McRoberts and suprapubic pressure are unable to deliver the anterior shoulder in a pregnant patient experiencing shoulder dystocia. The next step to attempt is what?

McRoberts and suprapubic pressure are unable to deliver the anterior shoulder in a pregnant patient experiencing shoulder dystocia. The next step to attempt is what?

• A. Delivery of the posterior arm
• B. Forceps delivery
• C. Internal podalic version
• D. Emergency cesarean section

Answer: (A)

Relieving shoulder dystocia proceeds from generating more space for the fetal shoulders to pass, using progressively more invasive maneuvers. After McRoberts maneuver and suprapubic pressure have failed to free the impacted shoulder, the next step is to deliver the posterior arm. Gently reaching into the vagina, identify the arm that is posterior to the pelvis, sweep it across the chest, and bring the hand and forearm out. This action reduces the shoulder diameter inside the birth canal and helps rotate the fetus, often allowing the anterior shoulder to slip past the symphysis. This approach is preferred before more invasive internal maneuvers or operative delivery. If delivering the posterior arm does not resolve the obstruction, clinicians proceed with additional internal maneuvers (such as Rubin’s or Woods’ screw) or consider instrumental vaginal delivery if feasible, and ultimately cesarean if vaginal birth remains unlikely or time is running out. The other options—internal podalic version or emergency cesarean—are not the immediate next steps in the standard progression after initial maneuvers fail.

Relieving shoulder dystocia proceeds from generating more space for the fetal shoulders to pass, using progressively more invasive maneuvers. After McRoberts maneuver and suprapubic pressure have failed to free the impacted shoulder, the next step is to deliver the posterior arm. Gently reaching into the vagina, identify the arm that is posterior to the pelvis, sweep it across the chest, and bring the hand and forearm out. This action reduces the shoulder diameter inside the birth canal and helps rotate the fetus, often allowing the anterior shoulder to slip past the symphysis.

This approach is preferred before more invasive internal maneuvers or operative delivery. If delivering the posterior arm does not resolve the obstruction, clinicians proceed with additional internal maneuvers (such as Rubin’s or Woods’ screw) or consider instrumental vaginal delivery if feasible, and ultimately cesarean if vaginal birth remains unlikely or time is running out. The other options—internal podalic version or emergency cesarean—are not the immediate next steps in the standard progression after initial maneuvers fail.