Shoulder dystocia: what is the recommended maneuver?

Shoulder dystocia: what is the recommended maneuver?

• A. Hyperflex mother's knees to her chest
• B. Apply downward traction on the neck
• C. Deliver the shoulders with forceps
• D. Do nothing

Answer: (A)

When shoulder dystocia occurs, the first step is to optimize the mother’s pelvis to give the baby more room. The best initial maneuver is to place the mother in a knee-to-chest position by hyperflexing the hips and bringing the knees toward the chest. This position changes the lumbosacral angle and widens the pelvic outlet, often allowing the anterior shoulder to pass under the pubic symphysis and enabling rotation of the fetus. This is the best choice because it is quick, noninvasive, and effective in many cases, without applying traction to the neck or using instruments. Downward traction on the neck carries a real risk of brachial plexus or other injuries. Using forceps is not an initial step and requires a skilled practitioner with a favorable situation. Doing nothing would leave the fetus at risk of prolonged distress.

When shoulder dystocia occurs, the first step is to optimize the mother’s pelvis to give the baby more room. The best initial maneuver is to place the mother in a knee-to-chest position by hyperflexing the hips and bringing the knees toward the chest. This position changes the lumbosacral angle and widens the pelvic outlet, often allowing the anterior shoulder to pass under the pubic symphysis and enabling rotation of the fetus.

This is the best choice because it is quick, noninvasive, and effective in many cases, without applying traction to the neck or using instruments. Downward traction on the neck carries a real risk of brachial plexus or other injuries. Using forceps is not an initial step and requires a skilled practitioner with a favorable situation. Doing nothing would leave the fetus at risk of prolonged distress.