Shoulder dystocia: obstetric maneuvers and its morbidity

• Main Author: Afonso,Maria Carvalho
• Publication Date: 2017
• Other Authors: Fonseca,Andreia, Clode,Nuno, Graça,Luis Mendes
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-58302017000100005
• topic: Shoulder dystocia; Obstetric emergency; Obstetric maneuvers; Maternal morbidity; Neonatal morbidity

Introduction: Shoulder dystocia (SD) is known for being an unpredictable and unpreventable event associated to substantial morbidity to the mother and neonate. The aim of this study was to determine the incidence of SD in a tertiary care hospital and the morbidity according to the type of maneuvers (McRoberts' maneuver and suprapubic pressure versus rotational maneuvers or delivery of the posterior arm) used to resolve the dystocia. Methods: This was a prospective cohort study of pregnancies complicated with SD carried during two years and a half. Maternal characteristics, duration of second stage of labor, type of delivery, fetal weight, neonatal morbidity (Apgar score <7 at 1st minute, type of injury, neonatal intensive care unit admission) and maternal morbidity (3rd or 4th degree laceration, cervical tear, post-partum hemoglobin < 8g/dL, perineal haematoma, post-partum fever, dehiscence of episiotomy) were collected. According to the maneuver performed, data were compared using Chi-square test, Fischer exact test or Student t test, as appropriate. A p-value of < 0,05 was considered significant. Results: During the study period 123 (3.3%) pregnancies were complicated with SD. Baseline patient characteristics for age, parity, BMI, weight gain did not vary significantly according to type of maneuver. Rotational maneuvers and delivery of the posterior arm were associated to longer second stage of labour (60 min vs 45 min), higher proportion of instruments applied in a transverse fetal head position (30%) and increased neonatal (45%) and maternal (27%) morbidity. Conclusion: Although rare, SD is associated to increased neonatal and maternal morbidity, specifically when rotational maneuvers and delivery of posterior arm are used.