Perinatal outcome and the type and number of maneuvers in shoulder dystocia.
OBJECTIVE
To ascertain the type and order of maneuvers that should be used for the treatment 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 four-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.
McFarland
M B
MB
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, USA.
Langer
O
O
Piper
J M
JM
Berkus
M D
MD
D000328:Adult; D000704:Analysis of Variance; D001720:Birth Injuries / Q000517:prevention & control*; D036861:Delivery, Obstetric / Q000379:methods*; D004420:Dystocia / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D012782:Shoulder; D014710:Version, Fetal / Q000379:methods