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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Shoulder Dystocia
Sponsored by The Indian Health Service Clinical Support Center
5. Management
Case Scenario
Mrs. B is an 18 y/o G1P0 at 41 weeks by good dates who has been in labor for 23 hours and who has been pushing for 2 hours. You estimate the fetus to weigh around 8 pounds. With encouragement she delivers the head in right occiput anterior (ROA) position when a “turtle sign” is noted. What order of maneuvers will you use to expeditiously effect delivery?
Having a high index of suspicion, and hence having attempted a ‘C C C Deliver Through’ maneuver, but better yet, having a well rehearsed emergency plan to deal with unexpected shoulder dystocia, is obviously of great importance for all birth attendants. What should you do when the problem occurs?
The AAFP’s ALSO course has a helpful (no pun intended) mnemonic for shoulder dystocia (SD) called “HELPERR” that is definitely worth reviewing.
H Call for help
E Evaluate for Episiotomy (this often isn’t necessary till later)
L Legs (the McRoberts position)
P supraPubic pressure|
E Enter maneuvers – internal rotation
R Remove the posterior shoulder
R Roll the patient, e.g., Gaskin maneuver
What will be presented in the following pages is a modification of the HELPERR algorithm.
Another good resource for diagrams on this topic is Managing Shoulder Dystocia by TJ Benedetti Contemporary OB/GYN Vol. 14:33-41 September 1979
