Abstract

Shoulder dystocia is a serious obstetric emergency, which whilst unexpected, should never be unanticipated. In three recent articles, Coates has documented the principles of identification, mechanisms and management of this condition and it is apparent that an approach using a systematic format or mnemonic to co-ordinate action is likely to be the most effective method of dealing with this dramatic and frightening event. In the recent CESDI report the management of shoulder dystocia received particular criticism. They identified that there was a lack of anticipation and a failure to swiftly implement procedures specifically designed to free the impacted shoulder. Deaths which occurred as a result of shoulder dystocia were associated with clinicians who lacked training and experience in dealing with the problem. The Conclusion of this research is: This small survey, although limited in its findings, does reveal that we cannot afford to be complacent in the face of an emergency such as shoulder dystocia. Many maternity units should look again at their guidelines on its management and update them in a manner that will help to facilitate action. It is also just as imperative that maternity units set time aside as part of their multiprofessional education programmes to ensure that their midwives, GPs and obstetrician can work together and work well in the event of such an overwhelming obstetric emergency.