to the editor: The article¹ on shoulder dystocia by Drs. Baxley and Gobbo in American Family Physician did not mention a very useful maneuver for reduction of the impacted shoulder.

In my own practice, I have found that as soon as shoulder dystocia is suspected it is highly effective to attempt delivery of the posterior shoulder while other personnel are simultaneously assisting the mother in the McRoberts maneuver. Once the physician determines that the anterior shoulder will not easily deliver, the physician can then gently elevate the head and neck, which pulls the posterior shoulder down further into the pelvis. Sometimes the posterior shoulder will then deliver first, sliding over the perineum. Then the physician can immediately lower the fetal head toward the floor, unlocking the anterior shoulder. Since I have adopted this maneuver I have rarely had to proceed to more invasive maneuvers to reduce the shoulders. The maneuver is simple and can be performed at the same time as the McRoberts maneuver, thus requiring no additional time.