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Peptic Ulcer Disease — UKMLA MCQ

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HardGastroenterologyPeptic Ulcer DiseaseUKMLAMRCGP AKTMRCP Part 1

After delivery of the fetal head, it retracts against the perineum and routine axial traction does not deliver the shoulders. Help is summoned and the mother is in a standard bed. What is the best initial manoeuvre sequence?

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Correct answer: C — Use McRoberts positioning with suprapubic pressure as the first sequence

The best answer is “Use McRoberts positioning with suprapubic pressure as the first sequence”. Shoulder dystocia requires a rehearsed sequence with immediate help, clear timing and avoidance of harmful traction. RCOG recommends McRoberts hyperflexion as the initial manoeuvre, adding suprapubic pressure to rotate or adduct the anterior shoulder. Fundal pressure can worsen impaction and increases injury risk. If these fail, internal rotational manoeuvres, delivery of the posterior arm or all-fours positioning follow according to the clinical setting and operator experience.

Reference: RCOG Green-top Guideline 42: Shoulder dystocia: https://www.rcog.org.uk/media/ewgpnmio/gtg_42.pdf