Is anterior Rubin's manuever best choice for shoulder dystocia?

In a simulator study comparing McRoberts', anterior Rubin's, and posterior Rubin's maneuvers for initial management of shoulder dystocia, researchers from Johns Hopkins found that anterior Rubin's maneuver required the least traction for delivery and produced the least amount of brachial plexus tension.

Using a laboratory birthing simulator, a single operator performed 30 simulated shoulder dystocia deliveries (10 with each of the three maneuvers), following each with standard downward traction.

The authors found that Rubin's maneuvers required less traction than McRoberts': 16.2 ± 2.1 lb for McRoberts' compared with 8.8± 2.2 lb and 6.5 ± 1.8 lb for posterior and anterior Rubin's, respectively (P<0.0001). Of course, they warned that further study is needed to validate these findings in clinical practice.