Risk Management Articles

MANEUVERS TO ACCOMPLISH DELIVERY WITH SHOULDER DYSTOCIA

• 1. McRobert’s Maneuver – DO THIS FIRST!
  
• The sharp flexion of the thighs onto the maternal abdomen. Apply supra pubic pressure.
  
• 2. Wood’s (Corkscrew) Maneuver
  
• Slide two fingers into vagina and reach the posterior shoulder. Rotate fetal posterior shoulder 180° thus dislodging the anterior shoulder.
  
• 3. Delivery of Posterior Arm
  

Follow the posterior arm to the hand and flex it across the body. Gentle guidance will result in delivery.

THE DELIVERY NOTE
The delivery note is often the only legal document that the defense attorney may have to defend the case if legal action is taken. It is strongly recommended that the procedure notes be dictated immediately. Therefore, notes should be thorough, accurate, legible and include the following:

• 1. Preventative measures addressed (glucose screen, etc.),
  
• 2. Diagnostic measures employed to assess the possibility of shoulder dystocia,
  
• 3. Patient compliance or non-compliance,
  
• 4. Documentation that the diagnosis of shoulder dystocia was made and that the maneuvers discussed above were systematically employed,
  
• 5. Informed consent,
  
• 6. Notation that excess traction was not employed,
  
• 7. Pediatric and anesthetic help were available,
  
• 8. A liberal episiotomy was performed,
  
• 9. The results of cord blood gases to document that the fetus was not derived of oxygen during delivery.
  

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