During shoulder dystocia, McRoberts manoeuvre, suprapubic pressure, Rubin II manoeuvre and delivery of the posterior arm have all failed. The fetus remains undelivered and bradycardic. Which is the most appropriate NEXT step?
- A Zavanelli manoeuvre with subsequent caesarean delivery ✓
- B Fundal pressure
- C Symphysiotomy
- D Continue posterior arm delivery attempts with increased traction
Correct answer: A. Zavanelli manoeuvre with subsequent caesarean delivery
Explanation
When all standard and secondary manoeuvres fail, the Zavanelli manoeuvre, flexing the fetal head and replacing it into the vagina followed by emergency caesarean delivery, is the recognised salvage procedure. Fundal pressure worsens impaction and risks uterine rupture and is never appropriate in shoulder dystocia. Symphysiotomy is a last resort where caesarean facilities are unavailable. Repeated forceful traction increases the risk of brachial plexus injury without relieving the impacted anterior shoulder.
Reference: Munro Kerr's Operative Obstetrics, 13th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.