• T Y Leung, O Stuart, S S H Suen, D S Sahota, T K Lau, and T T Lao.
• Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, China. tyleung@cuhk.edu.hk
• BJOG. 2011 Jul 1; 118 (8): 985-90.

ObjectiveTo evaluate the different types and sequences of manoeuvres to overcome shoulder dystocia and the rates of associated fetal injury.DesignRetrospective review.SettingA university hospital.PopulationPregnancies complicated with shoulder dystocia from 1995 to 2009.MethodsCases were identified from the hospital electronic delivery records.Main Outcome MeasuresThe success rate between McRoberts' manoeuvre, rotational methods and posterior arm delivery, and the incidences of brachial plexus injury (BPI), clavicular fracture (CF) and humeral fracture (HF) according to the types and sequences of manoeuvres applied to overcome shoulder dystocia.ResultsAmong 205 cases identified, McRoberts' manoeuvre was successful initially in 25% of cases, of which 7.8% suffered from BPI and 3.9% suffered from CF, but none had HF. In the failed cases, subsequent rotational methods and posterior arm delivery were similarly successful (72.0 versus 63.6%), whereas the former was associated with less BPI (4.4 versus 21.4%) and HF (1.1 versus 7.1%) despite similar risk of CF (5.6 versus 7.1%). The rotational methods were not associated with a higher fetal injury risk compared with McRoberts' manoeuvre. The remaining cases were managed by applying the third yet untried manoeuvre, and posterior arm delivery and rotational methods had similar success (77.1 versus 62.5%). The cumulative success rates after the second and the third manoeuvres were 79.0 and 94.6%, respectively.ConclusionFollowing the failure of McRoberts' manoeuvre, subsequent application of rotational methods and posterior arm delivery have similarly high success rates but the former may be associated with less fetal injury.© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

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