Both maternal thighs are flexed into the abdomen flattening the lower spine and a subsequent increase in the front-to-back dimension of the pelvis. permitting the anterior shoulder to slip past pubic symphysis.

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Suprapubic pressure (Rubin I maneuver)

Continuous pressure is applied to the suprapubic area with the palm or fist towards the direction to which the fetal head is facing.

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Posterior shoulder delivery

It involves sliding a hand along the posterior fetal shoulder and arm, grasping the forearm or wrist, and sweeping it across the fetal chest to deliver the posterior arm. With the successful delivery of the posterior arm, the relevant transverse diameter changes from shoulder to shoulder to axilla to shoulder, which can be up to 3 cm shorter. This dislodges the anterior fetal shoulder and allows for delivery.

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Rotational maneuvers

Rubin II maneuver

This is performed by placing a hand into the vagina and applying pressure to the scapula of the posterior fetal shoulder towards the fetal chest. This will lead to the adduction of the fetal shoulder, allowing the anterior shoulder to rotate and deliver from behind the pubic bone where it is impacted.

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The Woods screw maneuver

This is performed by placing one hand on the clavicular aspect of the posterior fetal shoulder and rotating the shoulder toward the fetal back. This allows the anterior fetal shoulder to descend while the rotation is occurring.

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If the above techniques fail, prepare a patient for surgical delivery.

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