Shoulder dystocia - Revision history

Danbot: Strip excess bold

2026-03-22T09:35:31Z

Strip excess bold

← Revisión anterior		Revisión del 09:35 22 mar 2026
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	''No consensus on best treatment/maneuver or order of their application.''		''No consensus on best treatment/maneuver or order of their application.''
	'''HELPERR''' mnemonic - all maneuvers able to be performed by Emergency Physician, generally from least to most invasive		'''HELPERR''' mnemonic - all maneuvers able to be performed by Emergency Physician, generally from least to most invasive
	*~~'''~~H~~'''~~ call for help		*H call for help
	*~~'''~~E~~'''~~ Evaluate for possible [[Episiotomy]] (or episioproctotomy) to increase the anteroposterior diameter of passage		*E Evaluate for possible [[Episiotomy]] (or episioproctotomy) to increase the anteroposterior diameter of passage
	*~~'''~~L~~'''~~ Legs flex (McRoberts maneuver) - best first option - hyperflexion of legs with mild abduction and external rotation (successful in 40% of cases)<ref name="Silver" />		*L Legs flex (McRoberts maneuver) - best first option - hyperflexion of legs with mild abduction and external rotation (successful in 40% of cases)<ref name="Silver" />
	*~~'''~~P~~'''~~ Pressure (suprapubic pressure, aka Rubin I maneuver) - apply pressure just proximal to pubic symphysis, either continuously or in rocking motion (in conjunction with McRoberts, increases success rate to 54%)<ref name="Silver" />		*P Pressure (suprapubic pressure, aka Rubin I maneuver) - apply pressure just proximal to pubic symphysis, either continuously or in rocking motion (in conjunction with McRoberts, increases success rate to 54%)<ref name="Silver" />
	*'''E''' Entry maneuvers - Wood’s corkscrew maneuver by applying pressure to anterior aspect of posterior shoulder causing movement of shoulder into more oblique position in pelvis<ref name="Mercado">Mercado J, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref> '''or''' Rubin II maneuver - applying pressure to posterior aspect of most accessible shoulder (anterior or posterior)		*'''E''' Entry maneuvers - Wood’s corkscrew maneuver by applying pressure to anterior aspect of posterior shoulder causing movement of shoulder into more oblique position in pelvis<ref name="Mercado">Mercado J, Brea I, Mendez B, et al. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.</ref> '''or''' Rubin II maneuver - applying pressure to posterior aspect of most accessible shoulder (anterior or posterior)
	*~~'''~~R~~'''~~ Remove posterior arm by sweeping it across the chest and bring fetal hand to the chin, grasp and pull out of the birth canal and across the face (effective in up to 84% of cases)<ref name="Silver" />		*R Remove posterior arm by sweeping it across the chest and bring fetal hand to the chin, grasp and pull out of the birth canal and across the face (effective in up to 84% of cases)<ref name="Silver" />
	*~~'''~~R~~'''~~ Roll on all fours (Gaskin position) - may relieve up to 83% of shoulder dystocia<ref name="Silver" />		*R Roll on all fours (Gaskin position) - may relieve up to 83% of shoulder dystocia<ref name="Silver" />


	~~'''~~ALARMER~~'''~~ mnemonic is an alternative to the HELPERR mnemonic and provides a slightly altered sequence of interventions:		ALARMER mnemonic is an alternative to the HELPERR mnemonic and provides a slightly altered sequence of interventions:
	*~~'''~~A~~'''~~ Ask for help		*A Ask for help
	*~~'''~~L~~'''~~ Legs to chest (McRoberts maneuver)		*L Legs to chest (McRoberts maneuver)
	*~~'''~~A~~'''~~ Anterior shoulder disimpaction by suprapubic pressure		*A Anterior shoulder disimpaction by suprapubic pressure
	*~~'''~~R~~'''~~ Release posterior shoulder (attempt made to deliver posterior shoulder prior to anterior shoulder)		*R Release posterior shoulder (attempt made to deliver posterior shoulder prior to anterior shoulder)
	*~~'''~~M~~'''~~ Maneuver of Wood		*M Maneuver of Wood
	*~~'''~~E~~'''~~ Episiotomy		*E Episiotomy
	*~~'''~~R~~'''~~ Roll on all fours		*R Roll on all fours

	==Disposition==		==Disposition==

Rossdonaldson1: /* Complications */

2021-05-13T23:04:25Z

Complications

← Revisión anterior		Revisión del 23:04 13 may 2021
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	==Complications==		==Complications==
			[[File:ClavicleFractureSD.jpg\|thumb\|Fracture of both clavicles as a result of shoulder dystocia: acute (top) and after healing (bottom).]]
	*Transient brachial plexus palsy (3.0 to 16.8%)		*Transient brachial plexus palsy (3.0 to 16.8%)
	*Clavicular fracture (1.7 to 9.5%)		*Clavicular fracture (1.7 to 9.5%)

Rossdonaldson1: /* Management */

2021-05-13T23:02:26Z

Management

← Revisión anterior		Revisión del 23:02 13 may 2021
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	==Management==		==Management==
	No consensus on best treatment/maneuver or order of their application.		[[File:Suprapubic-pressureforSD.jpg\|thumb\|Suprapubic pressure maneuver.]]
			''No consensus on best treatment/maneuver or order of their application.''
	'''HELPERR''' mnemonic - all maneuvers able to be performed by Emergency Physician, generally from least to most invasive		'''HELPERR''' mnemonic - all maneuvers able to be performed by Emergency Physician, generally from least to most invasive
	*'''H''' call for help		*'''H''' call for help

