After delivery of the head in a vertex vaginal birth, the anterior shoulder fails to deliver with gentle downward traction. The next step in management is:

• A Fundal pressure
• B Delivery of the posterior arm
• C Immediate episiotomy and Zavanelli manoeuvre
• D McRoberts manoeuvre with suprapubic pressure ✓

Explanation

McRoberts manoeuvre, hyperflexing the maternal hips onto the abdomen, straightens the lumbosacral angle and rotates the symphysis cephalad, freeing the impacted anterior shoulder. It resolves most cases and is the universally taught first step. Fundal pressure is contraindicated as it worsens impaction, and posterior arm delivery or Zavanelli manoeuvre are second line measures reserved for failed McRoberts.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.