Training, Comfort Guide Dystocia Management.

SAN JUAN, P.R. -- When it comes to managing shoulder dystocia, do what works for you, Dr. Gary D.V Hankins said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

The most appropriate maneuvers are those that the physician is trained in and feels most comfortable with, he noted.

"There is no set grouping of procedures that make up the right way to do this. Each of us has different-size hands, different levels of experience, and different degrees of manual dexterity," commented Dr. Hankins, chief of maternal-fetal medicine at the University of Texas, Galveston.

In his experience, the maneuvers that work best include the McRoberts maneuver and delivery of the posterior arm.

The McRoberts maneuver, which involves hyperflexion of the mother's legs, has the most merit, Dr. Hankins said. It can be used prophylactically in cases where it is suspected that delivery may be becomed difficult. Delivery of the infant's posterior arm in an attempt to rotate the infant and disengage the anterior shoulder is also of benefit and is a maneuver that Dr. Hankins described as his salvation when everything else fails.

Suprapubic pressure is worth trying but is best applied from the oblique position rather than straight down. It can be used along with other efforts to rotate the infant.

In addition to the various maneuvers that can be attempted for shoulder dystocia, anesthesia is an option that should also be considered.