Shoulder dystocia persists despite McRoberts maneuver, suprapubic pressure, Rubin II maneuver, and attempted delivery of the posterior arm. The fetus is alive with a heart rate of 70 bpm. Which of the following describes the appropriate LAST-RESORT intrauterine maneuver at this point?
- A Wood's screw rotational maneuver
- B Zavanelli maneuver: flexing the fetal head and replacing it into the pelvis followed by cesarean delivery ✓
- C Symphysiotomy
- D Intentional clavicle fracture from below
Correct answer: B. Zavanelli maneuver: flexing the fetal head and replacing it into the pelvis followed by cesarean delivery
Explanation
The Zavanelli maneuver involves flexing the fetal head back into the occiput anterior position, pushing it back into the vagina and pelvis, holding it there with tocolysis, and proceeding to cesarean delivery. It is reserved for shoulders that cannot be delivered by any other means. Wood's screw rotation and posterior arm delivery are earlier-line maneuvers already exhausted here, and clavicle fracture is performed deliberately from above by the operator, not from below.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.