Shoulder dystocia

Essential equipment

N/A

Steps

Progress through the following in a stepwise fashion until delivery progresses:

  1. Recognize by failure of delivery to progress past neck, “turtle sign” when head retracts back to perineum after pushing

  2. Call for help/assistant: Pediatrics, Obstetrics, Anesthesia

  3. Tell mother to stop pushing

  4. McRoberts maneuver: Place mother in knee-chest position. This may free the anterior fetal shoulder

  5. 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

  6. Shoulder sweep: Place hand in the vagina and exert pressure on fetal scapula to rotate torso, then deliver rotated shoulder

  7. Posterior shoulder delivery: Insert a hand and exert pressure on sweep the posterior arm across the chest and over the perineum

  8. Last resort - Zavenelli maneuver: Push delivered fetal head back into birth canal. Prepare for subsequent cesarean delivery