title: All-fours maneuver for reducing shoulder dystocia during labor.
abstract: OBJECTIVE
  To report on a large amount of clinical experience with shoulder dystocia managed primarily with the all-fours maneuver.
  
  
  METHODS
  The all-fours maneuver consists of moving the laboring patient to her hands and knees. Eighty-two consecutive cases of shoulder dystocia managed with this technique were reported to a registry through January 1996.
  
  
  RESULTS
  The incidence of shoulder dystocia was 1.8%, and half of the newborns weighed > or = 4,000 g. Sixty-eight women (83%) delivered without the need for any additional maneuvers. The mean diagnosis-to-delivery interval was 2.3 +/- 1.0 (SD) minutes (range, 1-6). No maternal or perinatal mortality occurred. Morbidity was noted in only four deliveries: a single case of postpartum hemorrhage that did not require transfusion (maternal morbidity, 1.2%), one infant with a fractured humerus and three with low Apgar scores (neonatal morbidity, 4.9%). All morbidity occurred in cases with a birth weight > 4,500 g (P = .0009).
  
  
  CONCLUSIONS
  The all-fours maneuver appears to be a rapid, safe and effective technique for reducing shoulder dystocia in laboring women.
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232-2519, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Bruner
authors.forename: S B
authors.initials: SB
authors.lastname: Drummond
authors.forename: A L
authors.initials: AL
authors.lastname: Meenan
authors.forename: I M
authors.initials: IM
authors.lastname: Gaskin
mesh_terms: D001034:Apgar Score; D001720:Birth Injuries / Q000517:prevention & control; D001724:Birth Weight; D004420:Dystocia / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011187:Posture; D011247:Pregnancy; D012782:Shoulder; D013997:Time Factors