Hehir Mark P, Rubeo Zachary, Flood Karen, Mardy Anne H, O'Herlihy Colm, Boylan Peter C, D'Alton Mary E
New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA.
National Maternity Hospital, Holles Street, Dublin 2, Ireland.
Int Urogynecol J. 2018 Mar;29(3):377-381. doi: 10.1007/s00192-017-3351-2. Epub 2017 May 18.
Shoulder dystocia is an obstetric emergency that occurs in 0.2-3% of all cephalic vaginal deliveries. We hypothesized that because of the difficult nature of deliveries complicated by shoulder dystocia, the condition may be associated with anal sphincter injury. We sought to identify risk factors for obstetric anal sphincter injury in women with shoulder dystocia.
This retrospective analysis included all cases of shoulder dystocia from 2007 to 2011 at two large tertiary referral centers, in the USA and Ireland. Details of maternal demographics, intrapartum characteristics, and delivery outcomes in cases of shoulder dystocia were analyzed. Univariate and multivariate analyses were used to describe the association between shoulder dystocia and anal sphincter injury.
There were 685 cases of shoulder dystocia, and the rate of shoulder dystocia was similar at both institutions. The incidence of anal sphincter injury was 8.8% (60 out of 685). The rate was 14% (45 out of 324) in nulliparas and 4.2% (15 out of 361) in multiparas. Women with sphincter injury were more likely to be nulliparous (75% [45 out of 60] vs 45% [279 out of 625]; p < 0.0001), have had an operative vaginal delivery (50% [30 out of 60] vs 36% [226 out of 625]; p = 0.03) and require internal maneuvers (50% [30 out of 60] vs 32% [198 out of 625], p = 0.004) than those with an intact sphincter. On multivariate regression analysis, these predictors of sphincter injury remained significant when adjusted for other risk factors. Episiotomy was negatively associated with sphincter injury on multivariate regression analysis.
In a retrospective cohort of 685 women with shoulder dystocia, the risk of anal sphincter injury is 9%. Risk factors include nulliparity, operative vaginal delivery, and use of internal maneuvers, whereas episiotomy was found to have a protective effect against anal sphincter injury during cases of shoulder dystocia.
肩难产是一种产科急症，在所有头位阴道分娩中发生率为0.2% - 3%。我们推测，由于肩难产所致分娩过程困难，该情况可能与肛门括约肌损伤有关。我们试图确定肩难产女性发生产科肛门括约肌损伤的危险因素。
这项回顾性分析纳入了2007年至2011年在美国和爱尔兰两家大型三级转诊中心发生的所有肩难产病例。分析了产妇人口统计学特征、产时特点以及肩难产病例的分娩结局。采用单因素和多因素分析来描述肩难产与肛门括约肌损伤之间的关联。
共有685例肩难产病例，两家机构的肩难产发生率相似。肛门括约肌损伤发生率为8.8%（685例中有60例）。初产妇发生率为14%（324例中有45例），经产妇发生率为4.2%（361例中有15例）。与括约肌未受损的女性相比，括约肌受损的女性更可能为初产妇（75% [60例中有45例] 对45% [625例中有279例]；p < 0.0001），有阴道助产史（50% [60例中有30例] 对36% [625例中有226例]；p = 0.03），且需要进行内转胎位术（50% [60例中有30例] 对32% [625例中有198例]，p = 0.004）。在多因素回归分析中，调整其他危险因素后，这些括约肌损伤的预测因素仍然具有显著性。在多因素回归分析中，会阴切开术与括约肌损伤呈负相关。
在一个包含685例肩难产女性的回顾性队列中，肛门括约肌损伤风险为9%。危险因素包括初产、阴道助产和使用内转胎位术，而在肩难产病例中，会阴切开术被发现对肛门括约肌损伤有保护作用。
