Shoulder Dystocia - Procedures

Procedures

A number of labor positions and/or obstetrical maneuvers are sequentially performed in attempt to facilitate delivery at this point, including :

• McRoberts maneuver; The McRoberts maneuver is employed in case of shoulder dystocia during childbirth and involves hyperflexing the mother's legs tightly to her abdomen. This widens the pelvis, and flattens the spine in the lower back (lumbar spine). If this maneuver does not succeed, an assistant applies pressure on the lower abdomen (suprapubic pressure), and the delivered head is also gently pulled. The technique is effective in about 42% of cases

• suprapubic pressure (or Rubin I)

• Rubin II or posterior pressure on the anterior shoulder, which would bring the fetus in an oblique position with head somewhat towards the vagina

• Woods' screw maneuver which leads to turning the anterior shoulder to the posterior and vice versa (somewhat the opposite of Rubin II maneuver)

• Jacquemier's maneuver (also called Barnum's maneuver), or delivery of the posterior shoulder first, in which the forearm and hand are identified in the birth canal, and gently pulled.

• Gaskin maneuver, named after Certified Professional Midwife, Ina May Gaskin, involves moving the mother to an all fours position with the back arched, widening the pelvic outlet.

More drastic maneuvers include

• Zavanelli's maneuver, which involves pushing the fetal head back in with performing a cesarean section. or internal cephalic replacement followed by Cesarean section

• intentional fetal clavicular fracture, which reduces the diameter of the shoulder girdle that requires to pass through the birth canal.

• maternal symphysiotomy, which makes the opening of the birth canal laxer by breaking the connective tissue between the two pubes bones facilitating the passage of the shoulders.

• abdominal rescue, described by O'Shaughnessy, where a hysterotomy facilitates vaginal delivery of the impacted shoulder