A woman at 39 weeks with a clinically estimated fetal weight of 4.3 kg presents in labour. She is a non-diabetic multipara. The head delivers with the next contraction, but the shoulders do not follow. Mc Roberts' manoeuvre and suprapubic pressure have failed after 60 seconds. What is the NEXT recommended step according to shoulder dystocia drill protocols?
- A Zavanelli manoeuvre and emergency cesarean
- B Internal rotation using Woods screw manoeuvre or Rubin II ✓
- C Delivery of the posterior arm
- D Fundal pressure (Kristeller manoeuvre)
Correct answer: B. Internal rotation using Woods screw manoeuvre or Rubin II
Explanation
The HELPERR mnemonic for shoulder dystocia management includes: after McRoberts and suprapubic pressure fail, the next step is internal rotational manoeuvres (Woods screw/Rubin II). Delivery of the posterior arm is another effective second-line manoeuvre. Fundal pressure (Kristeller) is absolutely contraindicated as it worsens shoulder impaction. The Zavanelli manoeuvre is a last resort. Internal rotation manoeuvres and posterior arm delivery are the preferred third-step options in the RCOG/ALSO shoulder dystocia algorithm.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.