La dystocie des épaules : description de la prise en charge à Port Royal entre 2006 et 2012 et comparaison avec deux études antérieures réalisées entre 1993 et 1998, puis entre 2000 et 2004

摘要

The purpose of this study was to describe cases of shoulder dystocia in terms of management and maternal and neonatal complications. This study also compared our results with those find in two previous studies that were conducted in the same maternity. One of theme was realized between 1993 and 1998 and the second between 2000 and 2004. We conducted a retrospective and descriptive study of cases of shoulder dystocia that occurred between January 2006 and December 2012 at Port Royal Hospital. We identified all women with a vertex fetus beyond 37 weeks of gestation who incurred a shoulder dystocia during the process of delivery. Women whose fetuses had a congenital anomaly and women with an antepartum stillbirth were excluded. The incidence of shoulder dystocia at Port Royal was 0.9%. Only 3 % were associated with instrumental deliveries. Majority of neonates had a birth-weight of less than 4000 g. The majority cases of shoulder dystocia were resolved by midwives (78%). Overall, management of shoulder dystocia was consistent with Royal College of Obstetricians and Gynaecologists guidelines in 76% of cases. We also noted an improvement of practices in the time. However the documentation of shoulder dystocia that occurred at Port Royal was not complete. And we observed 5 lesions of brachial plexus (2%) and 20 cases of clavicle fracture (8%). 17% of women had postpartum hemorrhage. In conclusion, shoulder dystocia is an unpreventable obstetric emergency. However, majority of cases of shoulder dystocia were well managed at Port Royal despite there wasn't recommendation for this subject. Improvement is needed in the quality of documentation when this event occurs. Regularly drills should be continued to update staff regarding the management of shoulder dystocia. And national guidelines for shoulder dystocia should be published to improvement and standardize our practices.