[Management of shoulder dystocia]

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Emergency Obstetric Care

Context:

• Shoulder dystocia is a critical obstetric emergency requiring immediate and skilled management.
• Current evidence and professional consensus guide the recommended interventions.
• Effective management protocols are essential to minimize maternal and neonatal morbidity.

Purpose:

• To provide evidence-based recommendations for the management of shoulder dystocia.
• To outline a stepwise approach to obstetric maneuvers for shoulder dystocia resolution.
• To emphasize the importance of timely intervention and appropriate technique.

Summary:

• Immediate notification of the obstetrician and summoning assistance are crucial upon recognizing shoulder dystocia.
• The McRoberts maneuver, with or without suprapubic pressure, is the recommended first-line intervention due to its simplicity and effectiveness.
• Second-line maneuvers, such as Wood's maneuver or posterior arm delivery, should be employed based on the clinical presentation and operator expertise, with no single maneuver demonstrating superiority.
• Routine episiotomy is not recommended, and clinicians should be proficient in at least two maneuvers beyond the McRoberts maneuver.

Impact:

• Improved clinical decision-making and standardized management of shoulder dystocia.
• Reduced risk of birth trauma and adverse neonatal outcomes associated with shoulder dystocia.
• Enhanced preparedness of healthcare providers to manage this obstetric emergency effectively.