Jevitt Cecilia M, Morse Shannon, O'Donnell Yong Sue
University of South Florida College of Nursing, Tampa, FL 33612, USA.
J Perinat Neonatal Nurs. 2008 Jan-Mar;22(1):14-20. doi: 10.1097/01.JPN.0000311870.07958.81.
Shoulder dystocia is a birth emergency that occurs in approximately 1% of all births. Shoulder dystocia can be followed by broken clavicle or humerus, brachial plexus injury, fetal hypoxia, or death. Although risk factors for shoulder dystocia include previous birth complicated by shoulder dystocia, maternal obesity, excessive prenatal weight gain, fetal macrosomia, gestational diabetes, and instrumental delivery, shoulder dystocia is not predictable. Perinatal nurses can reduce the risk for shoulder dystocia by teaching mothers about optimal weight gain in pregnancy and assisting mothers with diabetes to prevent hyperglycemia through diet management and medication use. During childbirth preparation or early labor, nurses can educate mothers about position changes and maneuvers used for shoulder dystocia. Nurses play a vital role in obtaining assistance during a shoulder dystocia, keeping time, assisting with maneuvers such as suprapubic pressure, and documenting the dystocia management. Nurses can assist mothers and families to review the shoulder dystocia and any newborn injuries in the postpartum period, thereby reducing confusion and anxiety. Regular drills and case reviews help build nursing shoulder dystocia management skills.
肩难产是一种分娩紧急情况，约占所有分娩的1%。肩难产可能会导致锁骨或肱骨骨折、臂丛神经损伤、胎儿缺氧或死亡。尽管肩难产的风险因素包括既往分娩有肩难产史、母亲肥胖、孕期体重过度增加、巨大儿、妊娠期糖尿病和器械助产，但肩难产是不可预测的。围产期护士可以通过教导母亲孕期最佳体重增加，并协助患有糖尿病的母亲通过饮食管理和药物使用来预防高血糖，从而降低肩难产的风险。在分娩准备或产程早期，护士可以向母亲们传授用于应对肩难产的体位改变和手法。护士在肩难产发生时寻求帮助、计时、协助进行耻骨上加压等手法以及记录难产处理过程中起着至关重要的作用。护士可以协助母亲及其家人在产后回顾肩难产情况及任何新生儿损伤，从而减少困惑和焦虑。定期演练和病例回顾有助于培养护士处理肩难产的技能。
