OBJECTIVE: To analyze the high risk factors of obstetric brachial plexus palsy (OBPP), and to explore how to evaluate the relationship between fault medical behavior and OBPP in the process of medical damage forensic identification.
METHODS: A retrospective analysis was carried out on 25 cases of medical damage liability disputes related to OBPP from 2017 to 2021 in Beijing Fayuan Judicial Science Evidence Appraisal Center. The shortcomings of hospitals in birth weight assessment, delivery mode selection, labor process observation and shoulder dystocia management, and the causal relationship between them and the damage consequences of the children were summarized.
RESULTS: Fault medical behavior was assessed as the primary cause in 2 cases, equal cause in 10 cases, secondary cause in 8 cases, minor cause in 1 case, no causal relationship in 1 case, and unclear causal force in 3 cases.
CONCLUSIONS: In the process of forensic identification of OBPP, whether medical behaviors fulfill diagnosis and treatment obligations should be objectively analyzed from the aspects of prenatal evaluation, delivery mode notification, standardized use of oxytocin, standard operation of shoulder dystocia, etc. Meanwhile, it is necessary to fully consider the objective risk of different risk factors and the difficulty of injury prevention, and comprehensively evaluate the causal force of fault medical behavior in the damage consequences.
目的: 分析新生儿分娩性臂丛神经损伤的高危因素，探讨在医疗损害法医学鉴定中如何评价过错诊疗行为与新生儿分娩性臂丛神经损伤之间的关系。方法: 对北京法源司法科学证据鉴定中心2017—2021年25例新生儿分娩性臂丛神经损伤医疗损害责任纠纷相关案例进行回顾性分析，总结医院在胎儿体质量评估、分娩方式选择、产程观察与肩难产处置等方面存在的不足之处及其与患儿损害后果之间的关系。结果: 过错医疗行为评定为主要原因2例，同等原因10例，次要原因8例，轻微原因1例，无因果关系1例，未明确原因力3例。结论: 新生儿分娩性臂丛神经损伤医疗损害法医学鉴定过程中，从产前评估、分娩方式告知、规范使用缩宫素、肩难产操作规范性等环节，客观分析医疗行为是否履行诊疗义务，同时需充分考量不同危险因素的客观风险性和损伤预防的困难性，综合评价过错医疗行为在损害结果中的原因力大小。.

BACKGROUND: Because there have been changes in the management of macrosomic pregnancies and shoulder dystocia in the past decade, this study was conducted to compare the incidences of shoulder dystocia and perinatal outcomes between the periods of 2000-2009 and 2010-2019.
METHODS: This retrospective study was conducted in a tertiary obstetric unit. All cases of shoulder dystocia were identified using the hospital\'s electronic database. The incidences, maternal and fetal characteristics, obstetric management methods, and perinatal outcomes were compared between the two study periods.
RESULTS: The overall incidence of shoulder dystocia decreased from 0.23% (134/58 326) in 2000-2009 to 0.16% (108/65 683) in 2010-2019 (P=0.009), mainly because of the overall decline in the proportion of babies with macrosomia (from 3.3% to 2.3%; P<0.001). The improved success rates of the McRoberts\' manoeuvre (from 31.3% to 47.2%; P=0.012) and posterior arm extraction (from 52.9% to 92.3%; P=0.042) allowed a greater proportion of affected babies to be delivered within 2 minutes (from 59.0% to 79.6%; P=0.003). These changes led to a significant reduction in the proportion of fetuses with low Apgar scores: <5 at 1 minute of life (from 13.4% to 5.6%; P=0.042) and <7 at 5 minutes of life (from 11.9% to 4.6%; P=0.045).
CONCLUSIONS: More proactive management of macrosomic pregnancies and enhanced training in the acute management of shoulder dystocia led to significant improvements in shoulder dystocia incidence and perinatal outcomes from 2000-2009 to 2010-2019.

暂无摘要。

BACKGROUND: The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women.
METHODS: A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery.
RESULTS: There were 7109 parturients included in this study. The duration of first stage was 6.2(3.6-10.0) hours, the second stage was 0.3(0.2-0.7) hour, the total stage was 6.9(4.1-10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21, 23.4, 28.8, 35.5, 38.4% in subgroups < 6 h, 6-11.9 h, 12-17.9 h, 18-23.9 h, ≥24 h, which increased significantly (X2 = 57.64, P < 0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup < 6 h (ARR = 1); At the second stage, the rates of overall adverse outcome were 20.0, 30.7, 38.5, 61.2, 69.6% in subgroups < 1 h, 1-1.9 h, 2-2.9 h, 3-3.9 h, ≥4 h (X2 = 349.70, P < 0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup < 1 h (ARR = 1)). At the total stage, the rates of overall adverse outcome were 21.5, 30.8, 42.4% in subgroups < 12 h, 12-23.9 h, ≥24 h (X2 = 84.90, P < 0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup < 12 h (ARR = 1).
CONCLUSIONS: The prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.

BACKGROUND: Results from epidemiological studies about the association between maternal prepregnancy obesity and the risk of shoulder dystocia are inconsistent.
OBJECTIVE: To evaluate the effect of maternal prepregnancy obesity on the risk of shoulder dystocia.
METHODS: We searched PubMed and the Web of Science database for all relevant studies up to 5 August 2016 and reviewed the reference lists of identified articles.
METHODS: Observational studies that investigated the association between prepregnancy obesity and the risk of shoulder dystocia were included.
METHODS: A total of 20 articles involving 2 153 898 participants were included in this meta-analysis. A random-effects model was used to calculate the pooled relative risks (RRs) with 95% CIs.
RESULTS: For obese versus nonobese, the pooled RR of shoulder dystocia was 1.63 (95% CI: 1.33-1.99). The findings remained significant in the cohort studies (RR = 1.57, 95% CI: 1.28-1.93) and case-control studies (RR = 2.70, 95% CI: 1.46-4.98). With regard to the subgroup \'continents\', there was a significant association between obesity and the risk of shoulder dystocia in Europe (RR = 1.51, 95% CI: 1.18-1.92) and Asia (RR = 2.59, 95% CI: 1.15-5.83). The result from the sensitivity analysis for studies adjusted for gestational diabetes was significant (RR = 1.61, 95% CI: 1.05-2.47). The pooled RRs for obesity classes I, II and III versus nonobese were 1.29 (95% CI: 1.06-1.57), 1.94 (95% CI: 1.26-2.98) and 2.47 (95% CI: 1.56-3.93), respectively.
CONCLUSIONS: This meta-analysis suggests that maternal prepregnancy obesity is associated with an increased risk of shoulder dystocia.
CONCLUSIONS: A meta-analysis shows that maternal prepregnancy obesity increases the risk of shoulder dystocia.

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.