Number 178, May 2017 (Replaces Practice Bulletin Number 40, November 2002)
Shoulder Dystocia
Shoulder dystocia is an unpredictable and unpreventable obstetric emergency that places the pregnant woman and
Downloaded from http://journals.lww.com/greenjournal by BhDMf5ePHKbH4TTImqenVMwtnSTRWRk8+HJzvhqBv7ygv0CBWEa8uXMgu8bVU263Ta5glOtazfo= on 11/24/2018
fetus at risk of injury. Studies have shown that prepregnancy, antepartum, and intrapartum risk factors have extremely
poor predictive value for shoulder dystocia. Several techniques to facilitate delivery exist, and there is evidence that a
systematic approach and simulation training can improve outcomes and documentation. The purpose of this document
is to provide clinicians with evidence-based information regarding management of pregnancies and deliveries at risk
of or complicated by shoulder dystocia.
Committee on Practice Bulletins––Obstetrics. This Practice Bulletin was developed by the American College of Obstetricians and Gynecologists’
Committee on Practice Bulletins—Obstetrics in collaboration with Robert B. Gherman, MD and Joseph G. Ouzounian, MD.
The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be
construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient,
resources, and limitations unique to the institution or type of practice.
VOL. 129, NO. 5, MAY 2017 Practice Bulletin Shoulder Dystocia e125
VOL. 129, NO. 5, MAY 2017 Practice Bulletin Shoulder Dystocia e127
VOL. 129, NO. 5, MAY 2017 Practice Bulletin Shoulder Dystocia e129
VOL. 129, NO. 5, MAY 2017 Practice Bulletin Shoulder Dystocia e131
VOL. 129, NO. 5, MAY 2017 Practice Bulletin Shoulder Dystocia e133