Shoulder Dystocia

Option List:
A. Axial traction
B. Axial traction downwards
C. Suprapubic pressure
D. All four position
E. Delivery on posterior arm
F. Cleidotomy
G. Symphysiotomy
H. Zavanelli Maneuver
I. Episiotomy
J. Cesarean Section
K. Mc Roberts
The above options describe various maneuvers used in delivery of shoulder dystocia. Please choose appropriate maneuver for the clinical scenarios below. All options can be used once, many times or not at all

1. Sara, low risk multiparous lady in her third pregnancy, she has been low risk, EFW was 2800gms. She planned home delivery with her midwife, Ms Angel Sara had spontaneous onset of labour, progressed well, delivered baby head but Ms. angel noticed difficulty with delivery of the face and chin & head started retracting, what’s is best manoeuvre Angel should try in this Situation?

2. Mrs. Sara, low risk multiparous lady in her third pregnancy she has been referred by midwife to hospital as she baby has EFW of 4500gns. Mrs Sara had spontaneous onset of labour, progressed well, delivered baby head but Midwife noticed difficulty with delivery of the face and chin & head started retracting. Called for help and what is the first maneuver to be done by Midwife?

3. Mrs Tina, in her third pregnancy presented in active labour. She is a known case of gestational diabetes mellitus on Insulin. Her BMI is 31Kg/m². She progressed on her own with epidural Analgesia. She pushed really hard, head was delivered but then head started retracting showing TURTLE sign midwife examined quickly and she said it’s bilateral shoulder dystocia. What is the best thing to do?