Prevention of shoulder dystocia related birth injuries: Myths and facts

Figure 1 The picture illustrates a “2-step delivery” complicated by umbilical cord around the fetal neck. External rotation occurred shortly after the expulsion of the head and the delivery process stopped at that point. The cord was loosened but no attempt was made to extract the body. The picture taken at the onset of the next uterine contraction depicts its effect, namely expulsion of amniotic fluid from the respiratory tract (arrow). Since external electronic monitoring had demonstrated variable fetal heart rate decelerations at the end of the 2^nd stage of labor, the cord complication was anticipated. Courtesy of Dr. Vivic Johnson.