Question

In the management of shoulder dystocia, after calling for help the first/next manoeuvre to be performed is:

• A. McRoberts manoeuvre (with suprapubic pressure)
• B. Zavanelli manoeuvre
• C. Wood's corkscrew manoeuvre
• D. Symphysiotomy

Hint:

Hyperflex the maternal hips first; it is simple, non-invasive and resolves most cases.

Answer 1

The Correct Option is A

Step 1: Recognise the emergency. Shoulder dystocia is failure of the anterior shoulder to deliver after the head, due to impaction behind the pubic symphysis. The HELPERR drill is followed.

Step 2: First-line manoeuvre. The initial step (after calling for help) is the McRoberts manoeuvre - hyperflexion and abduction of the maternal hips onto the abdomen. This straightens the lumbosacral angle and rotates the symphysis cephalad, freeing the anterior shoulder. It is combined with suprapubic pressure to dislodge the shoulder. McRoberts alone or with suprapubic pressure resolves the majority of cases.

Step 3: Why the others are wrong. Wood's corkscrew and delivery of the posterior arm are second-line internal rotational manoeuvres used if McRoberts fails. The Zavanelli manoeuvre (cephalic replacement followed by caesarean) and symphysiotomy are last-resort procedures for intractable dystocia.

Key fact: McRoberts manoeuvre with suprapubic pressure is the first step in managing shoulder dystocia.