Ansell Lesley, Ansell David Alan, McAra-Couper Judith, Larmer Peter John, Garrett Nicholas Kenneth Gerald
Birthing and Assessment, Middlemore Hospital, Auckland, New Zealand.
Women's Health, Middlemore Hospital, Auckland, New Zealand.
Aust N Z J Obstet Gynaecol. 2019 Oct;59(5):627-633. doi: 10.1111/ajo.13029. Epub 2019 Jul 10.
At Counties Manukau Health in Auckland, New Zealand, axillary traction is being used when an internal manoeuvre is required for resolution of shoulder dystocia.
This study presents the outcomes for mother and baby from use of axillary traction and other internal manoeuvres.
Retrospective review of the clinical records of mother and baby for all labours complicated by shoulder dystocia was carried out for an eight-year period. Maternal and neonatal information were compared for the three cohorts of the first internal manoeuvre documented: axillary traction, posterior arm delivery and rotational manoeuvres.
There were 226 women who required the use of internal manoeuvres with no significant differences in age, body mass index, parity, ethnicity, diabetes incidence, induction and augmentation of labour rates, length of the first stage and birth weight between the cohorts. Axillary traction was the first internal manoeuvre used for 119 (52.7%) with a success rate of 95.8%. Posterior arm delivery was used first for 49 (21.7%) women with a success rate of 85.7%. Rotational manoeuvres were used first for 58 (25.7%) women with a statistically inferior success rate of 48.3%. There was no significant difference in the maternal and neonatal complication rates between the cohorts.
Axillary traction has been utilised as the first internal manoeuvre for a large number of women with a higher success rate than other internal manoeuvres without any increase in maternal or neonatal morbidity. It is recommended that this be the first internal manoeuvre attempted when shoulder dystocia occurs.
在新西兰奥克兰的考蒂纽马努考健康中心，当需要进行内部操作以解决肩难产时，会使用腋窝牵引法。
本研究展示了使用腋窝牵引法和其他内部操作对母婴的影响。
对八年期间所有并发肩难产的分娩的母婴临床记录进行回顾性研究。比较首次记录的三种内部操作方法（腋窝牵引法、后臂娩出法和旋转操作法）的母婴信息。
共有226名女性需要进行内部操作，各队列之间在年龄、体重指数、产次、种族、糖尿病发病率、引产和催产率、第一产程时长及出生体重方面无显著差异。腋窝牵引法是119名（52.7%）产妇首次使用的内部操作方法，成功率为95.8%。后臂娩出法首次用于49名（21.7%）女性，成功率为85.7%。旋转操作法首次用于58名（25.7%）女性，成功率在统计学上较低，为48.3%。各队列之间母婴并发症发生率无显著差异。
腋窝牵引法已被大量女性用作首选的内部操作方法，其成功率高于其他内部操作方法，且未增加母婴发病率。建议在发生肩难产时，将此作为首选的内部操作方法尝试。
