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Shoulder dystocia.

Elizabeth G Baxley1, Robert W Gobbo

  • 1Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina 29203, USA. libby.baxley@palmettohealth.org

American Family Physician
|April 17, 2004
PubMed
Summary

Shoulder dystocia is a delivery room emergency managed with maneuvers like McRoberts and HELPERR. These techniques aim to resolve fetal shoulder impaction for safe infant delivery.

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Area of Science:

  • Obstetrics and Gynecology
  • Emergency Medicine
  • Neonatal Care

Background:

  • Shoulder dystocia is a critical obstetric emergency often occurring without warning.
  • Effective management relies on prompt recognition and intervention to prevent fetal injury.

Purpose of the Study:

  • To outline the recognition and management strategies for shoulder dystocia.
  • To introduce the HELPERR mnemonic as a structured approach to this obstetric emergency.

Main Methods:

  • Review of established obstetric maneuvers for shoulder dystocia.
  • Application of the HELPERR mnemonic (Help, Evaluate, Labor, Extra, Reposition, Remove) for systematic management.
  • Description of advanced interventions for refractory cases.

Main Results:

  • Maneuvers aim to enlarge the pelvis, reduce shoulder diameter, or alter fetal orientation.
  • The HELPERR mnemonic provides a framework for addressing shoulder dystocia.
  • Alternative procedures like clavicle fracture or symphysiotomy exist for rare, unresolved cases.

Conclusions:

  • Prompt recognition and application of standardized maneuvers are crucial for managing shoulder dystocia.
  • The HELPERR mnemonic offers a systematic approach to this delivery complication.
  • While most cases resolve with standard maneuvers, advanced options are available for rare, difficult situations.

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