dystocia

Objective To evaluate the effectiveness of McRoberts maneuver and Woods maneuver in the management of shoulder dystocia.Methods A retrospective analysis of 48 lying-in women with shoulder dystocia delivered at the affiliated hospital of Jining medical college and Weifang maternal and child health care hospital during January 1996 to December 2004 was performed.Results In the study period,86 lying-in women with shoulder dystocia were identified among 12 137 vaginal deliveries,with an incidence of 0.71%.Forty-eight lying-in women were divided into two groups based on their initial treatment methods to relieve shoulder dystocia,28 cases in group A with McRoberts maneuver alone and 20 cases in group B with both McRoberts maneuver and Woods maneuver combined.There was significant difference in the rates of successful vaginal delivery between groups A and B(46% vs 95%,P<0.01).Seventy-five per cent and 25 per cent of should dystocia with non-fetal macrosomia and fetal macrosomia were successful in vaginal delivery,respectively,by McRoberts maneuver alone(P<0.01).There was no significant difference in the rates of successful vaginal delivery with both McRoberts maneuver and Woods maneuver combined to deal with shoulder dystocia with non-fetal macrosomia and fetal macrosomia(P>0.05).Thirteen cases of shoulder dystocia all succeeded in vaginal delivery with both McRoberts maneuver and Woods maneuver combined after initial failure with McRoberts maneuver alone.Conclusions Both McRoberts maneuver and Woods maneuver are simple and feasible way to relieve shoulder dystocia.McRoberts maneuver combined with Woods maneuver should be performed in shoulder dystocia with fetal weight equal to or more than 4 000 g.McRoberts maneuver alone could be initially performed in shoulder dystocia with fetal weight less than(4 000 g,)and if it fails,Woods maneuver should be combined to perform in time.