Which is the correct sequence of maneuvers to resolve shoulder dystocia?

The correct sequence of maneuvers to resolve shoulder dystocia begins with McRoberts maneuver, followed by suprapubic pressure, posterior arm release, and finally Rubin maneuver.

Starting with the McRoberts maneuver, which involves the mother flexing her knees to her abdomen, is a crucial first step because it helps to reposition the pelvis and often opens up the birth canal, effectively reducing the angle of the pelvis. This can relieve pressure on the fetal shoulders.

Following this, the application of suprapubic pressure involves pushing down just above the pubic bone to help dislodge the impacted shoulder. This direct maneuver works in conjunction with the positioning from the McRoberts maneuver to facilitate the descent of the shoulder.

If these two maneuvers do not resolve the situation, the posterior arm release may be necessary. This involves reaching into the vagina to pull the fetal arm across the chest, which can help create more space for the shoulder to pass.

Lastly, if the previous maneuvers still don’t achieve the desired outcome, the Rubin maneuver is employed. This technique involves an attempt to apply pressure on the fetal shoulder to rotate the shoulder into a more favorable position for delivery.

Understanding the correct sequence helps in effectively managing shoulder dystocia, minimizing