Intrapartum interventions for preventing shoulder dystocia

Chaturica Athukorala; Philippa Middleton; Caroline A Crowther

doi:10.1002/14651858.CD005543.pub2

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Analysis 1.1

Comparison 1 Prophylactic McRoberts versus therapeutic manoeuvres, Outcome 1 Shoulder dystocia.

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Analysis 1.2

Comparison 1 Prophylactic McRoberts versus therapeutic manoeuvres, Outcome 2 Head‐to‐body delivery time (seconds).

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Analysis 1.3

Comparison 1 Prophylactic McRoberts versus therapeutic manoeuvres, Outcome 3 Newborn birth injuries.

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Analysis 1.4

Comparison 1 Prophylactic McRoberts versus therapeutic manoeuvres, Outcome 4 Apgar score < 7 at 5 minutes.

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Analysis 1.5

Comparison 1 Prophylactic McRoberts versus therapeutic manoeuvres, Outcome 5 Instrumental vaginal birth.

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Analysis 1.6

Comparison 1 Prophylactic McRoberts versus therapeutic manoeuvres, Outcome 6 Caesarean birth.

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Analysis 1.7

Comparison 1 Prophylactic McRoberts versus therapeutic manoeuvres, Outcome 7 Manoeuvres performed.

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Analysis 1.8

Comparison 1 Prophylactic McRoberts versus therapeutic manoeuvres, Outcome 8 Admission to special care nursery.

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Analysis 2.1

Comparison 2 Prophylactic McRoberts versus lithotomy position, Outcome 1 Shoulder dystocia.

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Analysis 2.2

Comparison 2 Prophylactic McRoberts versus lithotomy position, Outcome 2 Head‐to‐body delivery time (seconds).

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Analysis 2.3

Comparison 2 Prophylactic McRoberts versus lithotomy position, Outcome 3 Newborn birth injuries.

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Analysis 2.4

Comparison 2 Prophylactic McRoberts versus lithotomy position, Outcome 4 Apgar score < 7 at 5 minutes.

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Analysis 2.5

Comparison 2 Prophylactic McRoberts versus lithotomy position, Outcome 5 Instrumental vaginal birth.

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Analysis 2.6

Comparison 2 Prophylactic McRoberts versus lithotomy position, Outcome 6 Force of traction required for birth (peak force lb).

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Comparison 1. Prophylactic McRoberts versus therapeutic manoeuvres

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Shoulder dystocia Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Women with vaginal birth only	1	128	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.17, 1.14]
1.2 Women with caesarean or vaginal birth	1	170	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.12, 0.86]
2 Head‐to‐body delivery time (seconds) Show forest plot	1	128	Mean Difference (IV, Fixed, 95% CI)	‐3.0 [‐9.61, 3.61]

3 Newborn birth injuries Show forest plot	1	128	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.02, 10.61]

4 Apgar score < 7 at 5 minutes Show forest plot	1	128	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.02, 10.61]

5 Instrumental vaginal birth Show forest plot	1	128	Risk Ratio (M‐H, Fixed, 95% CI)	0.19 [0.01, 3.58]

6 Caesarean birth Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 All women	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	2.97 [1.59, 5.55]
6.2 Failure to progress	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	2.56 [1.12, 5.89]
6.3 Indication other than failure to progress	1	185	Risk Ratio (M‐H, Fixed, 95% CI)	3.69 [1.26, 10.80]
7 Manoeuvres performed Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

7.1 Prophylactic	1	128	Risk Ratio (M‐H, Fixed, 95% CI)	57.07 [8.11, 401.75]
7.2 Therapeutic	1	128	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.09, 1.02]
8 Admission to special care nursery Show forest plot	1	128	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.38, 1.68]

Comparison 1. Prophylactic McRoberts versus therapeutic manoeuvres

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Comparison 2. Prophylactic McRoberts versus lithotomy position

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Shoulder dystocia Show forest plot	1	27	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.06, 13.37]

2 Head‐to‐body delivery time (seconds) Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	3.70 [1.72, 5.68]

3 Newborn birth injuries Show forest plot	1	27	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Apgar score < 7 at 5 minutes Show forest plot	1	27	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5 Instrumental vaginal birth Show forest plot	1	27	Risk Ratio (M‐H, Fixed, 95% CI)	4.67 [0.24, 88.96]

6 Force of traction required for birth (peak force lb) Show forest plot	1	27	Mean Difference (IV, Fixed, 95% CI)	0.80 [‐2.16, 3.76]

Comparison 2. Prophylactic McRoberts versus lithotomy position

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