Adverse outcomes in maternity care : implications for practice, applying the recommendations of the confidential enquiries

The key findings and recommendations of the Confidential Enquiries are summarized in a clear, simple and accessible way, emphasizing the implications for clinical practice.

Within "Adverse Outcomes in Maternity Care" there is a reference to the HELPERR mnemonic devised by the Advanced Life Support in Obstetrics (ALSO)(page 106).

The reference is meant to inform the reader of the benefits of using mnemonics in emergency care, but also to direct readers to further reading.

A more comprehensive table suggested by ALSO is shown below: Table 6.2 HELPERR Mnemonic A.

Help 1. Call for Help B. Episiotomy 1. Evaluate for episiotomy C. Legs 1. Position legs using McRoberts Manoeuvre for 30-60 seconds D.

Pressure applied over suprapubic area 1. Oblique downward and anterior pressure for 30-60 sec E.

Enter 1. Position hands a. Two fingers on the posterior aspect of the anterior shoulder b.

Two fingers on the anterior aspect of the posterior shoulder 2.

Rubin Manoeuvre: Rotate counter-clockwise for 30-60s 3.

Wood-Screw Manoeuvre: Rotate clockwise for 30-60 sec F.

Remove the posterior arm G.Roll the patients to hands and knees If this does not succeed, proceed to the Enter manoeuvre again, but with the woman in the all fours position Avoid A.

Fundal pressure B. Excessive traction C. Twisting or bending neck Erratum. The sentence on page 107 should read: The use of the 'HELPER' mnemonic (Table 6.2) may be a good method in ensuring a co-ordinated multi-disciplinary response to vaginal breech deliveries shoulder dystocia.

This sentence should be placed at the end of the section on shoulder dystocia (page 105).