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Cochrane Database of Systematic Reviews

Intrapartum interventions for preventing shoulder dystocia

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

Chaturica Athukorala, Philippa Middleton, Caroline A Crowther


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 140 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 135 96%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 26 19%
Student > Master 23 16%
Student > Ph. D. Student 22 16%
Other 8 6%
Researcher 6 4%
Other 24 17%
Unknown 31 22%
Readers by discipline Count As %
Medicine and Dentistry 59 42%
Nursing and Health Professions 15 11%
Psychology 9 6%
Social Sciences 8 6%
Agricultural and Biological Sciences 4 3%
Other 9 6%
Unknown 36 26%