During a difficult shoulder dystocia, McRoberts maneuver, suprapubic pressure, Rubin II, Wood's screw, and delivery of the posterior arm have all failed. The fetus is alive. What is the next appropriate step?

• A Zavanelli maneuver followed by cesarean delivery ✓
• B Symphysiotomy
• C Fundal pressure
• D Intentional clavicle fracture of the anterior shoulder

Explanation

The Zavanelli maneuver, flexing the fetal head back into the vagina and replacing it into the uterus followed by emergency cesarean, is the recognized last-resort option once standard maneuvers fail with a live fetus. Fundal pressure is contraindicated throughout shoulder dystocia because it worsens impaction. Intentional clavicle fracture and symphysiotomy are salvage options generally considered when the Zavanelli maneuver fails or is impossible, and symphysiotomy is largely confined to settings where cesarean is unavailable.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.