- 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):
- 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.
- 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°.
- Jacquemier’s / Barnum’s maneuver:
- The hand and forearm are delicately pulled, delivering the infant with the farthest shoulder first.
- Gaskin all-fours maneuver:
- Apply downward traction to disimpact the posterior shoulder.
- Zavanelli maneuver:
- Least preferred
- Push the delivered fetal head back into birth canal
- Do a Cesarean section.
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