Cluver Catherine Anne, Hofmeyr G Justus
Department of Obstetrics and Gynecology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
Effective Care Research Unit, University of the Witwatersrand, Johannesburg; and Eastern Cape Department of Health, Eastern Cape, South Africa.
Am J Obstet Gynecol. 2015 Jun;212(6):784.e1-7. doi: 10.1016/j.ajog.2015.02.025. Epub 2015 Feb 28.
The purpose of this study was to report on all cases in which posterior axilla sling traction (PAST) has been used to deliver cases of intractable shoulder dystocia and to describe a new method of shoulder rotation with the sling.
A record of all published and known cases was collected that included information on preliminary obstetric techniques that were used and how the PAST technique was performed. Maternal outcomes that included maternal injury and length of hospital stay and fetal outcomes, which included birthweight, Apgar scores, nerve injuries, fractures, hospital stay, and outcome, were documented.
We have recorded 19 cases where PAST has been used. In 5 cases, the babies had died in utero. Ten were assisted deliveries. PAST was successful in 18 cases. In one case, it was partially successful because it enabled delivery of the posterior shoulder with digital axillary traction. The most commonly used material was suction tubing. Once the posterior shoulder was delivered, the shoulder dystocia was resolved in all cases. Time from insertion to delivery was <3 minutes when recorded. The birthweights of the infants varied from 3200-4800 g. Posterior arm humerus fractures occurred in 3 cases. There was one case of a permanent Erb's palsy and 4 cases of transient Erb's palsies. None were of the posterior arm. During this review, we found that, when direct delivery of the posterior shoulder was difficult because of very severe impaction, the sling could be used to rotate the shoulders easily through 180 degrees assisted by counter pressure on the back of the anterior shoulder. This new method was used in 5 cases and may reduce fetal trauma further during difficult shoulder delivery.
This review confirms that PAST can be a lifesaving technique when all another techniques for shoulder dystocia fail. Advantages are that it is easy to use (even by someone who has not seen it used previously), that the sling material is readily available, and that it is inserted quickly with 2 fingers. This is the first report of its use to rotate the posterior shoulder to the anterior position for delivery.
本研究旨在报告所有使用后腋窝吊带牵引术（PAST）处理难治性肩难产病例的情况，并描述一种使用吊带进行肩旋转的新方法。
收集所有已发表及已知病例的记录，包括所采用的初步产科技术信息以及PAST技术的实施方式。记录产妇结局，包括产妇损伤和住院时间，以及胎儿结局，包括出生体重、阿氏评分、神经损伤、骨折、住院时间和结局。
我们记录了19例使用PAST的病例。其中5例胎儿在子宫内死亡。10例为助产分娩。PAST在18例中成功。1例部分成功，因为通过数字腋窝牵引使后肩娩出。最常用的材料是吸引管。后肩娩出后，所有病例的肩难产均得到解决。记录显示从插入到分娩的时间<3分钟。婴儿出生体重在3200 - 4800克之间。3例发生后臂肱骨骨折。有1例永久性臂丛神经麻痹和4例短暂性臂丛神经麻痹。均非后臂损伤。在本次回顾中，我们发现，当由于严重嵌顿导致后肩直接娩出困难时，在对前肩背部施加反压力的辅助下，吊带可轻松将肩部旋转180度。此新方法应用于5例，可能在困难的肩分娩过程中进一步减少胎儿创伤。
本综述证实，当所有其他肩难产技术均失败时，PAST可成为一种挽救生命的技术。其优点包括易于使用（即使是之前未见过其使用的人）、吊带材料容易获得，且用两根手指即可快速插入。这是首次报告使用该方法将后肩旋转至前位进行分娩。
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