Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Division of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Am J Perinatol. 2021 Feb;38(3):278-282. doi: 10.1055/s-0039-1696675. Epub 2019 Sep 6.
The study aimed to evaluate risk factors and implications of shoulder dystocia (SD) on the neurological outcome of successfully delivered offspring.
This is a cohort analysis including 207,571 deliveries. Risk factors for SD were evaluated using general estimation equation multivariable analyses. Offspring hospitalization incidence up to age 18 years due to neurological conditions was compared between both groups. Kaplan-Meyer curve was used to assess the cumulative hospitalization incidence. Cox proportional hazards model was used to control for confounders.
SD complicated 0.2% (= 353) of deliveries included in the study ( = 207,571). Risk factors for SD were fetal macrosomia, maternal diabetes mellitus, male gender, and advanced maternal age ( < 0.05 for all). Higher perinatal mortality was observed among SD cases (2.8 vs. 0.4%, < 0.001). In most of the investigated neurological conditions no significant differences were found between the groups. Comparable rates of cumulative neurological-related hospitalization were observed (log rank -value = 0.342) as well as lack of association between SD and neurological hospitalization (adjusted HR = 0.73; 95% CI 0.36-1.47; = 0.381) when controlled for gestational age.
Risk factors for SD are macrosomia, diabetes mellitus, male gender, and advanced maternal age. SD is not associated with long-term neurological morbidity of the offspring.
本研究旨在评估肩难产（SD）对成功分娩后代神经结局的危险因素和影响。
这是一项包括 207571 例分娩的队列分析。使用广义估计方程多变量分析评估 SD 的危险因素。比较两组因神经系统疾病而在 18 岁以下住院的发生率。使用 Kaplan-Meier 曲线评估累积住院发生率。使用 Cox 比例风险模型控制混杂因素。
本研究中，SD 复杂分娩占 0.2%（=353）（=207571）。SD 的危险因素是胎儿巨大儿、母体糖尿病、男性和高龄（所有因素均 < 0.05）。SD 病例围产期死亡率较高（2.8%比 0.4%， < 0.001）。在大多数调查的神经系统疾病中，两组之间没有发现显著差异。观察到累积与神经相关的住院治疗率相当（对数秩检验值=0.342），并且在控制胎龄后，SD 与神经住院治疗之间也没有关联（调整 HR=0.73；95%CI 0.36-1.47； = 0.381）。
SD 的危险因素是巨大儿、糖尿病、男性和高龄。SD 与后代的长期神经发病率无关。
