Identify the following maneuver show in the image?

NORCET 8 Prelims-2025

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 8 Prelims-2025

Explanation

The image depicts the Prague maneuver, which is specifically used for delivering the aftercoming head in a breech birth when the fetus is in an occipito-posterior position (back facing down).
The technique involves grasping the fetal shoulders with one hand and the ankles with the other, then swinging the fetal body in an arc up and over the mother's abdomen.
This action facilitates flexion of the fetal head, allowing the occiput to pass under the pubic symphysis for a safe delivery.
The visual evidence of the baby's back-down position and the upward swing of the body are classic indicators of the Prague maneuver.

Option A: The Lovset maneuver is used to deliver extended arms by rotating the fetal trunk, not for delivering the head. The image clearly shows the arms are already delivered and the focus is on the head.
Option C: The Pinard maneuver is an intrauterine procedure performed before the baby's body is delivered. It is used to convert a frank breech (legs extended) into a footling breech by flexing a knee and bringing a foot down. In the image, the baby's body is already born.
Option D: The Burns-Marshall maneuver is used for an occipito-anterior position (fetal back facing up). It involves letting the baby's body hang for a moment to use gravity to flex the head before swinging the body upwards. The image shows an occipito-posterior position (back down) and a direct upward swing.

Visual 1: Diagram - A step-by-step illustration of the Prague maneuver, showing the initial grasp and the final upward arc.
Visual 2: Diagram - A comparative chart illustrating the key differences in action and indication for the Lovset, Prague, Pinard, and Burns-Marshall maneuvers.
Visual 3: Animation - A short animation showing the Prague maneuver in action to demonstrate how it flexes the fetal head.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Obstetric maneuvers for breech delivery as background academic context rather than a clinical decision trigger.
Knowledge of various breech delivery maneuvers is critical for obstetric nurses and practitioners to manage complicated vaginal breech births safely.
Improper technique or using the wrong maneuver for a given situation can lead to severe fetal complications, including neck injury, brachial plexus injury, or asphyxia from head entrapment.
What if? - If the fetus in the image were in an occipito-anterior position (back facing up), the Burns-Marshall maneuver would be the more appropriate choice, as it is specifically designed for that presentation.

How to Approach the Question

First, carefully analyze the image to identify the clinical situation. Note that it is a breech delivery with the baby's body already born.
Identify the key features of the maneuver being performed. Observe the position of the baby (back is facing down, which is occipito-posterior) and the actions of the healthcare provider (grasping shoulders and ankles, swinging the body upwards).
Recall the definitions and indications for each of the obstetric maneuvers listed in the options.
Compare the observed actions and fetal position in the image with the characteristics of each maneuver.
The Prague maneuver is specifically for an occipito-posterior aftercoming head and involves swinging the body upwards, which perfectly matches the image.
Eliminate the other options based on their different indications (Lovset for arms, Pinard for in-utero conversion, Burns-Marshall for occipito-anterior position).

Concept Tested & Keywords

Concept Tested: Obstetric maneuvers for breech delivery
Stem keywords: maneuver, image, breech delivery, aftercoming head
Lead-in keywords: Identify
Clinical cues: Image shows a breech delivery with the fetal back oriented posteriorly (downwards).

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