Procedure - Delivery

Question 1

How long should you attempt McRoberts maneuver before moving to delivery of the posterior elbow?

Answer 1

30 seconds

Question 2

True or false: You should apply pressure to the fundus when doing McRoberts maneuver

Answer 2

False

The pressure should be suprapubic, not on the fundus. If you press on the fundus you can actually worsen shoulder dystocia.

Question 3

How should you attempt to deliver the posterior shoulder?

Answer 3

Insert your hand into the vagina and find the posterior upper arm. Grab this (often needing to use the elbow) and slide it towards the chest and over the baby’s face.

Question 4

Review the order of maneuvers to try in shoulder dystocia.

Answer 4

1) McRoberts: hyperflexion of the bilateral hips with suprapubic pressure
2) Delivery of the posterior shoulder: use your hand to pull the baby’s posterior arm in front of the chest
3) Wood’s corkscrew: use both of your hands to grab the shoulder girdle (posterior scapula and anterior clavicle) and rotate the baby 180
4) Gaskin: have mom go on all fours and push
5) Zavanelli: push baby back up and attempt C-section

Question 5

Review the steps of perimortem C-section.

Answer 5

1) Large vertical incision in skin using scapel
2) Retract
3) Small vertical incision in uterus with scalpel
4) Complete vertical uterine incision with scissors
5) Remove baby and cut cord
6) Remove placenta and control bleeding