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this is dr. Cal Shipley with a review of the turtle sign in fetal shoulder dystocia before we get started let me mention that you can access hundreds of my medically related presentations @ww Kali MD comm and you can follow me on twitter at dr. Cal Shipley 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 and the babys body is much reduced and the babys head withdraws toward the mothers perineum this forward movement