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目的:探讨可能导致肩难产的高危因素,并观察其对母婴结局的影响。方法:回顾性分析来该院分娩发生肩难产40例产妇的临床资料,将其作为观察组,选取同时段内来该院正常分娩的40例产妇作为对照组。观察两组的产程特点、两组新生儿的情况以及通过多因素Logistic分析导致肩难产的独立危险因素。结果:观察组总产程的时间与对照组相比无统计学差异(P>0.05);但是观察组第二产程的时间要显著长于对照组(P<0.05);观察组的宫缩乏力、羊水Ⅲ度污染、胎心监护异常、会阴切开、宫缩应激反应阳性的发生比例均要显著高于对照组(P<0.05),在新生儿的结局上观察组新生儿窒息、臂丛神经损伤、锁骨骨折、巨大儿发生的比例均要显著高于对照组(P<0.05);通过多因素Logistic分析导致肩难产的独立危险因素分别为:宫缩乏力、巨大儿、合并糖尿病、孕周大于40周。结论:导致肩难产的高危因素为宫缩乏力、巨大儿、合并糖尿病、孕周大于40周,肩难产往往导致新生儿窒息、臂丛神经损伤、锁骨骨折的发生。
Objective: To explore the risk factors that may lead to shoulder dystocia and to observe its impact on maternal and infant outcomes. Methods: The clinical data of 40 maternal women who had shoulder dystocia during delivery in our hospital were analyzed retrospectively. The 40 maternal women whose normal labor was delivered within the same period were selected as the control group. The characteristics of labor, the status of newborns and the independent risk factors of shoulder dystocia by multivariate logistic analysis were observed. Results: The total duration of labor in the observation group was not significantly different from that in the control group (P> 0.05), but the duration of the second stage of labor in the observation group was significantly longer than that in the control group (P <0.05) Ⅲ degree of pollution, fetal heart rate monitoring anomalies, perineal incision, uterine contractions were significantly higher than the proportion of stress response was significantly higher than the control group (P <0.05), the outcome of newborns in the observation group neonatal asphyxia, brachial plexus (P <0.05). The independent risk factors of shoulder dystocia by multivariate logistic analysis were: uterine atony, macrosomia, diabetes mellitus, gestational age More than 40 weeks. Conclusion: The most common risk factors for shoulder dystocia are asystolemia, macrosomia, diabetes mellitus, gestational age more than 40 weeks, shoulder dystocia often leads to neonatal asphyxia, brachial plexus injury and clavicular fracture.