👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Reduction of Risk Potential🔖 Free to read, print, and share
Also known as: shoulder dystocia · stuck shoulder · impacted shoulder at birth
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Use this quick-reference guide to spot, treat, and prevent Shoulder Dystocia on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Def
Shoulder stuck behind pubic bone
Turtle sign → head retracts
📌 Risk
Macrosomia, maternal diabetes, obesity
✅ Do
McRoberts → hyperflex hips to chest
Suprapubic pressure (NOT fundal)
Call for help, document time
🚩 Report
Brachial plexus injury (Erb's palsy)
Clavicle fracture, fetal hypoxia
Maternal hemorrhage post-delivery
📚 Shoulder Dystocia — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Shoulder dystocia is an obstetric emergency in which the fetal head delivers but the anterior shoulder becomes lodged behind the maternal symphysis pubis, preventing delivery of the body. It is unpredictable and can cause neonatal brachial plexus injury, clavicle fracture, hypoxia, and maternal hemorrhage or tears. Rapid, coordinated maneuvers are needed to relieve the impaction.
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Key points
Understand these first
The 'turtle sign' (the fetal head retracts tightly against the perineum) signals shoulder dystocia.
Risk factors include fetal macrosomia, maternal diabetes, obesity, and a prolonged second stage.
The McRoberts maneuver (sharp hyperflexion of the mother's thighs onto her abdomen) plus suprapubic pressure is the first-line response.
Suprapubic (not fundal) pressure is applied to dislodge the anterior shoulder; fundal pressure worsens impaction.
Brachial plexus injury (Erb palsy) and clavicle fracture are common neonatal complications.
Maternal complications include postpartum hemorrhage and perineal/vaginal lacerations.
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Nursing priorities
What to do, in order
Call for help immediately and note the time; mobilize the obstetric emergency team.
Perform the McRoberts maneuver (hyperflex maternal hips/thighs) and apply suprapubic pressure as directed.
Assist with documentation of maneuvers, times, and personnel.
After birth, assess the neonate for arm movement, clavicle integrity, and respiratory effort.
Assess the mother for hemorrhage and lacerations postpartum.
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Red flags — report now
Escalate immediately
Never apply fundal pressure for shoulder dystocia; it worsens the impaction.
Report the turtle sign and absent restitution/delivery of the body promptly.
Report neonatal arm weakness/asymmetry or respiratory distress and maternal heavy bleeding after delivery.
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Patient teaching
What patients must know
Explain to the laboring woman the leg-positioning maneuver and the need to follow rapid directions.
Reassure parents that brachial plexus injury is often temporary and that follow-up will assess arm movement.
Counsel diabetic clients on glucose control to reduce macrosomia risk in future pregnancies.
❓ Shoulder Dystocia: NCLEX FAQs
What are the priority nursing interventions for Shoulder Dystocia?
Call for help immediately and note the time; mobilize the obstetric emergency team. Perform the McRoberts maneuver (hyperflex maternal hips/thighs) and apply suprapubic pressure as directed. Assist with documentation of maneuvers, times, and personnel. After birth, assess the neonate for arm movement, clavicle integrity, and respiratory effort.
What are the warning signs of Shoulder Dystocia a nurse must report?
Never apply fundal pressure for shoulder dystocia; it worsens the impaction. Report the turtle sign and absent restitution/delivery of the body promptly. Report neonatal arm weakness/asymmetry or respiratory distress and maternal heavy bleeding after delivery.
What do I need to know about Shoulder Dystocia for the NCLEX?
The 'turtle sign' (the fetal head retracts tightly against the perineum) signals shoulder dystocia. Risk factors include fetal macrosomia, maternal diabetes, obesity, and a prolonged second stage. The McRoberts maneuver (sharp hyperflexion of the mother's thighs onto her abdomen) plus suprapubic pressure is the first-line response. Suprapubic (not fundal) pressure is applied to dislodge the anterior shoulder; fundal pressure worsens impaction.
What patient teaching is important for Shoulder Dystocia?
Explain to the laboring woman the leg-positioning maneuver and the need to follow rapid directions. Reassure parents that brachial plexus injury is often temporary and that follow-up will assess arm movement. Counsel diabetic clients on glucose control to reduce macrosomia risk in future pregnancies.
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Quick Tip
The 'turtle sign' (the fetal head retracts tightly against the perineum) signals shoulder dystocia.