Immediate OB/Gyn consult
If OB/Gyn immediately available and<unk>  has not progressed, Zavanelli maneuver has been described for<unk>  births and may be considered.
Zavanelli maneuver - pushing presenting fetal part back into vagina until C-Section can be performed, though is associated with increased risk of soft tissue damage and sepsis
Place patient in lithotomy position
Have assistant maintain fundal pressure throughout<unk> 
Grab legs together with one hand if feet<unk> spontaneously
Make sure baby is sacral anterior - meaning baby's back to mother's anterior
Head will need to be<unk> d with baby's face looking to mother's posterior
If not sacral anterior, make it that way along<unk> 
If legs and feet are still extended, perform Pinard maneuver to<unk> fetal legs
Place hand behind and parallel to fetal leg, then sweep laterally (away from midline) to<unk> leg
Repeat for opposite leg
Check for cord:
If around the neck, try to reduce it by pushing it over baby's head or just<unk> baby through quickly
If between the legs, this must be reduced around the foot as it will definitely avulse if<unk>  continues
Allow<unk>  to proceed spontaneously until fetal umbilicus is at perineum
Once torso begins to<unk>  hold legs in one hand and hold bony pelvis with other (do not rupture spleen)
Allow<unk>  to progress until axilla is visible
If shoulders do not<unk> spontaneously, apply gentle upward traction on fetal body using other hand to apply leverage and<unk> posterior shoulder/arm/hand, then apply downward traction on fetal body to<unk> anterior shoulder/arm/hand
If posterior arm and hand do not<unk> spontaneously, grasp humerus and sweep downwards while still applying upward traction on fetal body.
If anterior arm and hand do not<unk> spontaneously, grasp humerus and sweet downwards over thorax while maintaining downward traction on fetal body.
To<unk> head, have assistant apply suprapubic pressure and rest fetal body on provider's forearm while reaching into vaginal canal to grasp fetal maxillae in order to flex head. (Mauriceau maneuver) - stabilize with other hand/forearm on fetal back and shoulders - avoid excessive angulation or traction of fetal body.
If fetal head becomes entrapped, administer terbutaline (0.25mg SQ or 2.5-10 μg/min IV) to relax uterus
Nitroglycerin (50 to 200 mcg IV) is an alternative.
If OB/Gyn immediately available and<unk>  has not progressed, Zavanelli maneuver has been described for<unk>  births and may be considered.
Zavanelli maneuver - pushing presenting fetal part back into vagina until C-Section can be performed, though is associated with increased risk of soft tissue damage and sepsis
Zavanelli maneuver - pushing presenting fetal part back into vagina until C-Section can be performed, though is associated with increased risk of soft tissue damage and sepsis
Head will need to be<unk> d with baby's face looking to mother's posterior
If not sacral anterior, make it that way along<unk> 
Place hand behind and parallel to fetal leg, then sweep laterally (away from midline) to<unk> leg
Repeat for opposite leg
If around the neck, try to reduce it by pushing it over baby's head or just<unk> baby through quickly
If between the legs, this must be reduced around the foot as it will definitely avulse if<unk>  continues
If posterior arm and hand do not<unk> spontaneously, grasp humerus and sweep downwards while still applying upward traction on fetal body.
If anterior arm and hand do not<unk> spontaneously, grasp humerus and sweet downwards over thorax while maintaining downward traction on fetal body.
Nitroglycerin (50 to 200 mcg IV) is an alternative.
Breech delivery
Emergent delivery
Shoulder dystocia
Umbilical cord prolapse
Preterm labor
Intrauterine fetal demise
Perimortem cesarean delivery
Vasa previa