Can shoulder dystocia be reliably predicted?
Can shoulder dystocia be reliably predicted?
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DOI：
10.1111/j.1479-828x.2012.01425.x
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发表时间：
2012-06-01
影响因子：
1.7
通讯作者：
Scheil, Wendy
中科院分区：
文献类型：
--
作者：
Dodd, Jodie M.;Catcheside, Britt;Scheil, Wendy
目的：评估增加肩难产风险的因素，并评估其在人群水平上的预测价值。方法访问2005年至2010年南澳大利亚州妊娠结局单位的人口数据库，以确定肩难产的发生率以及报告的风险因素，包括年龄，产次，自我报告的种族，糖尿病和婴儿出生体重。计算每个危险因素肩难产的比值比（和95%置信区间），然后将其纳入逻辑回归模型。计算预测肩难产的每个变量的测试特征。结果肩难产报告率从2005年的0.95%上升到2010年的1.38%，差异有统计学意义（P=0.0002）。使用逻辑回归模型，引产和婴儿出生体重大于4000和4500克被确定为肩难产的重要独立预测因素。单独的危险因素的价值和纳入逻辑回归模型时，肩难产的发生预测性较差。结论虽然有许多因素与肩难产的风险增加相关，但没有一个因素具有足够的敏感性或阳性预测值，无法在临床上可靠、准确地识别肩难产的发生。
Aims To evaluate factors reported to increase the risk of shoulder dystocia, and to evaluate their predictive value at a population level. Methods The South Australian Pregnancy Outcome Unit's population database from 2005 to 2010 was accessed to determine the occurrence of shoulder dystocia in addition to reported risk factors, including age, parity, self-reported ethnicity, presence of diabetes and infant birth weight. Odds ratios (and 95% confidence interval) of shoulder dystocia was calculated for each risk factor, which were then incorporated into a logistic regression model. Test characteristics for each variable in predicting shoulder dystocia were calculated. Results As a proportion of all births, the reported rate of shoulder dystocia increased significantly from 0.95% in 2005 to 1.38% in 2010 (P=0.0002). Using a logistic regression model, induction of labour and infant birth weight greater than both 4000 and 4500g were identified as significant independent predictors of shoulder dystocia. The value of risk factors alone and when incorporated into the logistic regression model was poorly predictive of the occurrence of shoulder dystocia. Conclusions While there are a number of factors associated with an increased risk of shoulder dystocia, none are of sufficient sensitivity or positive predictive value to allow their use clinically to reliably and accurately identify the occurrence of shoulder dystocia.