Effects of pelvic floor muscle function improvement of shoulder dystocia parturients by posterior shoulder rotation

doi:10.3877/cma.j.issn.1673-5250.2021.03.018

Objective

To evaluate effects of pelvic floor muscle function improvement of shoulder dystocia parturients after midwifery by posterior shoulder rotation.

Methods

A total of 28 parturients who were treated by posterior shoulder rotation maneuver during shoulder dystocia in Ningbo Women and Children Hospital were enrolled into study group from July 2018 to January 2020. Meanwhile, another 25 parturients who were treated by suprapubic pressure method during shoulder dystocia delivery in the same hospital were enrolled into control group. By surface electromyography (sEMG) technique, electromyographic parameters of pelvic floor muscle of parturients between two groups were recorded in 8 weeks after delivery. Independent-samples t test was used to compare general clinical data and electromyographic parameters between two groups. And chi-square test was used to analyze the difference between two groups in proportion of macrosomia, etc.. The study procedures obeyed the ethic rules established by the Ethics Committee of cases collection hospital and was approved by this Ethics Committee (Approval No.[2018] 28). All the patients enrolled submitted written informed consent.

Results

①There were no significant differences between two groups in general clinical data, including maternal height, weight, body mass index (BMI), gestational age, and age(P>0.05). ②There were no significant differences between two groups in neonatal birth weight, and the proportion of macrosomia (P>0.05). ③The data of pre-baseline rest, maximum level of rapid contractions, maximum level of tonic contractions, mean level of tonic contractions, mean level of endurance contractions, and post-baseline rest in study group were (1.4±0.3) μV, (23.8±5.5) μV, (19.9±3.4) μV, (17.2±2.9) μV, (13.7±3.0) μV, and (1.3± 0.3) μV, respectively, much higher than those(1.3±0.3) μV, (20.6±4.4) μV, (17.7±3.3) μV, (14.2±4.1) μV, (11.8±3.4) μV, and (1.1±0.3) μV, respectively in control group (P<0.05). There was no significant difference between two groups at maximum level of endurance contractions (P>0.05).

Conclusions

Comparing with treatment by suprapubic pressure during shoulder dystocia delivery, treatment by posterior shoulder rotation maneuver could be good for improvement of pelvic floor muscle function of parturients in short-term postpartum.

Key words: Natural childbirth, Postpartum period, Posterior shoulder rotation method, Shoulder dystocia, Muscle contraction, Pelvic floor muscle, Electromyography, Parturient

图1 旋后肩法胎头和胎肩旋转方向示意图

表1 2组肩难产产妇一般临床资料比较(±s)

组别	例数	身高(m)	体重(kg)	分娩孕龄(周)	分娩年龄(岁)	BMI(kg/m²)
研究组	28	1.61±0.06	65.2±6.5	39.9±1.3	28.2±4.0	25.3±2.2
对照组	25	1.59±0.06	63.6±5.3	39.7±0.9	27.3±3.9	25.0±1.2
t值		0.611	0.940	0.319	0.613	0.261
P值		0.438	0.337	0.574	0.437	0.612

表1 2组肩难产产妇一般临床资料比较(±s)

组别	例数	身高(m)	体重(kg)	分娩孕龄(周)	分娩年龄(岁)	BMI(kg/m²)
研究组	28	1.61±0.06	65.2±6.5	39.9±1.3	28.2±4.0	25.3±2.2
对照组	25	1.59±0.06	63.6±5.3	39.7±0.9	27.3±3.9	25.0±1.2
t值		0.611	0.940	0.319	0.613	0.261
P值		0.438	0.337	0.574	0.437	0.612

表2 2组肩难产产妇分娩新生儿结局比较

组别	例数	出生体重(g，±s)	巨大儿[例数(%)]
研究组	28	3 940±160	11(39.3)
对照组	25	4 000±140	12(48.0)
检验值		t＝1.896	χ²＝0.408
P值		0.175	0.523

表2 2组肩难产产妇分娩新生儿结局比较

组别	例数	出生体重(g，±s)	巨大儿[例数(%)]
研究组	28	3 940±160	11(39.3)
对照组	25	4 000±140	12(48.0)
检验值		t＝1.896	χ²＝0.408
P值		0.175	0.523

表3 2组肩难产产妇盆底表面肌电图检测结果比较(μV，±s)

组别	例数	前基线值	快肌收缩最大值	混合肌收缩最大值	混合肌收缩平均值	耐力肌收缩最大值	耐力肌收缩平均值	后基线值
研究组	28	1.4±0.3	23.8±5.5	19.9±3.4	17.2±2.9	17.5±3.1	13.7±3.0	1.3±0.3
对照组	25	1.3±0.3	20.6±4.4	17.7±3.3	14.2±4.1	16.3±3.6	11.8±3.4	1.1±0.3
t值		4.815	5.371	5.738	9.253	1.803	5.095	4.701
P值		0.033	0.025	0.020	0.004	0.185	0.028	0.035

表3 2组肩难产产妇盆底表面肌电图检测结果比较(μV，±s)

组别	例数	前基线值	快肌收缩最大值	混合肌收缩最大值	混合肌收缩平均值	耐力肌收缩最大值	耐力肌收缩平均值	后基线值
研究组	28	1.4±0.3	23.8±5.5	19.9±3.4	17.2±2.9	17.5±3.1	13.7±3.0	1.3±0.3
对照组	25	1.3±0.3	20.6±4.4	17.7±3.3	14.2±4.1	16.3±3.6	11.8±3.4	1.1±0.3
t值		4.815	5.371	5.738	9.253	1.803	5.095	4.701
P值		0.033	0.025	0.020	0.004	0.185	0.028	0.035

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