title: [Management of shoulder dystocia].
abstract: OBJECTIVE
  The objective of this review is to propose recommendations on the management of shoulder dystocia.
  
  
  METHODS
  The PubMed database, the Cochrane Library and the recommendations from the foreign obstetrical societies or colleges have been consulted.
  
  
  RESULTS
  In case of shoulder dystocia, if the obstetrician is not present at delivery, he should be systematically informed as quickly as possible (professional consensus). A third person should also be called for help in order to realize McRoberts maneuver (professional consensus). The patient has to be properly installed in gynecological position (professional consensus). It is recommended not to pull excessively on the fetal head (grade C), do not perform uterine expression (grade C) and do not realize inverse rotation of the fetal head (professional consensus). McRoberts maneuver, with or without a suprapubic pressure, is simple to perform, effective and associated with low morbidity, thus, it is recommended in the first line (grade C). Regarding the maneuvers of the second line, the available data do not suggest the superiority of one maneuver in relation to another (grade C). We proposed an algorithm; however, management should be adapted to the experience of the operator. If the posterior shoulder is engaged, Wood's maneuver should be performed preferentially; if the posterior shoulder is not engaged, delivery of the posterior arm should be performed preferentially (professional consensus). Routine episiotomy is not recommended in shoulder dystocia (professional consensus). Other second intention maneuvers are described. It seems necessary to know at least two maneuvers to perform in case of shoulder dystocia unresolved by the maneuver McRoberts (professional consensus).
  
  
  CONCLUSIONS
  All physicians and midwives should know and perform obstetric maneuvers if needed quickly but without precipitation.
authors.affiliation: Maternité Port-Royal, hôpital Cochin, Assistance publique des Hôpitaux de Paris, université Paris Descartes, 53, avenue de l'Observatoire, 75014 Paris, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, DHU risques et grossesse, université Paris Descartes, Sorbonne Paris Cité, 75014 Paris, France. Electronic address: camille.le-ray@aphp.fr.
authors.forename: C
authors.initials: C
authors.lastname: Le Ray
authors.affiliation: Maternité de l'hôpital Robert-Debré, université Paris Diderot, Assistance publique des Hôpitaux de Paris, 75019 Paris, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Oury
mesh_terms: D001720:Birth Injuries / Q000517:prevention & control; D036861:Delivery, Obstetric / Q000379:methods* / Q000592:standards*; D004420:Dystocia / Q000175:diagnosis / Q000628:therapy*; D005113:Extraction, Obstetrical / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011247:Pregnancy; D012782:Shoulder
keywords: Algorithme de prise en charge; Dystocie des épaules; Management algorithm; Manœuvres obstétricales; Obstetrical maneuvers; Shoulder dystocia