All-fours maneuver for reducing shoulder dystocia during labor

J Reprod Med. 1998 May;43(5):439-43.


Objective: To report on a large amount of clinical experience with shoulder dystocia managed primarily with the all-fours maneuver.

Study design: The all-fours maneuver consists of moving the laboring patient to her hands and knees. Eighty-two consecutive cases of shoulder dystocia managed with this technique were reported to a registry through January 1996.

Results: The incidence of shoulder dystocia was 1.8%, and half of the newborns weighed > or = 4,000 g. Sixty-eight women (83%) delivered without the need for any additional maneuvers. The mean diagnosis-to-delivery interval was 2.3 +/- 1.0 (SD) minutes (range, 1-6). No maternal or perinatal mortality occurred. Morbidity was noted in only four deliveries: a single case of postpartum hemorrhage that did not require transfusion (maternal morbidity, 1.2%), one infant with a fractured humerus and three with low Apgar scores (neonatal morbidity, 4.9%). All morbidity occurred in cases with a birth weight > 4,500 g (P = .0009).

Conclusion: The all-fours maneuver appears to be a rapid, safe and effective technique for reducing shoulder dystocia in laboring women.

MeSH terms

  • Apgar Score
  • Birth Injuries / prevention & control
  • Birth Weight
  • Dystocia / epidemiology
  • Dystocia / prevention & control*
  • Female
  • Humans
  • Infant, Newborn
  • Posture*
  • Pregnancy
  • Shoulder*
  • Time Factors