{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T08:14:31Z","timestamp":1771316071681,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare posterior arm delivery and the shoulder shrug maneuver in shoulder dystocia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective, randomized, simulation\u2010based experimental study was conducted with six physicians managing 96 simulated shoulder dystocia cases. Participants included three obstetricians with more than 15\u2009years of experience and three trainees. Variables collected included perineal pressure, maneuver time, simulated humeral fractures, first\u2010attempt success, and perceived difficulty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Posterior arm delivery exerted significantly less maximum perineal pressure than the shoulder shrug maneuver (median 12.5\u2009mm Hg, interquartile range (IQR) 7.0\u201322.5\u2009mm Hg versus median 22.0, IQR 13.0\u201337.0\u2009mm Hg;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002). Obstetricians with greater experience applied less perineal pressure and performed maneuvers faster compared with trainees. Two simulated humeral fractures occurred, one with each maneuver, both involving trainees. No significant differences were observed regarding hand dominance or hand size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Posterior arm delivery showed lower perineal pressure compared with the shoulder shrug maneuver, suggesting reduced maternal and neonatal risk. Clinical experience positively influenced outcomes, supporting recommendations for experienced obstetricians to lead shoulder dystocia management. Posterior arm delivery is recommended as the first\u2010choice internal maneuver when addressing the posterior shoulder in shoulder dystocia cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70375","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T12:16:03Z","timestamp":1752754563000},"page":"558-564","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Posterior arm delivery versus the shoulder shrug maneuver in shoulder dystocia management: A simulation\u2010based comparative study"],"prefix":"10.1002","volume":"172","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8013-4732","authenticated-orcid":false,"given":"Marcos Javier","family":"Cuerva","sequence":"first","affiliation":[{"name":"Department of Obstetrics Hospital Universitario La Paz  Madrid Spain"},{"name":"School of Medicine Universidad Aut\u00f3noma de Madrid  Madrid Spain"},{"name":"School of Medicine Universidad Alfonso X el Sabio  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celia","family":"Sanchez\u2010Giron","sequence":"additional","affiliation":[{"name":"School of Medicine Universidad Alfonso X el Sabio  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariona","family":"Cruset","sequence":"additional","affiliation":[{"name":"Independent Biotechnology Consultant  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard Bryan","family":"Hallam","sequence":"additional","affiliation":[{"name":"Independent Design\/Engineering Consultant, Freelance  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Fernandez\u2010Cuesta","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Hospital Universitario La Paz  Madrid 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