May 29th, 2022

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All-Fours Maneuver for Reducing Shoulder Dystocia During Labor
Authors:  Joseph P. Bruner, M.D., Susan B. Drummond, R.N., M.S.N., Anna L. Meenan, M.D., and Ina May Gaskin, M.A., C.P.M.
  OBJECTIVE: To report on a large amount of clinical experience with shoulder dystocia managed primarily with the all-fours maneuver.

STUDY DESIGN: The all-fours maneuver consists of moving the laboring patient to her hands and knees. Eighty-two consecutive cases of shoulder dystocia managed with this technique were reported to a registry through January 1996.

RESULTS: The incidence of shoulder dystocia was 1.8%, and half of the newborns weighed #4,000 g. Sixty-eight women (83%) delivered without the need for any additional maneuvers. The mean diagnosis-to-delivery interval was 2.31.0 (SD) minutes (range, 1-6). No maternal or perinatal mortality occurred. Morbidity was noted in only four deliveries: a single case of postpartum hemorrhage that did not require transfusion (maternal morbidity, 1.2%), one infant with a fractured humerus and three with low Apgar scores (neonatal morbidity, 4.9%). All morbidity occurred in cases with a birth weight >4,500 g (P=.0009).

CONCLUSION: The all-fours maneuver appears to be a rapid, safe and effective technique for reducing shoulder dystocia in laboring women. (J Reprod Med 1998;43: 439-443)
Keywords:  shoulder; dystocia; labor complications; all-fours maneuver
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