《2019RCOG肩难产指南》由会员分享,可在线阅读,更多相关《2019RCOG肩难产指南(16页珍藏版)》请在金锄头文库上搜索。
1、2019RCO(肩难产指南level 3level 3RCOG Green-top Guideline No. 422of 18 Royal College of Obstetricians andGynaecologistslevel 3RCOG Green-top Guideline No. 423of 18 Royal College of Obstetricians and GynaecologistsRCOG Green-top Guideline No. 424of 18 Royal College of Obstetricians and GynaecologistsRCOG G
2、reen-top Guideline No. 425of 18 Royal College of Obstetricians and GynaecologistsRCOG Green-top Guideline No. 426of 18 Royal College of Obstetricians and GynaecologistsRCOG Green-top Guideline No. 427of 18 Royal College of Obstetricians and GynaecologistsRCOG Green-top Guideline No. 428of 18 Royal C
3、ollege of Obstetricians and GynaecologistsSimilarly, symphysiotomy has been suggested as a potentially useful procedure, both inthedeveloping 74,75and developed world.76However, there is a high incidence of seriousmaternalmorbidity and poor neonatal outcome.77Serious consideration should be given to
4、 thesefacts,particularly where practitioners are not trained in the technique.Other techniques, including the use of a posterior axillary sling, have been recently reportedbutthere are few data available.78,79Evidence level 46.4What is the optimal management of the woman and baby after shoulder dyst
5、ocia?Birth attendants should be alert to the possibility of postpartum haemorrhage and severe perinealtears.Evidencelevel 2+andEvidence level 3There is significant maternal morbidity associated with shoulder dystocia,particularly postpartumhaemorrhage (11%) and third and fourth degree perineal tears
6、(3.8%).11Other reportedcomplications include vaginal lacerations,80cervical tears, bladder rupture,uterine rupture,symphyseal separation, sacroiliac joint dislocation and lateral femoral cutaneousneuropathy.81,82The baby should be examined for injury by a neonatal clinician.BPI is one of the most im
7、portantcomplications of shoulder dystocia, complicating 2.3% to 16% of suchdeliveries. 7,11,13,14Other reported fetal injuries associated with shoulder dystocia include fractures of thehumerusand clavicle, pneumothoraces and hypoxic brain damage.15,83,84An explanation of the delivery should be given
8、 to the parents (see section 9).Evidence level 37. Risk management7.1Training7.1.1What are the recommendations for training?All maternity staff should participate in shoulder dystocia training at least annually. Grade DEvidence level 4The fifth CESDI report recommended that aawareness and training f
9、or all birthattendantshigh level ofshould be observed.50Annualskill drills, including shoulder dystocia, are recommendedjointly by boththe Royal College of Midwives and the RCOG85and are one of the requirements inthe Clinical Negligence Scheme for Trusts (CNST) maternity standards.86Where training h
10、as been associated with improvements in neonatal outcome, all staffreceivedannual training.14One study looked at retention of skill for up to one year following training using simulation. Ifstaffhad the ability to manage a severe shoulder dystocia immediately following training, the abilitytodeliver
11、 tended to be maintained at one year.877.1.2What is the evidence for the effectiveness of shoulder dystocia training?Practical shoulder dystocia training has been shown to improve knowledge,88confidence 89andmanagement of simulated shoulder dystocia.90 93Training has also been shown to improve theac
