McFarland M, Hod M, Piper J M, Xenakis E M, Langer O
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio 78284-7836, USA.
Am J Obstet Gynecol. 1995 Oct;173(4):1211-4. doi: 10.1016/0002-9378(95)91355-6.
Our objective was to determine the association between labor abnormalities and shoulder dystocia.
All consecutive cases of shoulder dystocia from January 1986 to August 1994 were reviewed (n = 276). For purposes of comparison a control group of vaginally delivered patients was randomly selected in a 2:1 ratio (n = 600). Charts were reviewed for demographic information, labor and delivery events, and neonatal outcome.
Labor abnormalities were comparable in the shoulder dystocia and control groups, both in the active phase and in the second stage. When patients with diabetes and those with macrosomic infants were analyzed separately, no significant differences in labor abnormalities were identified. The rate of operative vaginal delivery was significantly higher in the shoulder group, and one third of the operative deliveries were midpelvic. In addition, the induction rate was higher in the shoulder group.
Our data suggest that labor abnormalities may not serve as clinical predictors for subsequent development of shoulder dystocia, thus emphasizing the unpredictability of this condition.
我们的目的是确定产程异常与肩难产之间的关联。
回顾了1986年1月至1994年8月期间所有连续的肩难产病例（n = 276）。为作比较，以2:1的比例随机选取了经阴道分娩患者的对照组（n = 600）。查阅病历以获取人口统计学信息、分娩过程及新生儿结局。
肩难产组与对照组在活跃期和第二产程的产程异常情况相当。当分别分析患有糖尿病的患者和巨大儿患者时，未发现产程异常有显著差异。肩难产组的手术助产率显著更高，且三分之一的手术助产发生在中骨盆。此外，肩难产组的引产率更高。
我们的数据表明，产程异常可能无法作为肩难产后续发生的临床预测指标，从而强调了这种情况的不可预测性。
