肩先露剖宫产子宫切口选择的回顾性分析

杨娜娜 王莉

【摘 要】目的：回顾性分析肩先露剖宫产子宫下段横切口和子宫下段-体部纵切口对产时并发症、产后出血量及围产结局的影响。方法：收集肩先露剖宫产以子宫下段横切口者为对照组（67例），以子宫下段-体部纵切口者为观察组（63例），分别比较两组研究对象剖宫产术中新生儿情况、术中并发症、术中出血及产后出血率及围产期结局。结果：年龄、孕周、新生儿出生体重、产后出血率等有关因素比较无统计学意义（P>0.05）。两组间新生儿娩出时间、新生儿阿氏评分、新生儿产伤、新生儿窒息率、子宫有无“丄”切口、子宫裂伤率、术中出血量的比较有统计学意义（P≤0.05）。结论：肩先露行子宫下段-体部纵切口剖宫产术不仅可以缩短新生儿娩出时间、减少新生儿窒息率及新生儿产伤，而且有效避免子宫“丄”形切口发生及子宫裂伤，不增加产后出血发生率，可作为肩先露剖宫产终止妊娠的首选切口。

【关键词】肩先露 ；剖宫产术； 围产期结局

[Abstract] Objective：To compare the complications during labor，postpartum hemorrhage and perinatal outcomes between the low transverse and the low vertical uterine incision in shoulder presentation.Methods We conducted a retrospective study with 130 cases of shoulder presentations at term in Binzhou Medical College Hospital between 1 January 2000 and 31 December 2016.Intraoperative complications，intraoperative bleeding，postpartum hemorrhage and perinatal outcomes of 67 shoulder deliveries by low transverse incision and 63 by low vertical incision were analyzed.Results No significant different in age，gestational age，newborn birth weight and amount of bleeding after operation （P> 0.05），while there were signifiant different in the delivery time of newborns ，the neonatal Apgar score，the neonatal birth injury，the neonatal asphyxia，uterine incision，uterine rupture rate，revent occurrence of uterine "丄" shaped incisio，and amount of bleeding during operation （P≤0.05）.Conclusion Low vertical incision in shoulder presentation effectively shortens the delivery time of newborns and reduce neonatal asphyxia and neonatal birth trauma.Meanwhile，it can dramatically prevent occurrence of uterine "丄" shaped incision and uterine laceration，without increasing the incidence of postpartum hemorrhage.For these reasons，Low vertical cesarean section should be preferred for shoulder presentations.

[Key words] shoulder presentation，cesarean section，outcome of prerinatal period

【中圖分类号】R656 【文献标识码】A 【文章编号】2095-6851（2018）04-0-01

当胎体横卧于骨盆入口以上，其纵轴与母体纵轴相垂直，先露为肩时称为肩先露（shoulder presentation）[1]。肩先露是最不利于分娩的胎位，除死胎及早产儿肢体折叠而自然娩出外，足月或活胎不可能自然娩出，如不及时处理，容易造成子宫破裂，危及母儿生命。肩先露约占分娩总数的0.2%～0.5%，近年来二胎政策的放开，经产妇的数量有所上升，肩先露的发生率也有所变化。肩先露时围产儿死亡率由3.9%上升到24%[2]，多因脐带脱垂及难产引起。肩……