In the case of a fetal shoulder dystocia during imminent delivery at home, which maneuver should be used?

The McRoberts Maneuver is the appropriate technique to use in the case of a fetal shoulder dystocia, particularly during an imminent delivery. This maneuver involves flexing the mother's legs tightly to her abdomen, which can significantly change the angle of the pelvis. This alteration helps to reduce the shoulder diameter and allows the fetal shoulders to navigate through the birth canal more effectively.

In situations of shoulder dystocia, where the baby’s shoulder becomes lodged behind the pubic symphysis, the McRoberts Maneuver is often the first intervention because it is simple to perform and can be very effective. The maneuver works by increasing the pelvic diameter and promoting a better alignment for the fetal shoulders, assisting in their delivery.

While the other options presented may be considered in different contexts of obstetric emergencies, they are not the first-line interventions for shoulder dystocia. Fundal pressure is discouraged as it can further entrap the shoulder. Rotational maneuvers might be necessary if the McRoberts doesn't resolve the issue, but they are generally considered after initial attempts to relieve dystocia. An episiotomy, while it can be a useful procedure in some obstetric emergencies, is not routinely indicated for shoulder dystocia and can potentially complicate the delivery process.