Department of Obstetrics & Gynaecology, University of Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia.
Eur J Obstet Gynecol Reprod Biol. 2010 Mar;149(1):44-6. doi: 10.1016/j.ejogrb.2009.12.003. Epub 2009 Dec 29.
To determine if shoulder dystocia can be predicted in babies born weighing 3.5 kg or more.
A case-control study nested in a perinatal database of 899 mothers and their babies who weighed 3.5 kg or more. All were term pregnancies and delivered vaginally. A case was defined as any baby that encountered shoulder dystocia at delivery. Controls were deliveries over the same period that were not complicated by shoulder dystocia. A logistic regression model was created with macrosomia, parity, previous delivery of more than 3.5 kg, diabetes in pregnancy, prolonged labor, prolonged second stage and instrumental delivery as the independent variables. The adjusted odds ratio and the receiver operator characteristics (ROC) curves were used to see if these variables, both individually and as a model, were associated with or were discriminative enough to predict shoulder dystocia; an ROC curve of more than 0.7 showing good prediction.
There were 36 cases of shoulder dystocia during the study period, an incidence of 4%. Previous delivery of more than 3.5 kg, prolonged labor and prolonged second stage were not associated with shoulder dystocia. Although diabetes and instrumental delivery were independently and significantly associated with shoulder dystocia their importance as a predictor became relevant only in the presence of macrosomia.
Macrosomia is the only reliable predictor of shoulder dystocia.
确定出生体重为 3.5 公斤或以上的婴儿是否可以预测肩难产。
在一项围产期数据库中进行的病例对照研究，该数据库包含 899 名母亲及其体重为 3.5 公斤或以上的婴儿。所有妊娠均为足月分娩且均经阴道分娩。病例定义为分娩时发生肩难产的任何婴儿。对照组为同一时期无肩难产并发症的分娩。使用宏程序创建了一个逻辑回归模型，其中巨大儿、经产、前次分娩体重超过 3.5 公斤、妊娠糖尿病、产程延长、第二产程延长和器械分娩为自变量。使用调整后的优势比和接收者操作特征（ROC）曲线来确定这些变量是否单独或作为模型与肩难产相关，或是否具有足够的判别力来预测肩难产；ROC 曲线超过 0.7 表明具有良好的预测能力。
在研究期间，有 36 例肩难产，发生率为 4%。前次分娩体重超过 3.5 公斤、产程延长和第二产程延长与肩难产无关。尽管糖尿病和器械分娩与肩难产独立且显著相关，但只有在存在巨大儿的情况下，它们作为预测因素的重要性才变得相关。
巨大儿是肩难产唯一可靠的预测指标。
