ABSTRACT
Shoulder dystocia should be suspected in the presence of a variety of risk factors including: recognized macrosomia of present pregnancy; previous shoulder dystocia or large baby; diabetes mellitus (DM); or maternal obesity. When risk factors such as fetal macrosomia, DM or previous shoulder dystocia have been identified, the specialist registrar on call should be on the labour ward and available during the second stage of labour. When anaesthesia is adequate, manipulation should be undertaken to rotate the shoulders using Wood’s manoeuvre. An attempt should be made to deliver the posterior shoulder. The Zavanelli manoeuvre involves repositioning of the head under anaesthesia and delivery by Caesarean section (CS). The procedure is as follows: the patient is prepared for CS delivery; a bolus dose of tocolytic is given subcutaneously; a scalp electrode is then applied, checking fetal heart; and the head is pushed back into the vagina in an occiput anterior position.
