What sequence correctly describes standard shoulder dystocia management?

What sequence correctly describes standard shoulder dystocia management?

• A. McRoberts maneuver, suprapubic pressure, deliver posterior arm, episiotomy
• B. Suprapubic pressure first, then McRoberts
• C. Immediate cesarean section without attempting maneuvers
• D. Apply Fundal Pressure to assist descent

Answer: (A)

In shoulder dystocia, the priority is to relieve the impaction quickly by altering the maternal pelvis shape and freeing the stuck shoulder with a sequence of safe, effective maneuvers. The first step is the McRoberts maneuver: you flex the mother's thighs up toward the abdomen and flatten the lumbar spine. This changes the pelvic dimensions and often reduces the angle between the symphysis and the sacrum, making more room for the fetal shoulder to slip over the bony clavicle area. If the shoulder remains wedged, apply suprapubic pressure just above the pubic symphysis to push the anterior shoulder downward and laterally. This helps rotate the shoulder and create space for delivery. If the anterior shoulder still cannot pass, carefully deliver the posterior arm by reaching inside to grasp the baby’s posterior arm and guide it out; this decreases the shoulder diameter that must pass through the birth canal. If space remains insufficient, enlarge the vaginal opening with an episiotomy to facilitate maneuvering and delivery. This sequence is preferred because it uses rapid, low-risk steps to relieve obstruction before moving to more invasive measures, and it avoids practices like fundal pressure, which can cause harm. Immediate cesarean without attempting these maneuvers is not favored during a vaginal birth because timely vaginal maneuvers can resolve the dystocia without delay.

In shoulder dystocia, the priority is to relieve the impaction quickly by altering the maternal pelvis shape and freeing the stuck shoulder with a sequence of safe, effective maneuvers. The first step is the McRoberts maneuver: you flex the mother's thighs up toward the abdomen and flatten the lumbar spine. This changes the pelvic dimensions and often reduces the angle between the symphysis and the sacrum, making more room for the fetal shoulder to slip over the bony clavicle area.

If the shoulder remains wedged, apply suprapubic pressure just above the pubic symphysis to push the anterior shoulder downward and laterally. This helps rotate the shoulder and create space for delivery. If the anterior shoulder still cannot pass, carefully deliver the posterior arm by reaching inside to grasp the baby’s posterior arm and guide it out; this decreases the shoulder diameter that must pass through the birth canal. If space remains insufficient, enlarge the vaginal opening with an episiotomy to facilitate maneuvering and delivery.

This sequence is preferred because it uses rapid, low-risk steps to relieve obstruction before moving to more invasive measures, and it avoids practices like fundal pressure, which can cause harm. Immediate cesarean without attempting these maneuvers is not favored during a vaginal birth because timely vaginal maneuvers can resolve the dystocia without delay.