The McRoberts maneuver in shoulder dystocia: A critical reappraisal.

This review summarizes the current evidence on the strengths and limitations of the McRoberts maneuver for the management of shoulder dystocia. It examines reported success rates, safety, maternal and neonatal outcomes, biomechanical mechanisms, and training requirements. The McRoberts maneuver remains the recommended first-line intervention because it is simple, rapid, and minimally invasive. However, reported success rates vary widely, ranging from 25% to 61% in most studies. Its effectiveness depends on several key factors. First, clinicians should receive regular simulation-based training and participate in repeated team drills. Second, the maneuver must be performed correctly. Proper technique includes adequate maternal hip hyperflexion, demonstrated by elevation of the buttocks and flattening of the sacrum. Equally important is correct timing. Firm and sustained axial traction on the fetal head is applied at the appropriate moment to counteract the anterior and upward rotation of the symphysis pubis. Premature initiation of the maneuver prior to traction should be avoided. Third, all components of shoulder dystocia management should be well coordinated. These include the McRoberts maneuver, suprapubic pressure to reduce the bisacromial diameter and rotate the shoulders into an oblique diameter, controlled fetal traction, maternal expulsive efforts, and, when feasible, uterine contractions. These interventions should be synchronized under the direction of the team leader, who is typically the delivering physician. Finally, effective management requires regular multidisciplinary drills with clearly defined team roles to ensure a coordinated response to this unpredictable obstetric emergency.