Maneuvers to extract a baby with Shoulder dystocia

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Introduction:

  • Macrosomia is defined as a birth weight ≥4000 gm
  • Single best USG criteria for macrosomia is abdominal circumference (AC)
  • The biggest problem of macrosomic baby is shoulder dystocia
  • Shoulder dystocia occurs when baby’s head passes through the birth canal and the shoulders become stuck during labor
  • Shoulder dystocia is an obstetric emergency.

Maneuvers performed to extract a baby with Shoulder dystocia (in decreased order of preference):

  1. McRobert’s maneuver:
    • It is the first maneuver tried
    • Procedure: Sudden flexion & abduction of maternal thigh on abdomen
    • Complication: Injury to the lateral femoral cutaneous nerve of thigh, which may lead to Meralgia paresthetica.
  2. Woods’ corkscrew maneuver:
    • Place at least two fingers (index and middle) on the anterior aspect of the fetal posterior shoulder
    • Apply pressure to abduct/extend the posterior shoulder and rotate the fetal body 180°.
  3. Jacquemier’s / Barnum’s maneuver:
    • The hand and forearm are delicately pulled, delivering the infant with the farthest shoulder first.
  4. Gaskin all-fours maneuver:
    • Apply downward traction to disimpact the posterior shoulder.
  5. Zavanelli maneuver:
    • Least preferred
    • Push the delivered fetal head back into birth canal
    • Do a Cesarean section.

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