Malpresentations and Positions & Operative Obstetrics
Following are maneuvers for management of shoulder dystocia except: (AIPG 2011)
↔ There is no role for fundal pressure because this action further impacts the shoulder against the pubic bone and makes the situation worse.
1. Shoulder dystocia is an obstetric emergency
2. A shoulder dystocia occurs when the fetal shoulders fail to spontaneously deliver secondary to impaction of the anterior shoulder against the pubic bone after delivery of the head has occurred.
3. A generous episiotomy should always be made to allow the obstetrician to have adequate room to perform a number of manipulations to try to relieve the dystocia
Such maneuvers include -------------- (Clue: Shoulder Dystocia Wale Maneuvers - GRZ!)
1. Suprapubic Pressure: This pressure is at the pubic bone, not at the top of the uterus. This might allow the shoulder enough room to move under the pubis symphysis.
2. Delivery of the posterior shoulder.
3. Woods Maneuver: This is also known as the corkscrew, the attendant tries to turn the shoulder of the baby by placing fingers behind the shoulder and pushing in 180 degrees.
4. McRobert's Maneuver: Flex the mother's legs toward her shoulders as she lays on her back, thus expanding the pelvic outlet. One study showed that this alleviated 42% of all cases of shoulder dystociA.
5. Gaskin Maneuver: Get the woman into a hands and knees position. This will also change the diameters of her pelvis, though is not always possible with epidural anesthesiA.
6. Rubin Maneuver: Like the Woods maneuver, two fingers are placed behind the baby's shoulder, this time they are pushing in the directions of the baby's eyes, to line up the shoulders.
7. Zavanelli Maneuver: Pushing the baby's head back inside the vagina and doing a cesarean. This is the mostly frequently asked about method, but also one of the most dangerous.