Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during delivery
In an effort to reduce shoulder dystocia incidence and morbidity, some obstetricians use prophylactic maternal hip hyperflexion (McRoberts maneuver), with the hope of facilitating delivery and decreasing the traction needed for delivery. The objective of this study was to evaluate whether the delive...
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| Veröffentlicht in: | American journal of obstetrics and gynecology 2004-09, Vol.191 (3), p.874-878 |
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| container_title | American journal of obstetrics and gynecology |
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| creator | Poggi, Sarah H. Allen, Robert H. Patel, Chirag R. Ghidini, Alessandro Pezzullo, John C. Spong, Catherine Y. |
| description | In an effort to reduce shoulder dystocia incidence and morbidity, some obstetricians use prophylactic maternal hip hyperflexion (McRoberts maneuver), with the hope of facilitating delivery and decreasing the traction needed for delivery. The objective of this study was to evaluate whether the delivery force is reduced with the prophylactic McRoberts maneuver in a prospective, objective manner.
Between April 2002 and July 2003, we randomly assigned multiparous women with term, cephalic singleton gestations to delivery in the lithotomy or McRoberts position. A single physician used a force-measuring system that consisted of a custom glove with force sensors to record the amount of force that was exerted on the fetal head. The primary outcomes of the study were peak force (pounds; highest force needed to accomplish entire delivery), peak force for delivery of anterior shoulder (pounds), and peak force rate (pounds per second; the duration required to reach the peak force).
The peak force was not different between the patients in the lithotomy position (n=13) versus the McRoberts position (n=14; 7.2 ± 0.8 lbs vs 8.0 ± 0.7 lbs;
P
=
.5). The peak force for delivery of the anterior shoulder (6.7 ± 0.8 lbs vs 7.1 ± 0.7 lbs;
P
=
.7) and peak force rate (32.3 ± 7.0 lbs/sec vs 29.1 ± 3.5 lbs/sec;
P
=
.7) were not different between the patients in the lithotomy position versus the McRoberts position, respectively. There was no difference between the groups for gestational age, birth weight, incidence of diabetes mellitus, or operative vaginal delivery. The subjective degree of difficulty of the delivery correlated with the peak force (
R
2
=
0.53;
P
=
.001).
The use of the McRoberts maneuver before clinical diagnosis of shoulder dystocia provides no reduction in the force that is used in traction on the fetal head during vaginal delivery in multiparous patients. The acceptance of this maneuver to be used prophylactically requires re-evaluation. |
| doi_str_mv | 10.1016/j.ajog.2004.07.024 |
| format | Article |
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Between April 2002 and July 2003, we randomly assigned multiparous women with term, cephalic singleton gestations to delivery in the lithotomy or McRoberts position. A single physician used a force-measuring system that consisted of a custom glove with force sensors to record the amount of force that was exerted on the fetal head. The primary outcomes of the study were peak force (pounds; highest force needed to accomplish entire delivery), peak force for delivery of anterior shoulder (pounds), and peak force rate (pounds per second; the duration required to reach the peak force).
The peak force was not different between the patients in the lithotomy position (n=13) versus the McRoberts position (n=14; 7.2 ± 0.8 lbs vs 8.0 ± 0.7 lbs;
P
=
.5). The peak force for delivery of the anterior shoulder (6.7 ± 0.8 lbs vs 7.1 ± 0.7 lbs;
P
=
.7) and peak force rate (32.3 ± 7.0 lbs/sec vs 29.1 ± 3.5 lbs/sec;
P
=
.7) were not different between the patients in the lithotomy position versus the McRoberts position, respectively. There was no difference between the groups for gestational age, birth weight, incidence of diabetes mellitus, or operative vaginal delivery. The subjective degree of difficulty of the delivery correlated with the peak force (
R
2
=
0.53;
P
=
.001).
