2. Definition
When fetal head is delivered, but shoulders are stuck
and cannot be delivered it is known as shoulder
dystocia.
Failure of the shoulders to traverse the pelvis
spontaneously after delivery of the head.
3. Shoulderdystocia
The anterior shoulder becomes trapped behind on the
symphysis pubis, whilst the posterior shoulder may be
in the hollow of the sacrum or high above the sacral
promontory.
6. Warningsignsanddiagnosis
The delivery may have been uncomplicated initially, but
the head may have advanced slowly and the chin may
havehaddifficulty in sweepingover theperineum.
Once the head is delivered it may look as if it is trying to
return into the vagina, which is caused by reverse
traction.
Diagnosed when maneouvers normally used by the
midwife fail to accomplish delivery.
13. Rubin’sManeuver
3. If the shoulder is still not delivered: insert a hand into
the vagina and apply pressure to the anterior shoulder
in the direction of the baby’s sternum to rotate the
shoulderanddecreasetheshoulderdiameter.
• If the needed, apply pressure to the posterior shoulder
in thedirection of thebaby’ssternum
14. Wood’smaneuver
4. If the shoulder is still not delivered despite the above
measures:
• Insert ahandinto thevagina
• Grasp the humerus of the posterior arm and keeping
the arm flexed at the elbow, sweep the arm across the
chest, graspthehandanddeliver theentire arm.
• With one hand on each side of the fetal head, apply
firm, continuous traction downward to move the anterior
shoulderunderthesymphysispubis
17. Cleidotomy
If all of the measures fail to deliver the anterior
shoulder:
– Another option is to fracture the baby’s anterior
clavicle to decrease the width of the shoulder. This is
done by pressing the anterior clavicle against the
symphysispubis.
– After birth, facilitate urgent and immediate newborn
careor transfer of thenewborn.
