Guidelines for management of shoulder dystocia.

Shoulder dystocia is an unpredictable obstetric emergency that occurs in approximately 0.5% of all vaginal deliveries. It appears to result from size discrepancy between the shoulder girdle and the maternal pelvis, abnormal labor mechanics, or both. Many maneuvers have been suggested to free the impacted anterior shoulder, but no specific maneuver or sequence of manipulations has been proved superior. This represents a difficult clinical problem for the obstetrician because it occurs without warning and can result in serious consequences for the infant and increased morbidity in the parturient. This report offers a descriptive review of the various maneuvers that can be used to resolve shoulder dystocia and outlines a suggested sequence that has been successful for these manipulations.