朱惠娟

[摘要]目的 探讨晚娩肩助产法在自然分娩中预防肩难产及新生儿产伤的效果。方法 选取2015年1～9月自然分娩的病例4030例为观察组，实施晚娩肩助产法，胎头娩出后不立即娩出胎肩，而是等待胎头自然复位或下一次宫缩到来时娩肩；选取实施新法接生前的2014年1～9月自然分娩病例3977例为对照组，按常规接生方法接生。比较两组的肩难产、新生儿锁骨骨折、臂丛神经损伤、新生儿窒息发生率。结果 观察组肩难产发生率为0.67%，明显低于对照组的1.68%（P<0.01）；观察组新生儿锁骨骨折发生率为0，明显低于对照组的0.15%（P<0.05）；两组新生儿均未发生臂丛神经损伤（P>0.05）；观察组、对照组新生儿窒息发生率分别为0.17%、0.30%，两组差异无统计学意义（P>0.05）。结论 晚娩肩助产法可减少肩难产的发生，降低新生儿锁骨骨折发生率。

[关键词]晚娩肩；肩难产；新生儿；产伤

[中图分类号] R714.3 [文獻标识码] A [文章编号] 1674-4721（2016）11（c）-0180-04

[Abstract]ObjectiveTo study the effect of late delivery of shoulder midwifery preventing shoulder dystocia and neonatal birth injuryinnatural childbirth.Methods From January to September 2015，4030 cases with natural childbirth wereselected observation group.Late delivery of shoulder midwifery was conducted：Not delivered shoulder immediately after the delivery of fetal head，but waiting for the delivery of fetal head shoulder reseting naturally or next contraction arriving to deliver shoulder；3977 cases with natural childbirth selected before conduction of new method to deliver from January to September 2014 were set as control group，and they were deliveried according to routine delivery method.The incidence rate of shoulder dystocia，neonatal clavicular fracture，brachial plexus injury，neonatal asphyxia between two groups was compared respectively.Results In the observation group，the incidence rate of shoulder dystocia （0.67%） was significantly lower than that of the control group （1.68%） （P<0.01）.In the observation group，the incidence rate of neonatal clavicular fracture rate （0） was was significantly lower than that of control group （0.15%） （P<0.05）.There was no neonatal brachial plexus injury in two groups （P>0.05）.The incidence rate of neonatal asphyxia in the observation group and the control group，was 0.17%，0.30% respectively，and there was no statistical difference （P>0.05）.Conclusion Late delivery of shoulder midwiferycan reduce the occurrence of shoulder dystocia，and reduce the incidence rate of neonatal clavicular fracture.

[Key words]Late delivery of shoulder midwifery；Shoulder dystocia；Newborn；Birth injury

新生儿产伤是指胎儿在分娩过程中，因机械因素对胎儿或新生儿造成的损伤，新生儿产伤的预防一直是产科的研究重点，而锁骨骨折和臂丛神经损伤是新生儿产伤中较为常见的类型。临床上新生儿产伤多数与难产相伴，以产程延长、产科手术或分娩处理不当引起的损伤多见[1]，而肩难产是“难产中的难产”，肩难产发生率为0.02%～0.20%[2]，甚至有研究显示高达0.2%～3.0%[3]，而新生儿锁骨骨折在肩难产患者中发生率高达6.1%～23.9%[4-5]，肩难产通常发生突然，处理时间紧迫且棘手，一旦处理不当，将引起严重的母儿并发症，因此，对肩难产进行早期识别、早期预防、正确处理显得尤为重要，是预防新生儿产伤的重要环节。据国外文献报道，晚娩肩可以降低新生儿锁骨骨折的发生率，晚娩肩通常是指胎头娩出后至少等待一次宫缩再娩肩[6]。晚……