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Managing Pregnancies at Risk of Shoulder Dystocia

Obstet Gynecol; ePub 2017 May; Gherman, et al

The American College of Obstetricians and Gynecologists (ACOG) has issued clinical management guidelines for the management of pregnancies and deliveries at risk of or complicated by shoulder dystocia. The practice bulletin recommendations include:

  • Although there are a number of known risk factors, shoulder dystocia cannot be accurately predicted or prevented. Clinicians should be aware of the risk factors for shoulder dystocia in order to anticipate those deliveries at high risk and should be prepared to address this complication in all deliveries.
  • Elective cesarean delivery should be considered for women without diabetes who are carrying fetuses with suspected macrosomia with an estimated fetal weight of at least 5,000 g and for women with diabetes whose fetuses are estimated to weigh at least 4,500 g.
  • When shoulder dystocia is suspected, the McRoberts maneuver should be attempted first because it is a simple, logical, and effective technique.
  • Contemporaneous documentation of the management of shoulder dystocia is recommended to record significant facts, findings, and observations about the shoulder dystocia event and its sequelae.
  • Simulation exercises and shoulder dystocia protocols are recommended to improve team communication and maneuver use because this may reduce the incidence of brachial plexus palsy associated with shoulder dystocia.


Shoulder dystocia. Practice Bulletin No. 178. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;129:e123–33.