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目的探讨超声下与肩难产相关的胎儿径线。方法2004年1月至2005年6月对北京妇产医院1000例孕37～41周经阴道分娩的孕妇产前3d内行超声检查,测量头围(HC)、双肩径(BSD)、胸围(CC)、腹围(AC)、股骨长度(FL),于分娩后1～2d测量新生儿的头围、胸围、肩宽。根据是否发生肩难产分为肩难产组和非肩难产组。结果胎儿双肩径、新生儿肩宽与胎儿体重有着良好的相关性,r值分别为0.70和0.73,P均小于0.01,但胎儿双肩径及新生儿肩宽,肩难产组和非肩难产组无明显差异,而肩难产组胸围/头围明显大于非肩难产组,P<0.01。若用胸围/头围(CC/HC)预测肩难产,选择0.99为截断值具有较好的灵敏度和特异度。结论胎儿双肩径预测肩难产的准确性、实用性较差;选择截断值为0.99胸围/头围预测肩难产的诊断指数最高,但由于所研究的肩难产组的病例数较少,其对肩难产的预测价值尚需进一步临床验证。
Objective To investigate the fetal diameter associated with shoulder dystocia under ultrasound. Methods From January 2004 to June 2005, 1000 pregnant women with vaginal deliveries of 37 ~ 41 weeks of gestation in Beijing Maternity Hospital were examined with ultrasound before and 3 days after operation. The changes of head circumference (HC), shoulder diameter (BSD), chest circumference ), Abdominal circumference (AC), and femur length (FL). The newborn’s head circumference, bust, and shoulder width were measured 1 to 2 days after delivery. According to whether the occurrence of shoulder dystocia is divided into shoulder dystocia group and non-dystocia group. Results There was a good correlation between fetal shoulders diameter and neonatal shoulder width and fetal body weight. The r values were 0.70 and 0.73, P <0.01 respectively, but no differences were found between shoulder diameter of newborns, shoulder width of newborns, shoulder dystocia and non-shoulder dystocia Significant differences were found in the patients with shoulder-dystocia but not in those with shoulder-dystocia (P <0.01). If the shoulder / head circumference (CC / HC) to predict shoulder dystocia, choose 0.99 for the cut-off value has good sensitivity and specificity. Conclusions Fetal shoulders can predict the accuracy of shoulder dystocia and its practicability is poor. The cutoff value of 0.99 is used to predict shoulder dystocia. The diagnostic index of shoulder dystocia is the highest, but due to the small number of cases of shoulder dystocia, The predictive value of dystocia need further clinical validation.