Department of Obstetrics and Gynecology, Franklin Square Hospital, Baltimore, MD, USA.
Obstet Gynecol. 2012 Apr;119(4):830-7. doi: 10.1097/AOG.0b013e31824be910.
To determine practice patterns for shoulder dystocia and concepts dealing with brachial plexus palsy.
An Internet-based 25-question survey was electronically disseminated to all current members of the Central Association of Obstetricians and Gynecologists. For those individuals who did not respond, an additional opportunity to complete the assessment was provided during the 2009 annual meeting.
Of 429 Central Association of Obstetricians and Gynecologists members, 268 (62%) responded, with 192 (78%) filling out the survey online. Nearly 90% of those queried believed that shoulder dystocia was unpredictable and unpreventable. Thirty-seven percent felt that an elective cesarean delivery should be offered for an estimated fetal weight of 4,500 g among nondiabetics. Just 40% would have allowed a trial of labor with a documented history of shoulder dystocia. Slightly more than half answered that they never used either lateral or excessive traction and obstetrician-gynecologists were more likely than maternal-fetal medicine specialists to conclude that traction applied by the clinician doing the delivery was the cause of shoulder dystocia-related brachial plexus palsy (36% compared with 12%, P=.005). Maternal-fetal medicine specialists were more likely to believe that 40-50% of brachial plexus palsies occur without concomitant shoulder dystocia (21% compared with 9%, P=.015).
Differences in practice patterns exist among with regard to management recommendations of the American College of Obstetricians and Gynecologists' Practice Bulletin on shoulder dystocia.
III.
确定肩难产的实践模式和与臂丛神经麻痹相关的概念。
采用基于互联网的 25 个问题的调查，以电子方式分发给所有现任中央妇产科医师协会成员。对于未回复的人，在 2009 年年会期间提供了另一次完成评估的机会。
在 429 名中央妇产科医师协会成员中，有 268 名（62%）做出了回应，其中 192 名（78%）在线填写了调查。近 90%的受访者认为肩难产是不可预测和不可预防的。37%的人认为对于非糖尿病患者，估计胎儿体重为 4500 克时应选择选择性剖宫产。只有 40%的人会允许有肩难产病史的试产。略多于一半的人回答说他们从未使用过侧卧位或过度牵引，妇产科医生比母胎医学专家更有可能认为由进行分娩的临床医生施加的牵引是导致肩难产相关臂丛神经麻痹的原因（36%比 12%，P=.005）。母胎医学专家更有可能认为 40%-50%的臂丛神经麻痹发生时没有伴随肩难产（21%比 9%，P=.015）。
对于美国妇产科医师学会实践公告中肩难产的管理建议，实践模式存在差异。
III。
