During shoulder dystocia, McRoberts maneuver with suprapubic pressure, Rubin II, Wood's screw, removal of the posterior arm, and all-fours repositioning have all failed. The fetus remains undelivered and the heart tones are still present. What is the next step?
- A Symphysiotomy
- B Repeat Wood's screw maneuver with increased fundal pressure
- C Zavanelli maneuver: flex the head and push it back into the vagina, then proceed to cesarean delivery ✓
- D Abdominal rescue through a Pfannenstiel incision to rotate the anterior shoulder
Correct answer: C. Zavanelli maneuver: flex the head and push it back into the vagina, then proceed to cesarean delivery
Explanation
When all standard and secondary maneuvers fail with a live fetus, the Zavanelli maneuver, replacing the fetal head into the vagina followed by cesarean, is the recognized last-resort option before destructive or maternal morbid procedures. Fundal pressure is never appropriate in shoulder dystocia as it impacts the shoulder further and risks uterine rupture. Symphysiotomy is reserved for settings where cesarean is unavailable, and abdominal rescue is described only after failed cephalic replacement.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.