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Is fetal manipulation during shoulder dystocia management associated with severe maternal and neonatal morbidities?

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

There is a lack of data regarding maternal morbidity and neonatal hypoxia associated with shoulder dystocia (SD), particularly with respect to whether SD is managed with our without fetal manipulation (FM). Our main objective was to compare severe maternal and neonatal morbidities associated with SD according to FM execution.

Methods

We conducted a retrospective study based on a medical record analysis that included all SD cases from 2007 to 2012. SD was considered when additional maneuvers were required to complete a delivery. Severe maternal morbidity was defined as the occurrence of an obstetric anal sphincter injury. Severe neonatal morbidity was defined as the occurrence of one of these complications: permanent brachial plexus palsy, arterial cord pH < 7.1, Apgar score < 7 at 5 min. We compared severe maternal and neonatal morbidities in the FM and the no-FM group.

Results

We report an SD incidence of 2.4 % (n = 227) with 93.8 % of patients treated without FM. We identified two cases of permanent brachial plexus palsy, fifteen cases of arterial cord pH < 7.1 and six cases with an Apgar score < 7 at 5 min; all of them were from the no-FM group. There were more cases of OASI in the FM group (odd ratio = 9.2 [1.32–50.71]). No statistical differences between these groups were observed with respect to severe neonatal morbidity.

Conclusions

Severe neonatal morbidity does not appear to be associated with FM during SD management, but severe maternal morbidity is associated with FM execution.

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Acknowledgments

We wish to thank Mrs. Severine Besson and Mrs. Catherine Sergueenkoff for their contributions to a standardized description of SD management in patient’s medical data. We are also grateful to the midwives and obstetricians who worked in our labor ward for their contributions to everyday data collection.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France

    Bertrand Gachon, David Desseauve, Xavier Fritel & Fabrice Pierre

  2. Poitiers Medical University, Poitiers, France

    Bertrand Gachon, David Desseauve, Xavier Fritel & Fabrice Pierre

  3. INSERM CIC802, University Hospital of Poitiers, Poitiers University, Poitiers, France

    Xavier Fritel

  4. INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, Paris-Sud University, UMRS 1018, Kremlin-Bicêtre, France

    Xavier Fritel

Authors
  1. Bertrand Gachon
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  2. David Desseauve
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  3. Xavier Fritel
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  4. Fabrice Pierre
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Corresponding author

Correspondence to Bertrand Gachon.

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No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest. The authors have full control of all primary data and they agree to allow the journal to review their data if requested.

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Gachon, B., Desseauve, D., Fritel, X. et al. Is fetal manipulation during shoulder dystocia management associated with severe maternal and neonatal morbidities?. Arch Gynecol Obstet 294, 505–509 (2016). https://doi.org/10.1007/s00404-016-4013-1

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  • DOI: https://doi.org/10.1007/s00404-016-4013-1

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