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Question: Shoulder dystocia

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A 17 year old G1P0 girl at 38 weeks gestation presents in active labor, crowning. OB has been called but is responding from home and won’t be there for 20 minutes. The head delivers, but the baby then has the “turtle sign” with fetal head retracting against the perineum.

Which of the following is a useful maneuver for shoulder dystocia?

pemsou5_wp • November 13, 2018

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  1. Kelly November 14, 2018 - 6:02 pm Reply

    B) Hyperflex the mother’s hips such that her thighs are against her abdomen

    The mnemonic HELPER4 can be used to remember maneuvers for shoulder dystocia deliveries. H H– call for Help (OB).
    E – evaluate for Episiotomy.
    L – legs – the McRoberts maneuver (mother’s hips hyperflexed against the abdomen and slightly abducted / externally rotated) is successful in 40% of shoulder dystocia presentations.
    P – apply Pressure suprapubic, not fundal (aka Rubin I maneuver).
    E – Enter the vagina with hands and rotate the infant to free entrapped shoulders (Rubin II or Woods Corkscrew maneuvers)
    R – Remove posterior arm, the practitioner reaches in and flexes the baby’s posterior arm across its chest, then delivers it over the perineum, allowing rotation to deliver the anterior shoulder.
    4 – Place mother on all fours (Gaskin position) – putting the mother on her hands and knees may resolve shoulder dystocia.
    A good review is found at
    A great video can be found at

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