{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T10:00:36Z","timestamp":1771581636527,"version":"3.50.1"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Most shoulder dystocia (SD) cases do not have associated adverse outcomes. The objective was to assess whether SD relieved with \u22653 maneuvers, compared with fewer, is associated with a higher likelihood of adverse outcomes. The secondary objective was to examine if postpartum hemorrhage is associated with SD managed with \u22653 maneuvers versus fewer.<\/jats:p>\n                  <jats:p>This was a secondary analysis of the assessment of perinatal excellence (APEX) study, an observational cohort of over 115,000 deliveries in 25 U.S. hospitals from 2008 to 2011. We included individuals with singleton, vertex, and nonanomalous fetuses at \u226534 weeks who had SD requiring at least one maneuver. We stratified participants according to if \u22653 maneuvers, versus fewer, were utilized to resolve the SD. The primary outcome was the incidence of a neonatal composite adverse outcome including APGAR &lt;5 at 5\u2009minutes, fetal fractures, intracranial hemorrhage, brachial plexus palsy, facial nerve palsy, hypotension treated, hypoxic-ischemic encephalopathy, or neonatal death. Using modified-Poisson-regression, we calculated adjusted incidence relative risk (aIRR) with 95% confidence intervals (CI).<\/jats:p>\n                  <jats:p>The rate of SD in APEX was 1.9% (2,138\/118,422). Of 2,138 cases of SD, 96% met the inclusion criteria. \u22653 maneuvers were utilized in 18.9% (391\/2,062) of SD cases. The composite neonatal adverse outcome occurred in 8.1% (168\/2,062) of cases, and in adjusted models, the risk for the composite outcome was significantly higher with SD requiring \u22653 maneuvers (15.1%) versus &lt;3 maneuvers (6.5%; aIRR: 2.08; 95% CI: 1.50\u20132.89). Additionally, APGAR &lt;5 at 5\u2009minutes (aIRR: 4.10; 95% CI: 1.18\u201314.25), neonatal brachial plexus palsy (aIRR: 2.58; 95% CI: 1.45\u20134.60), and hypoxic-ischemic encephalopathy (aIRR: 2.83; 95% CI: 1.36 and 5.89) were significantly more likely when \u22653 were used. No significant difference was noted for postpartum hemorrhage (PPH) by number of maneuvers (aIRR: 0.74; 95% CI: 0.44 and 1.21).<\/jats:p>\n                  <jats:p>SD relieved by \u22653 maneuvers, compared with &lt;3, was associated with a 2-fold-increased risk for the composite neonatal adverse outcome, with no difference in risk for PPH.<\/jats:p>","DOI":"10.1055\/a-2589-3709","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T19:20:46Z","timestamp":1744831246000},"page":"048-055","source":"Crossref","is-referenced-by-count":1,"title":["Neonatal and Maternal Outcomes following Shoulder Dystocia Resolution Utilizing \u2265 versus &lt; 3 Maneuvers"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4223-3203","authenticated-orcid":false,"given":"Fabrizio","family":"Zullo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware"},{"name":"Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa C.","family":"Logue","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele Di","family":"Mascio","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Giancotti","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2927-8693","authenticated-orcid":false,"given":"Matthew K.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hector Mendez","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony C.","family":"Sciscione","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware"},{"name":"Department of Maternal-Fetal Medicine, Delaware Center for Maternal-Fetal Medicine of Christiana Care, Newark, Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suneet P.","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware"},{"name":"Department of Maternal-Fetal Medicine, Delaware Center for Maternal-Fetal Medicine of Christiana Care, Newark, Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1097\/AOG.0000000000002043","article-title":"Practice bulletin no 178: shoulder 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