12、tor-their care during simulated shoulder dystocia.94Evidence level 3Evidence level 2-Evidence level 1-RCOG Green-top Guideline No. 429of 18 Royal College of Obstetricians and GynaecologistsRCOG Green-top Guideline No. 4210of 18 Royal College of Obstetricians and Gynaecologistspatientsperception ofma
13、noeuvres performed, their timing and sequence maternal perineal and vaginalexaminationestimated blood lossstaff in attendance and the time they arrived general condition of the baby (Apgar score) umbilicalcord blood acid-base measurementsneonatal assessment of the baby.104,106It is particularly impo
14、rtant to document the position of the fetal head at delivery as thisfacilitatesidentification of the anterior and posterior shoulder during the delivery.8.Suggested audit topicsincident reporting of shoulder dystocia (CNST standard)critical analysis of manoeuvres used in the management of shoulder d
15、ystocianeonatal teamcalled at diagnosis of shoulder dystocia documentation of the event (see above)performance ofcord blood gas analysismonitoring neonatal injury (BPI bony fractures) following shoulder dystocia staff attendance atannual trainingdiscussion of events with parents.9. SupportAn informa
16、tion leaflet for parentsA difficult birth: what is shoulderdystocia?produced by the RCOG isavailable online(http:/www.rcog.org.uk/womens-health/clinical-guidance/difficult-birth-what- shoulder-dystocia).The Erbs Palsy Group (www.erbspalsygroup.co.uk) provides an excellent support networkfor children
17、 andfamilies affected by BPI.References1.Resnick R. Management of shoulder dystocia girdle. Clin ObstetGynecol 1980;23:559-64.2. Spong CY, Beall M, Rodrigues D, Ross MG. An objectivedefinition of shoulder dystocia: prolonged head-to-bodydelivery intervalsan d/or the use of an ciliary obstetricma neu
18、vers. Obstet Gyn ecol 1995;86:4333. Beall MH, Spong C, McKay J, Ross MG. Objective definition ofshoulder dystocia: a prospective evaluation. Am J ObstetGynecol 1998;179:934-7.4. Gherman RB. Shoulder dystocia: an evidence-based evaluationof the obstetric nightmare. Clin Obstet Gynecol2002;45:345-6.-6
19、2.5. McFarland M, Hod M, Piper JM, Xenakis EM, Langer O. Are laborabnormalities more common in shoulder dystocia? Am JObstet Gynecol 1995;173:1211-4.6. Baskett TF , Allen AC. Perinatal implications of shoulder dystocia.Obstet Gynecol 1995;86:14-7.7. Gherman RB, Ouzounian JG, Goodwin TM. Obstetricman
20、euvres for shoulder dystocia and associated fetal morbidity.Am J Obstet Gynecol1998;178:1126-30.8. McFarland MB, Langer O, Piper JM, Berkus MD. Perinataloutcome and the type and number of maneuvers in shoulderdystocia. Int JGynaecol Obstet 1996;55:219-24.9. Ouzounian JG, Gherman RB. Shoulder dystoci
21、a: are historic riskfactors reliable predictors? Am J Obstet Gynecol2019;192:1933discussion 1935-5;-8.10. Smith RB, Lane C, Pearson JF. Shoulder dystocia: what happensat the next delivery? Br J Obstet Gyn aecol 1994;101:713Goodwin TM, Souter I, Neumann K, OuzounianJG, Paul RH. The McRobertsmaneuver
22、for the alleviation of12.shoulder dystocia: how successful is it? Am J Obstet Gyn ecol1997;176:65661.Mazouni C, Menard JP, Porcu G, Cohen-Solal E, Heckenroth H,Gamerre M, Bretelle F. Maternalmorbidity associated withobstetrical maneuvers in shoulder dystocia. Eur J ObstetGynecol ReprodBiol 2019;129:
