title: Catastrophic shoulder dystocia.
abstract: OBJECTIVE
  The objective of this paper is to outline in a stepwise fashion a life-saving management sequence for catastrophic shoulder dystocia.
  
  
  METHODS
  Five cases of catastrophic shoulder dystocia are analyzed to determine optimal management when confronted with this terrifying obstetric complication.
  
  
  RESULTS
  The management of these five cases reveals the importance of the early use of uterine relaxing agents and general anesthesia. A second physician is also ideal. The absence of a nuchal cord may result in more favorable outcomes.
  
  
  CONCLUSIONS
  The key to achieving improved outcomes when confronted with catastrophic shoulder dystocia include (1) immediate availability of an operating room and anesthesia personnel, (2) the willingness to use uterine relaxing agents, (3) the availability of a second physician, (4) an understanding of the best sequence of remedial measures to follow, (5) total delivery within 12-13 min of the delivery of the head (almost impossible when the delivery process begins in a birthing room) and (6) a cesarean room should be considered for delivery of all massively obese women.
authors.affiliation: Ob-gyn Associates of Green Bay Ltd., Green Bay, WI, USA. cryslcond@aol.com
authors.forename: H F
authors.initials: HF
authors.lastname: Sandmire
mesh_terms: D002388:Catastrophic Illness; D004420:Dystocia / Q000601:surgery*; D005113:Extraction, Obstetrical / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012782:Shoulder; D014710:Version, Fetal / Q000379:methods*