采用 PROMPT 对肩难产中永久性臂丛神经损伤和 III°/IV° 撕裂的影响：汉诺威队列研究

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-02-03 DOI:10.1155/2024/8712553

Spyridon Papageorgiou, Lars Brodowski, Halina Huppertz, Bettina Bohnhorst, M. Flentje, Constantin von Kaisenberg

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There was a total of 22,640 births, and shoulder dystocia increased from 48/18,031 (0.27%) to 23/4,609 (0.50%) ((p=0.017), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (p=0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) (p=0.23). However, adverse outcomes after one year were zero. McRoberts’ manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) ((p=0.013), OR: 1.62, 95% CI: (1.33; 1.98)), and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) (p=0.319). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) ((p<0.001), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) (p=0.546). Vaginal operative deliveries remained constant (6.5% vs. 7%). Conclusions. 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引用次数: 0

摘要

目的验证 PROMPT 可减少永久性臂丛神经麻痹和会阴撕裂的假设。设计。前瞻性/回顾性队列研究。地点：德国汉诺威医学院。德国汉诺威医学院。人群/样本。自选人群。方法。培训时间为 2017 年 11 月 9 日至 2019 年 12 月 31 日；对照组：2004年1月1日至2017年11月8日。主要结果测量指标。肩难产、非永久性和永久性臂丛神经损伤（BPI）、会阴撕裂 III°/IV°、人工操作和窒息。结果。共有 22,640 例分娩，肩难产从 48/18,031 例（0.27%）增加到 23/4,609 例（0.50%）（（P=0.017），OR：1.88，95% CI：(1.14; 3.09)），而臂丛神经损伤从 7/48 例（14.6%）减少到 1/23 例（4.3%）（P=0.261）。之前有 1/7 例（14.2%）永久性 BPI，之后则为 0/1 例（0%）。围产期窒息从 3/48 (6.3%) 增加到 4/23 (17.4%)（P=0.23）。然而，一年后的不良后果为零。麦克罗伯茨手法从 37/48 (77.1%) 增加到 23/23 (100%)（（p=0.013），OR：1.62，95% CI：(1.33; 1.98)），内旋手法和人工拔出后臂从 6/48 (12.5%) 增加到 5/23 (21.7%)（p=0.319）。外阴切开术从5,267/18,031（29.2%）减少到836/4,609（18.1%）（（p<0.001），OR：0.54，95% CI：（0.49，0.58）），而与肩难产相关的会阴撕裂III°/IV°从1/48（2.1%）增加到1/23（4.8%）（p=0.546）。阴道手术分娩率保持不变（6.5% 对 7%）。结论：PROMPTPROMPT能明显改善肩难产的处理，减少永久性臂丛神经损伤，但不能减少III°/IV°会阴撕裂。

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Impact of Introducing PROMPT on Permanent Brachial Plexus Injury and Tears III°/IV° in Shoulder Dystocia: The Hanover Cohort Study

Objective. To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears. Design. A prospective/retrospective cohort study. Setting. Hanover Medical School, Germany. Population/Sample. A self-selected population. Methods. The training period is from November 9th, 2017, until December 31st, 2019; control: January 1st, 2004, until November 8th, 2017. Main Outcome Measures. Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III°/IV°, manual manoeuvres, and asphyxia. Results. There was a total of 22,640 births, and shoulder dystocia increased from 48/18,031 (0.27%) to 23/4,609 (0.50%) ((p=0.017), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (p=0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) (p=0.23). However, adverse outcomes after one year were zero. McRoberts’ manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) ((p=0.013), OR: 1.62, 95% CI: (1.33; 1.98)), and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) (p=0.319). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) ((p<0.001), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) (p=0.546). Vaginal operative deliveries remained constant (6.5% vs. 7%). Conclusions. PROMPT significantly improves the management of shoulder dystocia and decreases permanent brachial plexus injuries but not perineal tears III°/IV°.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.