A Simple Maneuver to Facilitate Delivery in Shoulder Dystocia

Shoulder dystocia is an unpredictable complication of vaginal delivery and it could lead serious adverse maternal and neonatal outcomes. Prompt intervention and appropriate management of this obstetric emergency is essential to reduce the risk of adverse outcome. The maneuvers that had various advantages and disadvantages to alleviate shoulder dystocia have been described previously. In this report, we defined a new, easy to perform and noninvasive maneuver which could be used to relieve shoulder dystocia. This maneuver was successfully implemented in two nulliparous and two multiparous women who had experienced shoulder dystocia during vaginal delivery. After the diagnosis of shoulder dystocia and unsuccessful McRoberts and suprapubic pressure maneuver, the gentle upward traction on the fetal head and neck was performed in the lithotomy position. The posterior shoulder slipped forward in the sacral hollow and brought closer to the introitus with this maneuver. Thus, the anterior and posterior shoulders were no longer in the same antero-posterior plane of the pelvis. Then the gentle downward traction on the fetal head was applied until the anterior shoulder protruded through the perineum and the impacted anterior shoulder dislodged from behind the symphysis pubis. No other maneuver was needed for the completion of the delivery in these four cases, and no maternal or neonatal complication was observed. In conclusion, the presented maneuver is an easy and noninvasive maneuver. It could be easily learned with simulation training and used in the management of shoulder dystocia.