Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review

Objective To evaluate the different types and sequences of manoeuvres to overcome shoulder dystocia and the rates of associated fetal injury. Design Retrospective review. Setting A university hospital. Population Pregnancies complicated with shoulder dystocia from 1995 to 2009. Methods Cases were identified from the hospital electronic delivery records. Main outcome measures The success rate between McRoberts' manoeuvre, rotational methods and posterior arm delivery, and the incidences of brachial plexus injury (BPI), clavicular fracture (CF) and humeral fracture (HF) according to the types and sequences of manoeuvres applied to overcome shoulder dystocia. Results Among 205 cases identified, McRoberts' manoeuvre was successful initially in 25% of cases, of which 7.8% suffered from BPI and 3.9% suffered from CF, but none had HF. In the failed cases, subsequent rotational methods and posterior arm delivery were similarly successful (72.0 versus 63.6%), whereas the former was associated with less BPI (4.4 versus 21.4%) and HF (1.1 versus 7.1%) despite similar risk of CF (5.6 versus 7.1%). The rotational methods were not associated with a higher fetal injury risk compared with McRoberts' manoeuvre. The remaining cases were managed by applying the third yet untried manoeuvre, and posterior arm delivery and rotational methods had similar success (77.1 versus 62.5%). The cumulative success rates after the second and the third manoeuvres were 79.0 and 94.6%, respectively. Conclusion Following the failure of McRoberts' manoeuvre, subsequent application of rotational methods and posterior arm delivery have similarly high success rates but the former may be associated with less fetal injury.