William McRoberts
William Alexander McRoberts Jr (1914-2006) was an American obstetrician and gynaecologist.
McRoberts was the first to publish a series of cases with supine hypotensive syndrome or ‘postural shock in pregnancy‘ in the English literature. The term ‘supine hypotensive syndrome‘ appeared in the literature 2 years later (1953).
McRoberts is eponymously remembered for his description and teaching of the McRoberts Manoeuvre as a first-line procedure in the management of shoulder dystocia.
Biography
- Born on August 8, 1914 in Chekiang, China to missionary parents
- 1919 – Returned to America with his family
- 1940 – MD, University of Pittsburgh medical school
- 1941-1944 Residency in obstetrics and gynaecology at the Philadelphia Lying-in Hospital
- 1944-1982 Private practice in Obstetrics and Gynecology in Houston, Texas
- Chief of Obstetrics at Hermann Hospital; Professor of Clinical Obstetrics at the University of Texas Medical School
- 1982 – Retired from clinical practice
- Died on August 18, 2006
Medical Eponyms
McRoberts Manoeuvre
Obstetrical manoeuvre recommended as the initial technique for disimpaction of the anterior shoulder in shoulder dystocia. This simple and effective technique is associated with no neonatal injury and facilitates the descent of the posterior shoulder below the sacral promontory and the rotation and descent of the anterior shoulder.
1854 – Hubert von Luschka (1820–1875) published that the opposing surfaces of the sacrum and the ilium possess properties identical with those of a true joint [1854; 7: 299]. This prompted James Matthews Duncan (1826-1890) of Edinburgh, to study the mobility of this articulation. He found that its mobility increased during pregnancy and the puerperium [1854; 18:60-69].
Early interest in mobility of the pelvic articulations was evoked by obstetricians, who desired to assess the mouldability of the pelvic girdle during parturition, and related changes in inlet and outlet diameters with relative changes in body position.
1889 – Walcher showed that movements at the sacro-iliac joints altered the true conjugate diameter. He assessed the true conjugate by palpating the diagonal conjugate diameter in 6 pregnant women and found that the change from the lithotomy to the dorsal recumbent position with the thighs hyperextended resulted in an increase of the former by 8 mm.
1899 – Bonnaire and Bué confirmed Walcher’s findings in pregnant and puerperal women with a series of post-mortem findings relating to the pelvic brim and SIJ fibrous apparatus.
Original
English
L’emploi de la position de la taille périnéale est beaucoup plus profitable ; mais il est moins souvent indiqué que celui de l’attitude d’hyperextension. On doit le réserver pour les cas où il existe un rétrécissement du détroit inférieur (bassin cyphotique), pour ceux où la tête enclavée en présentation du front dans le petit bassin doit être extraite par le forceps, pour ceux encore où, la tête étant extraite, les épaules sont arrêtées sur le plancher du bassin, en raison de l’excès de volume du tronc
En élargissant le détroit inférieur et en déterminant une sorte de béance de la vulve, elle rend le fœtus, arrêté au détroit supérieur, mieux accessible aux instruments obstétricaux.
The use of the lithotomy is much more profitable; but less often indicated than that of (Walcher) hyperextension. It should be reserved for cases where there is kyphotic pelvis; for those forehead presentation in the small pelvis; and those where, the head being extracted, the shoulders are stopped on the floor of the pelvis, due to the excess volume of the trunk.
By widening the lower strait and determining a kind of open gap in the vulva, it makes the fetus, arrested in descent, better accessible to obstetric instruments.
1942 – As a a junior resident obstetrician alone on duty at the Philadelphia Lying-in Hospital, McRoberts encountered a neonatal death secondary to shoulder dystocia. He recalls:
A primigravida was admitted in active labour and made rapid progress. When the head was visible with contractions I applied low forceps as we were taught. On removal of the forceps the chin disappeared into the mother’s anus. I did not realise then what a problem I had. Forty minutes later, with great difficulty I delivered a dead 12-pound baby. I vowed then that it would never happen to me again.
1943 – Charles Woods published his manoeuvre for managing shoulder dystocia which McRoberts used with good effect until the mid 1950’s.
1955 – McRoberts encountered a case of shoulder dystocia refractory to the Woods manoeuvre. He recalled working with a gynaecologist who required his assistants to hold the patient’s legs in marked hip flexion to improve surgical access at vaginal hysterectomy. With this in mind, McRoberts flexed the patient’s hips up onto her abdomen, and was relieved to find immediate resolution of the shoulder dystocia.
