Management of shoulder dystocia using the HELPERR mnemonic

Abstract

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.

Maneuvering Through a Birth Complicated by Shoulder Dystocia

“…2 Other indications might be difficulty in the birth of the face or chin or the presence of the turtle sign, in which the chin remains tightly applied to the vulva or even appears to retract against the perineum. 15 Immediately upon diagnosis of shoulder dystocia, additional nursing, obstetric provider, anesthesia, and pediatric assistance should be requested, and roles, such as timekeeper, should be assigned. 2 The time should be noted as soon as the shoulder dystocia is diagnosed and when the birth is complete.…”

“…2,6,15,17,18 Second-line maneuvers are employed if the shoulder dystocia does not resolve through the use of first-line maneuvers alone. 2,15,17,18 Heroic measures are undertaken only when first-line and second-line maneuvers fail and catastrophic neurologic injury or death of the neonate is believed to be imminent. 2,17,18 Maneuvers are most typically described as they would be applied to a fetus in the left occiput anterior position position, the most common position of the fetus at birth.…”

“…6,14 Traditionally, intrapartum care providers have been trained to use the HELPERR mnemonic as an aid to shoulder dystocia management (Table 2). 15 This mnemonic focuses on systematic management of shoulder dystocia as soon as it is identified, presenting the most commonly used maneuvers in an easily remembered fashion. In clinical practice, however, there is no clear order in which second-line maneuvers must be performed after unsuccessful application of first-line maneuvers.…”

“…Some experts recommend extraction of the posterior arm whenever the first-line McRoberts and suprapubic pressure maneuvers are not immediately successful, as 95% of all shoulder dystocia events will be relieved within 4 minutes when these 3 maneuvers are used. 2,15 Episiotomy is not required but may be useful if additional space is needed for the clinician's hands when attempting to extract the posterior fetal arm or accomplish rotational or other internal maneuvers. 2,15 No randomized controlled trials have compared the various maneuvers used to resolve shoulder dystocia; thus the overarching goal is birth of the fetus in a timely manner, performing each maneuver correctly in order to decrease the risk of maternal and neonatal injury.…”

“…2,15 Episiotomy is not required but may be useful if additional space is needed for the clinician's hands when attempting to extract the posterior fetal arm or accomplish rotational or other internal maneuvers. 2,15 No randomized controlled trials have compared the various maneuvers used to resolve shoulder dystocia; thus the overarching goal is birth of the fetus in a timely manner, performing each maneuver correctly in order to decrease the risk of maternal and neonatal injury. 2 Each maneuver has its own risks and benefits, and their likely effectiveness will depend upon the position of the fetus, as well as maternal pelvic structures and body habitus.…”