In shoulder dystocia, the McRoberts maneuver fails and suprapubic pressure is applied without success. The operator decides to perform the Rubin II maneuver. This involves:

• A Rotating the posterior shoulder to anterior position
• B Applying pressure to the anterior shoulder from behind, adducting it toward the fetal chest ✓
• C Delivering the posterior arm first
• D Performing deliberate clavicle fracture

Explanation

Rubin II involves applying pressure to the posterior aspect of the anterior shoulder (from the vagina), pushing it toward the fetal chest/midline, thereby adducting the shoulder and reducing the shoulder-to-shoulder diameter. This can release the anterior shoulder from under the pubic symphysis. Woods screw maneuver applies counter-pressure to the anterior aspect of the posterior shoulder; combining Rubin II and Woods screw produces a rotational 'screw' effect (Rubin II + Woods = Rubin-Woods/screw maneuver). Delivery of the posterior arm reduces the shoulder diameter by up to 2 cm and is highly effective. The HELPERR mnemonic covers all shoulder dystocia maneuvers systematically.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.