Alan Rubin

Alan Rubin (1923 - 2011) 300

Alan Judah Rubin (1923 – 2011) was an American obstetrician and gynecologist.

Rubin was a prolific medical researcher. He was one of the first physicians to demonstrate a link between diabetes in men and erectile dysfunction (1958); recognize a hereditary link in some women with breast cancer; and use tissue cultures as a method of screening drugs for use as anticancer agents.

Eponymously remembered for his description of the Rubin Manoeuvre in managing shoulder dystocia in 1964.


Biography
  • 1923 – Born November 10
  • 1943 – University of Pennsylvania strength record for servicemen’s physical fitness tests
  • 1947 – MD, University of Pennsylvania medical school
  • 1948 – Residency in obstetrics and gynecology at the Hospital of the University of Pennsylvania
  • 1962 – President of Penn’s Medical Alumni Society
  • 1967-1973 – Citizens Council on City Planning in Philadelphia
  • 1979 – Clinical associate professor of obstetrics and gynaecology at Temple University School of Medicine
  • Other posts held: Chairman of the obstetrics and gynecology department at Albert Einstein Medical Center, Philadelphia; Chief of gynecology at the Graduate Hospital
  • 1989 – Retired
  • 2011 – Died May 16 of complications from Parkinson’s disease

Medical Eponyms
Rubin Manoeuvre (1964)

Obstetrical internal rotation or foetal manipulation manoeuvre performed in cases of shoulder dystocia where the McRoberts manoeuvre has failed. In the Rubin manoeuvre (or reverse Woods screw), pressure is applied to the posterior surface of the anterior shoulder to effect counterclockwise rotation of the posterior shoulder.

1964 – Alan J, Rubin (1923 – 2011) described two manoeuvre’s to assist with foetal delivery in cases of shoulder dystocia.

Firstly, Rubin advocated suprapubic pressure to rock the fetal shoulders from side to side to aid shoulder disimpaction.

The first maneuver is to rock the fetus’ shoulders from side to side once or twice by pushing on the mother’s lower abdomen (Fig 1). This often will disimpact the shoulder which is jammed against the symphysis if the shoulders are anteroposterior, or from the pelvic rami if the shoulders are somewhat oblique.

Secondly, Rubin measured 25 newborn infants, and found that the transverse diameter of their shoulders was about 1-2 cm less when adducted as opposed to straight or abducted.

Rubin shoulder dystocia measurements 1964
Shoulder Measurements of Newborn Infants *in Centimetres.
Rubin 1964

Rubin noted that with the Woods manoeuvre, the foetal shoulders are rotated by pressure on the anterior aspect of the shoulder, resulting in abduction (Fig 3). Instead, Rubin proposed placing the fingers on the scapula and pushing the foetal shoulder towards its chest, thereby adducting and reducing the diameter of the shoulders (Fig 2).

…inserting the fingers of one hand vaginally behind whichever shoulder is more readily accessible (usually the posterior) and pushing the shoulder toward the fetus’ chest (Fig 2). This adduction of the shoulder reduces the transverse diameter at the shoulders and turns the fetus on its long axis in such a direction that the second shoulder also tends to adduct and glide toward the fetus’ chest thus further reducing the circumference and transverse diameter of the shoulders. This motion also rotates the shoulders into a longer oblique diameter if they are directly anteroposterior or transverse.

At the same time, the fingers may be able to gain a purchase on the scapula, to urge it and the shoulder not only toward the fetus’ chest, but down the birth canal as well. The other hand can also exert slight traction in the opposite axilla while an assistant exerts fundal pressure at a time designated by the operator after the shoulders are disimpacted.

We have always succeeded in delivery by these maneuvers and have thus far never injured an infant.

Rubin Manoeuvre reverse woods screm shoulder dystocia 1964

Fig 2. Rubin Manoeuvre: Adducting most accessible shoulder. Motion imparted to fetus turns it on its long axis in such a direction that friction tends to adduct other shoulder and thus reduce circumference and transverse diameter.
Fig 3. Woods Manoeuvre: Abducting the posterior shoulder. Motion imparted to fetus tends to make other shoulder also abduct, resulting in a larger shoulder circumference and transverse diameter than with maneuver shown in Fig 2.


Rubin Manoeuvre: Johns Hopkins Medicine


Eponymous Shoulder Dystocia management techniques

Major Publications

References

Biography

Eponymous term


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

Graduated from Cardiff Medical School in 2017 with MBBCh and BSc in Psychology and Medicine. Currently working as a doctor in the emergency department at Sir Charles Gairdner Hospital in Perth, Australia.

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