Obstetrical Manoeuvres

Abstract

This chapter aims at approaching the obstetrical manoeuvres to solve faulty foetal dispositions. Malpresentations, malpositions and malpostures of the foetus cause obstruction of the birth canal impeding delivery. Once the obstetrician has diagnosed the type of dystocia and evaluated foetal size and vitality, an approach to convert abnormal to normal foetal disposition needs to be delineated. Appropriate foetal accessibility and handling per vagina are crucial to ensure effectiveness of the obstetrical manoeuvres, mainly inside the uterus. Integrity of the uterus and of the birth canal is considered a premise to initiate manipulation of the foetus. Some techniques, such as caudal epidural anaesthesia and the use of plenty obstetrical lubricant and/or foetal fluid replacers, may facilitate and speed the resolution of moderate or severe dystocias. Foetal mutation involves diverse type of movements: repulsion, rotation, version and extension forces and finally extraction through traction. Forced traction may also be used to improve foetal accessibility. Individual, simultaneous or sequential use determines the success of foetal mutation. The guidelines of obstetrical manoeuvres, according to the main foetal dystocia, are also described and illustrated in this chapter. Also, some recommendations as to when to abandon one type of approach and proceed to another (e.g. foetotomy or caesarean section) will also be presented.