STOP all activities that may lead to further shoulder impaction when you suspect possible shoulder dystocia

START your “rehearsed” algorithm immediately when shoulder dystocia is recognized

Professor, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts.

The author reports no financial relationships relevant to this article.

Shoulder dystocia is an obstetric complication that occurs in up to 1.4% of deliveries.¹ Although the vast majority can be managed successfully, the complication is associated with risk of fetal injury. The most serious injury is brachial plexus palsy, which occurs in 4% to 40% of shoulder dystocia cases, although less than 10% of these injuries are permanent. Other injuries include fractures of the clavicle and humerus; in rare instances the complication may be associated with fetal asphyxia and death. Early recognition of the complication followed by an orderly approach to management will reduce the risk of fetal injury.