title: Pitfalls in management of shoulder dystocia with occiput-posterior position.
abstract: BACKGROUND
  The protocol for shoulder dystocia assumes an anterior shoulder entrapped above the pubic symphysis. If the shoulders lie in a different position, a different strategy is required. Such a situation can occur in shoulder dystocia with an occipito-posterior position.
  
  
  METHODS
  An operative vaginal delivery in a nulliparous woman resulted in a shoulder dystocia with the head in the occipito-posterior position, and the usual maneuvers were unsuccessful. The shoulders were transverse and after being manipulated into the oblique plane, an atraumatic vaginal delivery resulted.
  
  
  CONCLUSIONS
  In the rare situation of an occipito-posterior shoulder dystocia, the shoulders may be in the transverse position. This situation can be addressed by manipulating the shoulders and by making an episiotomy to facilitate the maneuver. If unsuccessful, cephalic replacement may be an option.
authors.affiliation: Department of Obstetrics Gynecology, New York Presbyterian Medical Center and Columbia University's College of Physicians and Surgeons, New York City, USA.
authors.forename: Julian N
authors.initials: JN
authors.lastname: Robinson
authors.forename: Jane
authors.initials: J
authors.lastname: Cleary-Goldman
authors.forename: Mary E
authors.initials: ME
authors.lastname: D'Alton
mesh_terms: D000328:Adult; D004420:Dystocia / Q000628:therapy*; D005113:Extraction, Obstetrical / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009772:Obstetrical Forceps; D011247:Pregnancy; D014710:Version, Fetal / Q000379:methods*