A Comparison of Obstetric Maneuvers for the Acute Management of Shoulder Dystocia

被引:70
作者
Hoffman, Matthew K.
Bailit, Jennifer L.
Branch, D. Ware
Burkman, Ronald T.
Van Veldhusien, Paul
Lu, Li
Kominiarek, Michelle A.
Hibbard, Judith U.
Landy, Helain J.
Haberman, Shoshana
Wilkins, Isabelle
Quintero, Victor H. Gonzalez
Gregory, Kimberly D.
Hatjis, Christos G.
Ramirez, Mildred M.
Reddy, Uma M.
Troendle, James
Zhang, Jun
机构
[1] Christiana Care Hlth Syst, Newark, DE USA
[2] Case Western Reserve Univ, Metrohlth Med Ctr, Cleveland, OH USA
[3] Univ Utah, Salt Lake City, UT USA
[4] Intermt Healthcare, Salt Lake City, UT USA
[5] Tufts Univ, Baystate Med Ctr, Springfield, MA USA
[6] EMMES Corp, Rockville, MD USA
[7] Indiana Univ Clarian Hlth, Indianapolis, IN USA
[8] Univ Illinois, Chicago, IL USA
[9] Georgetown Univ Hosp, MedStar Hlth, Washington, DC 20007 USA
[10] Maimonides Hosp, Brooklyn, NY 11219 USA
[11] Univ Miami, Miami, FL USA
[12] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA
[13] Akron City Hosp, Summa Hlth Syst, Akron, OH USA
[14] Univ Texas Hlth Sci Ctr Houston, Houston, TX USA
[15] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Pregnancy & Perinatol Branch, NIH, Bethesda, MD USA
[16] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Div Epidemiol Stat & Prevent Res, NIH, Bethesda, MD USA
基金
美国国家卫生研究院;
关键词
DELIVERY;
D O I
10.1097/AOG.0b013e31821a12c9
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: To assess the efficacy of obstetric maneuvers for resolving shoulder dystocia and the effect that these maneuvers have on neonatal injury when shoulder dystocia occurs. METHODS: Using an electronic database encompassing 206,969 deliveries, we identified all women with a vertex fetus beyond 34 0/7 weeks of gestation who incurred a shoulder dystocia during the process of delivery. Women whose fetuses had a congenital anomaly and women with an antepartum stillbirth were excluded. Medical records of all cases were reviewed by trained abstractors. Cases involving neonatal injury (defined as brachial plexus injury, clavicular or humerus fracture, or hypoxic-ischemic encephalopathy or intrapartum neonatal death attributed to the shoulder dystocia) were compared with those without injury. RESULTS: Among 132,098 women who delivered a term cephalic liveborn fetus vaginally, 2,018 incurred a shoulder dystocia (1.5%), and 101 (5.2%) of these incurred a neonatal injury. Delivery of the posterior shoulder was associated with the highest rate of delivery when compared with other maneuvers (84.4% compared with 24.3-72.0% for other maneuvers; P<.005 to P<.001) and similar rates of neonatal injury (8.4% compared with 6.1-14.0%; P=.23 to P=.7). The total number of maneuvers performed significantly correlated with the rate of neonatal injury (P<.001). CONCLUSION: Delivery of the posterior shoulder should be considered following the McRoberts maneuver and suprapubic pressure in the management of shoulder dystocia. The need for additional maneuvers was associated with higher rates of neonatal injury. (Obstet Gynecol 2011;117:1272-8) DOI: 10.1097/AOG.0b013e31821a12c9
引用
收藏
页码:1272 / 1278
页数:7
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