Alternative Management of Shoulder Dystocia Reduces Brachial Plexus Injuries
- Discuss the state of the science related to shoulder dystocia and brachial plexus injury.
- Describe a nurse directed management of shoulder dystocia and the clinical outcomes produced.
- Explore nursing implications for teaching and practicing the alternative method of shoulder dystocia management with the entire health care team.
To examine differences in brachial plexus injury (BPI) with traditional and alternative management of shoulder dystocia (SD). |
Design:
Retrospective review of birth records pre and post intervention. |
Setting: An urban hospital located in a large multi-cultural city located in the North Eastern United States
Patients/Participants: The pre-intervention group was 5334 birth records from 2004 – 2006. The post-intervention group was 4517 birth records from 2007 – 2009
Methods:
Data was collected during a chart review of 16,124 birth records. Only birth records from live, singleton, cephalic infants > 36 weeks gestation and > 2500gms were included in the study. The “traditional” management was the ACOG recommended management for should dystocia including the McRoberts maneuver as the first or second maneuver. The alternative management was stop pushing, remove hands from baby’s head, rotation into an oblique plane with suprapubic pressure, change mother’s position to other than McRoberts, use Wood’s maneuver and attempt delivery of posterior shoulder. The variables examined between the groups were: McRoberts maneuver, shoulder/arm weakness in delivery room, minutes to SD resolution, BPI severity, apgar at 5 minutes, cord PH, cord base excess, neonatal disposition, episiotomy, birth weight, type of delivery and maternal BMI. |
Results: Two-sided T-test and Kolmogorov Smirnov (KS) revealed the following: significant differences (p = < 0.05) in the post-intervention group; fewer McRoberts, fewer BPI, fewer transient weakness, fewer episiotomies, longer time for SD resolution, higher c/section rate, lower birth weight and lower BMI. All other variables were not significantly different between the groups
Conclusion/Implications for nursing practice: Alternative management of shoulder dystocia appears to result in fewer BPI and better neonatal outcomes than traditional management. More research is necessary to further refine the alternative management strategy and duplication of the results in other clinical settings. There is evidence for need for strong nursing leadership in the managment of SD and for the development of training simulations for the entire health care team in the management of Sd and other obstetrical emergencies.
Keywords: Shoulder dystocia, brachial plexus injury, alternative nursing management, clinical simulations
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