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Management of shoulder dystocia using the HELPERR mnemonic

02 April 2017
Volume 25 · Issue 4


Shoulder dystocia is a rare obstetric emergency which can be managed using the HELPERR mnemonic. Midwives should recognise the signs and understand the principles of managing shoulder dystocia. Step-by-step images to illustrate the HELPERR mnemonic can enhance knowledge and understanding of this logical sequence of actions.

Shoulder dystocia occurs when a fetal shoulder becomes impacted, most commonly on the maternal symphysis pubis, or the sacral promontory of the maternal pelvis (Royal College of Obstetricians and Gynaecologists (RCOG), 2012). The RCOG reports that it is not common, occurring in between 0.58% and 0.70% of vaginal births. This does, however, constitute an obstetric emergency, as the bony dystocia will result in failure of delivery of the fetal shoulders following delivery of the head (Coates, 2014). The figures reported by RCOG may not truly reflect the occurrence of shoulder dystocia because some situations are managed by midwives before they become an obstetric emergency and, as such, may not be reported.

The Standards for pre-registration midwifery education (Nursing and Midwifery Council, 2009) require the newly registered midwife to be able to ‘identify and safely manage appropriate emergency procedures’. The management of shoulder dystocia is therefore taught and assessed in pre-registration midwifery training.

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