Despite Starting the Recommended Therapy, the Patient's 2-Hour Postprandial Blood

Despite starting the recommended therapy, the patient's 2-hour postprandial blood glucose levels remain >140 mg/dL.  At 37 weeks gestation, ultrasound examination reveals an estimated fetal weight of 4 kg (8 lb 13 oz) .  At 38 weeks gestation, the patient comes to the hospital in spontaneous labor and has a protracted labor course, pushing for 3 hours.  Following delivery of the fetal head, the anterior shoulder cannot be delivered.  A tight nuchal cord is palpated.  She is instructed not to push.  Which of the following is the best next step in management of this patient?

A) Apply traction to the fetal head with forceps
B) Clamp and cut the nuchal umbilical cord
C) Flex the patient's hips against her abdomen
D) Perform emergency cesarean delivery
E) Push the fetal head back into the maternal pelvis

Correct Answer:

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