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#Grand Rounds

New Technique: Shoulder Shrug Maneuver for Delivery During Shoulder Dystocia

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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)

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

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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

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