Dr. Barbieri is Editor in Chief, OBG Management; Chair, Obstetrics and Gynecology at Brigham and Women’s Hospital, Boston, Massachusetts; and Kate Macy Ladd Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School, Boston.
Dr. Barbieri reports no financial relationships relevant to this article.
If the posterior arm is positioned behind the back of the fetus, maneuvers similar to those described above can be used to grasp the wrist and pull the arm to the anterior side of the fetal trunk, followed by delivery of the posterior arm.
Practice, practice, and practice some more Obstetric emergencies create a rush of adrenaline and great stress for the obstetrician. This may adversely impact motor performance, decision-making, and communication skills.12 Low- and high-fidelity simulation exercises permit the obstetrics team to practice the sequence of maneuvers necessary to successfully resolve a shoulder dystocia, thereby reducing stress and improving performance when the emergency actually occurs.13 Simulating obstetric emergencies and visualizing the steps necessary to resolve an emergency are good approaches to prepare obstetricians for the most challenging emergencies. For the difficult to resolve shoulder dystocia, my recommendation is: “Deliver the posterior arm.”
Use this checklist to document a shoulder dystocia event
The American College of Obstetricians and Gynecologists (ACOG) has prepared an excellent checklist for documenting a shoulder dystocia case in the medical record. I use this checklist whenever I have a delivery complicated by a shoulder dystocia. This, and more, ACOG obstetric checklists are available at this publically accessible Web site: http://www.acog.org/Resources-And-Publications/Patient -Safety Checklists
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