Re: Shoulder Dystocia

From: Joanne Bulley, MD (islesannie@yahoo.com)
Fri Jan 7 20:02:16 2005

Well said, Anna. I too found it rather difficult to get in and do those maneuvers. The best one for me was McRoberts, SPP & gentle traction, count off the seconds then go in and get the arm.

I quit doing OB before this list started discussing the Gaskin Maneuver. But for years in residency (81-85) - when a mom was delivering in a standard hospital bed (before those fance LDR beds) I would roll the her up on her side and throw her upper leg over my shoulder and that usually gave plenty of room for getting the baby out. If I saw any remote hint of the "turtle sign" she was on her side - the legs pulled into McRoberts and the kid would come out ...

Joanne

At Fri, 7 Jan 2005, Anna Meenan, MD wrote: >
>Baby doesn't always just slide out. I fact, in the times I've used it,
>I can only recall once (the first time, actually), where the baby came
>very easily. In that case, the baby pretty much came shooting out when
>I inserted my hand into the vagina posterior to the baby (between the
>posterior shoulder and the sacrum). I suspect that I therefore released
>the posterior shoulder by lifting the sacrum up off of it. I've had a
>couple of times where steady gentle traction ultimately delivered the
>posterior shoulder (though I would not say that the baby "slid right
>out", and a couple of times where I had to deliver the posterior arm. to
>get the rest of the baby. What I find when I use the Gaskin Maneuver is
>that it gives me much more space to work posteriorly. The most recent
>shoulder dystocia that I had was in a lady with an extremely dense
>epidural. When we didn't get the anterior shoulder with gentle
>traction, McRoberts, and suprapubic pressure, I had her roll on her side
>and delivered the posterior arm ( I can't do any maneuvering posteriorly
>with mom sitting on her butt.). Unfortunately, baby ended up with an
>Erb's Palsey of the ANTERIOR arm.
>
>It would be interesting to measure forces involved in delivering the
>posterior arm, or in delivering the posterior shoulder with the Gaskin
>Maneuver, as Art suggested. I have never had much success with
>rotational maneuvers, and I find it difficult to do much of anything
>with the anterior shoulder, as you need to get up under the pubic
>symphysis to get at it in order to push it in either direction, and with
>the baby's cheeks plastered against the introitus, I find that difficult
>to do.
>
>--
> Anna Meenan, MD
>

--
Joanne Bulley, MD
Keene, NH, USA


"Every gun that is made, every warship launched, every rocket fired,
signifies in the final sense a theft from those who hunger and are not fed,
those who are cold and are not clothed."


President Dwight D. Eisenhower
April 16, 1953



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