Which of the following correctly describes the 'wedge' (turtle neck/recoil) sign of shoulder dystocia, and the first manoeuvre that should be attempted?

• A Head retracts against perineum after delivery; first manoeuvre is Zavanelli's manoeuvre
• B Head delivers but body remains undelivered for >1 minute; first manoeuvre is fundal pressure
• C Head retracts against perineum after delivery; first manoeuvre is McRoberts' manoeuvre with suprapubic pressure ✓
• D Head retracts after delivery of chin; first manoeuvre is internal rotation (Rubin II)

Explanation

The 'turtle sign' (or 'turtle neck sign') in shoulder dystocia refers to retraction of the fetal head against the maternal perineum after delivery, caused by impaction of the anterior fetal shoulder behind the symphysis pubis. The HELPERR mnemonic guides management; the first recommended manoeuvres are McRoberts' (maternal thighs hyperflexed onto abdomen, widening AP diameter of pelvis) with suprapubic pressure (directed downward/laterally to dislodge anterior shoulder). Fundal pressure is CONTRAINDICATED. Zavanelli's is a last-resort replacement manoeuvre. Rubin II is an internal rotation manoeuvre used if initial steps fail.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.