During a vaginal delivery, shoulder dystocia persists despite McRoberts manoeuvre, suprapubic pressure, Rubin II, and Wood's screw manoeuvres. The fetus is alive. Which is the appropriate NEXT step?

• A Zavanelli manoeuvre followed by cesarean delivery ✓
• B Symphysiotomy
• C Deliberate clavicle fracture of the anterior shoulder
• D Abandon pushing and await spontaneous resolution

Explanation

When all standard and secondary manoeuvres fail, the Zavanelli manoeuvre is performed: the fetal head is flexed and pushed back into the vagina (cephalic replacement), tocolysis such as terbutaline is given to relax the uterus, and delivery is completed by cesarean. It is a last-resort manoeuvre before destructive options like symphysiotomy, which is reserved for settings where cesarean is unavailable.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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