Management of shoulder dystocia

1. If a shoulder dystocia occurs, an assistant should provide suprapubic pressure to dislodge the impacted anterior fetal shoulder from the symphysis. McRoberts maneuver (extreme hip flexion) should be done simultaneously.

2. If the shoulder remains impacted anteriorly, an ample episiotomy should be cut and the posterior arm delivered.

3. In almost all instances, one or both of these procedures will result in successful delivery. The Zavanelli maneuver consists of replacement of the fetal lead into the vaginal canal and delivery by emergency cesarean section.

4. Fundal pressure is not recommended because it often results in further impaction of the shoulder against the symphysis.

References: See page 184.

0 0

Post a comment