ABSTRACT
Shoulder dystocia is an acute obstetric emergency requiring rapid intervention to prevent neonatal morbidity and mortality. The relative infrequency of shoulder dystocia means that few obstetricians are truly experienced in its management. Classically, shoulder dystocia is recognised when the fetal chin retracts firmly back onto the perineum immediately after delivery of the head, the so-called ‘turtle-neck’ sign. A logical approach to the assessment of severity of an earlier shoulder dystocia is essential. In cases of true shoulder dystocia, either the anterior shoulder or, in severe forms, both the anterior and posterior shoulders are arrested at the pelvic inlet. Shoulder dystocia has been associated with secondary arrest and mid-cavity instrumental deliveries, but since this reflects a significant failure of descent, it is again highlighting poor progress in labour. The recognition of significant macrosomia in association with other risk factors, particularly diabetes or a previous birth with shoulder dystocia, requires careful assessment.
