Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, China.
BJOG. 2011 Jul;118(8):985-90. doi: 10.1111/j.1471-0528.2011.02968.x. Epub 2011 Apr 12.
To evaluate the different types and sequences of manoeuvres to overcome shoulder dystocia and the rates of associated fetal injury.
Retrospective review.
A university hospital.
Pregnancies complicated with shoulder dystocia from 1995 to 2009.
Cases were identified from the hospital electronic delivery records.
The success rate between McRoberts' manoeuvre, rotational methods and posterior arm delivery, and the incidences of brachial plexus injury (BPI), clavicular fracture (CF) and humeral fracture (HF) according to the types and sequences of manoeuvres applied to overcome shoulder dystocia.
Among 205 cases identified, McRoberts' manoeuvre was successful initially in 25% of cases, of which 7.8% suffered from BPI and 3.9% suffered from CF, but none had HF. In the failed cases, subsequent rotational methods and posterior arm delivery were similarly successful (72.0 versus 63.6%), whereas the former was associated with less BPI (4.4 versus 21.4%) and HF (1.1 versus 7.1%) despite similar risk of CF (5.6 versus 7.1%). The rotational methods were not associated with a higher fetal injury risk compared with McRoberts' manoeuvre. The remaining cases were managed by applying the third yet untried manoeuvre, and posterior arm delivery and rotational methods had similar success (77.1 versus 62.5%). The cumulative success rates after the second and the third manoeuvres were 79.0 and 94.6%, respectively.
Following the failure of McRoberts' manoeuvre, subsequent application of rotational methods and posterior arm delivery have similarly high success rates but the former may be associated with less fetal injury.
评估克服肩难产的不同手法类型和顺序以及相关胎儿损伤的发生率。
回顾性研究。
一所大学医院。
1995 年至 2009 年期间患有肩难产的孕妇。
从医院电子分娩记录中确定病例。
McRoberts 手法、旋转手法和后臂娩出的成功率，以及根据克服肩难产所应用的手法类型和顺序，发生臂丛神经损伤（BPI）、锁骨骨折（CF）和肱骨骨折（HF）的发生率。
在 205 例确诊病例中，McRoberts 手法最初成功的比例为 25%，其中 7.8%发生 BPI，3.9%发生 CF，但无一例发生 HF。在失败的病例中，随后应用的旋转手法和后臂娩出同样成功（72.0%对 63.6%），而前者 BPI（4.4%对 21.4%）和 HF（1.1%对 7.1%）的发生率较低，尽管 CF 的风险相似（5.6%对 7.1%）。与 McRoberts 手法相比，旋转手法并不增加胎儿损伤的风险。对于其余病例，应用第三种尚未尝试的手法，后臂娩出和旋转手法的成功率相似（77.1%对 62.5%）。第二和第三种手法后的累积成功率分别为 79.0%和 94.6%。
在 McRoberts 手法失败后，随后应用旋转手法和后臂娩出的成功率相似，但前者可能与胎儿损伤程度较轻有关。
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