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Perinatal outcome and the type and number of maneuvers in shoulder dystocia
Author(s) -
McFarland M.B.,
Langer O.,
Piper J.M.,
Berkus M.D.
Publication year - 1996
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/s0020-7292(96)02766-x
Subject(s) - medicine , shoulder dystocia , vaginal delivery , apgar score , palsy , birth injury , surgery , birth trauma , incidence (geometry) , obstetrics , pregnancy , gestational age , genetics , alternative medicine , pathology , biology , physics , optics
Objectives: To ascertain the type and order of maneuvers that should be used for the treatment of shoulder dystocia; and to attempt to quantify the severity of shoulder dystocia, and to determine its correlation with perinatal outcome. Methods: We reviewed all consecutive cases of shoulder dystocia from January 1986 to August 1994 in our institution to obtain the type, order and number of maneuvers used for delivery. Patients were stratified by the number of maneuvers required for delivery. Outcome parameters included cord pH, Apgar score, neonatal trauma (Erb's palsy and fracture), and maternal trauma. Results: The incidence of shoulder dystocia was 0.7% (39 280 total vaginal deliveries). Use of only two maneuvers, McRoberts and suprapubic pressure, resulted in resolution in 58% of cases. The addition of the Woods screw maneuver and/or delivery of the posterior arm was sufficient in all remaining cases. The rates of neonatal palsy and fracture, and maternal fourth‐degree laceration, increased with the number of maneuvers. Conclusions: The McRoberts maneuver and suprapubic pressure should be first‐line treatment for shoulder dystocia. More difficult and damaging maneuvers such as Woods screw and delivery of the posterior arm may be reserved for refractory cases. Additional maneuvers are rarely necessary for delivery. The number of maneuvers may serve as a measure of the severity of the shoulder dystocia.