A 30-year-old primigravida at 41 weeks gestation is in active labor. After delivery of the fetal head, the head retracts tightly against the perineum ('turtle sign'), and gentle downward traction fails to deliver the anterior shoulder. What obstetric emergency is this, and what is the first-line maneuver?
Answer and explanation
Correct answer: B. Shoulder dystocia; perform McRoberts maneuver with suprapubic pressure
- Step 1: Shoulder dystocia occurs when the anterior fetal shoulder impacts against the maternal symphysis pubis.
- Step 2: The McRoberts maneuver (hyperflexion of maternal hips onto the abdomen) flattens the sacral promontory, combined with firm suprapubic pressure to disimpact the shoulder.
Answer
Shoulder dystocia; perform McRoberts maneuver with suprapubic pressure.
Why not the others: 'Breech presentation; perform Mauriceau-Smellie-Veit maneuver' is used for delivering the aftercoming head in vaginal breech delivery; 'Uterine rupture; perform emergent laparotomy' presents with loss of fetal station and maternal shock; 'Cord prolapse; perform Zavanelli maneuver' is a last-resort replacement of the head back into the pelvis for shoulder dystocia, not cord prolapse.
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