The use of the McRoberts maneuver before clinical diagnosis of shoulder dystocia provides no reduction in the force that is used in traction on the fetal head during vaginal delivery in multiparous patients. The acceptance of this maneuver to be used prophylactically requires re-evaluation.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2004.07.024</identifier><identifier>PMID: 15467557</identifier><identifier>CODEN: AJOGAH</identifier><language>eng</language><publisher>Philadelphia, PA: Mosby, Inc</publisher><subject>Adult ; Apgar Score ; Biological and medical sciences ; Birth Weight ; Delivery, Obstetric - methods ; Delivery. Postpartum. Lactation ; Diabetes Mellitus - epidemiology ; Dystocia - complications ; Dystocia - prevention & control ; Female ; Force ; Gestational Age ; Gynecology. Andrology. Obstetrics ; Humans ; Lithotomy position ; McRoberts maneuver ; Medical sciences ; Posture ; Pregnancy ; Pregnancy in Diabetics - epidemiology ; Shoulder ; Vaginal delivery</subject><ispartof>American journal of obstetrics and gynecology, 2004-09, Vol.191 (3), p.874-878</ispartof><rights>2004 Elsevier Inc.</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c382t-cec4d296063e7141efc32c633fb4708896fb497eb5ae5b2ae826662eb46d94983</citedby><cites>FETCH-LOGICAL-c382t-cec4d296063e7141efc32c633fb4708896fb497eb5ae5b2ae826662eb46d94983</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ajog.2004.07.024$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16227794$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15467557$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poggi, Sarah H.</creatorcontrib><creatorcontrib>Allen, Robert H.</creatorcontrib><creatorcontrib>Patel, Chirag R.</creatorcontrib><creatorcontrib>Ghidini, Alessandro</creatorcontrib><creatorcontrib>Pezzullo, John C.</creatorcontrib><creatorcontrib>Spong, Catherine Y.</creatorcontrib><title>Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during delivery</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>In an effort to reduce shoulder dystocia incidence and morbidity, some obstetricians use prophylactic maternal hip hyperflexion (McRoberts maneuver), with the hope of facilitating delivery and decreasing the traction needed for delivery. The objective of this study was to evaluate whether the delivery force is reduced with the prophylactic McRoberts maneuver in a prospective, objective manner.
Between April 2002 and July 2003, we randomly assigned multiparous women with term, cephalic singleton gestations to delivery in the lithotomy or McRoberts position. A single physician used a force-measuring system that consisted of a custom glove with force sensors to record the amount of force that was exerted on the fetal head. The primary outcomes of the study were peak force (pounds; highest force needed to accomplish entire delivery), peak force for delivery of anterior shoulder (pounds), and peak force rate (pounds per second; the duration required to reach the peak force).
The peak force was not different between the patients in the lithotomy position (n=13) versus the McRoberts position (n=14; 7.2 ± 0.8 lbs vs 8.0 ± 0.7 lbs;
P
=
.5). The peak force for delivery of the anterior shoulder (6.7 ± 0.8 lbs vs 7.1 ± 0.7 lbs;
P
=
.7) and peak force rate (32.3 ± 7.0 lbs/sec vs 29.1 ± 3.5 lbs/sec;
P
=
.7) were not different between the patients in the lithotomy position versus the McRoberts position, respectively. There was no difference between the groups for gestational age, birth weight, incidence of diabetes mellitus, or operative vaginal delivery. The subjective degree of difficulty of the delivery correlated with the peak force (
R
2
=
0.53;
P
=
.001).
The use of the McRoberts maneuver before clinical diagnosis of shoulder dystocia provides no reduction in the force that is used in traction on the fetal head during vaginal delivery in multiparous patients. The acceptance of this maneuver to be used prophylactically requires re-evaluation.</description><subject>Adult</subject><subject>Apgar Score</subject><subject>Biological and medical sciences</subject><subject>Birth Weight</subject><subject>Delivery, Obstetric - methods</subject><subject>Delivery. Postpartum. Lactation</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Dystocia - complications</subject><subject>Dystocia - prevention & control</subject><subject>Female</subject><subject>Force</subject><subject>Gestational Age</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Lithotomy position</subject><subject>McRoberts maneuver</subject><subject>Medical sciences</subject><subject>Posture</subject><subject>Pregnancy</subject><subject>Pregnancy in Diabetics - epidemiology</subject><subject>Shoulder</subject><subject>Vaginal delivery</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kFFr1TAUgIMo7m76B3yQvOhbuzRpkwZ8kaFO2BgMfQ5pcrrl0jY1Jx1cYf_dlnthbz7lhHznI3yEfKhYWbFKXu5Lu48PJWesLpkqGa9fkV3FtCpkK9vXZMcY44UWqj0j54j77co1f0vOqqaWqmnUjjzf28nHMfwFT3MKdqCxp7fuPnaQMtInSLggHUJ-jDmOBzpHDDnEKUwPNEfqwSWwCDQ_Au1jcttkMw1I7TwPYbPG4yPkVeSXtG16GMKqPrwjb3o7ILw_nRfk9_dvv66ui5u7Hz-vvt4UTrQ8Fw5c7bmWTApQVV1B7wR3Uoi-qxVrWy3XQSvoGgtNxy20XErJoaul17VuxQX5fPTOKf5ZALMZAzoYBjtBXNBIqYXgrFlBfgRdiogJejOnMNp0MBUzW3SzN1t0s0U3TJk1-rr08WRfuhH8y8qp8gp8OgEWnR36ZCcX8IWTnCulN9GXIwdri6cAyaALMDnwIYHLxsfwv3_8A2hAojw</recordid><startdate>20040901</startdate><enddate>20040901</enddate><creator>Poggi, Sarah H.