In shoulder dystocia management, the HELPERR mnemonic is used. After calling for help (H) and evaluating for episiotomy (E), which maneuver is listed next as the primary maneuver?

• A Rubin II maneuver (posterior shoulder pressure)
• B Delivery of posterior arm
• C Zavanelli maneuver (cephalic replacement)
• D McRoberts maneuver with suprapubic pressure ✓

Explanation

The HELPERR mnemonic: H=call for help, E=evaluate for episiotomy, L=Legs (McRoberts), P=suprapubic Pressure, E=Enter (internal rotational maneuvers like Rubin II/Woods screw), R=Remove the posterior arm, R=Roll the patient (all-fours). McRoberts maneuver with suprapubic pressure is the first-line intervention ('L' and 'P') with a success rate of ~42% alone and ~54% combined. Rubin II and delivery of the posterior arm are second-line internal maneuvers. Zavanelli is a last-resort measure.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.