THE MCROBERTS MANEUVER FOR THE ALLEVIATION OF SHOULDER DYSTOCIA - HOWSUCCESSFUL IS IT

OBJECTIVE: Our purpose was to determine the rate of success of the McR oberts' maneuver as the initial treatment for shoulder dystocia and to compare the rate of maternal and neonatal morbidity with those cases of shoulder dystocia requiring additional obstetric maneuvers. A secon dary goal was to assess those factors associated with successful McRob erts' maneuvers. STUDY DESIGN: A retrospective review of shoulder dyst ocia cases occurring between 1991 and 1994 was performed. The identifi ed cases were divided into two groups on the basis of the maneuvers us ed to relieve the shoulder dystocia. The first group comprised cases i n which the McRoberts' maneuver was used as the sole treatment and the second group consisted of cases in which additional maneuvers were su bsequently used. Exclusion criteria included lack of documentation con cerning the maneuvers used or cases in which the McRoberts' maneuver w as not the initial technique used. The two groups were compared with r espect to various antepartum, intrapartum, and neonatal characteristic s. RESULTS: During the study period we identified 250 cases of shoulde r dystocia among 44,072 vaginal deliveries, for an incidence of 0.57%. Of these, 236 cases (94%) fulfilled entry criteria. The McRoberts' po sition alone successfully alleviated the shoulder dystocia in 98 cases (42%). In the group of cases where the McRoberts' maneuver was the so le maneuver used, there were significantly lower mean birth weights (p = 0.008), shorter durations of the active phase of labor (p = 0.009), and shorter second stages (p < 0.0001). In the group of cases that re quired additional maneuvers to relieve the shoulder dystocia, there wa s a trend toward an increased incidence of postpartum hemorrhage and b rachial plexus injury (p = 0.07). CONCLUSIONS: These data suggest that the McRoberts' maneuver is associated with a significant degree of su ccess in relieving shoulder dystocia and may be associated with decrea sed morbidity compared with other maneuvers. On the basis of these fin dings, we recommend the McRoberts' maneuver as the initial technique f or disimpaction of the anterior shoulder.