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目的:探讨非巨大儿发生肩难产病例的分娩方式及妊娠结局。方法:回顾性分析珠海市妇幼保健院产科2011年4月至2016年3月收治的30例非巨大儿发生肩难产病例的分娩方式及妊娠结局。结果:(1)30例非巨大儿肩难产中,采用的肩难产处理方法包括:屈大腿法、耻骨联合上方压前肩法、旋肩法、娩后臂后肩法、人为锁骨骨折、耻骨联合切开术等,根据胎儿及母体不同情况采用以上不同方法单独或联合应用,30例非巨大儿发生肩难产儿均顺利经母体阴道娩出,阴道分娩率为100%,剖宫产率为0%。(2)产后出血3例,新生儿窒息6例;新生儿锁骨骨折1例;新生儿臂丛神经损伤4例;发生会阴Ⅱ度以上裂伤3例。新生儿出生体质量(3413.8±267.2)g,头围(34.71±1.81)cm;胸围(33.56±1.75)cm;出生1 min新生儿Apgar评分(7.2±2.5)分。结论:医护人员须重视非巨大儿肩难产的常见母婴并发症,严密观察产程,及时有效的处理能提高母婴存活率,降低剖宫产率。
Objective: To investigate the mode of delivery and pregnancy outcome of non-macrosomia patients with shoulder dystocia. Methods: A retrospective analysis of Zhuhai Maternal and Child Health Hospital Obstetrics from April 2011 to March 2016 admitted to 30 cases of non-macroscopic shoulder dysphagia cases of delivery and pregnancy outcome. Results: (1) In the 30 cases of non-giant shoulder-shoulder labor, shoulder dystocia treatment methods included flexion thigh method, suprapubic pressure anterior shoulder method, spin-shoulder method, delivery rear arm shoulder method, artificial clavicular fracture, Joint incision and so on, according to different fetuses and maternal conditions using the above different methods alone or in combination, 30 cases of non-macrosomia occurred shoulder hard dystocia were delivered vagina through the vagina, the vaginal delivery rate was 100%, cesarean section rate of 0 %. (2) 3 cases of postpartum hemorrhage, neonatal asphyxia in 6 cases; neonatal clavicle fracture in 1 case; neonatal brachial plexus injury in 4 cases; occurred in 2 cases of perineal laceration more than 3 cases. Neonatal birth weight (3413.8 ± 267.2) g, head circumference (34.71 ± 1.81) cm; bust (33.56 ± 1.75) cm; Apgar score of newborns at 1 min after birth (7.2 ± 2.5) points. Conclusion: Medical staff should pay attention to the common maternal and child complications of non-giant shoulder-dystocia, observe the labor process closely, and timely and effective treatment can improve maternal and infant survival rate and reduce cesarean section rate.