Refers to a situation where, after delivery of the head, the anterior shoulder of the fetus becomes impacted on the maternal pubic symphysis, or (less commonly) the posterior shoulder becomes impacted on the sacral promontory
Aetiology
Risk factors
Antenatal:
Previous shoulder dystocia
Obesity (BMI >30)
Short stature
Diabetes
Fetal acrosomia
Intrapartum:
Prolonged 1st and 2nd stage
Induction of labour
Instrumental delivery
Clinical presentation
Defined by a delay in delivery of the shoulders following the head during a vaginal delivery with the next contraction after using normal traction
On examination, signs that may occur to aid the diagnosis are:
Slow delivery of the head, face and chin
Failure of restitution - the fetal remains in the occipital-anterior position after delivery by extension and therefore does not ‘turn to look to the side’
‘Turtle neck’ sign - the fetal head retracts slightly back into the pelvis, so that the neck is no longer visible, akin to a turtle retreated into its shell
'Head bobbing' - this is when the head consistently retracts back between contractions during the active second stage
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