肩难产126例临床分析与处理

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目的:深入了解肩难产的临床发生情况及相关危险因素,以便采取积极有效的处理措施。方法:选取2008年9月~2012年9月期间,该院收治的肩难产分娩的孕产妇126例作为研究组,另选同期在该院经阴道头位正常分娩的孕产妇120例作为对照组,对两组孕产妇的临床分娩资料进行回顾性分析,比较两组孕产妇产前相关指标、产程、新生儿体重及相关径线。结果:与对照组正常分娩孕产妇相比,研究组肩难产孕产妇宫高和腹围明显提高,第一产程和第二产程时间明显延长,差异均有统计学意义(P<0.05)。同时,与对照组正常分娩新生儿相比,研究组肩难产新生儿出生体重明显提高,1 min Apgar评分明显降低,身长、头围及胸围等相关径线明显增加,差异具有统计学意义(P<0.05)。126例肩难产孕产妇中巨大儿和妊娠合并糖尿病是肩难产发生的主要因素,分别占43.65%和16.67%。新生儿发生锁骨骨折比例较高,占6.34%,其次为臂丛神经损伤,占3.96%;产妇产后出血占20.64%,软产道撕裂占10.32%。讨论:产科医生应在充分掌握分娩机制和助产操作的同时,进一步了解肩难产发生的相关因素,采取积极有效的应对措施,必将对新生儿和产妇并发症的降低起到显著的促进作用。 Objective: To understand the clinical occurrence of shoulder dystocia and related risk factors in order to take active and effective treatment measures. Methods: From September 2008 to September 2012, 126 pregnant women with shoulder dystocia who were treated in this hospital were selected as the study group. Another 120 pregnant women with normal vaginal delivery during the same period were selected as the control group , The data of clinical delivery of two groups of pregnant women were retrospectively analyzed. The prenatal related indicators of maternal age, birth weight, newborn weight and related diameters were compared between the two groups. Results: Compared with the normal pregnant women in the control group, the uterine height and abdominal circumference were significantly increased in the study group with shoulder dystocia and the first and second stage of labor was significantly longer (P <0.05). At the same time, compared with normal birth newborns in control group, the birth weight of newborns with shoulder dysthymia in study group increased significantly, Apgar score at 1 min decreased significantly, and related diameter of body length, head circumference and chest circumference increased significantly (P <0.05). In 126 cases of shoulder dystocia, maternal giant macrosomia and pregnancy complicated with diabetes were the main factors of shoulder dystocia, accounting for 43.65% and 16.67% respectively. The incidence of clavicular fracture in neonates was high, accounting for 6.34%, followed by brachial plexus injury, accounting for 3.96%; maternal postpartum hemorrhage accounted for 20.64%, soft birth canal tears accounted for 10.32%. Discussion: Obstetricians should fully grasp the delivery mechanism and midwifery operation, while further understanding of the relevant factors of shoulder dystocia, take positive and effective response measures, will certainly reduce the neonatal and maternal complications played a significant role in promoting .
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