During shoulder dystocia, McRoberts maneuver, suprapubic pressure, posterior arm delivery, and the all-fours position have all failed. The fetus is alive. What is the next step?

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

Explanation

The Zavanelli maneuver, flexing the fetal head and pushing it back into the vagina to allow cesarean delivery, is the accepted last-resort option once standard and secondary maneuvers fail in a live fetus. Fundal pressure is contraindicated because it impacts the shoulder further and can cause uterine rupture. Symphysiotomy and intentional clavicle fracture are salvage options considered only when abdominal delivery is impossible.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.