title: Is fetal manipulation during shoulder dystocia management associated with severe maternal and neonatal morbidities?
abstract: There is a lack of data regarding maternal morbidity and neonatal hypoxia associated with shoulder dystocia (SD), particularly with respect to whether SD is managed with our without fetal manipulation (FM). Our main objective was to compare severe maternal and neonatal morbidities associated with SD according to FM execution.
  
  
  
  We conducted a retrospective study based on a medical record analysis that included all SD cases from 2007 to 2012. SD was considered when additional maneuvers were required to complete a delivery. Severe maternal morbidity was defined as the occurrence of an obstetric anal sphincter injury. Severe neonatal morbidity was defined as the occurrence of one of these complications: permanent brachial plexus palsy, arterial cord pH < 7.1, Apgar score < 7 at 5 min. We compared severe maternal and neonatal morbidities in the FM and the no-FM group.
  
  
  
  We report an SD incidence of 2.4 % (n = 227) with 93.8 % of patients treated without FM. We identified two cases of permanent brachial plexus palsy, fifteen cases of arterial cord pH < 7.1 and six cases with an Apgar score < 7 at 5 min; all of them were from the no-FM group. There were more cases of OASI in the FM group (odd ratio = 9.2 [1.32-50.71]). No statistical differences between these groups were observed with respect to severe neonatal morbidity.
  
  
  
  Severe neonatal morbidity does not appear to be associated with FM during SD management, but severe maternal morbidity is associated with FM execution.
authors.affiliation: Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France. bertrand.gachon@gmail.com.|Poitiers Medical University, Poitiers, France. bertrand.gachon@gmail.com.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Gachon
authors.affiliation: Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France.|Poitiers Medical University, Poitiers, France.
authors.forename: David
authors.initials: D
authors.lastname: Desseauve
authors.affiliation: Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France.|Poitiers Medical University, Poitiers, France.|INSERM CIC802, University Hospital of Poitiers, Poitiers University, Poitiers, France.|INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, Paris-Sud University, UMRS 1018, Kremlin-Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Fritel
authors.affiliation: Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France.|Poitiers Medical University, Poitiers, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Pierre
mesh_terms: D001003:Anal Canal / Q000293:injuries; D001034:Apgar Score; D020516:Brachial Plexus Neuropathies / Q000209:etiology; D004420:Dystocia / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009017:Morbidity; D011247:Pregnancy; D012189:Retrospective Studies; D012782:Shoulder
keywords: Fetal manipulation; Neonatal morbidity; Obstetric anal sphincter injury; Shoulder dystocia; Training programs