The fetal head has delivered, but the shoulders do not deliver with gentle traction and the turtle sign is present. Which action is most appropriate first?

Correct answer: C. Place the woman in the McRoberts position

  • A. Apply strong downward traction to the head
  • B. Apply fundal pressure above the uterus
  • C. Place the woman in the McRoberts position
  • D. Ask the woman to walk around the room

Explanation

McRoberts positioning, with marked flexion of the maternal hips, is the first manoeuvre for shoulder dystocia. Fundal pressure and forceful traction can worsen impaction and increase the risk of birth injury.

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About Obstetric Emergencies

Acute threats to the mother or fetus include postpartum haemorrhage, eclampsia, shock, cord prolapse, shoulder dystocia, uterine rupture, amniotic fluid embolism and fetal distress. The subject covers rapid assessment, airway and circulation support, emergency medicines, positioning, preparation for assisted or operative birth, and coordinated referral.

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