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Fetus with a shoulder presentation during delivery with the left arm extending from the birth canal

Traction on the arm at this point can lead to severe traction on the brachial plexus and cervical nerve roots. (Source: Smellie W. A treatise on the theory and practice of midwifery, to which is added, a set of anatomical plates, exhibiting the various cases that occur in practice, accurately engraved, with explanations. London: Alexander Cleugh and M Watson, 1790. Figure edited by Dr. Douglas J Lanska.)