23、15-15.11. Gherman RB,-8.Acker DB, Sachs BP, Friedman EA. Risk factors for shoulderdystocia. ObstetGynecol 1985;66:762-8.Draycott TJ, Crofts JF, Ash JP, Wilson LV, Yard E, Sibanda T , Whitelaw A.Improving neonatal outcome through practicalshoulder dystocia training. ObstetGynecol 2019 ;112:14-20.Gher
24、man RB, Ouzounian JG, Miller DA, Kwok L, Goodwins palsy? Am JObstetTM. Spontaneous vaginal delivery: a risk factor for ErbGynecol 1998;178:423-7.Evans-Jones G, Kay SP, Weindling AM, Cranny G, Ward A,Bradshaw A, Hernon C. Congenitalbrachial plexus injury:incidence, causes and outcome in the UK and Re
25、public ofIrela nd. Arch DisChild Fetal Neo natal Ed 2019;88:F185RB, Ouzounian JG, Satin AJ, Goodwin TM, Phelan JP. Acomparison of shoulderdystocia-associated transient andpermanent brachial plexus palsies. Obstet Gynecol2019;102:544-9.Gherma n-8.Pondaag W, Allen RH, Malessy MJ. Correlating birthweig
26、ht withneurologicalseverity of obstetric brachial plexus lesio ns. BJOG 2019; 118:1098-103.Chauhan SP, Rose CH, Gherman RB, Magann EF, Holland MW, Morrison JC. Brachial plexusinjury: a 23-year experience froma tertiary center. Am JObstet Gynecol 2019;192:179513. 14.15.16.17.18.19.RCOG Green-top Guid
27、eline No. 4211of 18Royal College of Obstetricians and Gynaecologists20. Gherman RB, Chauhan S, Oh C, Goodwin TM. Brachial plexuspalsy. Fetal Matern Med Rev 2019; 16:221-800;discussion 1800-2.-43.21. Menjou M, Mottram J, Petts C, Stoner R. Common intrapartumdenominators of obstetric brachial plexus i
28、njury (OBPI).NHSLA J 2019;2 suppl:ii-viii.22. Draycott T , Sanders C, Crofts J, Lloyd J. A template for reviewingthe strength of evidence for obstetric brachial plexus injury inclinicalneglige nee claims. Clin Risk 2019;14:96NHSLA J 2019;5: 6.24. Sandmire HF, DeMott RK. Erbs palsy without shoulderdy
29、stocia. I nt J Gyn aecol Obstet 2002;78:253-100.23. NHSLA. Case 3 - Obstetrics.-6.25. Allen RH, Gurewitsch ED. Temporary Erb-Duchenne palsywithout shoulder dystocia or traction to the fetal head. Obstet Gynecol 2019;105:1210-2.26. Gilbert WM, Nesbitt TS, Danielsen B. Associated factors in 1611cases
30、of brachial plexus injury. Obstet Gynecol 1999;93:536-4027. GhermanRB, Goodwin TM, Ouzounian JG, Miller DA, Paul RH.Brachial plexus palsy associated with cesarean section: an inutero injury?Am J Obstet Gy necol 1997;177:1162Barnfield S (Eds). PROMPTPRactical Obstetric Multi-Professional Training Cou
31、rse Manual.Vol. 1.London: RCOG Press; 2019.29. Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia andassociated risk factors with macrosomic infants born inCalifornia. Am JObstet Gynecol 1998;179:476-4.28. Draycott T , Win ter C, Crofts J,-80.30. Bahar AM. Risk factors and fetal outcome in cases
32、of shoulderdystocia compared with normal deliveries of a similarbirthweight. Br JObstet Gynaecol 1996;103:868-72.31. Gross TL, Sokol RJ, Williams T , Thompson K. Shoulder dystocia: afetal-physician risk. Am J Obstet Gynecol 1987;156:14083rd, Martin JN Jr. Emergent management of shoulderdystocia. Obs
33、tet Gynecol Clin North Am 1995;22:247Ciampi A, Fahey J, Mighty H, Oppenheimer L,Hamilton EF. Prediction of risk for shoulder dystocia withneonatal injury.Am J Obstet Gynecol 2019;195:1544-9.34. Rouse DJ, Owen J, Goldenberg RL, Cliver SP. The effectivenessand costs of elective cesarean delivery for f
