Am Fam Physician. 2005 Jun 1;71(11) Online.
to the editor: The article1 on shoulder dystocia by Drs. Baxley and Gobbo in American Family Physician did not mention a very useful maneuver for reduction of the impacted shoulder.
In my own practice, I have found that as soon as shoulder dystocia is suspected it is highly effective to attempt delivery of the posterior shoulder while other personnel are simultaneously assisting the mother in the McRoberts maneuver. Once the physician determines that the anterior shoulder will not easily deliver, the physician can then gently elevate the head and neck, which pulls the posterior shoulder down further into the pelvis. Sometimes the posterior shoulder will then deliver first, sliding over the perineum. Then the physician can immediately lower the fetal head toward the floor, unlocking the anterior shoulder. Since I have adopted this maneuver I have rarely had to proceed to more invasive maneuvers to reduce the shoulders. The maneuver is simple and can be performed at the same time as the McRoberts maneuver, thus requiring no additional time.
1. Baxley EG, Gobbo RW. Shoulder dystocia. Am Fam Physician 2004;69:1707-14.
editor's note: This letter was sent to the authors of "Shoulder Dystocia," who declined to reply.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2005 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions