Abstract：
UNASSIGNED: Macrosomia represents the most significant risk factor of shoulder dystocia (SD), which is a severe and emergent complication of vaginal delivery. They are both associated with adverse pregnancy outcomes.
UNASSIGNED: The aim of this study was to review and compare the most recently published influential guidelines on the diagnosis and management of fetal macrosomia and SD.
UNASSIGNED: A comparative review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists, the National Institute for Health and Care Excellence, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and the Department for Health and Wellbeing of the Government of South Australia on macrosomia and SD was conducted.
UNASSIGNED: The ACOG and RANZCOG agree that macrosomia should be defined as birthweight above 4000-4500 g regardless of the gestational age, whereas the National Institute for Health and Care Excellence defines macrosomia as an estimated fetal weight above the 95th percentile. According to ACOG and RANZCOG, ultrasound scans and clinical estimates can be used to rule out fetal macrosomia, although lacking accuracy. Routine induction of labor before 39 weeks of gestation with the sole indication of suspected fetal macrosomia is unanimously not recommended, but an individualized counseling should be provided. Exercise, appropriate diet, and prepregnancy bariatric surgery are mentioned as preventive measures. There is also consensus among the reviewed guidelines regarding the definition and the diagnosis of SD, with the \"turtle sign\" being the most common sign for its recognition as well as the poor predictability of the reported risk factors. Moreover, there is an overall agreement on the algorithm of SD management with McRoberts technique suggested as first-line maneuver. In addition, appropriate staff training, thorough documentation, and time keeping are crucial aspects of SD management according to all medical societies. Elective delivery for the prevention of SD is discouraged by all the reviewed guidelines.
UNASSIGNED: Macrosomia is associated not only with SD but also with maternal and neonatal complications. Similarly, SD can lead to permanent neurologic sequalae, as well as perinatal death if managed in a suboptimal way. Therefore, it is crucial to develop consistent international practice protocols for their prompt diagnosis and effective management in order to safely guide clinical practice and improve pregnancy outcomes.
UNASSIGNED: The aim of this study was to review and compare the most recently published influential guidelines on the diagnosis and management of fetal macrosomia and SD.
UNASSIGNED: A comparative review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists, the National Institute for Health and Care Excellence, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and the Department for Health and Wellbeing of the Government of South Australia on macrosomia and SD was conducted.
UNASSIGNED: The ACOG and RANZCOG agree that macrosomia should be defined as birthweight above 4000-4500 g regardless of the gestational age, whereas the National Institute for Health and Care Excellence defines macrosomia as an estimated fetal weight above the 95th percentile. According to ACOG and RANZCOG, ultrasound scans and clinical estimates can be used to rule out fetal macrosomia, although lacking accuracy. Routine induction of labor before 39 weeks of gestation with the sole indication of suspected fetal macrosomia is unanimously not recommended, but an individualized counseling should be provided. Exercise, appropriate diet, and prepregnancy bariatric surgery are mentioned as preventive measures. There is also consensus among the reviewed guidelines regarding the definition and the diagnosis of SD, with the \"turtle sign\" being the most common sign for its recognition as well as the poor predictability of the reported risk factors. Moreover, there is an overall agreement on the algorithm of SD management with McRoberts technique suggested as first-line maneuver. In addition, appropriate staff training, thorough documentation, and time keeping are crucial aspects of SD management according to all medical societies. Elective delivery for the prevention of SD is discouraged by all the reviewed guidelines.
UNASSIGNED: Macrosomia is associated not only with SD but also with maternal and neonatal complications. Similarly, SD can lead to permanent neurologic sequalae, as well as perinatal death if managed in a suboptimal way. Therefore, it is crucial to develop consistent international practice protocols for their prompt diagnosis and effective management in order to safely guide clinical practice and improve pregnancy outcomes.
摘要：
■巨大儿是肩难产（SD）的最重要危险因素，这是阴道分娩的严重和紧急并发症。它们都与不良妊娠结局有关。
这项研究的目的是回顾和比较最近发表的关于胎儿巨大儿和SD的诊断和管理的有影响力的指南。
■对美国妇产科医师学会（ACOG）指南的比较审查，皇家妇产科学院，国家健康与护理卓越研究所，澳大利亚和新西兰皇家妇产科学院（RANZCOG），以及南澳大利亚州政府卫生和福利部就巨大儿和SD进行了研究。
■ACOG和RANZCOG同意，无论胎龄如何，巨大儿都应定义为出生体重超过4000-4500g，而美国国家健康与护理卓越研究所将巨大儿定义为估计的胎儿体重超过第95百分位数。根据ACOG和RANZCOG的说法，超声扫描和临床评估可以用来排除胎儿巨大儿，虽然缺乏准确性。不建议在妊娠39周前常规引产，仅有疑似胎儿巨大儿的指征，但是应该提供个性化的咨询。锻炼,适当的饮食，孕前减肥手术被称为预防措施。关于SD的定义和诊断，审查的指南之间也有共识。“乌龟标志”是最常见的识别标志，以及报告的风险因素的可预测性差。此外，建议将McRoberts技术作为一线操作，对SD管理算法达成了总体共识。此外,适当的员工培训，彻底的文档，根据所有医学协会的说法，时间保持是SD管理的关键方面。所有审查的指南都不鼓励选择性分娩以预防SD。
■巨大儿不仅与SD相关，而且与母体和新生儿并发症相关。同样，SD可以导致永久性神经后遗症，以及围产期死亡，如果以次优方式管理。因此,为了安全地指导临床实践和改善妊娠结局,制定一致的国际惯例方案对其及时诊断和有效管理至关重要.
这项研究的目的是回顾和比较最近发表的关于胎儿巨大儿和SD的诊断和管理的有影响力的指南。
■对美国妇产科医师学会（ACOG）指南的比较审查，皇家妇产科学院，国家健康与护理卓越研究所，澳大利亚和新西兰皇家妇产科学院（RANZCOG），以及南澳大利亚州政府卫生和福利部就巨大儿和SD进行了研究。
■ACOG和RANZCOG同意，无论胎龄如何，巨大儿都应定义为出生体重超过4000-4500g，而美国国家健康与护理卓越研究所将巨大儿定义为估计的胎儿体重超过第95百分位数。根据ACOG和RANZCOG的说法，超声扫描和临床评估可以用来排除胎儿巨大儿，虽然缺乏准确性。不建议在妊娠39周前常规引产，仅有疑似胎儿巨大儿的指征，但是应该提供个性化的咨询。锻炼,适当的饮食，孕前减肥手术被称为预防措施。关于SD的定义和诊断，审查的指南之间也有共识。“乌龟标志”是最常见的识别标志，以及报告的风险因素的可预测性差。此外，建议将McRoberts技术作为一线操作，对SD管理算法达成了总体共识。此外,适当的员工培训，彻底的文档，根据所有医学协会的说法，时间保持是SD管理的关键方面。所有审查的指南都不鼓励选择性分娩以预防SD。
■巨大儿不仅与SD相关，而且与母体和新生儿并发症相关。同样，SD可以导致永久性神经后遗症，以及围产期死亡，如果以次优方式管理。因此,为了安全地指导临床实践和改善妊娠结局,制定一致的国际惯例方案对其及时诊断和有效管理至关重要.
