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Impact of fetal manipulation on maternal and neonatal severe morbidity during shoulder dystocia management

  • General Gynecology
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Abstract

Purpose

There are few data on maternal and neonatal morbidities associated with shoulder dystocia (SD), depending on the use of fetal manipulation (FM). A prior 5-year study was conducted in our center in 2012 for this purpose. Our objective was to compare severe maternal and neonatal morbidities according to FM execution in a larger cohort.

Methods

We conducted a retrospective study between 2007 and 2020. SD was considered when additional maneuvers were required to complete a delivery. Severe maternal morbidity was defined as the occurrence of obstetric anal sphincter injury (OASI). Severe neonatal morbidity was defined as Apgar < 7 at 5 min and/or cord arterial pH < 7.1 and/or or a permanent brachial plexus palsy. We studied these data in the FM group compared to the non- FM group.

Results

FM was associated with increased OASI rates (21.1% vs. 3.8%, OR = 6.72 [2.7–15.8]). We found no significant difference in severe neonatal morbidity. Maternal age > 35 and FM appear to be associated with the occurrence of OASI, with ORa = 13.3 [1.5–121.8] and ORa = 5.3 [2.2–12.8], respectively. FM was the only factor associated with the occurrence of severe neonatal morbidity (ORa = 2.3 [1.1–4.8]. The rate of episiotomy was significantly decreased (20% versus 5% p < 0.05) and there was an increase in the rate of SD managed with FM in our center.

Conclusion

FM is the only factor associated with an increased risk of OASI. In case of failure of non-FM maneuvers, the rapid implementation of FM maneuvers resulted in no difference regarding severe neonatal morbidity.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Miletrie, 86000, Poitiers, France

    Bineta Diack, Fabrice Pierre & Bertrand Gachon

  2. Université de Poitiers, INSERM CIC 1402, CHU de Poitiers, Poitiers, France

    Bertrand Gachon

  3. Université de Nantes, EA 4334 MIP, Nantes, France

    Bertrand Gachon

Authors
  1. Bineta Diack
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  2. Fabrice Pierre
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BD: Data collection, data analysis, manuscript writing. FP: Project development. BG: Project development, data collection, data analysis, manuscript editing.

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Correspondence to Bineta Diack.

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The authors have no conflict of interest to disclose.

Ethical approval

As our study was observational and did not involve any change in our practices, patients underwent no supplementary procedures. We reported non-identifying data from patient’s medical records. Ethical Committee approval was therefore not required for this study according to the Jardé law. Nevertheless, upon admission in our institution, each patient receives a document stating that personal medical data collected during hospitalization could be used anonymously for research purposes.

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Diack, B., Pierre, F. & Gachon, B. Impact of fetal manipulation on maternal and neonatal severe morbidity during shoulder dystocia management. Arch Gynecol Obstet 307, 501–509 (2023). https://doi.org/10.1007/s00404-022-06783-y

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