Original Article: Shoulder Dystocia: Managing an Obstetric Emergency
Issue Date: July 15, 2020
See additional reader comments at: https://www.aafp.org/ afp/2020/0715/p84.html
To the Editor: I read Dr. Hill and colleagues' excellent review on shoulder dystocia with particular interest, remembering a terrifying experience early in my career attending the delivery of a patient who was short, morbidly obese, primiparous, and who had type 2 diabetes mellitus. At the time, I worked in a 40-bed rural hospital in the Smoky Mountains, and the blizzard of 1982 was occurring. I attempted to manage shoulder dystocia using the HELPERR mnemonic from an American Academy of Family Physicians Advanced Life Support in Obstetrics course. (1) None of the maneuvers worked, and the baby's heart rate dropped to 20.
Our general surgeon arrived despite deep snowdrifts; however, the surgery suites were without electricity, and our anesthetist could not get in. "Section here with local and conscious sedation?" I asked. The...