During a vaginal delivery, the baby's head delivers but the shoulders fail to deliver with routine axial traction. The McRoberts manoeuvre is performed without success. The next most appropriate step is:

• A Apply fundal pressure
• B Perform the Zavanelli manoeuvre
• C Clamp and cut the cord immediately
• D Perform suprapubic pressure (Rubin I) ✓

Explanation

Shoulder dystocia management follows a stepwise approach. After McRoberts manoeuvre fails, suprapubic pressure (directed downward and laterally toward the fetal face to dislodge the anterior shoulder from behind the pubic symphysis) is the next step. Fundal pressure is contraindicated in shoulder dystocia as it worsens impaction. The Zavanelli manoeuvre (cephalic replacement) is a last resort.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.