Shoulder dystocia has occurred. After McRoberts maneuver and suprapubic pressure fail to release the anterior shoulder. The next maneuver that should be attempted first, as it has the highest success rate as a secondary maneuver, is:

• A Rubin II maneuver (posterior pressure on the anterior shoulder)
• B Woods' screw maneuver (pressure on the posterior aspect of the posterior shoulder)
• C Delivery of the posterior arm ✓
• D Zavanelli maneuver (cephalic replacement)

Explanation

After McRoberts and suprapubic pressure fail, delivery of the posterior arm has the highest success rate among secondary maneuvers. By flexing the posterior arm and sweeping it across the fetal chest and out of the vagina, the shoulder is delivered and the overall shoulder diameter effectively reduced. The Rubin II and Woods' screw are rotational maneuvers typically attempted together (RUBIN II + WOODS = 'gaskin maneuver' combined, or 'corkscrew maneuver'). Zavanelli maneuver (cephalic replacement followed by cesarean) is a last resort. The 'HELPERR' mnemonic guides management: H-help, E-episiotomy, L-legs McRoberts, P-suprapubic pressure, E-enter, R-remove posterior arm, R-roll.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.