Impact of shoulder dystocia, stratified by type of manoeuvre, on severe neonatal outcome and maternal morbidity

Michelotti, Flurina , Flatley, Christopher and Kumar, Sailesh (2017) Impact of shoulder dystocia, stratified by type of manoeuvre, on severe neonatal outcome and maternal morbidity. The Australian and New Zealand Journal of Obstetrics and Gynaecology, . doi:10.1111/ajo.12718


Author Michelotti, Flurina
Flatley, Christopher
Kumar, Sailesh
Title Impact of shoulder dystocia, stratified by type of manoeuvre, on severe neonatal outcome and maternal morbidity
Journal name The Australian and New Zealand Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1479-828X
0004-8666
Publication date 2017-09-14
Year available 2017
Sub-type Article (original research)
DOI 10.1111/ajo.12718
Open Access Status Not yet assessed
Total pages 8
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Abstract Shoulder dystocia is an uncommon and unpredictable obstetric emergency. It is associated with significant neonatal, maternal and medico-legal consequences.

To ascertain the impact shoulder dystocia has on severe neonatal and maternal outcomes specific to the type of manoeuvre.

This was a retrospective study of 48 021 term singleton vaginal deliveries the Mater Mothers' Hospital in Brisbane between 2007 and 2015. Maternal and neonatal outcomes were compared between deliveries complicated by shoulder dystocia and those uncomplicated.

Deliveries complicated by shoulder dystocia are associated with low Apgar scores (≤3) at five minutes (odds ratio (OR) 5.25, 95% CI 3.23-8.56, P < 0.001), acidosis (OR 3.10, 95% CI 2.76-3.50, P < 0.001), postpartum haemorrhage (OR 2.28, 95% CI 1.90-2.75, P < 0.001) and perineal trauma (OR 1.92, 95% CI 1.54-2.39, P < 0.001). Compared to McRoberts' manoeuvre and suprapubic pressure alone, the odds of serious neonatal outcome are increased with internal rotational manoeuvres (OR 3.82, 95% CI 2.54-5.74, P < 0.001) and delivery of the posterior arm (OR 4.49, 95% CI 3.54-5.69, P < 0.001). The OR of maternal injury is 2.07 (95% CI 1.77-2.45, P < 0.001), 2.26 (95% CI 1.21-4.21, P < 0.001) and 2.29 (95% CI 1.58-3.32, P < 0.001) with McRoberts'/suprapubic pressure, internal rotation and posterior arm delivery, respectively. Brachial plexus injuries and fractures complicate 1.4 and 0.9% of deliveries, with the risk of injury increasing when greater than one manoeuvre is required.

The risk of neonatal and maternal trauma is strongly associated with the number and types of manoeuvres. Given the associated implications, adequate antenatal counselling, simulation training and enhanced labour surveillance are essential.
Keyword McRoberts' manoeuvre
birth injury
brachial plexus injury
shoulder dystocia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
HERDC Pre-Audit
School of Medicine Publications
 
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Created: Wed, 01 Nov 2017, 10:32:23 EST by Johanna Barclay on behalf of Mater Research Institute-UQ