In the management of shoulder dystocia, the HELPERR mnemonic is used. If initial manoeuvres (McRoberts, suprapubic pressure) fail, the Zavanelli manoeuvre is considered as a last resort. What does the Zavanelli manoeuvre involve?

• A Delivery of the posterior arm by sweeping it across the fetal chest
• B Cephalic replacement followed by emergency caesarean section ✓
• C Deliberate fracture of the fetal clavicle to reduce shoulder width
• D Symphysiotomy to widen the bony pelvis

Explanation

The Zavanelli manoeuvre involves manually returning the fetal head to its pre-restitution position (reversing the cardinal movements of labour), flexing and re-inserting the head into the vagina, and then performing emergency caesarean section. This last-resort procedure carries significant risk of fetal hypoxia and maternal/fetal injury but may be life-saving when all other manoeuvres have failed. Delivery of the posterior arm and deliberate clavicle fracture are also accepted manoeuvres for shoulder dystocia but are distinct from Zavanelli. Symphysiotomy is a separate procedure used in resource-limited settings.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.