Dystocia

Disease class: Obstetric labor complications

Dystocia: Slow or difficult labour

Shoulder dystocia

Initially, request senior help and ask the mother to hyperflex their legs (McRobert's manouvere) and apply suprapubic pressure. This method works in 90% of cases.

If this method fails, episiotomy is required. This allows internal manouveres including:

• Wood's screw manouvere
• Grasping and manipulation of the posterior arm. 

Final resorts

• Symphisiotomy
• The Zavanelli manouvere (leading to Caesarean section). By this point fetal damage is often irreversible.