Blickstein I, Ben-Arie A, Hagay Z J
Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, Israel.
Gynecol Obstet Invest. 1998;45(2):77-80. doi: 10.1159/000009929.
A cohort of 236 vaginally delivered neonates weighing > or = 4,200 g was evaluated. Shoulder dystocia was encountered in 27 deliveries (11.4%) and brachial plexus injury was diagnosed in 3 infants (1.3%). The 'traditional' antepartum risk factors could not be associated with shoulder dystocia. In this cohort, primiparity was significantly more frequent among the dystocia cases (OR = 8.58, 99% CI = 1.35-54.35, p = 0.021). Shoulder dystocia could not be attributed to a particular difference between the current and the previous heaviest birth weight. A policy of cesarean section for all infants weighing > or = 4,200 g would result in at least 5- to 6-fold increase in cesarean rate in this group of patients. Our data reconfirm that shoulder dystocia and brachial plexus injury are unpredictable, even in macrosomic infants. It is a matter of policy whether to accept the expected 1:9 and 1:79 respective risks associated with vaginal births.
对236例体重≥4200g的经阴道分娩新生儿进行了评估。27例分娩（11.4%）发生肩难产，3例婴儿（1.3%）被诊断为臂丛神经损伤。“传统”的产前危险因素与肩难产无关。在该队列中，初产妇在难产病例中显著更为常见（比值比=8.58，99%可信区间=1.35 - 54.35，p = 0.021）。肩难产不能归因于当前与既往最重出生体重之间的特定差异。对所有体重≥4200g的婴儿实施剖宫产政策将导致该组患者剖宫产率至少增加5至6倍。我们的数据再次证实，即使在巨大儿中，肩难产和臂丛神经损伤也是不可预测的。是否接受经阴道分娩分别预期的1:9和1:79的相关风险是一个政策问题。
