Gherman R B, Goodwin T M, Souter I, Neumann K, Ouzounian J G, Paul R H
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles 90033, USA.
Am J Obstet Gynecol. 1997 Mar;176(3):656-61. doi: 10.1016/s0002-9378(97)70565-9.
Our purpose was to determine the rate of success of the McRoberts' maneuver as the initial treatment for shoulder dystocia and to compare the rate of maternal and neonatal morbidity with those cases of shoulder dystocia requiring additional obstetric maneuvers. A secondary goal was to assess those factors associated with successful McRoberts' maneuvers.
A retrospective review of shoulder dystocia cases occurring between 1991 and 1994 was performed. The identified cases were divided into two groups on the basis of the maneuvers used to relieve the shoulder dystocia. The first group comprised cases in which the McRoberts' maneuver was used as the sole treatment and the second group consisted of cases in which additional maneuvers were subsequently used. Exclusion criteria included lack of documentation concerning the maneuvers used or cases in which the McRoberts' maneuver was not the initial technique used. The two groups were compared with respect to various antepartum, intrapartum, and neonatal characteristics.
During the study period we identified 250 cases of shoulder dystocia among 44,072 vaginal deliveries, for an incidence of 0.57%. Of these, 236 cases (94%) fulfilled entry criteria. The McRoberts' position alone successfully alleviated the shoulder dystocia in 98 cases (42%). In the group of cases where the McRoberts' maneuver was the sole maneuver used, there were significantly lower mean birth weights (p = 0.008), shorter durations of the active phase of labor (p = 0.009), and shorter second stages (p < 0.0001). In the group of cases that required additional maneuvers to relieve the shoulder dystocia, there was a trend toward an increased incidence of postpartum hemorrhage and brachial plexus injury (p = 0.07).
These data suggest that the McRoberts' maneuver is associated with a significant degree of success in relieving shoulder dystocia and may be associated with decreased morbidity compared with other maneuvers. On the basis of these findings, we recommend the McRoberts' maneuver as the initial technique for disimpaction of the anterior shoulder.
我们的目的是确定将麦克罗伯茨手法作为肩难产初始治疗方法的成功率，并将产妇和新生儿的发病率与那些需要额外产科手法的肩难产病例进行比较。第二个目标是评估与麦克罗伯茨手法成功相关的因素。
对1991年至1994年间发生的肩难产病例进行回顾性研究。根据用于缓解肩难产的手法，将确诊病例分为两组。第一组包括仅使用麦克罗伯茨手法作为唯一治疗方法的病例，第二组包括随后使用了额外手法的病例。排除标准包括缺乏关于所使用手法的记录或麦克罗伯茨手法不是最初使用技术的病例。比较两组在各种产前、产时和新生儿特征方面的情况。
在研究期间，我们在44072例阴道分娩中确定了250例肩难产病例，发病率为0.57%。其中，236例（94%）符合纳入标准。仅麦克罗伯茨体位就成功缓解了98例（42%）的肩难产。在仅使用麦克罗伯茨手法的病例组中，平均出生体重显著较低（p = 0.008），活跃期分娩持续时间较短（p = 0.009），第二产程较短（p < 0.0001）。在需要额外手法来缓解肩难产的病例组中，产后出血和臂丛神经损伤的发生率有增加的趋势（p = 0.07）。
这些数据表明，麦克罗伯茨手法在缓解肩难产方面具有显著的成功率，并且与其他手法相比可能与发病率降低有关。基于这些发现，我们建议将麦克罗伯茨手法作为解除前肩嵌顿的初始技术。
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