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肩难产产妇及新生儿结局的预测因素:一项对比分析。

Predictors of maternal and neonatal outcomes in labors complicated by shoulder dystocia: a comparative analysis.

机构信息

Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, Holon 58100, Tel Aviv, Israel.

出版信息

Arch Gynecol Obstet. 2024 Nov;310(5):2405-2411. doi: 10.1007/s00404-024-07663-3. Epub 2024 Aug 6.

Abstract

INTRODUCTION

Studies investigating the risk factors associated with unfavorable maternal/neonatal outcomes in cases of shoulder dystocia are scarce. This study aims to uncover the predictive factors that give rise to unfavorable outcomes within the context of shoulder dystocia.

MATERIALS AND METHODS

Medical records of pregnancies complicated by shoulder dystocia was obtained between 2008-2022 from a single tertiary center. This study involved the comparison of sociodemographic, sonographic, and delivery characteristics among pregnancies complicated by shoulder dystocia resulting in favorable vs. unfavorable maternal/neonatal outcomes.

RESULTS

A total of 275 pregnancies were analyzed, with 111 (40.3%) classified as unfavorable outcomes and 164 (59.7%) as favorable outcomes. Employing a multivariable regression analysis, several independent associations were identified with unfavorable maternal/neonatal outcomes. Specifically, short maternal stature, pre-gestational diabetes, vacuum extraction, Wood's screw maneuver, and macrosomia merged as significant predictors of unfavorable maternal/neonatal outcomes.

CONCLUSION

Short maternal stature, pre-gestational diabetes, vacuum extraction, Wood's screw maneuver, and macrosomia may all contribute to poor maternal/neonatal outcomes in shoulder dystocia cases. This knowledge allows clinicians to improve their decision-making, patient care, and counseling.

摘要

简介

研究肩难产相关的不良母婴结局的危险因素的研究较少。本研究旨在探讨肩难产不良结局的预测因素。

材料与方法

本研究收集了 2008 年至 2022 年期间一家三级中心因肩难产而住院的孕妇病历。比较肩难产导致母婴结局良好与不良的孕妇的社会人口统计学、超声和分娩特征。

结果

共分析了 275 例妊娠,其中 111 例(40.3%)为不良结局,164 例(59.7%)为良好结局。多变量回归分析显示,与母婴不良结局相关的独立因素有:母亲身材矮小、孕前糖尿病、真空吸引、Wood 螺钉操作和巨大儿。

结论

母亲身材矮小、孕前糖尿病、真空吸引、Wood 螺钉操作和巨大儿可能导致肩难产母婴不良结局。这些发现可以帮助临床医生改善决策、患者管理和咨询。

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本文引用的文献

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Critical analysis of risk factors for intrapartum fetal death.分娩期胎儿死亡危险因素的批判性分析。
Arch Gynecol Obstet. 2023 Oct;308(4):1239-1245. doi: 10.1007/s00404-022-06811-x. Epub 2022 Oct 12.
3
Predictors of neonatal brachial plexus palsy subsequent to resolution of shoulder dystocia.肩难产后新生儿臂丛神经麻痹的预测因素。
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5443-5449. doi: 10.1080/14767058.2021.1882982. Epub 2021 Feb 4.
9
Anal sphincter injury in vaginal deliveries complicated by shoulder dystocia.阴道分娩并发肩难产时的肛门括约肌损伤。
Int Urogynecol J. 2018 Mar;29(3):377-381. doi: 10.1007/s00192-017-3351-2. Epub 2017 May 18.
10
Practice Bulletin No 178: Shoulder Dystocia.第178号实践公告:肩难产
Obstet Gynecol. 2017 May;129(5):e123-e133. doi: 10.1097/AOG.0000000000002043.

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