[Shoulder dystocia, an analysis at hôpital Foch of Suresnes].
OBJECTIVE
To analyse the management of a series of shoulder dystocias with respect to the Anglo-Saxon recommendations. The study also analysed the maternal and neonatal morbidity associated with this incident.


METHODS
Retrospective study at hôpital Foch of Suresnes between January 2004 and December 2008, including the difficulties and shoulder dystocias.


RESULTS
The study is noted 192 shoulder dystocias, an incidence of about 2%. Mc Roberts's maneuver and suprapublic pressure were employed in first intention in 85.9% of the dystocias and were effective alone in 58.6% of the cases. Counter-rotation and abdominal expression were respectively used in 19.6 and 14.1% of the cases, even through they are not recommended in this situation. Six third degree perinatal lesions (3.1%) and nine lesions of the brachial plexus (4.7%) were observed although a causal link was not revealed between the type of maneuver used and the lesions observed.


CONCLUSIONS
Mc Roberts maneuver and supraprubic pressure, which had to be execute in first intention in case of shoulder dystocia, seem to be acquire by obstetricians and midwifes. However, other maneuvers not recommended are used and should be forbidden. That's why, our learned societies should publish Recommendations for Clinical Practice for the care of shoulder dystocia, in the purpose of the harmonisation of our practices, will help improve the care of the shoulder dystocia. The perpetual training of the manoeuvres seems also to be essential.
Hôpital Antoine-Béclère, Clamart, France. i.monier@hotmail.fr
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Monier
D000293:Adolescent; D000328:Adult; D004420:Dystocia / Q000628:therapy*; D005260:Female; D006761:Hospitals; D006801:Humans; D007746:Labor Presentation; D011247:Pregnancy; D012189:Retrospective Studies; D012782:Shoulder; D055815:Young Adult