CHARLAE CHARLEAD: Dual Mnemonics for Optimizing Shoulder Dystocia Management in Obstetric Emergencies

Dear Editor,

 Shoulder dystocia continues to represent one of the most challenging and time critical obstetrical emergencies encountered in the modern obstetric practice. I have been involved in medical teaching for 18 years and was actively involved in teaching obstetrics emergencies as an advanced life support in obstetric (ALSO) instructor for the last couple of years. I have identified a cognitive gap that many learners experience as they memorize and practice the classic HELPERR framework for the management of the shoulder dystocia. This old mnemonic is very helpful in recalling the different maneuvers, but it lacks the important pre and post maneuver principles emphasized in the modern guidelines from the organizations like RCOG (Royal college of Obstetricians and gynecologist) [1] and ACOG (American college of Obstetricians and gynecologist).[2]

Traditional mnemonics are excellent for the emergency recalls, but contemporary shoulder dystocia management now includes anticipation and communication, stopping harmful traction, understanding pelvic biomechanics, team preparations, maternal positioning nuances, sequential escalation and documentation and debriefing after wards. If these steps are not embedded into the learner’s mental model, students may incorrectly assume that the HELPERR mnemonic alone presents the complete management algorithm.

The idea of creating a broader mnemonic like CHARLAE CHARLEAD is very strong from an educational psychology perspective because a narrative of the human – name mnemonic is easier to retain, it can accommodate chronology and it allows inclusion of the concepts before, during and after the shoulder dystocia management in the real time situation.

It’s my profound pleasure to share this important learning that I have acquired in obstetrics which targets optimizing the care for shoulder dystocia in obstetric emergencies with a better streamlined and structured approach. This is intended not merely as a replacement of the existing HELPERR framework but as a more comprehensive and cognitive scaffold aligned with current evidence and biomechanics.