[An underestimated technique for the management of shoulder dystocia: the all-fours manoeuvre].

In two pregnant women, parturition was complicated by severe shoulder dystocia. Conventional techniques for the management of this complication of labour failed. By means of the all-fours manoeuvre in combination with conventional techniques it was possible to deliver the babies. Both mothers had received epidural anaesthesia, which did not cause any difficulty during the use of the all-fours procedure. Both newborn infants had low 1-minute Apgar scores and suffered from a brachial-plexus injury. No major maternal morbidity was associated with the use of this procedure. These cases emphasize the importance of keeping obstetrical ward personnel well-trained with multidisciplinary simulation sessions, as well as the importance of proper documentation of the management of this complication.