Al-Hawash Shadha, Whitehead Clare L, Farine Dan
a Department of Obstetrics and Gynecology , University of Toronto, Mount Sinai Hospital , Toronto , Canada.
b Department of Obstetrics and Gynaecology , University of Adelaide , Adelaide , Australia.
J Matern Fetal Neonatal Med. 2019 Sep;32(17):2928-2934. doi: 10.1080/14767058.2018.1450382. Epub 2018 Mar 27.
To determine the incidence and risk factors for recurrent shoulder dystocia in women. We searched Medline, Pubmed, Embase, and CINAHL for relevant articles in English and French from 1980 to February 2018 that described risks of recurrent shoulder dystocia undergoing a trial of labour in subsequent pregnancies. A total of 684 articles were found, of which 13 were included as they met criteria. We extracted data on study characteristics, incidence of recurrent shoulder dystocia, degree of neonatal injury, and presence of known risk factors. There was a wide variation in the incidence of shoulder dystocia in subsequent pregnancies from 1-25%. The largest cohort reported a risk of 13.5%. The most important risk factor for recurrent shoulder dystocia is an increase in birthweight in the subsequent pregnancy compared to the index pregnancy (OR 7-12). Prolonged second stage, instrumental delivery, maternal diabetes, increased maternal BMI, and severe neonatal morbidity in the index pregnancy were also associated with an increased risk of recurrent shoulder dystocia. However, many of these risk factors were present in women who did not have a recurrent shoulder dystocia. In addition, women with recurrent shoulder dystocia rarely had identifiable risk factors, other than the history of previous shoulder dystocia. Sample sizes were low as most studies are single centre, retrospective cohorts with low rates of subsequent pregnancy and vaginal birth as many women may have elected to have a caesarean section in subsequent pregnancies or were lost to follow up. There was a high rate of reporting bias and heterogeneity, prohibiting formal meta-analyses. Recurrent shoulder dystocia is an unpredictable obstetric complication with potentially devastating consequences. Individual assessment and thorough counselling should be offered to women contemplating a subsequent planned vaginal birth with specific attention paid to those women where the estimated birthweight is >4000 g or greater than in the index pregnancy.
确定女性复发性肩难产的发生率及危险因素。我们检索了1980年至2018年2月期间Medline、Pubmed、Embase和CINAHL数据库中用英文和法文撰写的相关文章，这些文章描述了后续妊娠中试产时复发性肩难产的风险。共检索到684篇文章，其中13篇因符合标准而被纳入。我们提取了有关研究特征、复发性肩难产的发生率、新生儿损伤程度以及已知危险因素存在情况的数据。后续妊娠中肩难产的发生率差异很大，为1%至25%。最大的队列报告风险为13.5%。复发性肩难产最重要的危险因素是与索引妊娠相比，后续妊娠出生体重增加（比值比7至12）。第二产程延长、器械助产、母亲患糖尿病、母亲体重指数增加以及索引妊娠中严重的新生儿发病率也与复发性肩难产风险增加有关。然而，许多这些危险因素也存在于未发生复发性肩难产的女性中。此外，除了既往有肩难产病史外，复发性肩难产的女性很少有可识别的危险因素。样本量较小，因为大多数研究是单中心回顾性队列，后续妊娠和阴道分娩率较低，因为许多女性可能选择在后续妊娠中进行剖宫产或失访。报告偏倚和异质性发生率很高，无法进行正式的荟萃分析。复发性肩难产是一种不可预测的产科并发症，可能产生毁灭性后果。对于考虑后续计划阴道分娩的女性，应进行个体评估并给予充分咨询，尤其要关注那些估计出生体重>4000g或高于索引妊娠的女性。
