肩难产发生的高危因素及母婴并发症的初步探讨  

Preliminary Study the Risk Factors and Complications of Shoulder Dystocia

作　　者：李富琴 

机构地区：[1]河南省开封市妇产医院,河南开封475000

出　　处：《中国医药指南》2013年第17期43-44,共2页Guide of China Medicine

摘　　要：目的分析肩难产的高危因素及母婴并发症的处理方法。方法我院2002年9月至2012年8月收治的80例肩难产患者为研究对象,按照新生儿体质量、娩肩时间以及助产手法的不同分组,分析母婴并发症发生率与它们的关系。结果巨大儿,妊娠期糖尿病以及子宫收缩乏力为肩难产发生的高危因素。新生儿窒息(53例),母体会阴部裂伤(30例)以及产后出血(14例)为肩难产主要母婴并发症,且与正常体质量儿组相比,巨大儿组的母婴并发症发生率较高;娩肩时间越长、助产手法越多,新生儿并发症发生率越高。而产妇并发症发生率与二者无明显关系。助产手法中以屈大腿法+压前肩法分娩成功28例,成功率最高。结论肩难产发生的首要高危因素是巨大儿。肩难产的常见并发症为新生儿窒息、母体会阴部裂伤和产后出血。产妇并发症与胎儿体质量密切相关,新生儿并发症与新生儿体质量的大小、娩肩时间的长短和助产手法的多少有关。助产手法首选屈大腿法+压前肩法。Objective To analysis the risk factors and complications of shoulder dystocia. Methods 80 cases of shoulder dystocia from September 2002 to August 2012 were analyzed. According to the occurrence rate of maternal fetus complications, weight of baby, time of shoulder delivery and delivery maneuver, clinical data were divided into different groups and analyzed. Results The riskfactors of shoulder dystocia were macrosomia, gestational diabetes, uterine inertia. The maternal fetus complicatons were mainly baby asphyxia （53）, maternal vulva laceration（10）, postpartum heamorrhage （14）. Maternal fetus complications were more frequent in macrosomia group than normal weight group. The incidence of matemal fetus complications was not correlated with maneuver and shoulder delivery time, while neonatal complications increased along with maneuver and prolonged shoulder delivery time. MCRobert maneuver added with suprapubie pressure was effective in 28 cases. Conclusions Macrosomia is the primary risk factor of shoulder dystocia. Maternal penneal lacerationpostpartum hemorrhage and neonatal asphyxia are the common complications of shoulder dystocia. Neonatal complications are closely related with fetal weight, while maternal complicationsare mainly related with fetal weight.

关 键 词：肩难产 高危因素 并发症 

分 类 号：R714.3[医药卫生—妇产科学]