Turtle Sign in Shoulder Dystocia

This is Dr. Cal Shipley with a review of the turtle sign in fetal shoulder dystocia.

Fetal shoulder dystocia occurs when one or both shoulders become trapped in the birth canal, delaying delivery of the baby. A common cause of dystocia is failure of shoulder rotation as the baby descends through the pelvis.

Depicted here the anterior, or front facing, shoulder has become trapped beneath the maternal pubic bone. In spite of the dystocia, powerful uterine contractions continue to attempt to propel the baby through the birth canal. During contractions, the head of the baby is propelled forward with stretching of the neck while the shoulders and the rest of the body remain trapped.

In between contractions, the force on the baby’s body is much reduced and the baby’s head withdraws toward the mother’s perineum. This forward movement from the birth canal of the baby’s head during uterine contractions and then withdrawal in between contractions, is known as the turtle sign and is considered a classic sign of shoulder dystocia.

You can learn much more about fetal shoulder dystocia by viewing the related videos listed below and by visiting the fetal shoulder dystocia section in the obstetrics library.

Cal Shipley, M.D. copyright 2020