Mollberg Margareta, Wennergren Margareta, Bager Börje, Ladfors Lars, Hagberg Henrik
Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, University of Göteborg, Göteborg, Sweden.
Acta Obstet Gynecol Scand. 2007;86(2):198-204. doi: 10.1080/00016340601089792.
To evaluate the association between obstetric brachial plexus palsy and obstetrical maneuvers during the second stage of delivery.
Prospective population-based case control study. Cases of obstetric brachial plexus palsy were compared with a randomly selected control group with regard to obstetric management.
Five or more obstetrical maneuvers were used to deliver the infants in 82% in the obstetric brachial plexus palsy group versus 1.8% in the controls. Risk factors independently associated with obstetric brachial plexus palsy were force applied when downward traction was imposed on the fetal head (odds ratio 15.2; 95% confidence interval 8.4-27.7). The incidence of obstetric brachial plexus palsy in the infants in the population was 3.3 per thousand. At 18 months of age 16.1% (incidence of 0.05%) of children had residual functional deficits and downward traction with substantial force was applied in all these cases.
Forceful downward traction applied to the head after the fetal third rotation represents an important risk factor of obstetric brachial plexus palsy in vaginal deliveries in cephalic presentation.
评估分娩第二产程中产科臂丛神经麻痹与产科操作之间的关联。
基于人群的前瞻性病例对照研究。将产科臂丛神经麻痹病例与随机选择的对照组在产科管理方面进行比较。
产科臂丛神经麻痹组中82%的婴儿分娩时使用了五种或更多产科操作，而对照组为1.8%。与产科臂丛神经麻痹独立相关的危险因素是在向下牵引胎儿头部时施加的力量（比值比15.2；95%置信区间8.4 - 27.7）。人群中婴儿产科臂丛神经麻痹的发生率为千分之3.3。在18个月大时，16.1%（发生率0.05%）的儿童有残留功能缺陷，所有这些病例中均施加了大力的向下牵引。
在头位阴道分娩中，胎儿第三次旋转后对头施加强力向下牵引是产科臂丛神经麻痹的一个重要危险因素。
