Posterior shoulder delivery is best strategy for managing shoulder dystocia

Delivering the baby’s posterior shoulder works better than other maneuvers to manage shoulder dystocia when McRoberts maneuver and suprapubic pressure are unsuccessful, reports a new multicenter study published in Obstetrics and Gynecology (2011;117[6]:1272-1278).

The researchers examined data on 132,098 women who delivered a term, cephalic, liveborn fetus vaginally. Shoulder dystocia occurred in 2,018 (1.5%) of the women; 101(5.2%) incurred a neonatal injury. Delivery of the posterior shoulder had a higher rate of successful delivery than other maneuvers (84.4% compared with 24.3% to 72%) and a similar rate of neonatal injury (8.4% compared with 6.1% to 14%). The total number of maneuvers performed correlated significantly with the rate of neonatal injury (defined as brachial plexus injury, clavicular or humerus fracture, hypoxic-ischemic encephalopathy, or intrapartum neonatal death attributed to the shoulder dystocia) (P

“We were able to clearly demonstrate that delivery of the posterior shoulder was superior to other maneuvers in the acute management of shoulder dystocia with a comparable rate of neonatal injury,” the authors write. “Based on our data, we strongly encourage the use of early maneuvers to deliver the posterior shoulder when a shoulder dystocia is encountered.”

The researchers add that “our analysis validates that McRoberts maneuver and suprapubic pressure are widely practiced as the primary steps to relieve shoulder dystocia and that these maneuvers are associated with low rates of neonatal injury.” They note: “because quick resolution of shoulder dystocia is the primary goal, delivery of the posterior shoulder after the less technically demanding maneuvers of McRoberts and suprapubic pressure would be an appropriate approach.”

Consistent with the findings of other investigations, this study found that the risk of neonatal injury increased with the number of maneuvers performed “further strengthens the argument for using the most effective maneuver (ie, delivery of the posterior shoulder) earlier in the approach to cases of shoulder dystocia,” the authors observe.