The Hook & Roll Maneuver for Resolution of Shoulder Dystocia

BACKGROUND: Shoulder dystocia is an obstetric emergency with the potential to cause maternal and neonatal injuries. TECHNIQUE: The hook & roll maneuver is a modification of other posterior axilla maneuvers that involves hooking the posterior axilla with one finger and providing gentle traction, elevating the posterior shoulder toward the vaginal opening while simultaneously rolling the anterior shoulder toward the fetal face and rotating approximately 30-90°. EXPERIENCE: At the time of this submission, the hook & roll maneuver has been used 54 times in our institution, successfully resolving shoulder dystocia in 53 of the 54 cases (98.1%). In 16 cases in which the hook & roll maneuver was used as the primary internal maneuver, no neonatal injuries occurred. CONCLUSION: Hook & roll is a posterior axilla maneuver combined with rotation of the anterior shoulder ventrally that is highly successful and easy to perform. The hook & roll maneuver is a promising alternative maneuver to consider in cases of shoulder dystocia, and early data suggest low rates of neonatal complications.