Dystocia is defined as an abnormal difficult labor and delivery. Several factors cause dystocia like abnormally irregular uterine contractions, abnormal fetal presentation and cephalopelvic disproportion.
Dystocia management ranges from the use of Oxytocin to improve uterine activity or assisted delivery like forceps or a c-section to ensure safe passage for the infant.
A specific case of dystocia is shoulder dystocia, which happens during delivery when the anterior shoulder of the infant cannot pass the symphysis pubis and cannot be delivered after expulsion of the head.
It is difficult to diagnose shoulder dystocia that is why the problem will surface only during the actual birth of the infant.
And in this case, it is an obstetrical emergency situation that needs immediate management or fetal death can occur within 5 minutes if the infant is not delivered immediately.
There are obstetrical maneuvers done by experienced obstetrician to facilitate the immediate delivery including:
- McRoberts maneuver involves hyperflexing the woman’s legs to widen the pelvic opening and flatten the lumbar spine. If this is not effective, pressure is applied on the lower abdomen and the head of the infant is gently pulled.
- Rubin I (suprapubic pressure) and Rubin II (posterior pressure) maneuver on the anterior shoulder, which will place the fetus in an oblique position somewhat towards the vagina.
- Woods’ screw maneuver, the opposite of Rubin maneuver which will turn the anterior shoulder to the posterior and vice versa.
- Jacquemier’s maneuver (also called Barnum’s maneuver), or delivery of the posterior shoulder first by identifying in the birth canal and be gently pulled.
- Gaskin maneuver, named after Certified Professional Midwife, Ina May Gaskin, mother is placed in all fours position with the back arched, widening the pelvic outlet for infant delivery.
- Zavanelli’s maneuver, involves pushing the fetal head back followed by Cesarean section
- Clavicular fracture, to reduce the diameter of the infant’s shoulder girdle to allow passage through the birth canal.
- Maternal symphysiotomy, this is done by opening the birth canal through creating a large incision in the connective tissue between the two pubic bones facilitating the passage of the shoulders.
- Hysterectomy facilitates vaginal delivery of the impacted shoulder.
More drastic maneuvers include:
The major concern with shoulder dystocia is the devastating risk it poses both to the mother and the infant whether the maneuver is performed or not.
But with the experience of a skilled and properly trained obstetrician and aid from health providers both mother and child will be saved from fatal injuries.