Management of shoulder girdle dystocia.

Avoidance of shoulder dystocia is the best form of management. The potential for such a situation should be considered in the presence of a large fetus when the second stage of labor is prolonged and the fetal head fails to descend to the pelvic outlet. Awareness of a past history of delivery of a large infant is also helpful. Liberal use of cesarean section in such cases will prevent serious neurologic sequelae. If shoulder dystocia occurs, the obstetrician should have a well-conceived approach directed toward disimpaction of the anterior shoulder. The most effective maneuver includes suprapubic pressure and delivery of the posterior arm.