From Newton Wellesley Hospital, Newton, Massachusetts; Harvard Medical School, Boston, Massachusetts; Suffolk University Law School, Boston, Massachusetts; the Departments of Obstetrics and Gynecology, Franklin Square Hospital, Baltimore, Maryland, and McGill University, Montreal, Quebec, Canada; and PeriGen, Montreal, Quebec, Canada.
Obstet Gynecol. 2011 Aug;118(2 Pt 1):318-322. doi: 10.1097/AOG.0b013e31822467e9.
To evaluate the relationship between the head-to-body delivery interval in shoulder dystocia, persistent brachial plexus injury, and neonatal depression.
We compared the head-to-body delivery intervals in 127 cases of uncomplicated shoulder dystocia-identified using medical record coding and verified by chart review in a university--affiliated community hospital--with a series of 55 medical-legal cases of shoulder dystocia with persistent brachial plexus injury, 14 of which included neonatal depression. Neonatal depression was defined as the presence of any of the following: fetal demise, cardiopulmonary resuscitation, intubation, umbilical artery pH lower than 7.00, or 5-minute Apgar score of 5 or lower.
In the uncomplicated shoulder dystocia group, the median head-to-body delivery interval was 1.0 minute (interquartile range 0.5-1.0). The median for neonates with persistent brachial plexus injury and no depression was 2.0 minutes (interquartile range 1.0-4.0). For those with both persistent brachial plexus injury and neonatal depression, the median was significantly longer at 5.3 minutes (interquartile range 3.9-13.3), P<.001.
Neonates born with persistent brachial plexus injury and neonatal depression after shoulder dystocia had longer head-to-body delivery intervals than those with uncomplicated shoulder dystocia or shoulder dystocia with persistent brachial plexus injury without depression. By 4 minutes, all of the neonates with uncomplicated shoulder dystocia were born. Conversely, the majority of neonates with depression-57%-had head-to-body delivery intervals greater than 4 minutes. Such information offers guidance to clinicians caught between the admonition to apply only gentle force when utilizing maneuvers to accomplish a shoulder dystocia delivery and the countervailing need to achieve delivery within a critical time frame to prevent hypoxic injury.
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评估肩难产中头部到身体的分娩间隔与持续性臂丛神经损伤和新生儿抑郁之间的关系。
我们比较了 127 例在大学附属社区医院通过病历编码识别并通过图表审查验证的无并发症肩难产的头部到身体的分娩间隔，以及一系列 55 例伴有持续性臂丛神经损伤的医学法律肩难产病例，其中 14 例包括新生儿抑郁。新生儿抑郁定义为存在以下任何一种情况：胎儿死亡、心肺复苏、插管、脐动脉 pH 值低于 7.00 或 5 分钟 Apgar 评分为 5 分或更低。
在无并发症肩难产组中，头部到身体的分娩间隔中位数为 1.0 分钟（四分位距 0.5-1.0）。无持续性臂丛神经损伤和无抑郁的新生儿中位数为 2.0 分钟（四分位距 1.0-4.0）。对于同时伴有持续性臂丛神经损伤和新生儿抑郁的新生儿，中位数显著延长至 5.3 分钟（四分位距 3.9-13.3），P<.001。
肩难产后伴有持续性臂丛神经损伤和新生儿抑郁的新生儿的头部到身体的分娩间隔长于无并发症肩难产或伴有持续性臂丛神经损伤但无抑郁的肩难产。所有无并发症肩难产的新生儿在 4 分钟内分娩。相反，大多数伴有抑郁的新生儿（57%）的头部到身体的分娩间隔大于 4 分钟。这些信息为临床医生提供了指导，他们在使用手法来完成肩难产分娩时，既要遵循只能施加轻柔力量的警告，又要在关键时间内完成分娩以防止缺氧损伤。
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