Shoulder dystocia: An obstetric emergency

Shoulder dystocia is one of the most dreaded complications of vaginal deliv ery encountered by the obstetrician. Although risk factors for shoulder dys tocia exist, approximately 50% of cases do not demonstrate the classic pred isposing signs. Obstetricians can help patients decrease their risk for fet al macrosomia by frequent attention to weight gain, nutrition, and exercise during pregnancy and by aggressive management of diabetes. All obstetricia ns must be familiar with the maneuvers used to effect delivery of impacted shoulders and must be prepared to institute these manuevers immediately in a crisis situation.