title: Neonatal morbidity associated with shoulder dystocia maneuvers.
abstract: OBJECTIVE
  We sought to examine neonatal morbidity associated with different maneuvers used among term patients who experience a shoulder dystocia.
  
  
  METHODS
  We conducted a retrospective cohort study of all women who experienced a clinically diagnosed shoulder dystocia at term requiring obstetric maneuvers at a single tertiary care hospital from 2005 through 2008. We excluded women with major fetal anomaly, intrauterine death, multiple gestation, and preterm. Women exposed to Rubin maneuver, Wood's screw maneuver, or delivery of the posterior arm were compared to women delivered by McRoberts/suprapubic pressure only, which served as the reference group. The primary outcome was a composite morbidity of neonatal injury (defined as clavicular or humeral fracture or brachial plexus injury) and neonatal depression (defined as Apgar <7 at 5 minutes, arterial cord pH <7.1, continuous positive airway pressure use, intubation, or respiratory distress). Logistic regression was used to adjust for nulliparity and duration of shoulder dystocia, defined as time from delivery of fetal head to delivery of shoulders.
  
  
  RESULTS
  Among the 231 women who met inclusion criteria, 135 were delivered by McRoberts/suprapubic pressure alone (57.9%), 83 women were exposed to Rubin maneuver, 53 women were exposed to Wood's screw, and 36 women were exposed to delivery of posterior arm. Individual maneuvers were not associated with composite morbidity, neonatal injury, or neonatal depression after adjusting for nulliparity and duration of shoulder dystocia.
  
  
  CONCLUSIONS
  We found no association between shoulder dystocia maneuvers and neonatal morbidity after adjusting for duration, a surrogate for severity. Our results demonstrate that clinicians should utilize the maneuver most likely to result in successful delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO. Electronic address: spainj@wudosis.wustl.edu.
authors.forename: Janine E
authors.initials: JE
authors.lastname: Spain
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Frey
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Methodius G
authors.initials: MG
authors.lastname: Tuuli
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Ryan
authors.initials: R
authors.lastname: Colvin
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D001917:Brachial Plexus / Q000293:injuries*; D002968:Clavicle / Q000293:injuries*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D004420:Dystocia / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012784:Shoulder Fractures / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: neonatal morbidity; shoulder dystocia; shoulder dystocia maneuvers