</creator><creator>Allen, Robert H.</creator><creator>Patel, Chirag R.</creator><creator>Ghidini, Alessandro</creator><creator>Pezzullo, John C.</creator><creator>Spong, Catherine Y.</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040901</creationdate><title>Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during delivery</title><author>Poggi, Sarah H. ; Allen, Robert H. ; Patel, Chirag R. ; Ghidini, Alessandro ; Pezzullo, John C. ; Spong, Catherine Y.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382t-cec4d296063e7141efc32c633fb4708896fb497eb5ae5b2ae826662eb46d94983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Apgar Score</topic><topic>Biological and medical sciences</topic><topic>Birth Weight</topic><topic>Delivery, Obstetric - methods</topic><topic>Delivery. Postpartum. Lactation</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Dystocia - complications</topic><topic>Dystocia - prevention & control</topic><topic>Female</topic><topic>Force</topic><topic>Gestational Age</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Lithotomy position</topic><topic>McRoberts maneuver</topic><topic>Medical sciences</topic><topic>Posture</topic><topic>Pregnancy</topic><topic>Pregnancy in Diabetics - epidemiology</topic><topic>Shoulder</topic><topic>Vaginal delivery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poggi, Sarah H.</creatorcontrib><creatorcontrib>Allen, Robert H.</creatorcontrib><creatorcontrib>Patel, Chirag R.</creatorcontrib><creatorcontrib>Ghidini, Alessandro</creatorcontrib><creatorcontrib>Pezzullo, John C.</creatorcontrib><creatorcontrib>Spong, Catherine Y.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poggi, Sarah H.</au><au>Allen, Robert H.</au><au>Patel, Chirag R.</au><au>Ghidini, Alessandro</au><au>Pezzullo, John C.</au><au>Spong, Catherine Y.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during delivery</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2004-09-01</date><risdate>2004</risdate><volume>191</volume><issue>3</issue><spage>874</spage><epage>878</epage><pages>874-878</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><coden>AJOGAH</coden><abstract>In an effort to reduce shoulder dystocia incidence and morbidity, some obstetricians use prophylactic maternal hip hyperflexion (McRoberts maneuver), with the hope of facilitating delivery and decreasing the traction needed for delivery. The objective of this study was to evaluate whether the delivery force is reduced with the prophylactic McRoberts maneuver in a prospective, objective manner.
Between April 2002 and July 2003, we randomly assigned multiparous women with term, cephalic singleton gestations to delivery in the lithotomy or McRoberts position. A single physician used a force-measuring system that consisted of a custom glove with force sensors to record the amount of force that was exerted on the fetal head. The primary outcomes of the study were peak force (pounds; highest force needed to accomplish entire delivery), peak force for delivery of anterior shoulder (pounds), and peak force rate (pounds per second; the duration required to reach the peak force).
The peak force was not different between the patients in the lithotomy position (n=13) versus the McRoberts position (n=14; 7.2 ± 0.8 lbs vs 8.0 ± 0.7 lbs;
P
=
.5). The peak force for delivery of the anterior shoulder (6.7 ± 0.8 lbs vs 7.1 ± 0.7 lbs;
P
=
.7) and peak force rate (32.3 ± 7.0 lbs/sec vs 29.1 ± 3.5 lbs/sec;
P
=
.7) were not different between the patients in the lithotomy position versus the McRoberts position, respectively. There was no difference between the groups for gestational age, birth weight, incidence of diabetes mellitus, or operative vaginal delivery. The subjective degree of difficulty of the delivery correlated with the peak force (
R
2
=
0.53;
P
=
.001).
The use of the McRoberts maneuver before clinical diagnosis of shoulder dystocia provides no reduction in the force that is used in traction on the fetal head during vaginal delivery in multiparous patients. The acceptance of this maneuver to be used prophylactically requires re-evaluation.</abstract><cop>Philadelphia, PA</cop><pub>Mosby, Inc</pub><pmid>15467557</pmid><doi>10.1016/j.ajog.2004.07.024</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9378 |
| ispartof | American journal of obstetrics and gynecology, 2004-09, Vol.191 (3), p.874-878 |
| issn | 0002-9378 1097-6868 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_66933205 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adult Apgar Score Biological and medical sciences Birth Weight Delivery, Obstetric - methods Delivery. Postpartum. Lactation Diabetes Mellitus - epidemiology Dystocia - complications Dystocia - prevention & control Female Force Gestational Age Gynecology. Andrology. Obstetrics Humans Lithotomy position McRoberts maneuver Medical sciences Posture Pregnancy Pregnancy in Diabetics - epidemiology Shoulder Vaginal delivery |
| title | Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during delivery |
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