October 24th, 2014

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Title:
Shoulder Dystocia
Authors:  Kirk D. Ramin, M.D., Patrick S. Ramsey, M.D., and Charles S. Field, M.D.
  We appreciate the interest and questions raised by Dr. Collins in regard to our article on shoulder dystocia. In response to the question of whether the figure depicts shoulder dystocia to be common to a fetal back right/vertex position, our answer is "no." Furthermore, with >25 years of clinical experience, we do not think that it is accurate to state that ">80% of vertexes are back left at the time of labor." We take great interest in Dr. Collins's questions as we are unaware of any previously reported series addressing the issue of what side the fetal back lies toward or which shoulder is injured in deliveries complicated by shoulder dystocia. In our practice, the Woods screw maneuver is equally effective for clockwise vs. counter-clockwise applications. Certainly, several of Dr. Collins's questions are important obstetric issues and should prompt further investigation.
Keywords:  dystocia, shoulder, fetus, labor
   
   
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