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Case 62 - A 30-Year-Old at 38 Weeks’ Gestation with “Turtle Sign” Noted at Delivery

from Section 6 - Intrapartum/Delivery

Published online by Cambridge University Press:  08 April 2025

By
Lauren R. Baker
Edited by
Peter F. Schnatz ,
D. Yvette LaCoursiere ,
Christopher M. Morosky ,
Jonathan Schaffir ,
Vanessa Torbenson  and
David Chelmow
Peter F. Schnatz
Affiliation:
The Reading Hospital, Pennsylvania
D. Yvette LaCoursiere
Affiliation:
University of California, San Diego
Christopher M. Morosky
Affiliation:
University of Connecticut School of Medicine
Jonathan Schaffir
Affiliation:
The Ohio State University College of Medicine
Vanessa Torbenson
Affiliation:
Mayo Clinic Alix School of Medicine
David Chelmow
Affiliation:
Virginia Commonwealth School of Medicine
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Summary

This case provides a complete overview of shoulder dystocia through a case-based learning approach. A shoulder dystocia scenario is presented with history of present illness and physical exam details outlined. An example of how to optimally manage the case is provided. Shoulder dystocia diagnosis, epidemiology, and fetal and maternal risk factors and complications are reviewed. Systematic maneuvers to relieve shoulder dystocia are explained and post-delivery best practices are discussed. A comprehensive shoulder dystocia management algorithm is proposed.

Keywords

shoulder dystociaturtle signobstetric emergencymacrosomiamaternal diabetesrisk factorsmanagementmaneuvercomplicationsdebriefdocumentation
Type
Chapter
Information
Pregnancy Complications
A Case-Based Approach
 , pp. 189 - 192
Publisher: Cambridge University Press
Print publication year: 2025

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References

Ouzounian, JG. Shoulder Dystocia: Incidence and Risk Factors. Clin Obstet Gynecol. 2016;59(4):791–794.CrossRefGoogle ScholarPubMed
Practice Bulletin No 178: Shoulder Dystocia. Obstet Gynecol 2017;129:e123–e133.CrossRefGoogle Scholar
Royal College of Obstetricians and Gynaecologists. Shoulder Dystocia: Green-top Guideline No. 42. London: Royal College of Obstetricians and Gynaecologists; 2012.Google Scholar
Al-Hawash, S, Whitehead, CL, Farine, D. Risk of Recurrent Shoulder Dystocia: Are We Any Closer to Prediction? J Matern Fetal Neonatal Med. 2019;32(17):2928–2934.Google ScholarPubMed
Athukorala, C, Middleton, P, Crowther, CA. Intrapartum Interventions for Preventing Shoulder Dystocia. Cochrane Database Syst Rev. 2006;(4):CD005543.CrossRefGoogle Scholar
Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol. 2020;135:e18–e35.CrossRefGoogle Scholar
Hoffman, MK, Bailit, JL, Ware Branch, D, et al. A Comparison of Obstetric Maneuvers for the Acute Management of Shoulder Dystocia. Obstet Gynecol. 2011;117(6):1272–1278.Google ScholarPubMed
Leung, TY, Stuart, O, Suen, SS, et al. Comparison of Perinatal Outcomes of Shoulder Dystocia Alleviated by Different Type and Sequence of Manoeuvres: A Retrospective Review. Br J Obstet Gynaecol. 2011;118(8):985–990.CrossRefGoogle ScholarPubMed
Hill, DA, Lense, J, Roepcke, F. Shoulder Dystocia: Managing an Obstetric Emergency. Am Fam Physician. 2020;102(2):84–90.Google ScholarPubMed

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