Identify the following maneuver which is used in breech delivery?

NORCET-7 Mains-2024

Obstetrics & Gynaecology

Hard

Appeared in: NORCET-7 Mains-2024

Explanation

The image depicts the classic Burns-Marshall maneuver, which is specifically used for delivering the after-coming head in a vaginal breech birth.
Step 'a' and 'b' show the baby's body hanging by its own weight, which uses gravity to promote flexion of the fetal head.
Step 'd' illustrates the key action of the maneuver: swinging the baby's trunk in an upward arc over the mother's abdomen.
This arcing motion pivots the head around the symphysis pubis, allowing for a controlled delivery of the face and brow over the perineum.
This technique is exclusively for breech presentations and is not used for head-first deliveries or shoulder dystocia.

Option A: The Ritgen maneuver is performed during a cephalic (head-first) delivery to control the extension of the head, which is the opposite of a breech delivery.
Option B: The McRobert's maneuver is a primary intervention for shoulder dystocia, a complication where the shoulder gets stuck after the head is delivered. The image clearly shows a breech delivery.
Option C: The Rubin maneuver is another technique used to resolve shoulder dystocia by rotating the fetal shoulders. It is not applicable to a breech delivery.

Visual 1: Infographic - A comparative chart showing the Burns-Marshall maneuver for breech, the McRobert's maneuver for shoulder dystocia, and the Ritgen maneuver for cephalic delivery, highlighting the different maternal and fetal positions for each.
Visual 2: Animation - A short animated clip demonstrating the full sequence of the Burns-Marshall maneuver, emphasizing the upward arcing motion and the pivoting of 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 complicated deliveries, specifically breech presentation as background academic context rather than a clinical decision trigger.
Nurses assisting in a breech delivery must be familiar with the Burns-Marshall maneuver to anticipate the provider's actions and assist effectively, such as applying suprapubic pressure if requested.
A critical nursing role is to advocate for a 'hands-off' approach until the baby's body is delivered to the umbilicus, as premature traction can cause the head to extend, leading to entrapment.
Preparation is key: The nurse should ensure that equipment for neonatal resuscitation is immediately available, as breech-born infants are at a higher risk for asphyxia. Piper forceps should also be ready in case manual maneuvers for the after-coming head are unsuccessful.

How to Approach the Question

First, carefully analyze the image provided. Break it down into the sequence of actions shown in panels a, b, c, and d.
Identify the presentation of the fetus. The image clearly shows the baby being delivered feet/buttocks first, which is a breech presentation.
Focus on the key action in the final panel (d): the baby's body is being swung upwards in an arc over the mother's abdomen. This is the defining step of the maneuver.
Read the question, which asks to identify the maneuver for a breech delivery.
Evaluate each option based on your knowledge of obstetric procedures.
Eliminate options used for other complications. McRobert's and Rubin maneuvers are for shoulder dystocia. Ritgen maneuver is for head-first deliveries.

Concept Tested & Keywords

Concept Tested: Obstetric maneuvers for complicated deliveries, specifically breech presentation.
Stem keywords: breech delivery, maneuver, obstetrics
Lead-in keywords: Identify
Clinical cues: Image showing a four-step process of delivering a baby feet-first.

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