Gaskin Maneuver “all fours” for Coping the Obstetric Nightmare “shoulder dystocia”

Abstract

Shoulder dystocia (SD) is one of the most serious intrapartum complications. It is also a common obstetric cause of litigation in Thai court.

Suprapubic pressure and McRoberts maneuvers

have been recommended as the primary management for SD. If delivery is not successful, the next step will be rotational maneuver (Woods screw maneuver), Rubin maneuver (reverse Woods screw maneuver) and delivery of the posterior arm. “All fours” or Gaskin maneuver is rarely recommended. Gaskin maneuver has long been reported as an effective management for SD by Bruner JP, et al(1)(1998). “All-fours” position is performed to deliver the upturned posterior shoulder before the downturned anterior shoulder (Fig.1) (2) while the other maneuvers are used when the parturients lying in supine or lithotomy position.