Rossdonaldson1: /* Complications */

2019-05-18T01:50:03Z

Complications

← Revisión anterior		Revisión del 01:50 18 may 2019
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	*Admit OB/GYN		*Admit OB/GYN

	===Complications===		==Complications==
	*Transient brachial plexus palsy (3.0 to 16.8%)		*Transient brachial plexus palsy (3.0 to 16.8%)
	*Clavicular fracture (1.7 to 9.5%)		*Clavicular fracture (1.7 to 9.5%)

Rossdonaldson1: /* Management */

2019-05-18T01:49:50Z

Management

← Revisión anterior		Revisión del 01:49 18 may 2019
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	*'''E''' Episiotomy		*'''E''' Episiotomy
	*'''R''' Roll on all fours		*'''R''' Roll on all fours

			==Disposition==
			*Admit OB/GYN

	===Complications===		===Complications===

Anm464: /* Complications */

2019-05-08T21:29:02Z

Complications

← Revisión anterior		Revisión del 21:29 8 may 2019
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	*Hypoxic-ischemic encephalopathy (0.3%)		*Hypoxic-ischemic encephalopathy (0.3%)
	*Death (0 to 0.35%)		*Death (0 to 0.35%)
			*Fourth degree perineal lacerations
			*Post-partum hemorrhage

	==See Also==		==See Also==

SLuckettG: /* Management */

2019-03-29T20:42:24Z

Management

@@ Línea 43: / Línea 43: @@
 *'''R''' Remove posterior arm by sweeping it across the chest and bring fetal hand to the chin, grasp and pull out of the birth canal and across the face (effective in up to 84% of cases)<ref name="Silver" />
 *'''R''' Roll on all fours (Gaskin position) - may relieve up to 83% of shoulder dystocia<ref name="Silver" />
 ===Complications===

SLuckettG: /* Clinical Features */

2019-03-29T20:38:59Z

Clinical Features

← Revisión anterior		Revisión del 20:38 29 mar 2019
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	==Clinical Features==		==Clinical Features==
	*Routine practice of gentle, downward traction of the fetal head fails to accomplish delivery of the anterior shoulder '''or''' additional obstetric maneuvers are required for delivery of anterior shoulder.		*Obstructed labor
	*"Turtle sign" - fetal head retracts against perineum after it appears (rare)		*"Turtle sign" - fetal head retracts against perineum after it appears (rare)

SLuckettG: /* Background */

2019-03-29T20:37:24Z

Background

← Revisión anterior		Revisión del 20:37 29 mar 2019
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	==Background==		==Background==
	*Occurs in 0.2-3% of all births<ref name="Silver">Silver DW, Sabatino F. Precipitous and difficult deliveries. Emerg Med Clin North Am. 2012 Nov;30(4):961-75. doi: 10.1016/j.emc.2012.08.004.</ref>		*Occurs in 0.2-3% of all births<ref name="Silver">Silver DW, Sabatino F. Precipitous and difficult deliveries. Emerg Med Clin North Am. 2012 Nov;30(4):961-75. doi: 10.1016/j.emc.2012.08.004.</ref>
	*Anterior shoulder becomes impacted in pubic symphysis		*Anterior shoulder becomes impacted against maternal pubic symphysis

	===Risk Factors===		===Risk Factors===
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	**Maternal BMI > 30		**Maternal BMI > 30
	**Induction of labor		**Induction of labor
			**Advanced maternal age
			**Short maternal stature
			**Small maternal pelvis
			**Significant post-dates delivery (>42 weeks gestation)
	*Intrapartum		*Intrapartum
	**Prolonged first or second stage		**Prolonged first or second stage
	**Oxytocin augmentation		**Oxytocin augmentation
			**Failure to restitute
			**Failure of shoulder rotation on descent
	**Assisted vaginal delivery		**Assisted vaginal delivery
	***Prolonged head to body delivery time >60 seconds		***Prolonged head to body delivery time >60 seconds

Rossdonaldson1 at 19:19, 18 December 2018

2018-12-18T19:19:39Z

← Revisión anterior		Revisión del 19:19 18 dic 2018
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	====		==Background==
	*Prolonged head to body delivery time more than 60 seconds.
	*Occurs in 0.2-3% of all births<ref name="Silver">Silver DW, Sabatino F. Precipitous and difficult deliveries. Emerg Med Clin North Am. 2012 Nov;30(4):961-75. doi: 10.1016/j.emc.2012.08.004.</ref>		*Occurs in 0.2-3% of all births<ref name="Silver">Silver DW, Sabatino F. Precipitous and difficult deliveries. Emerg Med Clin North Am. 2012 Nov;30(4):961-75. doi: 10.1016/j.emc.2012.08.004.</ref>
	*Anterior shoulder becomes impacted in pubic symphysis		*Anterior shoulder becomes impacted in pubic symphysis
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	**Oxytocin augmentation		**Oxytocin augmentation
	**Assisted vaginal delivery		**Assisted vaginal delivery
			***Prolonged head to body delivery time >60 seconds

	==Clinical Features==		==Clinical Features==