2019RCOG肩难产指南

2019RCOG肩难产指南

level3level3RCOG Green-top Guideline No.422of18Royal College of Obstetricians and Gynaecologists

level3

RCOG Green-top Guideline No.42

3of18Royal College of Obstetricians and Gynaecologists

RCOG Green-top Guideline No.424of18Royal College of Obstetricians and Gynaecologists

RCOG Green-top Guideline No.425of18Royal College of Obstetricians and Gynaecologists

RCOG Green-top Guideline No.426of18Royal College of Obstetricians and Gynaecologists

RCOG Green-top Guideline No.427of18Royal College of Obstetricians and Gynaecologists

RCOG Green-top Guideline No.428of18Royal College of Obstetricians and Gynaecologists

Similarly,symphysiotomy has been suggested as a potentially useful procedure,both in thedeveloping74,75and developed world.76However,there is a high incidence of serious maternalmorbidity and poor neonatal

outcome.77Serious consideration should be given to these facts,particularly where practitioners are not trained in the technique.

Other techniques,including the use of a posterior axillary sling,have been recently reported butthere are few data available.78,79Evidence level4

6.4What is the optimal management of the woman and baby after shoulder dystocia?

Birth attendants should be alert to the possibility of postpartum haemorrhage and severe perineal tears.Evidence

level2+

and

Evidence level3There is significant maternal morbidity associated with shoulder dystocia,particularly postpartumhaemorrhage(11%)and third and fourth degree perineal tears(3.8%).11Other reportedcomplications include vaginal lacerations,80cervical tears,bladder rupture,uterine

rupture,symphyseal separation,sacroiliac joint dislocation and lateral femoral cutaneous neuropathy.81,82

The baby should be examined for injury by a neonatal clinician.BPI is one of the most important complications of shoulder dystocia,complicating2.3%to 16%of suchdeliveries.7,11,13,14

Other reported fetal injuries associated with shoulder dystocia include fractures of the humerusand clavicle,pneumothoraces and hypoxic brain damage.15,83,84

An explanation of the delivery should be given to the parents(see section 9).Evidence level3

7.Risk management

7.1Training

7.1.1What are the recommendations for training?

All maternity staff should participate in shoulder dystocia training at least annually.Grade D

Evidence level4The fifth CESDI report recommended that a‘high level of awareness and training for all birthattendants’should be observed.50Annual ‘skill drills’,including shoulder dystocia,are recommendedjointly by both the Royal College of Midwives and the RCOG85and are one of the requirements in

the Clinical Negligence Scheme for Trusts(CNST)maternity standards.86

Where training has been associated with improvements in neonatal outcome, all staff receivedannual training.14

One study looked at retention of skill for up to one year following training using simulation.If staffhad the ability to manage a severe shoulder dystocia immediately following training,the ability todeliver tended to be maintained at one year.87

7.1.2What is the evidence for the effectiveness of shoulder dystocia training?