Shoulder dystocia: An update and review of new techniques

The definition of shoulder dystocia and the incidence vary. Worldwide, shoulder dystocia may be increasing. In this update we look at the complications for both mother and fetus, and review the risk factors and strategies for possible prevention. Management options include the McRoberts position, techniques to deliver the anterior and posterior shoulder, and finally salvage manoeuvres, which include posterior axillary sling traction (PAST), the Zavanelli manoeuvre and fracture of the clavicles. In cases of fetal death associated with undelivered shoulder dystocia, one can consider the trans-abdominal performance or facilitation of traditional vaginal manoeuvres. We suggest a simplified mnemonic, ‘MAPS’ – M: McRoberts, A: anterior shoulder, P: posterior shoulder, and S: salvage. A video teaching programme will be available shortly on the World Health Organization Reproductive Health Library (www.who.int/rhl; rhl@who.int).