Wagner R K, Nielsen P E, Gonik B
Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington, USA.
Obstet Gynecol Clin North Am. 1999 Jun;26(2):371-83. doi: 10.1016/s0889-8545(05)70080-2.
Shoulder dystocia is an infrequent and unexpected emergency requiring rapid and deft solution. Identifiable risk factors include maternal diabetes, fetal macrosomia (especially in the presence of diabetes), and maternal history of previous delivery of a large infant. Other reported risk factors include arrest and protraction disorders of labor and midpelvic operative delivery; however, more than 50% of shoulder dystocia occurs in instances without identifiable risk factors, and permanent neonatal injury is thus unpredictable. Therefore, all personnel in the delivery suite must be well versed in the timely and appropriate application of corrective measures. Although most instances of shoulder dystocia cannot be predicted, the judicious use of CS delivery in diabetic patients with expected birth weights of more than 4250 g should reduce the risk of shoulder dystocia in this subgroup of patients. A trial of labor for nondiabetic patients with suspected fetal macrosomia is recommended because predicting actual birth weights in this population remains difficult.
肩难产是一种罕见且意外的紧急情况，需要迅速而巧妙地解决。可识别的风险因素包括母亲患糖尿病、胎儿巨大（尤其是在母亲患糖尿病的情况下）以及母亲既往有分娩巨大婴儿的病史。其他报道的风险因素包括产程停滞和延长障碍以及中骨盆手术分娩；然而，超过50%的肩难产发生在无明确风险因素的情况下，因此新生儿永久性损伤无法预测。因此，产房的所有人员必须精通及时、恰当地应用纠正措施。虽然大多数肩难产情况无法预测，但对于预计出生体重超过4250g的糖尿病患者，明智地选择剖宫产应可降低该亚组患者肩难产的风险。对于疑似胎儿巨大的非糖尿病患者，建议进行试产，因为预测该人群的实际出生体重仍然困难。
