During a delivery, shoulder dystocia is encountered. The McRoberts maneuver and suprapubic pressure have been applied for 60 seconds without success. The NEXT appropriate maneuver in the HELPERR algorithm is:
- A Woods screw maneuver or Rubin II maneuver ✓
- B Zavanelli maneuver (cephalic replacement) for emergency cesarean
- C Delivery of posterior arm
- D Fundal pressure to impact shoulders deeper
Correct answer: A. Woods screw maneuver or Rubin II maneuver
Explanation
The HELPERR mnemonic guides shoulder dystocia management. After McRoberts (H — call for Help, E — Evaluate for Episiotomy, L — Legs — McRoberts) and suprapubic pressure, the next step is internal rotational maneuvers: P — Pressure (suprapubic, already done), then Enter (internal maneuvers) — Rubin II (push anterior shoulder toward fetal face) or Woods screw (push posterior shoulder toward fetal back) to rotate shoulders to the oblique diameter. Remove the posterior arm (R) is also an option at this stage. Zavanelli (all-fours) is a last-resort option. Fundal pressure worsens impaction.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.