During birth, complications can occur due largely to the position of the baby at the time of birth or to particular conditions of the new mother's body. Among these, one of the most serious (but also one of the rarest) is the shoulder dystocia, i.e. the failure of the baby's shoulders to be expelled from the womb.
This situation must be resolved in a short time and one of the solutions that obstetricians can adopt to bring the birth to a successful end is the so-called McRoberts maneuver.
In this article
- Shoulder dystocia: what is it?
- The McRoberts maneuver
- The other maneuvers to resolve shoulder dystocia
Shoulder dystocia: what is it?
Shoulder dystocia occurs when the mother's thrusts and moderate pulls by obstetric personnel are not enough to come out the shoulders of the child from the womb.
This usually occurs when the fetal head that comes out of the vulva is unable to rotate due to pressure against the external genitalia. Often this is because the anterior shoulder is hampered by the pubic symphysis (a small cartilage joint), although in some cases the posterior shoulder may also be blocked. Rarer, however, that both shoulders get "stuck".
In any case, shoulder dystocia is a complication that occurs very rarely, although some risk factors could increase the likelihood to occur. Between these:
- Gestational diabetes
- Obesity
- Fetal macrosomia
- Previous shoulder dystocia
The risks
If the dystocia is not resolved in a short time, the fetus runs great risks, since the pressure exerted on the unborn child reduces itsoxygenation, while the displacement of blood mass towards the head aggravates the danger of asphyxiation. Death is the most serious consequence if the problem is resolved quickly.
What to do when shoulder dystocia occurs?
In the event that this complication occurs, the medical staff in the delivery room is required to stop the voluntary pushes of the mother e communicate to the patient the presence of a problem and the need for perform an obstetric maneuver. Then the mother's bladder is emptied to proceed with the maneuver.
Read also: Fetal macrosomia: what to do if the fetus is largeThe McRoberts maneuver
The Mc Roberts maneuver is an obstetric maneuver which consists ofhyperflexion of the maternal thighs on the abdomen.
In this operation, in fact, the mother's legs are spread apart and they bring their knees almost to touch the chest in order to rotate the symphysis upward, flatten lumbar lordosis and thus increase the space in which to move the baby.
Possible complications
Carrying out the Mc Roberts maneuver (or other maneuvers) can involve some side effect for the mother:
- Traumatic soft tissue injuries
- Postpartum hemorrhages
- Postpartum pelvic infections
- Hematoma
- Rupture of the uterus
- Diastasis of the pubic symphysis
- Psychological trauma
The other maneuvers to resolve shoulder dystocia
Should McRoberts fail, other obstetric maneuvers can be used:
- Rubin Maneuver 1: this maneuver can be chosen even before McRoberts. Here an assistant presses on the suprapubic area, the area where the anterior shoulder should be, first in the direction of the anterior end closest to an oblique diameter of the superior strait and then in the dorsal and caudal direction.
- Mazzanti's maneuver: in this case the pressure is exerted centrally in the suprapubic anteroposterior region on the anterior shoulder, with the palm of the hand, in order to facilitate its sliding under the pubic symphysis.
- Rubin Maneuver 2: a hand is introduced into the vagina by exerting pressure on the posterior aspect of the anterior shoulder with a finger, pushing it ventrally towards the fetal thorax and then bringing the bisacromial diameter from anteroposterior to oblique.
- Jacquemier's maneuver: with this maneuver the aim is to extract the posterior arm of the fetus.
- Zavanelli maneuver: if all the maneuvers have been performed in succession, without success, the Zavanelli maneuver is performed by retracing the path taken by the baby's head during birth, repositioning the same head as it was just out of the vulva and performing a caesarean section.
SOURCES: University of Ferrara; Paeseni Obstetricians and Gynecologists Association
Read also: The pains of childbirth: what to compare them to?TAG:
- give birth
- Natural childbirth
