BACKGROUND AND PURPOSE:

• Sancetta, Khanzada, and Leante (Obstetrics & Gynecology, 2019) describe the shoulder shrug technique, to follow an unsuccessful McRoberts maneuver

METHODS:

• 3 case studies of new technique
• Technique
  • Shrug the posterior shoulder and rotate the head–shoulder unit 180 degrees to resolve the shoulder dystocia

Technique in 6 Steps

See Video (Supplemental Digital Material in ‘Learn More – Primary Sources’ below)  

• Grasp the posterior shoulder at the axilla using the obstetrician’s thumb and index finger in a pincer grip
• ‘Shrug’ the shoulder by pulling axilla out toward the head and retracting the shoulder toward the vaginal opening
• Maintain the pincer grip and use opposite hand to hold the head and retracted shoulder together as a unit
• Rotate this unit toward the neonate’s face 180 degrees
• Rotating in the opposite direction away from face may attempted if rotating toward face is not possible
• Shrugged shoulder will deliver anteriorly if remains inferior to the symphysis
• Following delivery of shrugged shoulder, the remaining, previously trapped shoulder can be delivered posteriorly

RESULTS:

Shrug Maneuver Attempted Followed Failed McRoberts And Superpubic Pressure

Patient 1

• 46-year old | Previous vaginal delivery
• Following shoulder shrug maneuver delivery proceeded without complication
  • Apgar: 9₁9₅
  • Newborn injury: None
  • Maternal injury: First-degree tear

Patient 2

• 37-year old | Previous VBAC
• Following shoulder shrug maneuver delivery proceeded without complication (although required rotation in opposite direction away from face)
  • Apgar: 9₁9₅
  • Newborn injury: Mild left brachial plexus palsy, resolved within 2 weeks  

Patient 3

• 28-year old | Shoulder dystocia previously
• Following shoulder shrug maneuver delivery proceeded without complication
  • Apgar: 9₁9₅
  • Newborn injury: None
  • Maternal injury: Repaired second degree tear

CONCLUSION:

• The authors conclude that this maneuver can be easily learned during simulation training and further state that

The shoulder shrug maneuver is a technique that can be added to any obstetrician’s management of shoulder dystocia

Learn More – Primary Sources:

Shoulder Shrug Maneuver to Facilitate Delivery During Shoulder Dystocia

Supplemental Digital Material Illustrating the Shrug Maneuver (Green Journal)

Related ObG Topics:

Does Pre-Pregnancy Obesity Increase Risk of Shoulder Dystocia?

Macrosomia: Determination of EFW and Recommendations for Delivery

Does Elective Induction Lower Risk for Adverse Obstetrical Outcomes in the Setting of Obesity

Shoulder Dystocia: Diagnosis, Evaluation and Management