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Updated: Jun 2, 2026
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
A comparison of obstetric maneuvers for the acute management of shoulder dystocia
Matthew K Hoffman1, Jennifer L Bailit, D Ware Branch
1From Christiana Care Health System, Newark, Delaware; MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio; Intermountain Healthcare and the University of Utah, Salt Lake City, Utah; Tufts University, Baystate Medical Center, Springfield, Massachusetts; the EMMES Corporation, Rockville, Maryland; Indiana University Clarian Health, Indianapolis, Indiana; the University of Illinois at Chicago, Chicago, Illinois; Georgetown University Hospital, MedStar Health, Washington, DC; Maimonides Medical Center, Brooklyn, New York; the University of Miami, Miami, Florida; Cedars-Sinai Medical Center, Los Angeles, California; Summa Health Systems Akron City Hospital, Akron, Ohio; the University of Texas Health Science Center at Houston, Houston, Texas; and the Pregnancy and Perinatology Branch and the Division of Epidemiology, Statistics and Prevention Research, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Objective:
To assess the efficacy of obstetric maneuvers for resolving shoulder dystocia and the effect that these maneuvers have on neonatal injury when shoulder dystocia occurs.
Methods:
Using an electronic database encompassing 206,969 deliveries, we identified all women with a vertex fetus beyond 34 0/7 weeks of gestation who incurred a shoulder dystocia during the process of delivery. Women whose fetuses had a congenital anomaly and women with an antepartum stillbirth were excluded. Medical records of all cases were reviewed by trained abstractors. Cases involving neonatal injury (defined as brachial plexus injury, clavicular or humerus fracture, or hypoxic-ischemic encephalopathy or intrapartum neonatal death attributed to the shoulder dystocia) were compared with those without injury.
Results:
Among 132,098 women who delivered a term cephalic liveborn fetus vaginally, 2,018 incurred a shoulder dystocia (1.5%), and 101 (5.2%) of these incurred a neonatal injury. Delivery of the posterior shoulder was associated with the highest rate of delivery when compared with other maneuvers (84.4% compared with 24.3-72.0% for other maneuvers; P<.005 to P<.001) and similar rates of neonatal injury (8.4% compared with 6.1-14.0%; P=.23 to P=.7). The total number of maneuvers performed significantly correlated with the rate of neonatal injury (P<.001).
Conclusion:
Delivery of the posterior shoulder should be considered following the McRoberts maneuver and suprapubic pressure in the management of shoulder dystocia. The need for additional maneuvers was associated with higher rates of neonatal injury.
