OB Guideline 24: Management of Shoulder Dystocia

Diagnosis of shoulder dystocia is made when the practice of gentle downward guidance of the fetal head fails to accomplish delivery of the anterior shoulder requiring the need for additional obstetrical maneuvers for the delivery of the fetal shoulders.¹

A plan for the use of maneuvers to alleviate the shoulder dystocia and obtaining assistance by additional members of the obstetrical team should be in place since shoulder dystocia is most often an unpredictable and unpreventable obstetrical emergency.

Documentation

If a shoulder dystocia occurs, this event and the details used to resolve it must be entered into the medical record as an operative report and dictated (or the electronic equivalent completed) immediately after the delivery.

This information should include:

1. time of delivery of the fetal head and the time of complete expulsion of the body,
2. maneuvers used,
3. Apgars of the newborn,
4. complications, and
5. names of staff in attendance at the delivery.

The clinician’s hospital risk management unit should be notified of all cases of infant complications.

Institutional Responsibility

Each obstetrical institution is responsible for developing a plan for obstetrical safety drills to prepare staff in the event of high acuity, low frequency emergent events such as shoulder dystocia.

1. Shoulder dystocia. ACOG Practice Bulletin No. 178. May 2017. American College of Obstetricians and Gynecologists.