Management of Shoulder Dystocia

MacKenzie, I.Z.; Shah, Mutayyab; Lean, Katie; Dutton, Susan; Newdick, Helen; Tucker, Danny

doi:10.1097/01.aog.0000287615.35425.5c

Cited by 171 publications

(26 citation statements)

References 28 publications

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“…This finding implies that inadequate screening for glucose intolerance and superficial treatment of diabetes are conducive to these injuries. This being the case, implementation of the proposed measures could probably reduce the rate of shoulder dystocia markedly both in America and in other countries, where its rate has also increased in recent years [1,9,[33][34][35][36]. The "CESDI Committee", having investigated shoulder dystocia related fetal deaths in England, Wales and Northern Ireland, found substandard intrapartum management the most frequent causative factor [3].…”

Section: Discussionmentioning

confidence: 99%

Shoulder dystocia related fetal neurological injuries: the role of diabetic control

Iffy¹,

Brimacombe

Váradi³

et al. 2009

Open Medicine

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AbstractThe study explores the roles of routine prenatal diabetic screening and control in the occurrence of neurological birth injuries associated with shoulder dystocia. The investigation involved retrospective review of 226 medical records that contained information about the antenatal events in cases that resulted in permanent neonatal injuries following arrest of the shoulders at delivery. Close attention was paid to diabetic screening and management of mothers with evidence of glucose intolerance. Analysis of the records revealed that one-third of all women, including those with predisposing factors, received no diabetic screening during pregnancy. The majority of confirmed diabetic patients were not treated adequately. Among babies of diabetic women, birth weights exceeding 4500 g were about 30-fold more frequent than among those with normal glucose tolerance. The data suggest that universal screening and rigid diabetic control, including mothers with borderline glucose tolerance, are effective measures for the prevention of excessive fetal growth and intrapartum complications deriving from it. If ignored, impaired maternal glucose tolerance may become a major predisposing factor for neurological birth injuries. It appears therefore that with routine screening for diabetic predisposition and effective control of gestational diabetes the risk of fetal damage can be reduced substantially.

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Section: Discussionmentioning

confidence: 99%

Shoulder dystocia related fetal neurological injuries: the role of diabetic control

Iffy¹,

Brimacombe

Váradi³

et al. 2009

Open Medicine

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“…The frequency of the injury is independent of the experience of the clinician (Jennett et al 1992;Mollberg et al 2005b;Wolf et al 2000) (Table II) 5. The frequency of Erb's palsy is increasing slightly or remaining the same (Gurewitsch et al 2006;Graham et al 1997;Gordon et al 1973;Bager 1997;MacKenzie et al 2007;Mollberg et al 2005a;Boyd et al 1983;Evans-Jones et al 2003), despite the universal call for gentleness in the literature of the 1980s and early 1990s (Table III) 6. Fracture of the clavicle has been described by Chez (Chez et al 1994) as 'an unpredictable, unavoidable complication of normal labour' (due to maternal labour forces).…”

Section: Erb's Palsy (Bpi): What Is the Cause?mentioning

confidence: 96%

“…Bager (1997) reported an increase of BPI in Sweden from 1980 (1.3/1000) to 1994 (2.2/1000). MacKenzie et al (2007) at the University of Oxford reported that 'by 2001, regular training sessions for labour ward staff on the management of shoulder dystocia were being conducted in our obstetric unit, as in many other units. By 2004, the routine monthly performance indicators of problem deliveries in the unit indicated that there seemed to be an increasing number of cases of shoulder dystocia and possibly also brachial plexus injuries and this prompted the present study'.…”

Section: Is Shoulder Dystocia Under-reported?mentioning

confidence: 99%

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Newborn brachial plexus palsy

Sandmire¹,

DeMott²

2008

Journal of Obstetrics and Gynaecology

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“…Common elements between the various algorithms are to perform McRoberts’ manoeuvre and suprapubic pressure in the first instance, and a failure of these two methods should be followed by other manoeuvres such as rotational methods, posterior arm delivery and all- fours manoeuvre. More injurious manoeuvres such as clavicular fracture, symphysiotomy and Zavanelli manoeuvres are rarely used due to the high success rates of the less invasive manoeuvres [5, 13, 14]. …”

Section: Introductionmentioning

confidence: 99%

Predictive factors for the success of McRoberts’ manoeuvre and suprapubic pressure in relieving shoulder dystocia: a cross-sectional study

Lok

Cheng

Leung

2016

BMC Pregnancy Childbirth

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BackgroundMcRoberts’ and suprapubic pressure are often recommended as the initial choices of manoeuvres to manage shoulder dystocia, as they are believed to be less invasive compared to other manoeuvres. However, their success rates range from 23 to 40 %. This study aims to investigate the predictive factors for the success of McRoberts’ manoeuvre with or without suprapubic pressure (M+/−S).MethodsAll cases of shoulder dystocia in a tertiary hospital in South East Asia were recruited from 1995 to 2009. Subjects were analysed according to either ‘success’ or ‘failure’ of M+/−S. Maternal and fetal antenatal and intrapartum factors were compared by univariate and multivariate analysis.ResultsAmong 198 cases of shoulder dystocia, M+/−S as the primary manoeuvre was successful in 25.8 %. The other 74.2 % needed either rotational or posterior arm manoeuvres or combination of manoeuvres. Instrumental delivery was the single most significant factor associated with an increased risk of failed M+/−S on logistic regression (p < 0.001, OR 4.88, 95 % CI 2.05–11.60). The success rate of M+/−S was only 15.0 % if shoulder dystocia occurred after instrumental delivery but was 47.7 % after spontaneous vaginal delivery.ConclusionsWhen shoulder dystocia occurs after instrumental vaginal delivery, the chance of failure of M+/−S is 85 %, which is 4.7 times higher than that after spontaneous vaginal delivery. Hence all operators performing instrumental delivery should be proficient in performing all manoeuvres to relieve shoulder dystocia when M+/−S cannot do so.

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Management of Shoulder Dystocia

Abstract: II.

Cited by 171 publications

References 28 publications

Shoulder dystocia related fetal neurological injuries: the role of diabetic control

Shoulder dystocia related fetal neurological injuries: the role of diabetic control

Newborn brachial plexus palsy

Predictive factors for the success of McRoberts’ manoeuvre and suprapubic pressure in relieving shoulder dystocia: a cross-sectional study

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