UNCONTROLLED WHEN PRINTED
Indications
  • To facilitate the delivery of a foetus’ impacted anterior shoulder against the maternal symphysis pubis after the foetal head has birthed.
Contraindications
Contraindications
Patient Factors & Considerations
  • Brachial plexus injury; avoid strong downward traction, jerking or tugging on the foetal head
  • Perineal tears
  • Postpartum hemorrhage
  • Perinatal morbidity and mortality
  • Hypoxia
Procedure
  • All relevant infection control methods to be utilised.
  • Consider the need for a back up crew.
  • Prepare equipment required:
    • Adult and infant BVM
    • Baby mucus extractor
    • Oxygen
    • Placenta bucket
    • Small combine
    • Space blanket
    • Sterile gauze pad
    • Sterile scissors
    • Towel
    • Umbilical clamps
  • Reassure mother, remove constrictive clothing and place an incontinence sheet below pelvis.

A systematic approach should be adopted;

McRoberts Manouvre

  • Position the woman flat on her back and position her thighs up onto her abdomen "knees to nipples"
  • During the next contraction, apply gentle downward traction for 30 seconds.
  • If no resolution, move onto Rubin manoeuvre without waiting for contractions.

Rubin I manoeuvre (suprapubic compression)

  • Continue mild downward traction of the foetal head.
  • An assistant adopts a 'hand over hand position', CPR style.
  • Place both hands suprapubically over the posterior aspect of the fetal shoulder, and apply continuous pressure in a downward lateral motion. Doing so will encourage the impacted shoulder to roll towards the baby’s chest.
  • Coach the mother to push with the contraction at the same time as the assistant attempts manipulation of the baby’s shoulder.
  • If no resolution after 30 seconds, commence Rockin Rubin manoeuvre.

Rocking Rubin manoeuvre (compression / relaxation)

  • Maintain downward traction while the assistant applies pressure to the impacted shoulder in a rocking motion.
  • If delivery is unsuccessful after 30 seconds place the mother in the Reverse McRoberts position, by rotating her onto all fours.

Reverse McRoberts Position (roll onto all fours)

  • Attempt delivery of the non-impacted shoulder (which is now the uppermost shoulder).
  • Manoeuvres should only be performed once each before extricating the patient and transporting Priority 1 to nearest obstetric facility. Manoeuvres should be continued en route as best as possible, whilst ensuring safe transport.
Obstetric - McRoberts
Success
Discontinue
  • Transport Priority 1 to nearest obstetric unit repeating all manoeuvres en route.
Additional Information

References
References

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Responsible Manager
Head of Clinical Services

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