Management of Shoulder Dystocia During Childbirth

Initial Management

The American College of Obstetricians and Gynecologists recommends the McRoberts maneuver as first-line intervention for shoulder dystocia, involving hyperflexion of the mother's legs tightly to her abdomen, with the possibility of lowering the fetal head in the umbilical-coccygian axis 1, 2
The American College of Obstetricians and Gynecologists suggests that suprapubic pressure may be applied simultaneously with the McRoberts maneuver to help dislodge the anterior shoulder from behind the pubic symphysis 3
Positioning the patient in a supine position compatible with the McRoberts maneuver is recommended to ensure optimal effectiveness 2

The American Journal of Obstetrics and Gynecology recommends manual vaginal disimpaction (vaginal push method) as a secondary maneuver, involving introduction of a hand into the vagina to move the fetal head upward, if the McRoberts maneuver is unsuccessful 4, 5
Care must be taken to apply pressure correctly to avoid further deflexion of the fetal head which could compound impaction behind the pubic symphysis 6

The American College of Obstetricians and Gynecologists does not systematically recommend episiotomy for the sole purpose of reducing the risk of anal sphincter injury during shoulder dystocia management 1, 2
The American Academy of Family Physicians recommends considering prophylactic cesarean delivery for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes 7
The American Academy of Family Physicians advises against labor induction for suspected fetal macrosomia as it doubles the risk of cesarean delivery without reducing the risk of shoulder dystocia 7

The American College of Obstetricians and Gynecologists recommends administering 5 to 10 IU of oxytocin via slow IV or intramuscular infusion to reduce the incidence of postpartum hemorrhage after successful resolution of shoulder dystocia 1, 2
The American College of Obstetricians and Gynecologists suggests considering intravenous administration of 1 g of tranexamic acid within 1 to 3 hours after bleeding onset in case of post-partum hemorrhage 3

The American Society of Anesthesiologists strongly recommends simulation-based training programs on mechanical dystocia (shoulder dystocia) for emergency medicine teams to improve management skills and reduce maternal and fetal morbidity and mortality 8
The American Journal of Obstetrics and Gynecology recommends multidisciplinary team training, focusing on recognition of risk factors, proper execution of maneuvers, and effective communication during this obstetric emergency 5, 9

Using only 1-2 fingers for suprapubic pressure is less effective and may increase the risk of fetal injury, as stated by the American College of Obstetricians and Gynecologists 10

Simulation-based training is strongly recommended for all delivery room personnel to improve management skills for shoulder dystocia, according to the American Society of Anesthesiologists 11