Shoulder dystocia
Essential equipment
Steps
Progress through the following in a stepwise fashion until delivery progresses:
Recognize by failure of delivery to progress past neck, “turtle sign” when head retracts back to perineum after pushing
Call for help/assistant: Pediatrics, Obstetrics, Anesthesia
Tell mother to stop pushing
McRoberts maneuver: Place mother in knee-chest position. This may free the anterior fetal shoulder
Suprapubic pressure: Provide gentle downward traction on fetal head while an assistant provides moderate suprapubic (not fundal) pressure in efforts to rotate and deliver the anterior shoulder
Shoulder sweep: Place hand in the vagina and exert pressure on fetal scapula to rotate torso, then deliver rotated shoulder
Posterior shoulder delivery: Insert a hand and exert pressure on sweep the posterior arm across the chest and over the perineum
Last resort - Zavenelli maneuver: Push delivered fetal head back into birth canal. Prepare for subsequent cesarean delivery