Objective To use information collected by the Confidential Enquiry into Stillbirths and Deaths inInfancy to help obstetric, midwifery and paediatric practice in the management of shoulder dystocia. Main outcome measures Case notes were reviewed with respect to a range of perinatal variables.Comparisons were made with normative data from other studies when appropriate.Results Maternal obesity and big babies were over-represented in pregnancies complicated by fatal shoulder dystocia. Fetal compromise was recorded in 26% of labours. The median time interval between delivery of the head and the rest of the body was only five minutes. The lead professional at the time the head was delivered was a midwife in 65% of cases. Middle grade or senior obstetric staff were supervising 47Yi of cases by the time the body was delivered.Conclusions Antenatal prediction of shoulder dystocia is imprecise, and the majority of deliveries are attended by midwives. A relatively brief delay in delivery of the shoulders may be associated with a fatal outcome.

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