Abnormal Labour Management
CALL FOR HELP
Key Personnel to Call
- Midwife Coordinator
- Additional midwifery help
- Experienced obstetrician
- Neonatal team
- Anaesthetist
Management of Shoulder Dystocia
Initial Steps
- McROBERTS’ MANOEUVRE
- Thighs to abdomen
- SUPRAPUBIC PRESSURE
- And routine axial traction
- Consider episiotomy if it will make internal manoeuvres easier
- Try either manoeuvre first depending on clinical circumstances and operator experience
Further Actions
- DELIVER POSTERIOR ARM
- INTERNAL ROTATIONAL MANOEUVRES
- Inform consultant obstetrician and anaesthetist
- If above manoeuvres fail to release impacted shoulders, consider
- ALL FOURS POSITION (if appropriate)
- OR
- Repeat all the above again
- Consider cleidotomy, Zavanelli manoeuvre or symphysiotomy
Post-Delivery Care
- Baby to be reviewed by neonatologist after birth and referred for Consultant Neonatal review if any concerns
- DOCUMENT ALL ACTIONS ON PROFORMA AND COMPLETE CLINICAL INCIDENT REPORTING FORM
Additional Measures
- Discourage pushing
- Lie flat and move buttocks to edge of bed
Wood’s Corkscrew Manoeuvre
- 180-degree shoulder rotation of posterior shoulder
- Delivery of posterior shoulder
- Roll over onto all-fours (maintain McRoberts’s position)
Procedures Used in Shoulder Dystocia Management
Key Manoeuvres
- McRoberts maneuver
- thighs are abducted and flexed onto her abdomen.
- (suprapubic pressure)
- Rubin II maneuver (posterior pressure on anterior shoulder)
- Wood’s corkscrew maneuver
- posterior shoulder is rotated to anterior position.
- Delivery of the posterior shoulder first
- All fours position with the back arched.
- This widens the pelvic outlet
- Zavanelli’s maneuver
- Cleidotomy
- Maternal symphysiotomy
Management Protocol
First-line Maneuvers
- H - Call for Help
- E - Evaluate for Episiotomy
- L - Legs: McRoberts Maneuver
- P - External Pressure - suprapubic
Second-line Maneuvers
- E - Enter: rotational maneuvers
- R - Remove the posterior arm
- R - Roll the patient to her hands and knees
