KHALAF maneuver, a new maneuver for management of shoulder dystocia.

Document Type : Original Article

Authors

1 Assistant Professor, Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt

2 Mouwasat Hospital, Saudi Arabia

3 Obstetrics and Gynaecology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

4 King Faisal Military Hospital (Armed Forces Hospital)

Abstract

Background : Shoulder dystocia is a vaginal cephalic delivery in which the foetus must be delivered via further obstetric procedures after the head has been delivered and gentle traction has failed. Even when the illness is well controlled, there may be severe prenatal morbidity and mortality.   
Technique : Khalaf technique is a new technique that can be used as a second-line maneuver to resolve shoulder dystocia. It involves combined rotation and traction of the shoulders so that the biacromial diameter occupies the wider oblique diameter of the pelvis and at the same time traction will help delivery of the posterior shoulder followed by the anterior shoulder.   
Patients and methods: We conducted this maneuver during the period from 2019 till 2023 on 35 women with shoulder dystocia only after failure of 1st line maneuvers to resolve the condition . Cases underwent vaginal delivery in Mouwasat hospital Qatif and Riyadh in collaboration King Faisal military hospital (Armed forces Hospital).  
Results: Age of studied women ranged from (19-43) with a mean of 31.03 + 6.75 years .Their Gestational age  ranged from (37-41) with a mean of 39.46+1.38weeks and BMI ranged from (23.60-42) with a mean of 32.67+4.39Kg/m2.  Head to shoulder interval ranged from (45-120) seconds with a mean of 74.57 + 18.80 seconds. Fetal weight ranged from (3.40-4.40) with a mean of 3.94 + 0.27 Kg, APGAR score at first minute ranged from (5-8) with a mean of 6.54 + 0.82 and five minutes ranged from (8-10) with a mean of 9 + 0.49. Our new maneuver was successful in all cases of the case series ,  Khalaf maneuver  was not associated with any maternal or fetal mortality . No cases of fetal injuries occurred in our case series and also no significant maternal morbidity.
Conclusion: Khalaf maneuver is a safe effective and not time consuming maneuver that can be used for cases of unresolved shoulder dystocia.

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