第二次分娩时发生肩难产的风险：有肩难产病史有影响吗？
Risk of shoulder dystocia in second delivery: does a history of shoulder dystocia matter?
作者信息
Overland Eva A, Spydslaug Anny, Nielsen Christopher S, Eskild Anne
机构信息
Department of Obstetrics and Gynecology and Medical Faculty Division, Akershus University Hospital, University of Oslo, Oslo, Norway.
出版信息
Am J Obstet Gynecol. 2009 May;200(5):506.e1-6. doi: 10.1016/j.ajog.2008.12.038. Epub 2009 Mar 9.
OBJECTIVE
Our aim was to estimate the relative and absolute risk of shoulder dystocia in the second delivery according to history of shoulder dystocia and offspring birthweight.
STUDY DESIGN
A retrospective cohort study including all women in Norway with 2 consecutive singleton vaginal deliveries with fetus in cephalic presentation, during the period 1967-2005 (n = 537,316).
RESULTS
In the second delivery shoulder dystocia occurred in 0.8% of all women. In women with a prior shoulder dystocia the recurrence risk was 7.3%. Most cases of shoulder dystocia in second delivery were in women without such history (96.2%). Offspring birthweight was the most important risk factor for shoulder dystocia in second delivery: crude odds ratio, 292.9 (95% confidence interval, 237.8-360.7) comparing birthweight > 5000 g with 3000-3499 g.
CONCLUSION
Prior shoulder dystocia increased the risk of shoulder dystocia in the second delivery. However, offspring birthweight was by far the most important risk factor.
目的
我们的目的是根据肩难产病史和子代出生体重，评估第二次分娩时肩难产的相对风险和绝对风险。
研究设计
一项回顾性队列研究，纳入了1967年至2005年期间挪威所有有两次连续单胎头位阴道分娩的妇女（n = 537,316）。
结果
在第二次分娩中，所有妇女的肩难产发生率为0.8%。有既往肩难产史的妇女复发风险为7.3%。第二次分娩时的大多数肩难产病例发生在无此类病史的妇女中（96.2%）。子代出生体重是第二次分娩时肩难产最重要的风险因素：将出生体重>5000 g与3000 - 3499 g进行比较，粗比值比为292.9（95%置信区间，237.8 - 360.7）。
结论
既往肩难产增加了第二次分娩时肩难产的风险。然而，子代出生体重是迄今为止最重要的风险因素。
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