PERINATAL OUTCOME AND THE TYPE AND NUMBER OF MANEUVERS IN SHOULDER DYSTOCIA

Objectives: To ascertain the type and order of maneuvers that should b e used for the treatment of shoulder dystocia; and to attempt to quant ify the severity of shoulder dystocia, and to determine its correlatio n with perinatal outcome. Methods: We reviewed all consecutive cases o f shoulder dystocia from January 1986 to August 1994 in our institutio n to obtain the type, order and number of maneuvers used for delivery. Patients were stratified by the number of maneuvers required for deli very. Outcome parameters included cord pH, Apgar score, neonatal traum a (Erb's palsy and fracture), and maternal trauma. Results: The incide nce of shoulder dystocia was 0.7% (39 280 total vaginal deliveries). U se of only two maneuvers, McRoberts and suprapubic pressure, resulted in resolution in 58% of cases. The addition of the Woods screw maneuve r and/or delivery of the posterior arm was sufficient in all remaining cases. The rates of neonatal palsy and fracture, and maternal fourth- degree laceration, increased with the number of maneuvers. Conclusions : The McRoberts maneuver and suprapubic pressure should be first-line treatment for shoulder dystocia. More difficult and damaging maneuvers such as Woods screw and delivery of the posterior arm may be reserved for refractory cases. Additional maneuvers are rarely necessary for d elivery. The number of maneuvers may serve as a measure of the severit y of the shoulder dystocia. Copyright (C) 1996 International Federatio n of Gynecology and Obstetrics.