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Shoulder dystocia risk — DRCOG MCQ

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HardLabourShoulder dystocia riskDRCOG

Shoulder dystocia persists after McRoberts positioning and suprapubic pressure. Which manoeuvre is a reasonable next internal step while help continues?

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

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Correct answer: BInternal rotational manoeuvre or delivery of the posterior arm

The best answer is “Internal rotational manoeuvre or delivery of the posterior arm”. If McRoberts and suprapubic pressure fail, internal rotational manoeuvres or delivery of the posterior arm are appropriate next steps in the shoulder-dystocia sequence. Fundal pressure should not be used because it may worsen impaction. The team should track time, communicate clearly and prepare neonatal resuscitation while manoeuvres continue. Intrapartum management starts with recognition, calling for help and immediate reversible measures while preparing escalation. The presence of fetal compromise, presentation, station and response to initial manoeuvres determine whether operative birth is required. A single monitoring feature without the full trace and clinical context should not automatically be converted into an unqualified caesarean decision.

Reference: NICE NG235: Intrapartum care: https://www.nice.org.uk/guidance/ng235/chapter/Recommendations