胎儿复合先露的处理
- Author
- Clint M Cormier, MD
Clint M Cormier, MD
- Co-Director of Perinatal Ultrasound
- Willis Knighton Health System
- Section Editor
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- The American Board of Obstetrics and Gynecology (ABOG)
- Deputy Editor
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Translators
- 陈颖, 副主任医师
陈颖, 副主任医师
- 吉林大学第一医院产科
引言
复合先露是指胎儿的肢体与胎先露部同时入盆，可能为1个或多个肢体(如：手、手臂或足)伴随胎头或胎臀入盆，大部分复合先露为胎手或胎臂与胎头同时入盆[1]。
发病率与病因学
复合先露在分娩中的发生率为1/1000-1/700[2,3]。当由于低出生体重、多胎妊娠、羊水过多或骨盆宽大而导致骨盆未被胎头(或臀)充分占据时，更容易发生复合先露[2,4]。胎先露部高浮时胎膜破裂也会增加复合先露和/或脐带脱垂的风险。复合先露的另一个诱发因素是外倒转术[4,5]。在实施外倒转术时，胎儿肢体(通常是手/臂，偶尔是胎足)可被卡在胎头下方，从而在随后临产时成为先露部。多胎妊娠时，第1个胎儿的胎头与第2个胎儿的肢体可能同时进入产道。
诊断
复合先露通常在产程早期通过产前超声检查或阴道内诊检查发现。检查者会在胎头或胎臀的前方或旁边触到形状不规则的物体。若宫颈较长或呈闭合状态，则产妇进入待产室时可能尚未被诊断出复合先露，但随着产程进展和宫口逐渐扩张，则将会发现复合先露。当胎膜破裂后胎头仍高浮或未衔接，或是活跃期延迟时，临床医生应考虑该情况。
临产处理
复合先露的处理尚存争议。一些专家推荐尝试将胎儿肢体复位，但其他人则不赞成这种做法[6]。目前只就避免使用缩宫素达成了共识。
若产妇产程进展正常，我们倾向于仅给予观察。有时，随着产程进展，胎先露部会直接将肢体推开，或是胎儿会缩回肢体。
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2016-11-29.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Cruikshank DP, White CA. Obstetric malpresentations: twenty years' experience. Am J Obstet Gynecol 1973; 116:1097.
- GOPLERUD J, EASTMAN NJ. Compound presentation; a survey of 65 cases. Obstet Gynecol 1953; 1:59.
- Cunningham G, Leveno KJ, Bloom SL, et al. Williams Obstetrics, 22nd, McGraw-Hill Professional, New York 2005. p.511.
- Brost BC, Calhoun BC, Van Dorsten JP. Compound presentation resulting from the forward-roll technique of external cephalic version: a possible mechanism. Am J Obstet Gynecol 1996; 174:884.
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- Tebes CC, Mehta P, Calhoun DA, Richards DS. Congenital ischemic forearm necrosis associated with a compound presentation. J Matern Fetal Med 1999; 8:231.
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