Shoulder dystocia with a 'turtle sign' is managed using the HELPERR mnemonic. Which manoeuvre involves suprapubic pressure with maternal hip hyperflexion to flatten the lumbar lordosis and widen the pelvic inlet?

• A McRoberts manoeuvre ✓
• B Rubin II manoeuvre
• C Woods screw manoeuvre
• D Zavanelli manoeuvre

Explanation

The McRoberts manoeuvre involves hyperflexion of the maternal thighs against the abdomen, which flattens the lumbar lordosis, rotates the pubic symphysis superiorly, and changes the angle of the pelvic inlet to facilitate release of the impacted anterior shoulder. Used with suprapubic pressure (not fundal), this first-line combination resolves 50–60% of shoulder dystocias. Rubin II applies pressure to the posterior aspect of the anterior shoulder to adduct it; Woods screw rotates the posterior shoulder; Zavanelli involves cephalic replacement (a last resort).

Reference: Williams Obstetrics, 26th ed.

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