Gei Alfredo F, Mastache Jorge Suarez, Pacheco Luis D, Villanueva Mariana
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Methodist Hospital, Houston, Texas.
The Department of Obstetrics and Gynecology, Hospital Rafael Calderón Guardia, San José, Costa Rica.
AJP Rep. 2020 Apr;10(2):e133-e138. doi: 10.1055/s-0040-1708498. Epub 2020 Apr 15.
The main purpose of this article is to describe the technique and mechanism of action of a novel intervention for the relief of shoulder dystocia we are labeling Carit maneuver. We report a cohort study of eight cases of shoulder dystocia not relieved by the combination of McRobert's maneuver and suprapubic pressure treated with the Carit maneuver. This intervention involves the use of the fetal head and neck as the grasping point of the fetus to exert a ventral rotation of the fetal trunk, reduce the bi-acromial diameter, and deliver the posterior shoulder by passive displacement. In all these cases, the direction of the original head restitution, direction of exerted rotation, and side and location of delivery of the first shoulder were recorded. Maternal and neonatal outcomes were reviewed and reported. In all cases, the Carit rotational maneuver resulted in the delivery of the posterior shoulder in the transverse (4), oblique anterior (2), or direct anterior (2) diameters. No instances of neonatal depression or fetal acidemia were noted in this cohort. The Carit maneuver is an original and successful intervention in the management of shoulder dystocia unresponsive to McRobert's maneuver and suprapubic pressure.
本文的主要目的是描述一种新型助产干预措施——我们称之为“卡里特手法（Carit maneuver）”——缓解肩难产的技术及作用机制。我们报告了一项队列研究，研究对象为8例肩难产患者，这些患者采用麦克罗伯茨手法（McRobert's maneuver）联合耻骨上加压均未能缓解，随后接受了卡里特手法治疗。该干预措施是将胎儿头部和颈部作为胎儿的抓握点，使胎儿躯干进行腹侧旋转，减小双肩径，并通过被动移位娩出后肩。记录了所有这些病例中原始胎头复位方向、施加旋转的方向以及第一肩娩出的侧别和位置。回顾并报告了母婴结局。在所有病例中，卡里特旋转手法均使后肩以横径（4例）、斜前径（2例）或直前径（2例）娩出。该队列中未发现新生儿窒息或胎儿酸血症病例。卡里特手法是一种针对麦克罗伯茨手法和耻骨上加压无效的肩难产管理的创新且成功的干预措施。
