Which Maneuvers Work Best for Shoulder Dystocia?

Shoulder dystocia is a technically demanding obstetric emergency. To evaluate the efficacy and safety of various obstetric maneuvers for managing this condition, researchers analyzed data from 2018 cases of shoulder dystocia that occurred during 132,098 term deliveries attended by physicians, midwives, and residents at multiple U.S. centers in the Consortium on Safe Labor. In all, 101 neonatal injuries attributable to shoulder dystocia occurred, most commonly Erb palsy (59%) and clavicular fractures (39%). Eight fetuses had multiple injuries, and six experienced hypoxic–ischemic encephalopathy; no neonatal deaths occurred.

In 10 of 12 centers, McRoberts maneuver (flexion of maternal thighs onto the abdomen) and suprapubic pressure were first…