BackgroundAt Counties Manukau Health in Auckland, New Zealand, axillary traction is being used when an internal manoeuvre is required for resolution of shoulder dystocia.AimsThis study presents the outcomes for mother and baby from use of axillary traction and other internal manoeuvres.Materials and MethodsRetrospective review of the clinical records of mother and baby for all labours complicated by shoulder dystocia was carried out for an eight‐year period. Maternal and neonatal information were compared for the three cohorts of the first internal manoeuvre documented: axillary traction, posterior arm delivery and rotational manoeuvres.ResultsThere were 226 women who required the use of internal manoeuvres with no significant differences in age, body mass index, parity, ethnicity, diabetes incidence, induction and augmentation of labour rates, length of the first stage and birth weight between the cohorts. Axillary traction was the first internal manoeuvre used for 119 (52.7%) with a success rate of 95.8%. Posterior arm delivery was used first for 49 (21.7%) women with a success rate of 85.7%. Rotational manoeuvres were used first for 58 (25.7%) women with a statistically inferior success rate of 48.3%. There was no significant difference in the maternal and neonatal complication rates between the cohorts.ConclusionAxillary traction has been utilised as the first internal manoeuvre for a large number of women with a higher success rate than other internal manoeuvres without any increase in maternal or neonatal morbidity. It is recommended that this be the first internal manoeuvre attempted when shoulder dystocia occurs.
Shoulder dystocia is a rare complication of childbirth that can result in significant neonatal and maternal morbidity and even neonatal death.1,2 This literature review identifies the success rates of the internal rotational manoeuvres and delivery of the posterior arm to resolve shoulder dystocia and subsequent neonatal outcomes.
Shoulder dystocia is a life-threatening childbirth emergency that has been recognised by midwives and obstetricians for centuries. When Lesley Ansell experienced a severe shoulder dystocia that resulted in the fracture of the fetal humerus, she knew there needed to be a change in practice. Here, she charts the journey that led her to discuss, investigate and research the notion of axillary traction as a method of resolving shoulder dystocia.
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