October 31st, 2014

Shoulder Dystocia
Authors:  Jason H. Collins, M.D.
  The article "Shoulder Dystocia: Rotational Maneuvers Revisited," by Ramsey et al (2000;45:85-88), shows a relationship of the fetus to the mother in Figure 1. The fetus is drawn with its back to the mother's right. The Woods screw maneuver is depicted as occurring clockwise; that requires the obstetrician to use the right hand. Is this depiction to suggest that shoulder dystocia is common to a fetal back right/vertex position? Is it accurate to state that >80% of vertexes are back left at the time of labor? If so, is there literature that has examined this relationship and determined that shoulder dystocias are more common to the fetal vertex/back right position? Or is there literature that has demonstrated the most common fetal shoulder (right/left) to be injured/impacted? Last, is the Woods screw manuever more effective clockwise vs. counterclockwise, depending on the initial back position, right vs. left?
Keywords:  dystocia, shoulder, fetus, labor
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