During shoulder dystocia, which statements are true regarding management?

• A. McRoberts Maneuver
• B. Suprapubic pressure
• C. Do not apply fundal pressure
• D. All of the above

Answer: (D)

Managing shoulder dystocia hinges on prompt, effective maneuvers that relieve the impaction while minimizing injury. The McRoberts maneuver—gently but firmly flexing the mother's hips toward the abdomen—widens the pelvic outlet by changing the sacral angle, which often frees the impacted shoulder. Suprapubic pressure involves applying a firm, quick push just above the pubic bone to rotate and dislodge the anterior shoulder from under the pubic symphysis. Importantly, fundal pressure (pushing on the top of the uterus) is not recommended because it has not been shown to help and can increase the risk of uterine rupture and neonatal injury. When these steps are taken together, they reflect the standard, evidence-based approach to resolving shoulder dystocia, so all of the listed statements are true.