Shoulder dystocia with postpartum hemorrhage

Scenario overview A 28-year-old woman G3P2 at approximately 38 weeks of pregnancy presents to ED. She has received no prenatal care but states her last baby was “big.” Her water broke about 1 hour prior to arrival and contractions are less than 2 minutes apart. Patient presents in active labor pushing as the case begins. When team inspects vagina they find crowning head with turtle sign (between pushes the fetal head moves back into the vaginal canal). No progression and no obstetrics available. Once team performs maneuvers for shoulder dystocia, baby is delivered in mild distress requiring some resuscitation. Mother has heavy vaginal bleeding requiring fundal massage, oxytocin and transfusion of PRBC. Teaching objectives/discussion points Clinical and medical management.