O'Leary J A, Cuva A
Department of Obstetrics and Gynecology, St. Luke's Hospital, Bethlehem, Pennsylvania.
Obstet Gynecol. 1992 Sep;80(3 Pt 2):514-6.
Since the introduction of cephalic replacement for shoulder dystocia, the management of failures has not been addressed. The purpose of this report is to describe abdominal hysterotomy as an alternative approach to the resolution of shoulder dystocia.
A 21-year-old woman, gravida 1, experienced severe shoulder dystocia following partial delivery of a 4320-g infant. Classical maneuvers as well as cephalic replacement were unsuccessful before and after general anesthesia. A low transverse hysterotomy permitted manual rotation of the anterior shoulder to the oblique diameter and further descent of the posterior shoulder. Delivery of the posterior arm was then completed without difficulty.
Persistent failed cephalic replacement, especially after general anesthesia, can be successfully resolved with a hysterotomy using a low transverse uterine incision.
自从采用胎头复位法处理肩难产以来，对于复位失败的处理方法尚未得到探讨。本报告的目的是描述经腹子宫切开术作为解决肩难产的一种替代方法。
一名21岁初产妇，在娩出体重4320克婴儿的部分过程中发生严重肩难产。在全身麻醉前后，经典手法以及胎头复位均未成功。低位横切口子宫切开术使前肩手动旋转至斜径，后肩进一步下降。随后顺利娩出后臂。
持续的胎头复位失败，尤其是在全身麻醉后，采用低位子宫横切口行子宫切开术可成功解决。
