Iaconianni Joy A, Bakhri Rania, Gonik Bernard, Balasubramanian Sriram, Singh Anita
School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States.
Bioengineering Department, Temple University, Philadelphia, PA, United States.
Front Bioeng Biotechnol. 2025 May 1;13:1474154. doi: 10.3389/fbioe.2025.1474154. eCollection 2025.
This study investigates the effects of clinical delivery maneuvers on neonatal brachial plexus (BP) during complicated birthing scenarios such as shoulder dystocia. Shoulder dystocia occurs when the anterior shoulder of the neonate is obstructed behind the maternal symphysis pubis and prevents the delivery of the neonate. Maneuvers such as McRoberts, application of suprapubic pressure (SPP), oblique positioning, and posterior arm delivery are performed sequentially to alleviate the obstruction. This study used MADYMO, a computer software program, to simulate these maneuvers during shoulder dystocia while maternal endogenous forces (82N and 129N) were applied. The recorded outcomes were the magnitude of neonatal BP stretch during delivery and the amount of clinician-applied traction (CAT) force, if required, to achieve delivery. The lithotomy position was treated as the baseline and compared to the McRoberts position, at 82N and 129N maternal forces. Additionally, in McRoberts position, at 82N and 129N maternal forces, neonate-focused maneuvers were applied, and the clinician applied traction (CAT) force, if required, to achieve delivery was recorded along with the resulting neonatal BP stretch. The simulations, at 82N maternal force, reported a decrease in required CAT force in the McRoberts position compared to the lithotomy position. The results of the neonate-focused maneuvers reported a further decrease in the CAT force and the resulting BP stretch. Furthermore, increasing SPP from 40N to 100N reported no required CAT force for delivery along with decreased BP stretch. Oblique positioning further decreased the BP stretch, and the posterior arm delivery of the neonate resulted in the least amount of BP stretch. No CAT forces were required during these maneuvers. The simulations, at 129N maternal force, reported similar trends of reduced BP stretch during delivery except no CAT forces were required during any simulated conditions. Findings from this study help understand the effects of McRoberts position and neonate-focused maneuvers on neonatal brachial plexus during complicated shoulder dystocia delivery. The reported required delivery forces, both maternal and CAT also lay the groundwork for clinician training and education while guiding the development of preventative approaches that can limit neonatal injuries.
本研究调查了在肩难产等复杂分娩情况下临床助产操作对新生儿臂丛神经（BP）的影响。当新生儿的前肩卡在母体耻骨联合后方并阻碍新生儿娩出时，就会发生肩难产。通常会依次进行诸如麦罗伯茨手法、耻骨上加压（SPP）、斜位姿势以及后臂娩出等操作来缓解梗阻。本研究使用计算机软件程序MADYMO，在施加母体内生力量（82N和129N）的情况下模拟肩难产时的这些操作。记录的结果包括分娩过程中新生儿BP拉伸的幅度以及如果需要为实现分娩而由临床医生施加的牵引（CAT）力的大小。截石位被视为基线，并与麦罗伯茨位进行比较，施加82N和129N的母体力量。此外，在麦罗伯茨位，施加82N和129N的母体力量时，采用以新生儿为中心的操作，并记录如果需要为实现分娩而由临床医生施加的牵引（CAT）力以及由此产生的新生儿BP拉伸情况。在母体力量为82N的模拟中，与截石位相比，麦罗伯茨位所需的CAT力有所降低。以新生儿为中心的操作结果显示CAT力和由此产生的BP拉伸进一步降低。此外，将SPP从40N增加到100N时，实现分娩无需CAT力，同时BP拉伸也有所降低。斜位姿势进一步降低了BP拉伸，新生儿后臂娩出导致的BP拉伸量最少。在这些操作过程中无需CAT力。在母体力量为129N的模拟中，报告了分娩过程中BP拉伸减少的类似趋势，只是在任何模拟条件下都无需CAT力。本研究的结果有助于了解在复杂的肩难产分娩过程中麦罗伯茨位和以新生儿为中心的操作对新生儿臂丛神经的影响。所报告的所需分娩力量，包括母体力量和CAT力，也为临床医生的培训和教育奠定了基础，同时指导了可限制新生儿损伤的预防方法的开发。
