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Shoulder dystocia occurs after vaginal delivery of the head, when the baby's anterior shoulder is obstructed by the mother's pubic bone. [3] [1] It is typically diagnosed when the baby's shoulders fails to deliver despite gentle downward traction on the baby's head, requiring the need of special techniques to safely deliver the baby. [2]
McRoberts maneuver (1) in combination with suprapubic pressure (2) The McRoberts maneuver is an obstetrical maneuver used to assist in childbirth.It is named after William A. McRoberts, Jr. [1] It is employed in case of shoulder dystocia during childbirth and involves hyperflexing the mother's legs tightly to her abdomen.
Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically blocked during childbirth although the uterus contracts normally. [2] Complications for the baby include not getting enough oxygen which may result in death. [ 1 ]
Wood's screw maneuver is practiced in obstetrics when dealing with shoulder dystocia – a condition in which the fetal shoulders cannot easily pass through the vagina.In this maneuver the anterior shoulder is pushed towards the baby's chest, and the posterior shoulder is pushed towards the baby's back, [1] making the baby's head somewhat face the mother's rectum.
Rubin's I and II maneuvers, rotational maneuver to deliver the baby in case of shoulder dystocia. [1] The Rubin's I maneuver is dislodging the anterior shoulder under pubic symphysis by adding suprapubic pressure while in the McRoberts' position. As a result, the bisacromial diameter is rotated from anteroposterior to oblique lie.
The most common indications are a trapped head of a breech baby, [5] [6] shoulder dystocia which does not resolve with routine manoeuvres, and obstructed labor at full cervical dilation, especially with failed vacuum extraction. [5] Use for shoulder dystocia is controversial. [5]
A shoulder presentation is an indication for a caesarean section. Generally, as it is diagnosed early, the baby is not damaged by the time of delivery. With the rupture of the membranes, there is an increased risk of a cord prolapse as the shoulder may not completely block the birth canal.
Newborns undergoing operative delivery have a higher likelihood of experiencing shoulder dystocia, a delivery emergency that may lead to further injury such as brachial plexus palsy. [17] [18] Scalp and facial injuries leading to fractures and bleeding may be possible. [5]