McRoberts taught this manoeuvre to residents in training at the Hermann Hospital and University of Texas Medical School, but never published the technique.
1982 – On McRoberts’ retirement, two of his former residents Department of Obstetrics and Gynecology, University of Texas Medical School, wrote up the method and named it the McRoberts manoeuvre
This report describes a delivery complicated by shoulder dystocia which was managed by a maneuver involving manipulation of the mother to relieve the obstruction. This maneuver, which has been utilized at our institution for many years, was popularized by Dr. William A. McRoberts, Jr.
The McRoberts maneuver involves exaggerated flexion of the patient’s legs (knee-chest position). This results in a straightening of the sacrum relative to the lumbar spine with consequent rotation of the symphysis pubis cephalad and a decrease in the angle of inclination…although this maneuver does not change the dimensions of the true pelvis, rotation of the symphysis superiorly frees the impacted anterior shoulder without manipulation of the fetus.
Gonik B, Stringer CA, Held B, 1983
In a retrospective review of 236 cases of shoulder dystocia occurring (between 1991-1994) at Los Angeles County-University of Southern California Medical Center, the McRoberts maneuver alone alleviated 42% of cases [1997]. When combined with suprapubic pressure, the McRoberts maneuver results in resolution of 58% of cases [1996]
McRoberts Manoeuvre: Johns Hopkins Medicine
Major Publications
- McRoberts WA Jr. Postural shock in pregnancy. Am J Obstet Gynecol. 1951 Sep;62(3):627-32
- Samaan NA, McRoberts WA, Smith JP, Myers LG. Metabolic changes in women with trophoblastic disease and with intrauterine fetal death compared with metabolic changes during normal pregnancy. J Clin Endocrinol Metab. 1971 Sep;33(3):521-9
- Samaan NA, Gallager HS, McRoberts WA, Faris AM Jr. Serial estimation of human placental lactogen, estriol, and pregnanediol in pregnancy correlated with whole organ section of placenta. Am J Obstet Gynecol. 1971 Jan 1;109(1):63-73
- Samaan NA, Gallager HS, McRoberts WA Jr, Holt B. Differential evaluation of the fetoplacental unit in patients with diabetes. Am J Obstet Gynecol. 1974 Nov 15;120(6):825-32.
Eponymous Shoulder Dystocia management techniques
- McRoberts manoeuvre (1983)
- Woods Screw manoeuvre (1943)
- Rubin manoeuvre (1964)
- Gaskin (all-fours) manoeuvre (1977)
- Zavanelli manoeuvre (1978)
References
Biography
- Dr. William A. McRoberts. Houston Chronicle Aug. 20, 2006
- Baskett TF. McRoberts, William Alexander (1914–2006). Eponyms and Names in Obstetrics and Gynaecology. 3e. 2019: 274-275
Eponymous term
- Luschka H. Die Kreuzdarmbeinfuge und die Schambeinfuge des Menschen. [The sacrum and the pubic symphysis of humans] Archiv für pathologische Anatomie und Physiologie und für klinische Medicin. 1854; 7: 299–316
- Duncan JM. The behaviour of the pelvic articulations in the mechanism of parturition. Dublin Quarterly Journal of Medical Science, 1854; 18(2): 60–69
- Walcher G. Die Conjugata eines engen Beckens ist keine konstante Gröfse, sondern lässt sich durch die Körperhaltung der Trägerin verändern. 1889; 13: 892
- Bonnaire C, Bué E. Influence de la position sur la forme et les dimensions du bassin. Annales de gynécologie et d’obstétrique 1899; 52: 296–310.
- Gonik B, Stringer CA, Held B. An alternate maneuver for management of shoulder dystocia. Am J Obstet Gynecol. 1983 Apr 1;145(7):882-4.
- McFarland MB, Langer O, Piper JM, Berkus MD. Perinatal outcome and the type and number of maneuvers in shoulder dystocia. Int J Gynaecol Obstet. 1996 Dec;55(3):219-24.
- Gherman RB, Goodwin TM, Souter I, Neumann K, Ouzounian JG, Paul RH. The McRoberts’ maneuver for the alleviation of shoulder dystocia: how successful is it? Am J Obstet Gynecol. 1997 Mar;176(3):656-61
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.
Fourth-year MBBS student at Curtin Medical School. Conducting penultimate year of medicine with the Rural Clinical School of WA in Kalgoorlie. Passionate about women's health, emergency medicine and rural health care.