Shoulder dystocia — MRCEM SBA MCQ

Instant feedback + full explanation. One question, done properly.

EasyObstetric and gynaecological emergenciesShoulder dystociaMRCEM SBA

A woman at 40 weeks’ gestation gives birth unexpectedly in the emergency department. After the head is born, it retracts tightly against the perineum, and the shoulders do not deliver with gentle axial traction. An obstetric emergency call has been made, the neonatal team has been summoned, and assistants are present. McRoberts manoeuvre is performed, but a further gentle attempt at axial traction does not deliver the shoulders. What is the most appropriate next manoeuvre?

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

Reveal the answer and explanation

Correct answer: C — Apply suprapubic pressure and repeat gentle axial traction

Failure of the shoulders to deliver after the head, together with retraction of the head against the perineum, indicates shoulder dystocia. Help has been called and McRoberts manoeuvre has failed. The next external manoeuvre is **suprapubic pressure**, applied by an assistant while McRoberts position is maintained, followed by gentle axial traction. The pressure aims to dislodge or rotate the impacted shoulder; forceful traction should be avoided. ([rcog.org.uk](https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/shoulder-dystocia-green-top-guideline-no-42/)) Moving onto all fours (A) can help if earlier manoeuvres fail, but bypasses suprapubic pressure when assistants are available. Delivering the posterior arm (B) is an appropriate internal manoeuvre if external measures do not release the shoulder. Episiotomy (D) may provide room for an internal manoeuvre, but does not itself relieve the bony obstruction. Fundal pressure (E) is inappropriate because it can worsen shoulder impaction. The key decision is the *sequence*: after unsuccessful McRoberts manoeuvre, try suprapubic—not fundal—pressure before escalating to internal manoeuvres. ([nnuh.nhs.uk](https://www.nnuh.nhs.uk/publication/download/shoulder-dystocia-io31-v7/))

Reference: Shoulder Dystocia (Green-top Guideline No. 42) (Page reviewed 1 September 2026) — https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/shoulder-dystocia-green-top-guideline-no-42/ Clinical Guideline for the Management of Shoulder Dystocia (Approved 27 September 2024; next review September 2027) — https://www.nnuh.nhs.uk/publication/download/shoulder-dystocia-io31-v7/