Get Safety Checklist For Shoulder Dystocia

Roll the patient over to her hands and knees towards the fetal chest. This manoeuvre requires a mobile compliant woman and may be commonly used by midwives as the first step in the management of shoulder dystocia. In this position the posterior shoulder slips below the sacral promontory allowing delivery.

The 4 maneuvers generally used by obste- tricians to resolve shoulder dystocia are considered the standard of care: • McRoberts maneuver • Suprapubic pressure • Woods screw maneuver • Delivery of the posterior arm Although the order in which the maneuvers are described below is the usual order in which they are ...

The immediate steps in the management of shoulder dystocia include: Call for help – shoulder dystocia is an obstetric emergency (will need senior obstetrician, senior midwife and paediatrician in attendance). Advise the mother to stop pushing – this can worsen the impaction.

Avoid strong downward traction until the shoulder is disimpacted. Excessive traction is associated with neonatal trauma including permanent brachial plexus injury. Avoid jerking or tugging on the fetal head during traction as this may be more damaging to the brachial plexus. Avoid fundal pressure.

Risk factors Most prominent are a history of prior shoulder dystocia or brachial plexus injury, current fetal macrosomia, maternal obesity, diabetes mellitus, excessive weight gain and dysfunctional labor patterns, especially a long deceleration phase followed by a long second stage.

There are two main categories of shoulder dystocia maneuvers: primary maneuvers and secondary maneuvers.

Nurses play a vital role in obtaining assistance during a shoulder dystocia, keeping time, assisting with maneuvers such as suprapubic pressure, and documenting the dystocia management.