FFinalistSouthampton · 2027
Obstetrics & gynaecology
AKT · Obstetrics & gynaecology/Late pregnancy & labour

Complications of labour

Intrapartum emergencies

Overview

A group of intrapartum emergencies the exam tests by their specific manoeuvre/response: shoulder dystocia (McRoberts), cord prolapse, malpresentation and preterm labour. Each has a defining first action.

Recognise

  • Shoulder dystocia: head delivers then retracts ("turtle sign"), shoulders stuck — McRoberts + suprapubic pressure
  • Cord prolapse: cord palpable/visible after ROM with fetal bradycardia — relieve pressure, knee-chest, deliver
  • Malpresentation (breech/transverse): consider ECV/caesarean
  • Preterm labour: tocolysis, steroids, magnesium for neuroprotection

Red flags

  • Shoulder dystocia, cord prolapse — time-critical fetal emergencies

Differentials & how to tell them apart

Shoulder dystocia vs simple slow deliveryturtle sign + failure of restitution = dystocia
Cord prolapse vs cord presentationprolapse is past the presenting part after ROM

Investigations

Recognise clinically and act immediately; continuous CTG.

Management

Emergency-specific: McRoberts (dystocia); relieve cord + deliver (prolapse)

  1. 1Shoulder dystocia: call for help, McRoberts position + suprapubic pressure first, then internal manoeuvres.Gate: Cord prolapse → relieve pressure on the cord (push presenting part up, knee-chest/left lateral, fill bladder), avoid handling the cord, and deliver by emergency caesarean
  2. 2Preterm labour: corticosteroids (<34–36 weeks), magnesium sulfate for neuroprotection (<30–34 weeks), consider tocolysis to allow steroids; malpresentation → ECV or caesarean.
Tocolysis (nifedipine/atosiban) — preterm labour — buy time for steroids
Corticosteroids + magnesium sulfate — preterm: lung maturation + neuroprotection (<30–34 weeks)
Terbutaline — acute tocolysis e.g. for cord prolapse/hyperstimulation

Key points

Know the FIRST action for each: McRoberts for shoulder dystocia; relieve cord pressure + emergency caesarean for cord prolapse; steroids + magnesium for preterm. Shoulder dystocia complications: brachial plexus injury (Erb palsy), PPH.

Monitor & prognosis

Fetal CTG, post-delivery for injury/PPH.

Good with prompt correct manoeuvres.

Source: RCOG Green-top guidelines (shoulder dystocia, cord prolapse, preterm labour)