Prevention Unintentional Mechanical Birth Injuries

预防意外机械性分娩伤害

• 批准号: 6870849
• 负责人: EDITH DIAMENT GUREWITSCH ALLEN
• 金额: $ 29.82万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6870849
• 关键词: behavioral /social science research tag; biomechanics; birth injury; clinical research; clinical trials; computer simulation; head movements; health care personnel education; health care personnel performance; human pregnant subject; human subject; injury prevention; limb injury; musculoskeletal injury; obstetrics; shoulder

The objective of this proposal is to elucidate mechanisms involved in mechanical birth injuries that occur following an obstetric emergency known as shoulder dystocia and to develop practical interventions to control or prevent such injuries, some of which can lead to lifelong disability. Affecting up to 15% of vaginal deliveries, shoulder dystocia is a naturally-occurring mechanical obstruction in which, after the head delivers, the fetal shoulders become impacted behind the mother's pubic bone and the trunk cannot deliver without specific intervention by the clinician who must act expediently to prevent asphyxia while simultaneously avoiding undue stretch on the fetal neck. The latter can result in skeletal fractures and/or brachial plexus nerve injury -- unintended outcomes of up to nearly 30% of shoulder dystocias. Standard obstetric maneuvers used to resolve shoulder dystocia involve manipulation of either the mother or the fetus. The superiority of one maneuver over another has not been proven; yet biomechanical considerations support the hypothesis that fetal manipulation requires 20% to 30% less force to deliver the infant than maternal manipulation and, if prioritized, could reduce the incidence of injury. However, most clinicians are less familiar with fetal maneuvers and defer their use in favor of repeating maternal ones. The goals of this research proposal are to demonstrate the mechanical advantage of fetal over maternal manipulation in accomplishing atraumatic resolution of shoulder dystocia and to familiarize clinicians with fetal maneuvers as a public health measure to reduce and prevent neonatal injury. To achieve these objectives, biomedical engineering will be integrated with clinical obstetrics through 5 specific aims: 1. to measure clinician-applied traction on the fetal head using a custom-designed shoulder dystocia birthing simulator and correlate direction, magnitude and rate of this force with fetal neck extension, flexion and rotation, brachial plexus stretch and skeletal fracture; 2. to objectively assess, in a laboratory setting, the effect of uterine and maternal expulsive forces and of different shoulder dystocia maneuvers on clinician-applied force, fetal neck motion parameters and brachial plexus stretch; 3. to conduct an educational program for clinicians on the performance of shoulder dystocia maneuvers, employing the laboratory simulator and force-measuring systems, and assess its effect on clinicians' ability to estimate the amount of traction they apply during delivery; 4. to measure clinician-applied traction in vivo and compare this with laboratory-derived force parameters; 5. to conduct a small, randomized clinical trial comparing clinician-applied forces following McRoberts' maneuver (a maternal manipulation) and following Rubin's maneuver (a fetal manipulation).

该提案的目的是阐明在称为肩部障碍的产科紧急情况下发生的机械出生损伤的机制，并开发实际的干预措施以控制或预防这种伤害，其中一些可能导致终身残疾。肩部障碍性影响多达15％的阴道分娩，是一种天然发生的机械障碍物，在头部伸出后，胎儿肩膀在母亲的耻骨骨骼后面受到影响，而胎盘不能在没有特定干预的情况下进行，而临床医生不能采取特殊的干预，以防止窒息，同时避免避免痛苦的脖子伸展肌neck弱。后者可能导致骨骼骨折和/或臂丛神经损伤 - 意外的结果多达近30％。 用来解决肩膀不足的标准产科动作涉及对母亲或胎儿的操纵。一个机动比另一个机动的优越性尚未得到证明。然而，生物力学考虑支持以下假设：胎儿的操纵需要比产妇的操作要少20％至30％的力量，并且如果优先，则可以减少损伤的发生率。但是，大多数临床医生对胎儿操纵和 推迟使用以重复母亲的使用。这项研究建议的目标是证明胎儿在完成肩部障碍的漫画解决方面的机械优势，而不是孕产妇的操纵，并熟悉临床医生以胎儿操纵为一种公共卫生措施，以减少和预防新生儿损伤。 为了实现这些目标，生物医学工程将通过5个特定目标与临床产科融合： 1。使用定制设计的肩部障碍物模拟器在胎儿上测量临床医生的牵引力，并将这种力的方向，幅度和速率与胎儿颈部伸展，屈曲和旋转，臂神经丛拉伸和骨骼骨折； 2。为了在实验室环境中客观地评估子宫和孕产妇驱除力以及不同肩部障碍动作对临床医生施加的力，胎儿颈运动参数和臂丛神经的影响； 3。为临床医生开展一项教育计划，以实现肩膀难题动作的性能，采用实验室模拟器和力量测量系统，并评估其对临床医生估计交付过程中应用牵引力量的影响； 4。在体内测量临床医生应用的牵引力，并将其与实验室衍生的力参数进行比较； 5。进行一项小型，随机的临床试验，比较麦克罗伯特（McRoberts）操纵（孕产妇操纵）和鲁宾（Rubin）的操纵（胎儿操纵）之后的临床医生施加的力量。