The Lovset maneuver, also known as the Lovset’s procedure or Lovset’s maneuver, is a technique used in obstetrics to manage cases of shoulder dystocia during childbirth.

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Shoulder dystocia occurs when the fetal shoulders become impacted behind the maternal symphysis pubis after the delivery of the head. This can lead to complications such as fetal hypoxia, brachial plexus injury, and maternal trauma. The Lovset maneuver is designed to dislodge the impacted shoulder and facilitate delivery of the baby’s body. Here’s how the Lovset maneuver is performed:

Procedure:

Identify Shoulder Dystocia:

Recognize the signs of shoulder dystocia during delivery, including failure of the shoulders to deliver spontaneously after the head, prolonged delivery time, and difficulty in delivering the anterior shoulder.

Call for Assistance:

Alert the obstetric team and call for additional assistance, including obstetricians, midwives, nurses, and neonatal resuscitation personnel, to help manage the shoulder dystocia.

McRoberts Maneuver:

Initiate the McRoberts maneuver as the first-line intervention by flexing the mother’s hips sharply towards her abdomen, hyperflexing the thighs onto the maternal abdomen. This maneuver helps to flatten the lumbar lordosis, rotate the symphysis pubis, and increase the pelvic outlet diameter.

Suprapubic Pressure:

Apply suprapubic pressure simultaneously with the McRoberts maneuver to push the anterior shoulder downward and release it from behind the pubic bone. Place one hand on the mother’s abdomen just above the pubic symphysis and exert firm, downward pressure in a cephalad and posterior direction.

Reverse Woods’ Screw Maneuver:

After the McRoberts maneuver and suprapubic pressure, if the shoulder remains impacted, proceed to perform the Lovset maneuver.
Rotate the posterior shoulder girdle gently but firmly towards the fetal chest in a reverse “Woods’ screw” motion. This maneuver aims to dislodge the impacted shoulder and facilitate its delivery.

Gentle Traction:

Apply gentle traction on the baby’s head while performing the Lovset maneuver to guide the dislodged shoulder downward and assist with delivery of the baby’s body.

Document and Debrief:

Document the occurrence of shoulder dystocia, the interventions performed, maternal and fetal responses, and the outcome of the delivery in the medical records.
Conduct a multidisciplinary debriefing session with the healthcare team following the delivery to review the management of the shoulder dystocia, identify contributing factors, and discuss strategies for prevention and improvement in future cases.

The Lovset maneuver is an important adjunctive technique used in conjunction with other maneuvers, such as the McRoberts maneuver and suprapubic pressure, to manage shoulder dystocia effectively during childbirth. By employing a systematic approach, clear communication, and coordinated teamwork, healthcare providers can optimize maternal and fetal outcomes and minimize the risk of complications associated with shoulder dystocia.