Clinical Analysis of 45 Cases of Shoulder Dystocia

Objective:To investigate the risk factors,complications and treatment of shoulder dystocia.Methods:45 cases of shoulder dystocia from October 2000 to October 2010 were analyzed Retrospectively.According to the occurrence rate of maternal fetus complications,weight of baby,delivery maneuver and time of shoulder delivery,clinical data were divided into different groups and analyzed.Results:①The risk factors of shoulder dystocia were macrosomia(62.2%),uterine inertia(15.6%),gestational diabetes mellitus(11.1%).②The maternal fetus complicatons were mainly maternal vulva laceration(17cases,37.8%),postpartum heamorrhage(7 cases,15.6%),baby asphyxia(29 cases,64.4%).Maternal fetus complications were more frequent in macrosomia group than normal weight group(P0.05).The incidence of maternal fetus complications was not correlated with maneuver and shoulder delivery time(P0.05),while neonatal complications increased along with maneuver and prolonged shoulder delivery time(P0.05).③McRobert maneuver was effective in 10 cases(22.2%),McRobert maneuver added with suprapubic pressure was effective in 16 cases(35.6%),McRobert maneuver added with suprapubic pressure and shouler rotation was effective in 12 cases(26.7%),above mentioned gestures with pulling posterior arm was effective in 7 cases(15.6%).Conclusions:Macrosomia is the primary risk factor of shoulder dystocia.Neonatal complications are closely related with fetal weight,maneuver and shoulder delivery time,while maternal complications are mainly related with fetal weight.Maternal perineal laceration,postpartum hemorrhage and neonatal asphyxia are the common complications of shoulder dystocia.McRobert maneuver added with suprapubic pressure is suggested as the first choice for shoulder dystocia.