Labour: shoulder dystocia manoeuvres: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Labour: shoulder dystocia manoeuvres

Sample item

At delivery of a macrosomic infant the head retracts against the perineum (turtle sign). McRoberts position and suprapubic pressure have failed. Which next manoeuvre is appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Delivery of the posterior arm after internal access

After McRoberts and suprapubic pressure, internal manoeuvres follow: delivery of the posterior arm by sweeping it across the chest or Rubin and Woods screw rotations. These reduce the shoulder girdle diameter or rotate the shoulders into the oblique. Fundal pressure impacts the shoulder further, and traction on the head risks brachial plexus injury.

Option by option

  • A. Delivery of the posterior arm after internal access (correct)

    Correct. Posterior arm delivery is the recommended internal manoeuvre when external methods fail.

  • B. Cleidotomy in the live fetus

    Cleidotomy is not used on a live fetus.

  • C. Traction on the head with forceps

    Traction on the head causes Erb palsy and does not free the shoulder.

  • D. Fundal pressure

    Fundal pressure worsens the impaction and is contraindicated.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Delivery of the posterior arm after internal access. After McRoberts and suprapubic pressure, internal manoeuvres follow: delivery of the posterior arm by sweeping it across the chest or Rubin and Woods screw rotations.

Why is "Cleidotomy in the live fetus" not the answer?

Cleidotomy is not used on a live fetus.

Why is "Traction on the head with forceps" not the answer?

Traction on the head causes Erb palsy and does not free the shoulder.

Why is "Fundal pressure" not the answer?

Fundal pressure worsens the impaction and is contraindicated.

What concept does this question test?

It tests Labour: shoulder dystocia manoeuvres in OBG. These reduce the shoulder girdle diameter or rotate the shoulders into the oblique. Fundal pressure impacts the shoulder further, and traction on the head risks brachial plexus injury.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Labour: shoulder dystocia manoeuvres?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.