Shoulder dystocia is a critical obstetric emergency that requires immediate and effective intervention to prevent severe complications for both the mother and baby. This condition occurs when the fetal shoulders become trapped behind the maternal pelvis during delivery, obstructing progress and increasing the risk of injury. Rapid recognition and a structured approach are essential to resolving the dystocia safely. The following maneuvers provide a step-by-step guide for healthcare providers to manage shoulder dystocia efficiently, ensuring the best possible outcomes in this high-stakes situation.
1. CALL FOR HELP
Call for help so others can assist with tasks to resolve the shoulder dystocia. If a surgery team is not readily available at your facility, call them to arrive ASAP.
2. FLEX THE HIPS (MCROBERT’S)
Flexing the hips onto the abdomen can shift the pelvis and allow the fetal shoulder to disimpact. Hips typically remain flexed with each maneuver.
3. SUPRAPUBIC PRESSURE
Pushing at the suprapubic area, towards the fetal nose, can help rotate the fetal shoulders and release the impacted fetal shoulder. This can be repeated with each maneuver.
4. DELIVERY OF THE POSTERIOR ARM
Delivering the posterior arm can release an impacted anterior fetal shoulder. Some call this the swimmer’s move. To deliver, the arm should be flexed across the fetal abdomen. If time allows, a Foley catheter could be fed under the fetal armpit, then with gentle traction across the fetal chest, deliver this posterior arm.
5. ROTATE THE POSTERIOR SHOULDER
Applying pressure to the posterior fetal shoulder, caving in the shoulder girth, can rotate the fetus enough to disimpact the anterior fetal shoulder.
6. ROTATE THE ANTERIOR SHOULDER
The anterior fetal shoulder can have pressure applied to help rotate it out from under the pubic symphysis. Typically, rotating towards the fetal nose has the best results, but the opposite pressure has also helped, just not as commonly. During this emergency, if one doesn’t work, try the other.
7. EVALUATE FOR AN EPISIOTOMY
The episiotomy alone would not resolve a shoulder dystocia, but if more room is needed to perform the maneuvers, it may be warranted.
8. ALL FOURS (GASKIN’S)
Moving the mother into the all-fours position may shift the pelvis and fetus, allowing the shoulder dystocia to be resolved and the delivery to be accomplished.
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