The article on shoulder dystocia by Drs. Gimovsky and Michael [December] was a very useful review of a serious and common problem. I would like to add 2 relevant pearls.
- A generous episiotomy or episio-proctotomy may facilitate prompt delivery by permitting easier shoulder rotation and more room for delivery of the posterior arm.
- Delivery of the posterior arm—as mentioned in the article—may result in humeral fracture. To avoid this, the practitioner should slide his or her hand along the posterior arm to the elbow and place thumb pressure in the antecubital fossa. This will cause the arm to flex at the elbow. The operator should grab the forearm and sweep it across the chest as indicated by the authors. Pressure applied to the midhumerus should be avoided, as this may result in fracture.
—MARK S. BROWN, MD, FACOG
Dr. Gimovsky responds:
Dr. Brown makes a most important observation. Since few deliveries with this complication require delivery via the posterior arm, flexing the arm in this manner is an effective technique for resolving shoulder girdle dystocia.
Avoiding humerus fracture by generating flexion in the manner described by Dr. Brown can reduce the risk of neonatal injuries.