34、etal macrosomiadiagnosed byultrasound. JAMA 1996; 13;276:1480-18.32. Naef RW-59.33. Dyachenko A,-635. Gupta M, Hockley C, Quigley MA, Yeh P, Impey L. Antenatal and intrapartum prediction ofshoulder dystocia. Eur J ObstetGynecol ReprodBiol 2019;151:134-9.36. Centre for Reviews and Dissemination, NHS
35、National Institutefor Health Research. Expectant management versus laborinduction for suspected fetal macrosomia: a systematic review.Database of Abstracts of Reviewsof Effectiveness 2019;2:2.37. Irion O, Boulvain M. Induction of labour for suspected fetalmacrosomia. Cochrane Database Syst Rev 2000;
36、2: CD000938.38. Horvath K, Koch K, Jeitler K,Matyas E, Bender R, Bastian H, etal. Effects of treatment in women with gestational diabetesmellitus: systematic review andmeta-analysis. BMJ 2019;340:c1395.39. National Institute for Health and Clinical Excellence. Diabetesin pregnancy. Management of dia
37、betes and its complicationsfrom preconception to the postnatalperiod. ClinicalGuideline 63. London: NICE; 2019.40. Sokol RJ, Blackwell SC; American College of Obstetricians andGynecologists. ACOG Practice Bulletin: shoulder dystocia. Int JGynaecol Obstet 2019;80:87-92.41. National Institute for Heal
38、th and Clinical Excellence. Antenatalcare: Routine care for the healthy pregnant woman. ClinicalGuideline 62. London: NICE; 2019.42. Mehta SH, Blackwell SC, Chadha R, Sokol RJ. Shoulder dystociaand the next delivery: outcomes and management. J MaternFetal Neonatal Med 2019;20:729-33.43. Usta IM, Hay
39、ek S, Yahya F, Abu-Musa A, Nassar AH. Shoulderdystocia: what is the risk of recurrence? Acta Obstet GynecolScand 2019;87:992-7.44. Lewis DF, Raymond RC, Perkins MB, Brooks GG, Heymann AR.Recurrence rate of shoulder dystocia. Am J Obstet Gynecol1995;172:136945. Ginsberg NA Moisidis C. How to predict
40、recurrent shoulderdystocia. Am J Obstet Gynecol 2001;184:1427-30.46. Lewis DF, Edwards MS, Asrat T , Adair CD, Brooks G, London S.Can shoulder dystocia be predicted? Preconceptive andprenatal factors. JReprod Med 1998;43:654-8.47. Metaizeau JP, Gayet C, Plenat F. Les Lesions Obstetricales duPlexus B
41、rachial. Chir Pediatr 1979;20:159-63.48. Mollberg M, Wennergren M, Bager B, Ladfors L, Hagberg H.Obstetric brachial plexus palsy: a prospective study on riskfactors related to manual assistanceduring the second stage oflabor. Acta Obstet Gynecol Scand 2019;86:198-204.49. Poggi SH, Allen RH, Patel CR
42、, Ghidini A, Pezzullo JC, Spong CY.Randomized trial of McRoberts versus lithotomy positioning todecrease the force that is appliedto the fetus during delivery.Am J Obstet Gynecol 2019;191:874-8.50. Focus Group Shoulder Dystocia. In: Confidential Enquiries intoStillbirths and Deaths in Infancy. Fifth
43、 Annual Report. London:Maternal and Child HealthResearch Consortium;1998 p 73-9.51. Leung TY , Stuart O,Sahota DS, Suen SS, Lau TK, Lao TT . Head-to-body delivery interval and risk of fetal acidosis andhypoxicischaemic encephalopathy in shoulder dystocia: a retrospectivereview. BJOG2019;118:474-9.52
44、. Hope P, Breslin S, Lamont L, Lucas A, Martin D, Moore I, et al.Fatal shoulder dystocia:a review of 56 cases reported to theConfidential Enquiry into Stillbirthsand Deaths in Infancy. Br JObstet Gynaecol 1998;105:1256-61.53. Grobman WA, Miller D, Burke C, Hornbogen A, Tam K, CostelloR. Outcomes ass
