Abstract：
McRoberts\' and suprapubic pressure are often recommended as the initial choices of manoeuvres to manage shoulder dystocia, as they are believed to be less invasive compared to other manoeuvres. However, their success rates range from 23 to 40 %. This study aims to investigate the predictive factors for the success of McRoberts\' manoeuvre with or without suprapubic pressure (M+/-S).
All cases of shoulder dystocia in a tertiary hospital in South East Asia were recruited from 1995 to 2009. Subjects were analysed according to either \'success\' or \'failure\' of M+/-S. Maternal and fetal antenatal and intrapartum factors were compared by univariate and multivariate analysis.
Among 198 cases of shoulder dystocia, M+/-S as the primary manoeuvre was successful in 25.8 %. The other 74.2 % needed either rotational or posterior arm manoeuvres or combination of manoeuvres. Instrumental delivery was the single most significant factor associated with an increased risk of failed M+/-S on logistic regression (p < 0.001, OR 4.88, 95 % CI 2.05-11.60). The success rate of M+/-S was only 15.0 % if shoulder dystocia occurred after instrumental delivery but was 47.7 % after spontaneous vaginal delivery.
When shoulder dystocia occurs after instrumental vaginal delivery, the chance of failure of M+/-S is 85 %, which is 4.7 times higher than that after spontaneous vaginal delivery. Hence all operators performing instrumental delivery should be proficient in performing all manoeuvres to relieve shoulder dystocia when M+/-S cannot do so.
All cases of shoulder dystocia in a tertiary hospital in South East Asia were recruited from 1995 to 2009. Subjects were analysed according to either \'success\' or \'failure\' of M+/-S. Maternal and fetal antenatal and intrapartum factors were compared by univariate and multivariate analysis.
Among 198 cases of shoulder dystocia, M+/-S as the primary manoeuvre was successful in 25.8 %. The other 74.2 % needed either rotational or posterior arm manoeuvres or combination of manoeuvres. Instrumental delivery was the single most significant factor associated with an increased risk of failed M+/-S on logistic regression (p < 0.001, OR 4.88, 95 % CI 2.05-11.60). The success rate of M+/-S was only 15.0 % if shoulder dystocia occurred after instrumental delivery but was 47.7 % after spontaneous vaginal delivery.
When shoulder dystocia occurs after instrumental vaginal delivery, the chance of failure of M+/-S is 85 %, which is 4.7 times higher than that after spontaneous vaginal delivery. Hence all operators performing instrumental delivery should be proficient in performing all manoeuvres to relieve shoulder dystocia when M+/-S cannot do so.
摘要：
McRoberts\'和耻骨上压力通常被推荐作为治疗肩难产的初始选择，因为与其他操作相比，它们被认为具有较小的侵入性。然而,他们的成功率从23%到40%不等。本研究旨在探讨McRoberts有或没有耻骨上压力（M+/-S）操作成功的预测因素。
东南亚某三级医院的肩难产病例均为1995年至2009年的病例。根据M+/-S的“成功”或“失败”分析受试者。通过单因素和多因素分析比较了产妇和胎儿的产前和产时因素。
198例肩难产中,以M+/-S为主要策略的成功率为25.8%。其他74.2%需要旋转或后臂动作或组合动作。在逻辑回归分析中，工具递送是与M+/-S失败风险增加相关的最重要因素(p<0.001,OR4.88,95%CI2.05-11.60)。如果在器械分娩后发生肩难产，M/-S的成功率仅为15.0％，而在自发阴道分娩后为47.7％。
当器械阴道分娩后发生肩难产时，M+/-S失败的几率为85%,是阴道自然分娩后的4.7倍。因此，当M+/-S无法缓解肩难产时，所有执行器械输送的操作员都应精通执行所有操作以缓解肩难产。
东南亚某三级医院的肩难产病例均为1995年至2009年的病例。根据M+/-S的“成功”或“失败”分析受试者。通过单因素和多因素分析比较了产妇和胎儿的产前和产时因素。
198例肩难产中,以M+/-S为主要策略的成功率为25.8%。其他74.2%需要旋转或后臂动作或组合动作。在逻辑回归分析中，工具递送是与M+/-S失败风险增加相关的最重要因素(p<0.001,OR4.88,95%CI2.05-11.60)。如果在器械分娩后发生肩难产，M/-S的成功率仅为15.0％，而在自发阴道分娩后为47.7％。
当器械阴道分娩后发生肩难产时，M+/-S失败的几率为85%,是阴道自然分娩后的4.7倍。因此，当M+/-S无法缓解肩难产时，所有执行器械输送的操作员都应精通执行所有操作以缓解肩难产。
