Shoulder dystocia happens when the baby's head is delivered but the front shoulder gets stuck behind the mother's pubic bone. It is an obstetric emergency because the baby can lose oxygen within minutes, and it needs a calm, practiced team response.
Key symptoms
- Head delivers and then pulls back against the perineum (turtle sign)
- Shoulders do not deliver with gentle downward traction
- Risk factors: large baby, diabetes, obesity, prior shoulder dystocia
- Long second stage of labor or assisted vaginal delivery
What you find on exam
- Note the time the head was delivered
- Check the baby's position to plan maneuvers
- No fundal pressure and no strong pulling on the head
- After birth: check the newborn for arm weakness (brachial plexus injury) and a broken clavicle
Tests
- Diagnosis is clinical during the birth
- Cord blood gas after delivery
- Apgar score and newborn assessment
- X-ray if a clavicle or humerus fracture is suspected
Treatment basics
- Call for help, including pediatrics and anesthesia
- McRoberts maneuver (legs flexed to the chest) with suprapubic pressure
- Deliver the posterior arm or use rotational maneuvers
- All-fours position (Gaskin) if needed; newborn resuscitation ready
- Check the mother for postpartum hemorrhage and tears; document the event
Red flags
- Turtle sign after the head delivers
- Head-to-body delivery time getting long
- Limp baby with a low heart rate, or postpartum hemorrhage
Practice it in Making Synapses
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.