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Comparative Study
. 2011 Jun;117(6):1272-1278.
doi: 10.1097/AOG.0b013e31821a12c9.

A comparison of obstetric maneuvers for the acute management of shoulder dystocia

Matthew K Hoffman  1 , Jennifer L Bailit, D Ware Branch, Ronald T Burkman, Paul Van Veldhusien, Li Lu, Michelle A Kominiarek, Judith U Hibbard, Helain J Landy, Shoshana Haberman, Isabelle Wilkins, Victor H Gonzalez-Quintero, Kimberly D Gregory, Christos G Hatjis, Mildred M Ramirez, Uma M Reddy, James Troendle, Jun Zhang; Consortium on Safe Labor
Affiliations
Comparative Study

A comparison of obstetric maneuvers for the acute management of shoulder dystocia

Matthew K Hoffman et al. Obstet Gynecol. 2011 Jun.

Abstract

Objective: To assess the efficacy of obstetric maneuvers for resolving shoulder dystocia and the effect that these maneuvers have on neonatal injury when shoulder dystocia occurs.

Methods: Using an electronic database encompassing 206,969 deliveries, we identified all women with a vertex fetus beyond 34 0/7 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. Medical records of all cases were reviewed by trained abstractors. Cases involving neonatal injury (defined as brachial plexus injury, clavicular or humerus fracture, or hypoxic-ischemic encephalopathy or intrapartum neonatal death attributed to the shoulder dystocia) were compared with those without injury.

Results: Among 132,098 women who delivered a term cephalic liveborn fetus vaginally, 2,018 incurred a shoulder dystocia (1.5%), and 101 (5.2%) of these incurred a neonatal injury. Delivery of the posterior shoulder was associated with the highest rate of delivery when compared with other maneuvers (84.4% compared with 24.3-72.0% for other maneuvers; P<.005 to P<.001) and similar rates of neonatal injury (8.4% compared with 6.1-14.0%; P=.23 to P=.7). The total number of maneuvers performed significantly correlated with the rate of neonatal injury (P<.001).

Conclusion: Delivery of the posterior shoulder should be considered following the McRoberts maneuver and suprapubic pressure in the management of shoulder dystocia. The need for additional maneuvers was associated with higher rates of neonatal injury.

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Conflict of interest statement

Financial Disclosure: The authors did not report any potential conflicts of interest.

Figures

Figure 1
Figure 1
Flow of participants through the study.
Figure 2
Figure 2
Percentage with injury by number of maneuvers.
See this image and copyright information in PMC

Comment in

References

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