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Axlaklemma : skráning tilvika á kvennadeild Landspítalans 1979-1986

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Authors
Gerður Jónsdóttir
Jón Þorgeir Hallgrímsson
Reynir Tómas Geirsson
Marta Lárusdóttir
Atli Dagbjartsson
Issue Date
1989-03-15

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Citation
Læknablaðið 1989, 75(3):85-9
Abstract
The incidence and coding of shoulder dystocia at the Departments of Obstetrics and Gynaecology and of Pediatrics, National Hospital, Reykjavik, was evaluated by reviewing deliveries with this diagnosis during 1979-86 (coded cases) and all deliveries of babies with a birthweight of 4000 g and more during 1982-85 (uncoded cases). The diagnosed cases numbered 46 with a early incidence rate from one to nineteen deliveries, i.e. an increase in incidence 0.05% to 1.0%. This is likely to be due to improved registering of intrapartum diagnoses, rather than a true increase. In 1982-85 a total of 2150 babies of birthweight over 4000 g were born (23.8% of deliveries). In 132 of these difficulties in delivering the shoulders were described in the delivery notes (6.1%). The two study groups were compared to a healthy pregnant population (7). Maternal age and weight were similar in all groups, but height was significantly lower in the coded cases. Birthweight, parity and gestational length were all significantly greater in the dystocia groups. The midwifes' estimate of weight before delivery was inaccurate, usually underestimating weight by a mean of around 450 g. Instrumental delivery had been used in a quarter of the coded cases. Birth trauma was noted in 30.4% of the babies of the coded cases; most often clavicular fracture but also severe birth asphyxia and brachial nerve paresis. In the uncoded cases 10.6% sustained birth trauma. One of the 11 babies with nerve paresis at birth had signs of permanent damage at the age of two years. Shoulder dystocia is a serious emergency where permanent damage to the child can occur. Educated and skilled staff attending delivery is the most essential
Erfið fæðing barns í hvirfilstöðu vegna árekstra axla við beinhluta fæðingargangs nefnist á ensku »shoulder girdle dystocias» Í þessari grein verður fyrirbærið kallað axlaklemma. Axlaklemma var skráð sem sjúkdómsgreining í 46 tilvikum á Kvennadeild Landspítalans á árunum 1979-86 og fjölgaði þeim á tímabilinu úr 0,05% fæðinga í 1%. Auk skráðra tilvika voru yfirfarnar fæðingarskýrslur 2.150 barna, sem fæddust á árunum 1982-85 og vógu 4.000 grömm eða meira við fæðingu til að athuga hvort erfiðleikar axla við fæðingu axla. í 132 tilvikum (6,1%) reyndist svo hafa verið (óskráð tilvik). Í skráðu og óskráðu tilvikunum var ekki munur á aldri eða líkamsþyngd mæðranna miðað við samanburðarhóp heilbrigðra þungaðra kvenna. Í skráðu tilvikunum var hæð mæðranna marktækt lægri en í samanburðarhópnum. Fæðingarþyngd, meðgöngulengd og fjöldi fyrri fæðinga voru marktækt hærri í báðum rannsóknarhópunum en hjá samanburðarkonunum. Mat ljósmæðra á þyngd barnanna fyrir fæðingu reyndist mjög ónákvæmt. Þyngd var oftast vanmetin, að meðaltali um 450 grömm. Sogklukka eða töng hafði verið notuð í fjórðungi skráðu tilfellanna. Áverki á barni greindist hjá 30,4% skráðu tilfellanna, en 10,6% óskráðu tilvikanna. Helstu áverkar voru skemmdir á armflækju (plexus brachialis), köfnunardá (asphyxia) og viðbeinsbrot. Af ellefu börnum með taugalömun handleggs við fæðingu var eitt með varanlegan skaða við tveggja ára aldur. Axlaklemma er alvarlegt bráðatilvik í fæðingu sem getur leitt til varanlegs skaða hjá barninu. Þekking og þjálfun í réttum og skjótum viðbrögðum hjá þeim sem annast fæðingahjálp er besta vörnin, en grunur um þungbura fyrir fæðingu, lágvaxin móðir, síðburafæðing og langdregin fæðing ætti að vera aðvörun um mögulega axlaklemma.
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http://www.laeknabladid.is
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Icelandic Journal Articles (Peer Reviewed)

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