Shoulder Dystocia

• Head and neck should be grasped and taken posteriorly while suprapubic pressure is applied by an assistant slightly toward the sideof fetal chest.
• This will reduce the bisacromial diameter and rotate the anterior shoulder toward the oblique diameter.
• This maneuver is simple as well as effective. 

McRoberts maneuver:

• Abduct the maternal thighs and sharply hyperflex them onto her abdomen.
• This straightens the lumbosacral angle, rotates the maternal pelvis upward and increases the anterior-posterior diameter of the pelvis.
• Suprapubic pressure may be used together. 
• Involves  Lateral cutaneous nerve of thigh 

Wood’s maneuver:

• Under GA
• The posterior shoulder is rotated to anterior position (180°) by a corkscrew movement by inserting two fingers in the posterior vagina.
• Simultaneous suprapubic pressure is applied.
• This helps easy entry of the bisacromial diameter into the pelvic inlet.

 Extraction of the posterior arm:

• The operator’s hand is introduced into the vagina along the fetal posterior humerus in the sacral hollow.
• The arm is then swept across the chest and thereafter delivered by gentle traction.
• This procedure may cause either fracture clavicle or humerus or both.

“All Fours” Position:

• Changing the mother on to all fours may increase the pelvic dimensions and allow the fetal position to shift.
• Downward traction on the posterior shoulder helps to free the impacted shoulder. 

Other techniques :

• Deliberate fracture of the clavicle by finger pressure (fracture heals rapidly) or cleidotomy:In living anencephalic baby as a first choice or in a dead fetus.
• Zavanelli maneuver (pushing the fetus back to the uterus and delivering by cesarean section) or symphysiotomy is done rarely