Method of shoulder delivery and neonatal outcomes: A meta-analysis of prospective controlled studies

Background. We compared the neonatal outcomes between 2 methods of shoulder delivery: 2-step and 1-step. Methods. We did a comprehensive search of 7 electronic databases up to 31 October 2016. Two of the authors independently identified relevant studies for inclusion in the review, assessed their quality and extracted data. The primary outcome was the rate of neonatal asphyxia; secondary outcomes were neonatal brachial plexus injury and clavicular fracture of newborns. Review Manager 5.3 was used for the metaanalysis. The pooled relative risk (RR) was estimated by the fixed or random effect model, based on heterogeneity. Seven cohort studies were included in the meta-analysis. Results. A total of 14 627 women had successful vaginal delivery; 7212 women had 2-step and 7415 women had 1-step delivery. The rate of neonatal asphyxia (RR 0.55; 95% confidence interval [CI] 0.35–0.86; p = 0.008) and occurrence of neonatal clavicular fracture (RR 0.19; 95% CI 0.07–0.51; p = 0.001 ) were lower in the 2-step group than in the 1-step group. The neonatal brachial plexus injury rate was not statistically significant between the 2 groups (RR 0.2; 95% CI 0.04–1.10; p = 0.06). Conclusions. Current evidence supports the use of 2-step method of shoulder delivery with no major adverse neonatal outcomes, lower incidence of neonatal asphyxia rate, and neonatal clavicular fracture rate than delivery by the 1-step method. The clinical value is high for the adoption of 2-step method for better neonatal outcomes.