- McRoberts: Mother's hips are placed in hyperflexion against the abdomen while being slightly abducted and externally rotated. Position can be augmented by 2 assistants with each holding one of the patient's legs.
- Rubin I: Downward pressure is applied just proximal to the symphysis pubis. Pressure can be applied continuously or in a rocking motion. Success is increased when combined with McRoberts maneuver.
- Rotational: Rotate infant slightly clockwise or counterclockwise to try and free up and subsequently deliver the anterior shoulder. If this doesn't work, consider rotating the infant 180 degrees and trying to deliver the posterior shoulder first.
- Manual delivery of posterior arm: Insert hand into the vagina and flex the posterior arm of the fetus, bringing it across the chest. The posterior arm is then delivered over the perineum which allows the provider to rotate the fetus to allow delivery of the anterior shoulder once the rotation has disimpacted it from the pubic symphysis.
- Gaskin Position: Place mother in a hands-and-knees position, "on all fours."
Here's a video that puts it all together ...
Sources
Image Source (McRoberts): http://altair.chonnam.ac.kr/~tbsong/medical/sh-dyst/McRoberts.htm
Image Source (Rubin I): http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2009/dec16_6(suppl1)/Pages/18.aspx
Image Source (Rotational): http://shoulderdystociainfo.com/resolvedwithoutfetal.htm
Image Source (Manual delivery of posterior arm): http://www.glowm.com/resources/glowm/cd/pages/v2/v2c079.html
Image Source (Gaskin): http://www.sciencedirect.com/science/article/pii/S0889854505700899
Video Source: http://www.youtube.com/watch?v=YB3_fPhgmUM
Silver, D. and Sabatino, F. "Precipitous and Difficult Deliveries" Emerg Med Clin N Am.
Roberts, J. and Hedges, J. "Emergency Childbirth" Clinical Procedures in Emergency Medicine. 2010.
Image Source (Rubin I): http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2009/dec16_6(suppl1)/Pages/18.aspx
Image Source (Rotational): http://shoulderdystociainfo.com/resolvedwithoutfetal.htm
Image Source (Manual delivery of posterior arm): http://www.glowm.com/resources/glowm/cd/pages/v2/v2c079.html
Image Source (Gaskin): http://www.sciencedirect.com/science/article/pii/S0889854505700899
Video Source: http://www.youtube.com/watch?v=YB3_fPhgmUM
Silver, D. and Sabatino, F. "Precipitous and Difficult Deliveries" Emerg Med Clin N Am.
Roberts, J. and Hedges, J. "Emergency Childbirth" Clinical Procedures in Emergency Medicine. 2010.