45、ociated with introduction of a shoulderdystocia protocol. Am J Obstet Gynecol2019;205:513-7.54. Siassakos D, Bristowe K, Draycott TJ, Angouri J, Hambly H,Winter C, et al. Clinical efficiency in a simulated emergencyand relationship to team behaviours:a multisite cross-sectionalstudy. BJOG 2019;118:5
46、96-607.55. Gonik B, Zhang N, Grimm MJ. Defining forces that areassociated with shoulder dystocia:the use of a mathematicdynamic computer model. Am JObstet Gynecol2019;188:1068-72.56. Gonik B, Stringer CA, Held B. An alternate maneuver formanagement of shoulder dystocia. Am J Obstet Gynecol1983;145:8
47、8257. Buhimschi CS, Buhimschi IA, Malinow A, Weiner CP. Use ofMcRobertsposition during delivery and increase in pushingefficiency.Lan cet 2001;358:470-1.58. Lurie S, Ben-Arie A, Hagay Z. The ABC of shoulder dystocia-4.management. Asia Oceania J Obstet Gynaecol 1994;20:195Leonetti HB. Shoulder dystoc
48、ia: prevention andtreatment. Am J Obstet Gynecol 1990;162:5-7.59. OLeary JA,-9.60. Gurewitsch ED, Donithan M, Stallings SP, Moore PL, Agarwal S,Allen LM, Allen RH. Episiotomy versus fetal manipulation inmanaging severe shoulder dystocia:a comparison of outcomes.Am J Obstet Gynecol 2019;191:911 16.61
49、. Hinshaw K. Shoulder dystocia. In: Johanson R, Cox C, Grady K,Howell C (Eds). Managing Obstetric Emergencies andTrauma: The MOET Course Manual.London: RCOG Press;2019. p. 165-74.62. Crofts JF, Fox R, Ellis D, Winter C, Hinshaw K, Draycott TJ.Observations from 450 shoulder dystocia simulations: less
50、onsfor skillstraining. Obstet Gynecol 2019;112:906dystocia. JAMA1964;189:835-1263. Rubin A. Ma nageme nt of shoulder-7.64. Woods CE, Westbury NYA. A principle of physics as applicableto shoulder delivery. Am J Obstet Gynecol 1943;45:796-804. 65. Barnum CG.Dystocia due to the shoulders. Am J ObstetGy
51、necol 1945;50:439-42.66. Hoffman MK, Bailit JL, Branch DW, Burkman RT, Van VeldhusienP , Lu L, et al. A comparison of obstetric maneuvers for theacutemanagement of shoulder dystocia. Obstet Gynecol2019;117:127267. Poggi SH, Spong CY, Allen RH. Prioritizing posterior armdelivery during severe shoulde
52、r dystocia. Obstet Gynecol2019;101:106868. Leung TY , Stuart O, Suen SS, Sahota DS, Lau TK, Lao TT .Comparison of perinatal outcomes of shoulder dystociaRCOG Green-top Guideline No. 4212of 18 Royal College of Obstetricians and Gynaecologistsalleviated by different type and sequence of manoeuvres: ar
53、etrospective review. BJOG2019;118:985-90.69. Bruner JP, Drummond SB, Meenan AL, Gaskin IM. All-foursmaneuver for reducing shoulder dystocia during labor. J Reprod Med 1998;43:439-43.70. Sandberg EC. The Zavanelli maneuver: a potentiallyrevolutionary method for the resolution of shoulder dystocia.Am
54、J ObstetGynecol 1985;152:479-84.71. Vaithilingam N, Davies D. Cephalic replacement for shoulderdystocia: three cases. BJOG 2019;112:674-8.-572. Spellacy WN. The Zavanelli maneuver for fetal shoulderdystocia. Three cases with poor outcomes. J Reprod Med1995;40:54373. Gherman RB, Ouzounian JG, Chauhan
55、 S. Posterior armshoulder dystocia alleviated by the Zavanelli maneuver. Am JPerinatol 2019;27:749-51.74. Van Roosmalen J. Shoulder dystocia and symphysiotomy. Eur JObstet Gy necol Reprod Biol 1995;59:1154.-16.75. Hartfield VJ. Symphysiotomy for shoulder dystocia. Am J ObstetGynecol 1986;155:228.76.
