Relias Shoulder Dystocia Exam STUDY GUIDE 2026
COMPLETE QUESTIONS WITH CORRECT DETAILED
ANSWERS || 100% GUARANTEED PASS <RECENT
VERSION>
Core Principles & Initial Recognition
1. Q: What is the definition of shoulder dystocia?
A: It is an obstetric emergency where, after delivery of the fetal head, the anterior fetal
shoulder impacts against the maternal symphysis pubis, preventing delivery of the body.
It is diagnosed when routine downward traction is insufficient.
2. Q: What is the "turtle sign"?
A: The retraction of the delivered fetal head back against the maternal perineum,
resembling a turtle pulling its head into its shell. This is a classic sign of shoulder
dystocia.
3. Q: Shoulder dystocia is often (predictable/unpredictable).
A: Unpredictable. While there are known risk factors (e.g., diabetes, macrosomia,
previous history), most cases occur in patients with no risk factors.
4. Q: What is the single most important first action when shoulder dystocia is diagnosed?
A: Call for help. Activate the emergency response team (additional nursing, obstetrics,
anesthesia, pediatrics).
5. Q: What should the clinician avoid during a shoulder dystocia?
A: Avoid forceful downward traction on the fetal head and fundal pressure. These
actions can worsen the impaction and risk brachial plexus injury (e.g., Erb's palsy) and
other fetal damage.
The HELPERR Mnemonic (The Standard Algorithm)
6. Q: What does the HELPERR mnemonic stand for?
A: Help (call for), Evaluate for episiotomy, Legs (McRoberts maneuver), Pressure
(suprapubic), Enter maneuvers (internal rotations), Remove the posterior arm, Roll the
patient (Gaskin/all-fours).
, 7. Q: What is the first recommended maneuver after calling for help?
A: The McRoberts maneuver. This involves sharply flexing the maternal thighs onto the
abdomen, which flattens the lumbar spine and rotates the symphysis pubis cephalad,
often dislodging the impacted shoulder.
8. Q: How is suprapubic pressure applied correctly?
A: Pressure is applied to the posterior aspect of the fetal anterior shoulder (from the
side of the fetal back). It is a steady or rocking pressure directed laterally, not fundal
pressure. The goal is to adduct the fetal shoulders, reducing the bisacromial diameter.
9. Q: What is the difference between Rubin's and Woods' screw maneuvers?
A: Rubin's: Insert fingers behind the posterior aspect of the anterior shoulder and push
the shoulder toward the fetal chest (adduction). Woods' Screw: Insert fingers in front of
the posterior shoulder (which is now more accessible) and push it toward the fetal back.
Both aim to rotate the fetus into an oblique diameter.
10. Q: When attempting to deliver the posterior arm, how should the clinician proceed?
A: Insert a hand into the posterior vagina, locate the posterior fetal arm (usually flexed at
the elbow), sweep the arm across the chest, and deliver the hand. This reduces the
shoulder diameter.
Specific Maneuvers & Advanced Techniques
11. Q: What maternal position is associated with the Gaskin maneuver?
A: The hands-and-knees or all-fours position. This uses gravity and can change pelvic
dynamics to free the impacted shoulder.
12. Q: What is the purpose of an episiotomy in shoulder dystocia?
A: To create more space for the operator's hand to perform internal maneuvers (e.g.,
Rubin's, Woods', posterior arm delivery). It does not directly relieve the bony impaction.
13. Q: What is the Zavanelli maneuver?
A: A last-resort maneuver involving cephalic replacement of the fetal head into the
uterus followed by cesarean delivery.
14. Q: What are symphysiotomy and intentional clavicular fracture considered?
A: Salvage procedures of last resort, used when all other maneuvers have failed in a
living fetus.
COMPLETE QUESTIONS WITH CORRECT DETAILED
ANSWERS || 100% GUARANTEED PASS <RECENT
VERSION>
Core Principles & Initial Recognition
1. Q: What is the definition of shoulder dystocia?
A: It is an obstetric emergency where, after delivery of the fetal head, the anterior fetal
shoulder impacts against the maternal symphysis pubis, preventing delivery of the body.
It is diagnosed when routine downward traction is insufficient.
2. Q: What is the "turtle sign"?
A: The retraction of the delivered fetal head back against the maternal perineum,
resembling a turtle pulling its head into its shell. This is a classic sign of shoulder
dystocia.
3. Q: Shoulder dystocia is often (predictable/unpredictable).
A: Unpredictable. While there are known risk factors (e.g., diabetes, macrosomia,
previous history), most cases occur in patients with no risk factors.
4. Q: What is the single most important first action when shoulder dystocia is diagnosed?
A: Call for help. Activate the emergency response team (additional nursing, obstetrics,
anesthesia, pediatrics).
5. Q: What should the clinician avoid during a shoulder dystocia?
A: Avoid forceful downward traction on the fetal head and fundal pressure. These
actions can worsen the impaction and risk brachial plexus injury (e.g., Erb's palsy) and
other fetal damage.
The HELPERR Mnemonic (The Standard Algorithm)
6. Q: What does the HELPERR mnemonic stand for?
A: Help (call for), Evaluate for episiotomy, Legs (McRoberts maneuver), Pressure
(suprapubic), Enter maneuvers (internal rotations), Remove the posterior arm, Roll the
patient (Gaskin/all-fours).
, 7. Q: What is the first recommended maneuver after calling for help?
A: The McRoberts maneuver. This involves sharply flexing the maternal thighs onto the
abdomen, which flattens the lumbar spine and rotates the symphysis pubis cephalad,
often dislodging the impacted shoulder.
8. Q: How is suprapubic pressure applied correctly?
A: Pressure is applied to the posterior aspect of the fetal anterior shoulder (from the
side of the fetal back). It is a steady or rocking pressure directed laterally, not fundal
pressure. The goal is to adduct the fetal shoulders, reducing the bisacromial diameter.
9. Q: What is the difference between Rubin's and Woods' screw maneuvers?
A: Rubin's: Insert fingers behind the posterior aspect of the anterior shoulder and push
the shoulder toward the fetal chest (adduction). Woods' Screw: Insert fingers in front of
the posterior shoulder (which is now more accessible) and push it toward the fetal back.
Both aim to rotate the fetus into an oblique diameter.
10. Q: When attempting to deliver the posterior arm, how should the clinician proceed?
A: Insert a hand into the posterior vagina, locate the posterior fetal arm (usually flexed at
the elbow), sweep the arm across the chest, and deliver the hand. This reduces the
shoulder diameter.
Specific Maneuvers & Advanced Techniques
11. Q: What maternal position is associated with the Gaskin maneuver?
A: The hands-and-knees or all-fours position. This uses gravity and can change pelvic
dynamics to free the impacted shoulder.
12. Q: What is the purpose of an episiotomy in shoulder dystocia?
A: To create more space for the operator's hand to perform internal maneuvers (e.g.,
Rubin's, Woods', posterior arm delivery). It does not directly relieve the bony impaction.
13. Q: What is the Zavanelli maneuver?
A: A last-resort maneuver involving cephalic replacement of the fetal head into the
uterus followed by cesarean delivery.
14. Q: What are symphysiotomy and intentional clavicular fracture considered?
A: Salvage procedures of last resort, used when all other maneuvers have failed in a
living fetus.
