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Case Reports
. 2019 Jun;133(6):1178-1181.
doi: 10.1097/AOG.0000000000003278.

Shoulder Shrug Maneuver to Facilitate Delivery During Shoulder Dystocia

Ronald Sancetta, Hiba Khanzada, Ricardo Leante
Case Reports

Shoulder Shrug Maneuver to Facilitate Delivery During Shoulder Dystocia

Ronald Sancetta et al. Obstet Gynecol. 2019 Jun.

Abstract

Background: Shoulder dystocia is a potential complication of vaginal delivery that increases the chances of injury to the neonate and the mother. The incidence of dystocia can be up to 3%, and sudden presentation and the lack of reliable predictors make shoulder dystocia a challenge for obstetricians.

Technique: The shoulder shrug technique involves shrugging the posterior shoulder and rotating the head-shoulder unit 180 degrees to resolve the shoulder dystocia.

Experience: We describe successful delivery in three cases of persistent shoulder dystocia using the shoulder shrug technique after the dystocia could not be resolved with McRoberts maneuver.

Conclusion: When successful, the shoulder shrug maneuver may decrease the likelihood of morbidity for the neonate. The technique has resolved dystocia in three cases in which the posterior shoulder could be shrugged. Because it does not take much time to perform the shoulder shrug maneuver, it is worth considering this technique during management of unresolved shoulder dystocia.

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Figures

Fig. 1.
Fig. 1.. Failure of progression due to shoulder dystocia. Flex the neck toward the anterior shoulder, then slide hand behind the posterior shoulder (A). Clamp the thumb and index finger around the posterior shoulder (B). With the thumb and index finger, form a pincer grip through the axilla, resembling an “OK” sign (C). Retract the posterior shoulder toward the shrug position (elevation of the shoulder). Arrow represents movement of the posterior shoulder to the shrug position (D). Restore the head toward the body's axis to form the head–shoulder unit and rotate this unit 180 degrees in the direction of the chest. Arrow represents counterclockwise rotation of the head and shoulder unit (E). On rotation, the anterior shoulder is now posterior and has advanced from the dystocia; normal delivery now proceeds with minimal forward traction. Arrow represents delivery of the neonate (F).
Sancetta. Shrug Maneuver for Shoulder Dystocia. Obstet Gynecol 2019.
Video 1.
Video 1.. The shoulder shrug maneuver. The video highlights a new technique to facilitate delivery during shoulder dystocia. Video created by Ricardo Leante, MS. Used with permission.
See this image and copyright information in PMC

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References

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