56、 Wykes CB, Johnston TA, Paterson-Brown S, Johanson RB.Symphysiotomy: a lifesaving procedure. BJOG 2019;110:219-21.77. Goodwin TM, Banks E, Millar LK, Phelan JP. Catastrophicshoulder dystocia and emergency symphysiotomy. Am J ObstetGynecol 1997;177:463-4.78. Gherman R. Posterior axillary sling tracti
57、on: another empirictechnique for shoulder dystocia alleviation? Obstet Gynecol2019;113(2 Pt2):478-9.79. Hofmeyr GJ, Cluver CA. Posterior axilla sling traction forin tractable shoulder dystocia. BJOG 2019;116:1818A, Hershkovitz R, Hallak M, Hammel RD, KatzM, Mazor M. Determining factors associated wi
58、th shoulderdystocia: a population-based study.Eur J Obstet GynecolReprod Biol 2019;126:1181. Gherman RB. Shoulder dystocia: prevention and management.Obstet Gynecol Clin North Am 2019;32:297-20. 80. Shei ner E, Levy-5.-305.82. Heath T , Gherman RB. Symphyseal separation, sacroiliac jointdislocation
59、and transient lateral femoral cutaneous neuropathyassociated with McRobertsmaneuver. A case report. J ReprodMed 1999;44:90283. Ouzounian JG, Korst LM, Phelan JP. Permanent Erb palsy: atraction-related injury? Obstet Gynecol 1997;89:139McKenzie DK, Thomas LJ, Hansell RS. Shoulderdystocia: an analysis
60、 of risks and obstetric maneuvers. Am JObstet Gynecol 1993;168:1732-9.85. Royal College of Obstetricians and Gynaecologists, RoyalCollege of Midwives. Towards Safer Childbirth. Minimum Standards for the Organisation ofLabour Wards: Report of a Joint Working Party. London: RCOG Press; 1999.86. NHS Li
61、tigationAuthority. Clinical Negligence Scheme forTrusts Maternity Clinical Risk Management Standards, 2019: London.87. Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott TJ.Management of shoulder dystocia: skill retention 6 and 12months aftertrai ning. Obstet Gynecol 2019;110:1069-4.-41.84. No
62、con JJ,74.88. Crofts JF, Ellis D, Draycott TJ,Winter C, Hunt LP, Akande VA.Change in knowledge of midwives and obstetricians followingobstetric emergency training: arandomised controlled trial oflocal hospital, simulation centre and teamwork training. BJOG2019;114:1534-41.89. S?rensen JL, L?kkegaard
63、 E, Johansen M, Ringsted C, Kreiner S,McAleer S. The implementation and evaluation of a mandatorymulti- professional obstetricskills training program. Acta ObstetGynecol Scand 2019;88:1107-17.90. Goffman D, Heo H, Pardanani S, Merkatz IR, Bernstein PS.Improving shoulder dystocia management among res
64、ident andattendingphysicians using simulations. Am J Obstet Gynecol2019;199:294.e191. Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott TJ. Trainingfor shoulder dystocia: a trial of simulation using low-fidelity andhigh- fidelity mannequins.Obstet Gynecol 2019;108:1477-5.-85.92. Crofts JF, At
65、tilakos G, Read M, Sibanda T , Draycott TJ. Shoulderdystocia training using a new birth training mannequin. BJOG 2019;112:997-9.93. Deering S, Poggi S, Macedonia C, Gherman R, Satin AJ.Improving resident competency in the management ofshoulder dystocia with simulationtraining. Obstet Gynecol2019;103
66、:1224-8.94. Crofts JF, Bartlett C, Ellis D, Winter C, Donald F, Hunt LP,Draycott TJ. Patient-actor perception of care: a comparison ofobstetric emergency trainingusing manikins and patient-actors. Qual Saf Health Care 2019;17:20-4.95. Inglis SR, Feier N, Chetiyaar JB, Naylor MH, Sumersille M,Cervell
67、ione KL, Predanic M. Effects of shoulder dystociatraining on the incidence of brachial plexus injury. Am J ObstetGynecol 2019;204:322.e1-6.96. Walsh JM, Kandamany N, Ni Shuibhne N, Power H, Murphy JF,OHerlihy C. Neonatal brachial plexus injury: comparison ofincidence andantecedents between 2 decades
