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- W2087449050 abstract "To the Editors: The article by E. D. Gurewitsch et al1Gurewitsch E.D. Kim E.J. Yang J.H. Outland K.E. McDonald M.K. Allen R.H. Comparing McRoberts' and Rubin's maneuvers for initial management of shoulder dystocia: an objective evaluation.Am J Obstet Gynecol. 2005; 192: 153-160Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar was a very interesting read. The authors have done an excellent job comparing and evaluating the 2 maneuvers typically used for shoulder dystocia. I would like the authors' opinion on a couple of issues with these maneuvers.An assistant is quite useful in all shoulder dystocia maneuvers, except a posterior arm extraction. The assistant can flex the pelvis while the obstetrician applies traction. Utility of an assistant is clear for the Rubin's maneuver; the assistant applies traction while the obstetrician is rotating the shoulders. Experience has shown that without traction you will not achieve descensus. Again, the Woods' maneuver has been likened to “winding a screw caught in threads.” This catching of the threads does not happen if there is not traction along with rotation. Rotation alone will make a circle without descensus. Have the authors noted a similar relationship between traction and rotation?The other factor of concern is that when the bisacromial diameter is rotated to the pelvic oblique diameter and traction is done, the soft tissue immediately rotates the bisacromial diameter to the anterior posterior pelvic diameter and progress was not obtained. Could this position be held in place by the assistant holding pressure at the scapula with a forceps blade or Dr. Chavis's idea, the shoe horn?2Chavis W.M. A new instrument for the management of shoulder dystocia.Int J Gynaecol Obstet. 1979; 16: 331Google ScholarIt is good to know the anterior Rubin's maneuver is more beneficial and that it needs less pull from the obstetrician and less strain to the brachial plexus. Some of us will first try the posterior Rubin's maneuver to take advantage of the sacrum curvature, although in light of this review, it will not be a first option.Thank you for allowing us to ask a question. To the Editors: The article by E. D. Gurewitsch et al1Gurewitsch E.D. Kim E.J. Yang J.H. Outland K.E. McDonald M.K. Allen R.H. Comparing McRoberts' and Rubin's maneuvers for initial management of shoulder dystocia: an objective evaluation.Am J Obstet Gynecol. 2005; 192: 153-160Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar was a very interesting read. The authors have done an excellent job comparing and evaluating the 2 maneuvers typically used for shoulder dystocia. I would like the authors' opinion on a couple of issues with these maneuvers. An assistant is quite useful in all shoulder dystocia maneuvers, except a posterior arm extraction. The assistant can flex the pelvis while the obstetrician applies traction. Utility of an assistant is clear for the Rubin's maneuver; the assistant applies traction while the obstetrician is rotating the shoulders. Experience has shown that without traction you will not achieve descensus. Again, the Woods' maneuver has been likened to “winding a screw caught in threads.” This catching of the threads does not happen if there is not traction along with rotation. Rotation alone will make a circle without descensus. Have the authors noted a similar relationship between traction and rotation? The other factor of concern is that when the bisacromial diameter is rotated to the pelvic oblique diameter and traction is done, the soft tissue immediately rotates the bisacromial diameter to the anterior posterior pelvic diameter and progress was not obtained. Could this position be held in place by the assistant holding pressure at the scapula with a forceps blade or Dr. Chavis's idea, the shoe horn?2Chavis W.M. A new instrument for the management of shoulder dystocia.Int J Gynaecol Obstet. 1979; 16: 331Google Scholar It is good to know the anterior Rubin's maneuver is more beneficial and that it needs less pull from the obstetrician and less strain to the brachial plexus. Some of us will first try the posterior Rubin's maneuver to take advantage of the sacrum curvature, although in light of this review, it will not be a first option. Thank you for allowing us to ask a question. ReplyAmerican Journal of Obstetrics & GynecologyVol. 194Issue 2PreviewTo the Editors: We thank Dr Escamilla for his interest in our recent paper. To address concerns that he expressed about shoulder dystocia maneuvers, we offer the following thoughts: Full-Text PDF" @default.
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- W2087449050 title "Comparing McRoberts' and Rubin's maneuvers for initial management of shoulder dystocia: An objective evaluation" @default.
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