Rubin's I and II maneuvers, rotational maneuver to deliver the baby in case of
shoulder dystocia
Shoulder dystocia is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone. Signs include retraction of the baby's head back into the vagina, known as "turtle sign". Complications for the ...
.
The Rubin's I maneuver is dislodging the anterior shoulder under
pubic symphysis
The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic ...
by adding suprapubic pressure while in the
McRoberts' position. As a result, the
bisacromial diameter is rotated from anteroposterior to
oblique lie
Oblique may refer to:
* an alternative name for the character usually called a slash (punctuation) ( / )
*Oblique angle, in geometry
*Oblique triangle, in geometry
*Oblique lattice, in geometry
* Oblique leaf base, a characteristic shape of the ba ...
.
The Rubin's II maneuver, usually performed after all other exterior maneuvers are exhausted (including
McRoberts' and
Gaskin's) is performed by inserting one hand vaginally behind the posterior aspect of anterior shoulder of the baby and rotating the shoulder towards the chest of the baby, shifting it from the anterior-posterior pelvic diameter into the oblique pelvic diameter and dislodging it from behind the symphysis pubis. If ineffective, this may progress to the
Wood's screw,
Reverse Wood's screw
Reverse or reversing may refer to:
Arts and media
* ''Reverse'' (Eldritch album), 2001
* ''Reverse'' (2009 film), a Polish comedy-drama film
* ''Reverse'' (2019 film), an Iranian crime-drama film
* ''Reverse'' (Morandi album), 2005
* ''Reverse'' ...
, or sweeping the foetal arm.
File:ShoulderDystociaFig1.jpg, Step 1: Index and middle fingers insertion with the hand opposite the baby's face
File:ShoulderDystociaFig2.jpg, Step 2: Baby's head slightly tilted downward with the free hand
File:ShoulderDystociaFig3.jpg, Step 3: Two fingers are placed on the humerus like a splint
File:ShoulderDystociaFig4.jpg, Step 4: Baby's hand appears under the maternal pubic symphysis, allowing the anterior arm to be delivered
References
{{reflist
Obstetrical procedures