12 - Shoulder dystocia: diagnosis and management

Summary

Shoulder dystocia occurs when the baby's head has been born but a shoulder becomes stuck behind the mother's pelvic bone, resulting in a delivery that requires additional obstetric manoeuvres to release the shoulder after gentle downward traction has failed. Failure of external rotation of the fetal head and turtle sign, the retraction of the fetal head into the vagina from the perineum, are the key diagnostic signs. First line manoeuvres (SPR) and second line manoeuvres are carried out to manage shoulder dystocia. If facilities for safe and immediate emergency caesarean sections are not available, then clinicians should be trained on symphysiotomy as the main second-line measure. A metal catheter, scalpel handle and blade and suitable local anaesthetic should be made available in birth settings. All staff providing intrapartum care should undergo annual skills and drills training on the management of shoulder dystocia.