ABSTRACT
The position of the shoulders in shoulder dystocia is anterior–posterior. In the more common high dystocia, the posterior shoulder is lodged at the inlet on the sacral promontory and the anterior shoulder is wedged against the pubis. Kjos and colleagues found that induction of labor routinely at 38 to 39 weeks of gestation in insulin-requiring diabetes reduced the risk for macrosomia and shoulder dystocia versus conservative management and did not increase the cesarean section rate. Considerable force is often applied to the fetal head prior to the recognition and appropriate treatment of shoulder dystocia. Rotation using the fetal head has been described, but this may increase stretching of the brachial plexus, similar to direct and lateral traction on the fetal head. The ones presented here have either been observed by the authors to be effective without injury or are theoretically likely to be effective biomechanically and have been reported to be safe and effective.
