This cross-sectional study was conducted in a tertiary university hospital in Hong Kong with an annual delivery of more than 6000. All consecutive cases of shoulder
dystocia reported from 1995 to 2009 inclusively were identified from our hospital electronic database. As per our previous studies [2, 3], shoulder dystocia was defined as either a need to perform an additional obstetric manoeuvre in addition to downward traction of the fetal
neck or when the head to body delivery interval was longer than 1 min [17]. Cases were only included for analysis if McRoberts’ manoeuvre with or without suprapubic pressure (M+/−S) was the first manoeuvre performed, and documentation was available regarding
the management of dystocia. Cases of intrauterine fetal death or fetal malformations were excluded. Our unit protocol for the management of shoulder dystocia was
based on and similar to the Green Top Guideline on shoulder dystocia published by the Royal the College of Obstetricians & Gynaecologists [1]. All midwives and obstetricians took part in annual drills on the management of shoulder dystocia. In all cases, unless otherwise
stated, McRoberts’ combined with suprapubic pressure was the first manoeuvre attempted. If this failed other manoeuvres would be attempted based on the operators’ experience at the time. A nurse was always designated to document time sequences, in particular head and body delivery times. At least one obstetrician and one paediatrician would attend the cases at the time of diagnosis. All instrumental deliveries in our unit were conducted
by obstetricians. All cases of shoulder dystocia were audited in a monthly meeting and logged. Unless otherwise stated, M+/−S in this study refers to the use of McRoberts’ manoeuvre with or without suprapubic pressure, as our unit protocol requires the two to be
carried out simultaneously.