Skip to content
Browse cases

Case 11 · Obstetrics

Shoulder dystocia

The head is born and the shoulders will not follow. The clock on the monitor is the head-to-body interval, and it runs in real time. Call for help, work through McRoberts, suprapubic pressure and the internal manoeuvres without harmful traction, then resuscitate the newborn and protect the mother from haemorrhage.

PlayableClinical review pendingIntermediateAbout 10–20 minutes, real timeHindi · English · both
Start Case 11All cases

About this case

What you will practise

Learning objectives

  • Recognise shoulder dystocia and call for help, stating the problem clearly.
  • Avoid fundal pressure and strong or downward traction, and ask the mother to stop pushing.
  • Perform McRoberts and suprapubic pressure correctly, then move without delay to internal manoeuvres.
  • Deliver the baby within about 5 minutes of the head.
  • Resuscitate the newborn: airway, inflation breaths, ventilation, heart-rate checks, compressions only when indicated.
  • Prevent PPH, examine for perineal tears, document and debrief.

Key decisions this case tests

  • How do you recognise shoulder dystocia, and who do you call?
  • Which side do you press from?
  • When do you stop repeating first-line manoeuvres?
  • Posterior arm or internal rotation?
  • When does a newborn need compressions, and when not?

Reference basis

  • RCOG Green-top Guideline No. 42: Shoulder dystocia (2nd edition, 2012).
  • PROMPT Course Manual, 3rd edition (2017).
  • Resuscitation Council UK. Newborn resuscitation and support of transition of infants at birth (2021).
  • World Health Organization. Intrapartum care for a positive childbirth experience (2018).

Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.

Before you start

The physiology is a simplified teaching model: the link between the head-to-body interval and the baby’s condition, and the newborn’s response to resuscitation, are timed for learning, not prediction. In this scenario the first-line manoeuvres are set to fail; in real life they resolve many cases. Doses follow the cited guidelines but have not yet been signed off by a clinician.

Visle is for education only and is not medical advice. Shoulder dystocia is an obstetric emergency: call for skilled help immediately.

Ready for another emergency?

Case 10 puts you in casualty with a young woman who has collapsed with abdominal pain.

Play Case 10Case library