Olivier Poujade1, Elie Azria2, Pierre-François Ceccaldi3, Carine Davitian4, Carine Khater4, Paul Chatel3, Emilie Pernin3, Nizar Aflak4, Martin Koskas2, Agnès Bourgeois-Moine5, Laurence Hamou-Plotkine5, Morgane Valentin5, Jean-Paul Renner6, Carine Roy7, Candice Estellat8, Dominique Luton9. 1. AP-HP, Beaujon Hospital, Department of Obstetrics and Gynecology, 100 Boulevard du General Leclerc, 92110, Clichy, France; DHU Risks in Pregnancy, 75014, Paris, France. Electronic address: olivierpoujade@hotmail.com. 2. DHU Risks in Pregnancy, 75014, Paris, France; AP-HP, Bichat-Claude Bernard Hospital, Department of Obstetrics and Gynecology, 46 rue Henri-Huchard, 75018, Paris, France; Université Paris VII, Paris Diderot, Sorbonne Paris Cité, 75205, Paris, France. 3. AP-HP, Beaujon Hospital, Department of Obstetrics and Gynecology, 100 Boulevard du General Leclerc, 92110, Clichy, France; DHU Risks in Pregnancy, 75014, Paris, France; Université Paris VII, Paris Diderot, Sorbonne Paris Cité, 75205, Paris, France. 4. AP-HP, Beaujon Hospital, Department of Obstetrics and Gynecology, 100 Boulevard du General Leclerc, 92110, Clichy, France. 5. DHU Risks in Pregnancy, 75014, Paris, France; AP-HP, Bichat-Claude Bernard Hospital, Department of Obstetrics and Gynecology, 46 rue Henri-Huchard, 75018, Paris, France. 6. Université Versailles Saint-Quentin-En-Yvelines, 78035, Versailles, France. 7. AP-HP, Bichat-Claude Bernard Hospital, Département d'Epidémiologie et Recherche Clinique, URC Paris-Nord, 46 rue Henri-Huchard, 75018, Paris, France; CIC-EC 1425, UMR 1123, INSERM, Paris, France. 8. AP-HP, Bichat-Claude Bernard Hospital, Département d'Epidémiologie et Recherche Clinique, URC Paris-Nord, 46 rue Henri-Huchard, 75018, Paris, France; CIC-EC 1425, UMR 1123, INSERM, Paris, France; UMR 1123, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 9. AP-HP, Beaujon Hospital, Department of Obstetrics and Gynecology, 100 Boulevard du General Leclerc, 92110, Clichy, France; DHU Risks in Pregnancy, 75014, Paris, France; AP-HP, Bichat-Claude Bernard Hospital, Department of Obstetrics and Gynecology, 46 rue Henri-Huchard, 75018, Paris, France; Université Paris VII, Paris Diderot, Sorbonne Paris Cité, 75205, Paris, France.
Abstract
OBJECTIVE:Shoulder dystocia is a major obstetric emergency defined as a failure of delivery of the fetal shoulder(s). This study evaluated whether an obstetric maneuver, the push back maneuver performed gently on the fetal head during delivery, could reduce the risk of shoulder dystocia. STUDY DESIGN: We performed a multicenter, randomized, single-blind trial to compare the push back maneuver with usual care in parturient women at term. The primary outcome, shoulder dystocia, was considered to have occurred if, after delivery of the fetal head, any additional obstetric maneuver, beginning with the McRoberts maneuver, other than gentle downward traction and episiotomy was required. RESULTS: We randomly assigned 522 women to thepush back maneuver group (group P) and 523 women to the standard vaginal delivery group (group S). Finally, 473 women assigned to group P and 472 women assigned to group S delivered vaginally. The rate of shoulder dystocia was significantly lower in group P (1·5%) than in group S (3·8%) (odds ratio [OR] 0·38 [0·16-0·92]; P = 0·03). After adjustment for predefined main risk factors, dystocia remained significantly lower in group P than in group S. There were no significant between-group differences in neonatal complications, including brachial plexus injury, clavicle fracture, hematoma and generalized asphyxia. CONCLUSION: In this trial in 945 women who delivered vaginally, the push back maneuver significantly decreased the risk of shoulder dystocia, as compared with standard vaginal delivery.
RCT Entities:
OBJECTIVE: Shoulder dystocia is a major obstetric emergency defined as a failure of delivery of the fetal shoulder(s). This study evaluated whether an obstetric maneuver, the push back maneuver performed gently on the fetal head during delivery, could reduce the risk of shoulder dystocia. STUDY DESIGN: We performed a multicenter, randomized, single-blind trial to compare the push back maneuver with usual care in parturient women at term. The primary outcome, shoulder dystocia, was considered to have occurred if, after delivery of the fetal head, any additional obstetric maneuver, beginning with the McRoberts maneuver, other than gentle downward traction and episiotomy was required. RESULTS: We randomly assigned 522 women to the push back maneuver group (group P) and 523 women to the standard vaginal delivery group (group S). Finally, 473 women assigned to group P and 472 women assigned to group S delivered vaginally. The rate of shoulder dystocia was significantly lower in group P (1·5%) than in group S (3·8%) (odds ratio [OR] 0·38 [0·16-0·92]; P = 0·03). After adjustment for predefined main risk factors, dystocia remained significantly lower in group P than in group S. There were no significant between-group differences in neonatal complications, including brachial plexus injury, clavicle fracture, hematoma and generalized asphyxia. CONCLUSION: In this trial in 945 women who delivered vaginally, the push back maneuver significantly decreased the risk of shoulder dystocia, as compared with standard vaginal delivery.
Authors: Morgen S Doty; Suneet P Chauhan; Kate W-C Chang; Leen Al-Hafez; Connie McGovern; Lynda J-S Yang; Sean C Blackwell Journal: AJP Rep Date: 2020-03-04