Risk Factors for Shoulder Dystocia
Risk Factors for Shoulder Dystocia
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肩难产的危险因素
DOI：
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发表时间：
1985
影响因子：
7.2
通讯作者：
E. A. Friedman
中科院分区：
文献类型：
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作者：
D. Acker;B. Sachs;E. A. Friedman
与肩难产的发生相关的危险因素进行了检查，在一般产科人口的妇女阴道分娩。肩难产的发生率随着婴儿出生体重的增加而增加。尽管三分之一的肩难产发生在42周以上的妊娠中，但除了那些导致婴儿体重4500+ g的情况外，绝大多数未受肩难产的影响。非糖尿病孕妇阴道分娩体重4000 ~ 4499和4500+ g婴儿时肩难产的发生率分别为10.0和22.67r。在4000- 4499-g组中，没有分娩异常是明确的预测因素;然而，在最重出生体重组中，55.0%的病例中停搏障碍预示着肩难产。糖尿病患者肩难产发生率高于非糖尿病患者。其中，31%的阴道分娩的新生儿体重4000+ g发生肩难产。然而，糖尿病和巨大胎儿（4000+ g）的危险因素可以预测73%的糖尿病患者肩难产;在非糖尿病患者中，巨大胎儿单独标记了52%的肩难产。对于估计胎儿体重为4000+ g的糖尿病孕妇，建议采用剖宫产术作为分娩方法。如果其他人证实了这一风险，作者建议对胎儿估计为4500+ g且分娩异常的孕妇认真考虑剖宫产。
The risk factors associated with the occurrence of shoulder dystocia were examined in the general obstetrical population of women delivering vaginally. An increasing incidence of shoulder dystocia was found as infant birth weight increased. Although one-third of shoulder dystocia occurred in pregnancies at 42 + weeks, except for those resulting in infants weighing 4500+ g, the vast majority was unaffected by shoulder dystocia. The incidence of shoulder dystocia in nondiabetic gravidas delivering an infant weighing 4000 to 4499 and 4500+ g vaginally was 10.0 and 22.67r, respectively. Within the 4000- to 4499-g group, no labor abnormality was clearly predictive; however, in the heaviest birth weight group, an arrest disorder heralded a shoulder dystocia in 55.0% of cases. Diabetics experienced more shoulder dystocia than nondiabetics. Among them, 31% of vaginally delivered neonates weighing 4000+ g experienced shoulder dystocia. Nevertheless, the risk factors of diabetes and large fetus (4000+ g) could predict 73% of shoulder dystocia among diabetics; large fetus alone flagged 52% of shoulder dystocia in nondiabetics. Cesarean section is recommended as the delivery method for diabetic gravidas whose estimated fetal weight is 4000+ g. If others confirm the risk, the authors advise serious consideration of cesarean section for gravidas who are carrying fetuses estimated to be 4500+ g and who experience an abnormal labor.