Shoulder dystocia occurs after delivery of the fetal head. The McRoberts maneuver and suprapubic pressure fail after 60 seconds. What is the next maneuver in the structured HELPERR protocol?
- A Rubin II (internal rotation — pressure applied to posterior aspect of anterior shoulder to adduct it) ✓
- B Woods screw maneuver (pressure applied to anterior aspect of posterior shoulder to rotate fetus)
- C Zavanelli maneuver (cephalic replacement followed by cesarean)
- D Deliberate clavicle fracture of the anterior shoulder to reduce shoulder width
Explanation
In the HELPERR mnemonic (H=call for Help, E=Evaluate for Episiotomy, L=Legs McRoberts, P=Suprapubic Pressure, E=Enter internal maneuvers, R=Remove posterior arm, R=Roll patient), after McRoberts and suprapubic pressure fail, 'Enter' refers to internal rotational maneuvers: Rubin II (pressure on the posterior aspect of the anterior shoulder to adduct and rotate) is performed first, or combined with Woods screw (pressure on anterior aspect of posterior shoulder to create a screw-like rotation). Zavanelli is a last-resort maneuver. Deliberate clavicle fracture, while described, is rarely recommended.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.