What is the management approach for shoulder dystocia?

Generally, shoulder dystocia refers to a situation during childbirth where the fetal head has already exited the vaginal opening, but the fetal shoulders remain lodged above the pubic symphysis. Shoulder dystocia can be managed using methods such as the thigh flexion maneuver, suprapubic pressure maneuver, rotational maneuver, delivery of the posterior arm and shoulder, and episiotomy. Detailed descriptions of these methods are as follows:

1. Thigh Flexion Maneuver

The mother flexes both legs sharply toward her abdomen and holds her knees with her hands, thereby reducing the inclination of the pelvis. At the same time, the birth attendant applies gentle downward traction on the fetal head to deliver the anterior shoulder. This maneuver changes the shape of the pelvis, allowing the anterior shoulder, which is impacted above the pubic symphysis, to become naturally disengaged, thus facilitating delivery of the fetus.

2. Suprapubic Pressure Maneuver

The birth attendant applies downward and backward pressure on the anterior shoulder of the fetus at the suprapubic region, while gently pulling the fetal head. The coordinated application of pressure and traction helps reduce the biacromial diameter, enabling the fetal shoulders to pass smoothly through the pelvic outlet.

3. Rotational Maneuver

The birth attendant inserts the index and middle fingers into the vagina and presses against the posterior shoulder of the fetus, rotating the posterior shoulder upward and laterally. Simultaneously, the fetal head is rotated in the same direction. As the posterior shoulder gradually rotates to the anterior position, it can then be delivered. This maneuver changes the position of the fetal shoulders to better conform to the shape of the pelvis, thereby facilitating delivery.

4. Delivery of the Posterior Arm and Shoulder

The birth attendant inserts a hand along the sacrum into the vagina, grasps the upper posterior limb of the fetus, flexes the elbow joint in front of the fetal chest, and delivers the posterior arm in a wiping motion, thereby assisting in the delivery of the posterior shoulder. This direct manipulation of the fetal limb helps adjust the position of the shoulders for a smoother delivery.

5. Episiotomy

Upon diagnosis of shoulder dystocia, an episiotomy or extension of an existing episiotomy should be considered promptly under the guidance of a physician to increase the space for vaginal maneuvers and assist in delivering the fetus. Episiotomy enlarges the vaginal opening, providing more space for obstetric interventions and improving the success rate of managing shoulder dystocia.

Shoulder dystocia is an emergency situation that requires prompt and effective management to prevent serious harm to both the fetus and the mother. During labor, medical staff should closely monitor the conditions of both the fetus and the mother to detect and manage shoulder dystocia in a timely manner.