McFarland M B, Langer O, Piper J M, Berkus M D
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, USA.
Int J Gynaecol Obstet. 1996 Dec;55(3):219-24. doi: 10.1016/s0020-7292(96)02766-x.
To ascertain the type and order of maneuvers that should be used for the treatment of shoulder dystocia, and to determine its correlation with perinatal outcome.
We reviewed all consecutive cases of shoulder dystocia from January 1986 to August 1994 in our institution to obtain the type, order and number of maneuvers used for delivery. Patients were stratified by the number of maneuvers required for delivery. Outcome parameters included cord pH, Apgar score, neonatal trauma (Erb's palsy and fracture), and maternal trauma.
The incidence of shoulder dystocia was 0.7% (39,280 total vaginal deliveries). Use of only two maneuvers, McRoberts and suprapubic pressure, resulted in resolution in 58% of cases. The addition of the Woods screw maneuver and/or delivery of the posterior arm was sufficient in all remaining cases. The rates of neonatal palsy and fracture, and maternal four-degree laceration, increased with the number of maneuvers.
The McRoberts maneuver and suprapubic pressure should be first-line treatment for shoulder dystocia. More difficult and damaging maneuvers such as Woods screw and delivery of the posterior arm may be reserved for refractory cases. Additional maneuvers are rarely necessary for delivery. The number of maneuvers may serve as a measure of the severity of the shoulder dystocia.
确定用于治疗肩难产的手法类型及顺序，并确定其与围产期结局的相关性。
我们回顾了1986年1月至1994年8月在我院发生的所有连续肩难产病例，以获取分娩时使用的手法类型、顺序及数量。根据分娩所需手法数量对患者进行分层。结局参数包括脐动脉血pH值、阿氏评分、新生儿创伤（臂丛神经麻痹和骨折）及母体创伤。
肩难产发生率为0.7%（阴道分娩总数39280例）。仅使用两种手法，即麦克罗伯茨手法和耻骨上加压，58%的病例得以解决。在所有其余病例中，加用伍兹螺旋手法和/或娩出后臂就足够了。新生儿麻痹和骨折的发生率以及母体四度裂伤的发生率随手法数量增加而升高。
麦克罗伯茨手法和耻骨上加压应作为肩难产的一线治疗方法。对于难治性病例，可保留更困难且有损伤性的手法，如伍兹螺旋手法和娩出后臂。分娩时很少需要额外的手法。手法数量可作为肩难产严重程度的一个衡量指标。
