Shoulder Dystocia: An update and review of new techniques

Abstract

The definition for shoulder dystocia and the incidence varies. Worldwide, shoulder dystocia may be increasing23. In this update we look at the complications for both the mother and fetus. We review the risk factors and strategies for possible prevention. Management options include Mc Roberts position, techniques to deliver the anterior and posterior shoulder and finally salvage maneuvers. Salvage maneuvers which include Posterior Axillary Sling traction (PAST), the Zavanelli Maneuver and fracture of the clavicles. In cases of fetal death associated with an undelivered shoulder dystocia one can consider the transabdominal performance or facilitation of traditional vaginal maneuvers.28, 29

We suggest a simplified mnemonic “MAPS”,M: Mc Roberts, A: Anterior shoulder, P: Posterior shoulder, S: Salvage. A video teaching program will be available shortly on the World Health Organisation Reproductive Health Library (www.who.int/rhl ; rhl@who.int )