68、. Am J ObstetGynecol 2019;204:324.e197. MacKenzie IZ, Shah M, Lean K, Dutton S, Newdick H, Tucker-6.DE. Management of shoulder dystocia: trends in incidence andmaternal and neo natalmorbidity. Obstet Gyn ecol2019;110:1059-68.98. Crofts JF, Ellis D, James M, Hunt LP, Fox R, Draycott TJ. Patternand de
69、gree of forces applied during simulation of shoulderdystocia. Am J Obstet Gynecol2019;197:156.e1-6.99. Deering SH, Weeks L, Benedetti T . Evaluation of force appliedduring deliveries complicated by shoulder dystocia usingsimulation. Am J Obstet Gynecol2019;204:234.e1-5.100. Kelly J, Guise J-M, Oster
70、weil P, Li H. 211: Determining the valueof force-feedback simulation training for shoulder dystocia. Am J Obstet Gynecol2019;199(Suppl A):S70.101. Vanderhoeven J, Marshall N, Segel S, Li H, Osterweil P, Guise J-M.201: Evaluating in-situ simulation and team training onresponse to shoulder dystocia. A
71、m JObstet Gynecol2019;199(Suppl A):S67.102. The4kg and overenquiries. In: Confidential Enquiries intoStillbirths and Deaths in Infancy. Sixth Annual Report. London: Maternal and Child HealthResearch Consortium;1999. p35-47.103. Deering S, Poggi S, Hodor J, Macedonia C, Satin AJ. Evaluation ofresiden
72、ts delivery notes after a simulated shoulder dystocia.Obstet Gynecol 2019;104:667-70.104. National Health Service Litigation Authority: Summary ofsubstandard care in cases in brachial plexus injury. NHSLA J2019;2 suppl:ix-xi105. Acker DB. A shoulder dystocia intervention form. ObstetGy necol 1991;78
73、:150-1.106. Crofts JF, Bartlett C, Ellis D, Fox R, Draycott TJ. Documentationof simulated shoulder dystocia: accurate and complete? BJOG 2019;115:1303-8.107. Royal College of Midwives. Clinical risk management Paper 2:Shoulder dystocia. RCM Midwives J 2000;3.RCOG Green-top Guideline No. 4213of 18Roy
74、al College of Obstetricians and GynaecologistsAPPENDIX1Figure 1. The McRoberts manoeuvre (from the SaFE study)Figure 2Suprapubic pressure (from SaFE study)Figure 3 Delivery of the posterior arm (from the SaFE study)RCOG Green-top Guideline No. 4214of 18 Royal College of Obstetricians and Gynaecologi
75、stsAPPENDIX2RCOG Green-top Guideline No. 4215of 18Royal College of Obstetricians and GynaecologistsRCOG Green-top Guideline No. 4216of 18 Royal College of Obstetricians and GynaecologistsAPPENDIX 4Clinical guidelines aresystematically developed statements which assistclinicians and women in makingde
76、cisions about appropriate treatment for specific conditions.Each guideline is systematically developedusing a standardised methodology. Exact details ofthis process can be found in Clinical Governance Advice No.1: Development of RCOG Green-topGuidelines (available on the RCOG website athttp:/www.rco
77、g.org.uk/guidelines). Theserecommendations are not intended to dictate an exclusivecourse of management or treatment.They must be evaluated with reference to individual patient needs,resources and limitationsunique to the institution and variations in local populations. It is hoped that thisprocess
78、of localownership will help to incorporate these guidelines into routine practice. Attention isdrawn toareas of clinical uncertainty where further research might be indicated.The evidence used in this guideline was graded using the scheme below and therecommendationsformulated in a similar fashion with a standardised grading scheme.RCOG Green-top Guideline No. 4217of 18Royal College of Obstetricians and GynaecologistsRCOG Green-top Guideline No. 4218of 18Royal College of Obstetricians and Gynaecologists