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Wood's screw maneuver is practiced in obstetrics when dealing with shoulder dystocia – a condition in which the fetal shoulders cannot easily pass through the vagina.In this maneuver the anterior shoulder is pushed towards the baby's chest, and the posterior shoulder is pushed towards the baby's back, [1] making the baby's head somewhat face the mother's rectum.
Shoulder dystocia occurs after vaginal delivery of the head, when the baby's anterior shoulder is obstructed by the mother's pubic bone. [3] [1] It is typically diagnosed when the baby's shoulders fail to deliver despite gentle downward traction on the baby's head, requiring the need of special techniques to safely deliver the baby. [2]
Rubin's I and II maneuvers, rotational maneuver to deliver the baby in case of shoulder dystocia. [1] The Rubin's I maneuver is dislodging the anterior shoulder under pubic symphysis by adding suprapubic pressure while in the McRoberts' position. As a result, the bisacromial diameter is rotated from anteroposterior to oblique lie.
The main causes of obstructed labour include a large or abnormally positioned baby, a small pelvis, and problems with the birth canal. [2] Both the size and the position of the fetus can lead to obstructed labor. Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the pubic bone. [2]
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Use for shoulder dystocia is controversial. [ 5 ] Currently the procedure is rarely performed in developed countries, but is still performed in "rural areas and resource-poor settings of developing countries" [ 7 ] where caesarean sections are not available, or where obstetricians may not be available to deliver subsequent pregnancies. [ 8 ]
Obstetric injuries may occur from mechanical injury involving shoulder dystocia during difficult childbirth, [5] with a prevalence of 1 in 1000 births. [6] "The brachial plexus may be injured by falls from a height on to the side of the head and shoulder, whereby the nerves of the plexus are violently stretched.
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