Shoulder Dystocia

A 28-year-old primigravida at 39 weeks gestation presents to the labor ward in active labor. She has a BMI of 32 kg/m² and her antenatal glucose tolerance test showed fasting glucose of 110 mg/dL. After 2 hours of pushing in the second stage, the fetal head delivers but the shoulders do not deliver with the next contraction. The chin retracts into the perineum (turtle sign). What is the most appropriate immediate next step in the management of this shoulder dystocia?

A 32-year-old multiparous woman (G3P2) with a history of type 2 diabetes mellitus (HbA1c 8.2%) delivers a 4.2 kg male infant vaginally at 38 weeks. After delivery of the head, the shoulders do not deliver with gentle traction. The attending obstetrician performs McRoberts positioning and suprapubic pressure without success. The Rubin maneuver is then attempted. After 4 minutes of unsuccessful maneuvers, the infant is delivered but shows poor respiratory effort, absent Moro reflex, and flaccid tone. What is the most likely neonatal complication in this case?

Which of the following risk factors is MOST strongly associated with shoulder dystocia in vaginal delivery?