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Intrapartum interventions for preventing shoulder dystocia

Overview of attention for article published in Cochrane database of systematic reviews, October 2006
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Title
Intrapartum interventions for preventing shoulder dystocia
Published in
Cochrane database of systematic reviews, October 2006
DOI 10.1002/14651858.cd005543.pub2
Pubmed ID
Authors

Chaturica Athukorala, Philippa Middleton, Caroline A Crowther

Abstract

The early management of shoulder dystocia involves the administration of various manoeuvres which aim to relieve the dystocia by manipulating the fetal shoulders and increasing the functional size of the maternal pelvis. To assess the effects of prophylactic manoeuvres in preventing shoulder dystocia. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 June 2006). Randomised controlled trials comparing the prophylactic implementation of manoeuvres and maternal positioning with routine or standard care. Two review authors independently applied exclusion criteria, assessed trial quality and extracted data. Two trials were included; one comparing the McRobert's manoeuvre and suprapubic pressure with no prophylactic manoeuvres in 185 women likely to give birth to a large baby and one trial comparing the use of the McRobert's manoeuvre versus lithotomy positioning in 40 women. We decided not to pool the results of the two trials. One study reported fifteen cases of shoulder dystocia in the therapeutic (control) group compared to five in the prophylactic group (relative risk (RR) 0.44, 95% confidence interval (CI) 0.17 to 1.14) and the other study reported one episode of shoulder dystocia in both prophylactic and lithotomy groups. In the first study, there were significantly more caesarean sections in the prophylactic group and when these were included in the results, significantly fewer instances of shoulder dystocia were seen in the prophylactic group (RR 0.33, 95% CI 0.12 to 0.86). In this study, thirteen women in the control group required therapeutic manoeuvres after delivery of the fetal head compared to three in the treatment group (RR 0.31, 95% CI 0.09 to 1.02). One study reported no birth injuries or low Apgar scores recorded. In the other study, one infant in the control group had a brachial plexus injury (RR 0.44, 95% CI 0.02 to 10.61), and one infant had a five-minute Apgar score less than seven (RR 0.44, 95% CI 0.02 to 10.61). There are no clear findings to support or refute the use of prophylactic manoeuvres to prevent shoulder dystocia, although one study showed an increased rate of caesareans in the prophylactic group. Both included studies failed to address important maternal outcomes such as maternal injury, psychological outcomes and satisfaction with birth. Due to the low incidence of shoulder dystocia, trials with larger sample sizes investigating the use of such manoeuvres are required.

Mendeley readers

The data shown below were compiled from readership statistics for 75 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Ireland 1 1%
Italy 1 1%
Australia 1 1%
Brazil 1 1%
United States 1 1%
Unknown 70 93%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 17 23%
Student > Ph. D. Student 15 20%
Student > Master 11 15%
Other 6 8%
Researcher 5 7%
Other 10 13%
Unknown 11 15%
Readers by discipline Count As %
Medicine and Dentistry 37 49%
Psychology 7 9%
Nursing and Health Professions 6 8%
Social Sciences 4 5%
Agricultural and Biological Sciences 2 3%
Other 2 3%
Unknown 17 23%