During delivery of a macrosomic baby, after the head delivers, the anterior shoulder fails to deliver despite routine traction. The turtle sign is noted. Which maneuver should be attempted FIRST?
- A McRoberts' maneuver with suprapubic pressure ✓
- B Zavanelli maneuver (cephalic replacement)
- C Internal rotation — Woods' screw maneuver
- D Deliberate fracture of the clavicle
Explanation
Shoulder dystocia management follows the HELPERR mnemonic. The first maneuver after calling for help, positioning, and episiotomy consideration is McRoberts' maneuver — hyperflexion of the maternal thighs onto the abdomen — combined with suprapubic pressure by an assistant. This combination resolves up to 90% of shoulder dystocia cases. The McRoberts' position straightens the lumbosacral angle and rotates the pubic symphysis superiorly, increasing the functional AP diameter. Internal rotation maneuvers (Woods', Rubin II) and posterior arm delivery are second-line. Zavanelli maneuver is a last-resort destructive procedure.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.