Fig. 1. Failure of progression due to shoulder dystocia. Flex the neck toward the anterior shoulder, then slide hand behind the posterior shoulder (A). Clamp the thumb and index finger around the posterior shoulder (B). With the thumb and index finger, form a pincer grip through the axilla, resembling an “OK” sign (C). Retract the posterior shoulder toward the shrug position (elevation of the shoulder). Arrow represents movement of the posterior shoulder to the shrug position (D). Restore the head toward the body's axis to form the head–shoulder unit and rotate this unit 180 degrees in the direction of the chest. Arrow represents counterclockwise rotation of the head and shoulder unit (E). On rotation, the anterior shoulder is now posterior and has advanced from the dystocia; normal delivery now proceeds with minimal forward traction. Arrow represents delivery of the neonate (F).

Sancetta. Shrug Maneuver for Shoulder Dystocia. Obstet Gynecol 2019.