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Shoulder dystocia — MCCQE Part 1 MCQ

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HardPregnancyShoulder dystociaMCCQE Part 1

25-year-old woman in labour presents with difficulty delivering after the fetal head emerges. The head retracts against the perineum and traction is ineffective. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Call for help and perform McRoberts manoeuvre with suprapubic pressure

Call for help and perform McRoberts manoeuvre with suprapubic pressure is best because turtle sign indicates shoulder dystocia needing structured manoeuvres. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Fundal pressure is avoided because it worsens impaction.

Reference: SOGC shoulder dystocia guidance