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.
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。