Extended arms in breech presentation can be successfully delivered by?

Appeared in: HPSSC - 2015

Explanation

The Lovset maneuver is specifically designed to manage nuchal arms, where one or both of the baby's arms are extended behind their neck, obstructing delivery.
The core principle of the maneuver is to rotate the fetal trunk by 180 degrees.
This rotation brings the posterior shoulder into an anterior position, under the pubic symphysis.
Once the posterior shoulder is anterior, the arm can be easily swept down across the baby's chest and delivered.
The process is then repeated by rotating the trunk 180 degrees in the opposite direction to deliver the second arm.
This technique is crucial for preventing injuries like humerus fractures or brachial plexus nerve damage that can occur with forceful traction.

Option B: The Burns Marshall method is not used for delivering the arms. Its purpose is to facilitate the delivery of the aftercoming head.
Option C: The Mauriceau-Smellie-Veit (MSV) maneuver is also for the delivery of the aftercoming head, not for managing extended arms.
Option D: This option is incorrect because a specific and effective maneuver, the Lovset maneuver, exists for managing extended arms in a breech presentation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of complications in breech delivery as background academic context rather than a clinical decision trigger.
Knowing the correct sequence and application of breech delivery maneuvers is a critical skill in obstetrics, especially in emergency situations where a cesarean section is not immediately possible.
Improper technique or applying the wrong maneuver can lead to severe neonatal injuries, including fractures of the clavicle or humerus, and permanent nerve damage like Erb's palsy from brachial plexus injury.
What if? If the baby's legs were extended (frank breech) instead of the arms, the Pinard's maneuver would be used first to flex and deliver the legs before proceeding to the delivery of the trunk and arms.

How to Approach the Question

First, identify the core clinical problem in the question stem: the delivery of 'extended arms' in a 'breech presentation'.
Recall the different stages and potential complications of a breech delivery: delivery of the legs, the trunk/arms, and the aftercoming head.
Mentally categorize the maneuvers listed in the options based on their primary purpose.
Match the specific problem (extended arms) with the corresponding maneuver.
Lovset maneuver is specifically for extended arms.
Burns Marshall and Mauriceau-Smellie-Veit are for the aftercoming head.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 28-46

Practise the full HPSSC - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.