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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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