Lewis D F, Edwards M S, Asrat T, Adair C D, Brooks G, London S
Department of Obstetrics and Gynecology, Louisiana State University Medical Center, Shreveport 71130, USA.
J Reprod Med. 1998 Aug;43(8):654-8.
To evaluate the predictability of shoulder dystocia using preconceptive and prenatal risk factors.
Data from 1,622 term patients with prenatal care prior to 20 weeks who delivered single, vertex fetuses during a consecutive 12-month period were analyzed. Two groups were chosen. The first group was patients whose fetuses experienced shoulder dystocia during delivery (cases). The second group (controls) consisted of the remaining patients, whose fetuses had not experienced shoulder dystocia. The two groups were compared with regard to demographics and pregnancy characteristics.
Factors not significantly different between the two groups included were obesity, multiparity, history of diabetes, short maternal stature, postdatism and advanced maternal age. The incidence of macrosomia was significantly higher (P < .001) in cases (35.4%) than in controls (4.8%). Other factors associated with shoulder dystocia were previous shoulder dystocia, concurrent diabetes, prior delivery of a fetus > 4,000 g and excessive weight gain during pregnancy. Many factors previously associated with shoulder dystocia were found to be nonsignificant in our study.
Macrosomia appears to be the single important factor associated with shoulder dystocia which, even in the presence of significant risk factors, remains largely unpredictable.
利用孕前和产前危险因素评估肩难产的可预测性。
分析了1622例在妊娠20周前接受产前检查、在连续12个月期间分娩单胎头位胎儿的足月患者的数据。选取了两组。第一组是胎儿在分娩时发生肩难产的患者（病例组）。第二组（对照组）由其余胎儿未发生肩难产的患者组成。比较了两组的人口统计学和妊娠特征。
两组之间无显著差异的因素包括肥胖、多产、糖尿病史、母亲身材矮小、过期妊娠和高龄产妇。病例组巨大儿的发生率（35.4%）显著高于对照组（4.8%）（P <.001）。与肩难产相关的其他因素包括既往肩难产史、并发糖尿病、既往分娩胎儿体重>4000g以及孕期体重过度增加。在我们的研究中，许多先前与肩难产相关的因素被发现无统计学意义。
巨大儿似乎是与肩难产相关的唯一重要因素，即使存在显著的危险因素，肩难产在很大程度上仍然无法预测。
