After delivery of head of baby next action ?

NORCET 1 - 2020

Obstetrics & Gynaecology

Easy

Appeared in: NORCET 1 - 2020

Explanation

After the fetal head is delivered, it undergoes restitution and external rotation to align the shoulders with the anteroposterior diameter of the pelvic outlet.
The immediate next step in the delivery process is the delivery of the anterior shoulder.
This is accomplished by applying gentle downward traction on the baby's head, which allows the anterior shoulder to pass beneath the mother's pubic symphysis.
Following the delivery of the anterior shoulder, the posterior shoulder is then delivered, followed by the rest of the body.

Option A: Cutting the umbilical cord is performed after the entire baby has been delivered, not immediately after the head.
Option C: While fetal heart rate (FHR) is monitored throughout labor, once the head is delivered, the priority is to complete the birth of the baby's body.
Option D: The delivery of the baby's body (trunk and legs) occurs after both the anterior and posterior shoulders have been delivered.

Visual 1: Diagram - An illustration showing the cardinal movements of labor, with a specific focus on the sequence from head delivery, external rotation, to the delivery of the anterior shoulder.
Visual 2: Illustration - A depiction of the correct hand placement and direction of traction (downward) for delivering the anterior shoulder to prevent brachial plexus injury.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The concept tested is the sequence of events in the normal mechanism of labor, specifically the actions taken immediately following the delivery of the fetal head as background academic context rather than a clinical decision trigger.
Understanding the correct sequence of delivery is critical for preventing complications such as shoulder dystocia, a medical emergency where the shoulder gets stuck behind the pubic bone.
Proper technique, including applying gentle and correctly directed traction, minimizes the risk of birth injuries like brachial plexus palsy (Erb's palsy) or clavicle fractures.
What if? If a nuchal cord (cord wrapped around the neck) is identified after the head delivers, the priority is to manage it by either slipping it over the head or, if tight, clamping and cutting it before proceeding with shoulder delivery.

How to Approach the Question

This is a process-based question that requires knowledge of a specific sequence of events.
First, recall the cardinal movements and stages of normal labor.
Identify the specific point in the process mentioned in the question stem: 'After delivery of head of baby'.
Mentally review the steps that immediately follow this event: checking for a nuchal cord, external rotation of the head, and then the delivery of the shoulders.
Evaluate the given options to find the one that correctly represents the next major action in this sequence.
Eliminate options that occur later in the process (like cutting the cord or delivering the body) or are not the immediate priority (like checking FHR).

Concept Tested & Keywords

Concept Tested: The concept tested is the sequence of events in the normal mechanism of labor, specifically the actions taken immediately following the delivery of the fetal head.
Stem keywords: delivery of head, baby, next action
Lead-in keywords: next action

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