American Journal of Obstetrics & Gynecology
Volume 191, Issue 3 , Pages 874-878, September 2004

Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during delivery

  • Sarah H. Poggi, MD

      Affiliations

    • Georgetown University Hospital, Department of Obstetrics and Gynecology, Washington, DC
    • Corresponding Author InformationReprint requests: Sarah H. Poggi, MD, Department of Obstetrics and Gynecology, 3800 Reservoir Road-3PHC, Washington, DC 20007.
    • ,
  • Robert H. Allen, PhD

      Affiliations

    • Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Md
    • ,
  • Chirag R. Patel, BS

      Affiliations

    • Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Md
    • ,
  • Alessandro Ghidini, MD

      Affiliations

    • Georgetown University Hospital, Department of Obstetrics and Gynecology, Washington, DC
    • ,
  • John C. Pezzullo, PhD

      Affiliations

    • Georgetown University Hospital, Department of Obstetrics and Gynecology, Washington, DC
    • ,
  • Catherine Y. Spong, MD

      Affiliations

    • Georgetown University Hospital, Department of Obstetrics and Gynecology, Washington, DC

Objective

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.

Study design

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).

Results

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 (R2=0.53; P=.001).

Conclusion

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.

Key words: Force, Vaginal delivery, McRoberts maneuver, Lithotomy position

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 Supported in part by the Dougherty Fund, managed by Dr. John Queenan, Professor Emeritus at Georgetown University Hospital, for the development of the force measuring system and by H. Montgomery Hougen, who donated the laptop computer that was used in the system.Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal Fetal Medicine, New Orleans, La, February 2-7, 2004.

PII: S0002-9378(04)00784-7

doi:10.1016/j.ajog.2004.07.024

American Journal of Obstetrics & Gynecology
Volume 191, Issue 3 , Pages 874-878, September 2004

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