永久性臂丛神经损伤的分娩期危险因素。

Intrapartum risk factors for permanent brachial plexus injury.

作者信息

Poggi Sarah H, Stallings Shawn P, Ghidini Alessandro, Spong Catherine Y, Deering Shad H, Allen Robert H

机构信息

Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC, USA.

出版信息

Am J Obstet Gynecol. 2003 Sep;189(3):725-9. doi: 10.1067/s0002-9378(03)00654-9.

DOI:10.1067/s0002-9378(03)00654-9

PMID:14526302

Abstract

OBJECTIVE

The purpose of this study was to compare maternal, neonatal, and second stage of labor characteristics in shoulder dystocia deliveries that result in permanent brachial plexus injury with shoulder dystocia deliveries that result in no injury.

STUDY DESIGN

Our cases were culled from a database of deliveries that resulted in permanent brachial plexus injuries and matched to control cases that were taken from a database of consecutive shoulder dystocia deliveries from one hospital. Deliveries that resulted in injury were excluded from the control cases; those cases with no recorded shoulder dystocia were excluded from the cases. Matching was for birth weight (+/-250 g), parity, and diabetic status. Rates of precipitous and prolonged second stage, operative delivery, neonatal depression, and average number of shoulder dystocia maneuvers used were compared between the two groups with chi(2) test, Fisher exact test, and the Student t test; a probability value of <.05 was considered significant.

RESULTS

There were 80 matched patients, of which 26 patients were nulliparous and 11 patients were diabetic. Mothers of the uninjured group were younger than those of the injured group (23.7+/-6.2 years vs 27.4+/-5.1 years, P<.001). The injured group had a significantly higher rate of 5-minute Apgar scores of <7 (13.9% vs 3.8%, P=.04). Differences in maternal weight, body mass index, height, race, gestational age, average number of maneuvers, head-to-body delivery interval, operative delivery rate, prolonged second stage rate, precipitous second stage rate, and sex were not significant between groups. The rates of precipitous second stage for both groups (28.0% injured and 35.0% uninjured) were more than triple the rates of prolonged second stage (9.5% injured and 11.3% uninjured).

CONCLUSION

No characteristic of second-stage of labor predicts permanent brachial plexus injury. Precipitous second stage is the most prevalent labor abnormality that is associated with shoulder dystocia.

摘要

目的

本研究旨在比较导致永久性臂丛神经损伤的肩难产分娩与未导致损伤的肩难产分娩中产妇、新生儿及第二产程的特征。

研究设计

我们的病例从导致永久性臂丛神经损伤的分娩数据库中筛选，并与从一家医院连续肩难产分娩数据库中选取的对照病例进行匹配。导致损伤的分娩被排除在对照病例之外；无肩难产记录的病例被排除在病例组之外。匹配因素为出生体重（±250克）、产次和糖尿病状态。采用卡方检验、Fisher精确检验和学生t检验比较两组之间急产和第二产程延长的发生率、手术分娩率、新生儿窒息率以及肩难产手法的平均使用次数；概率值<0.05被认为具有统计学意义。

结果

共有80例匹配患者，其中26例为初产妇，11例患有糖尿病。未受伤组的母亲比受伤组的母亲年轻（23.7±6.2岁对27.4±5.1岁，P<0.001）。受伤组5分钟Apgar评分<7的发生率显著更高（13.9%对3.8%，P = 0.04）。两组之间产妇体重、体重指数、身高、种族、孕周、手法平均使用次数、头身娩出间隔、手术分娩率、第二产程延长率、急产率和性别差异均无统计学意义。两组的急产率（受伤组28.0%，未受伤组35.0%）均超过第二产程延长率（受伤组9.5%，未受伤组11.3%）的三倍以上。