Identify the following maneuver which is used in shoulder dystocia?

NORCET-7 Mains-2024

Obstetrics & Gynaecology

Easy

Appeared in: NORCET-7 Mains-2024

Explanation

The second image illustrates the Rubin maneuver, a key internal rotational technique for resolving shoulder dystocia.
In this maneuver, pressure is applied to the posterior aspect of the most accessible shoulder (usually the anterior one) to push it toward the fetal chest.
This action adducts the shoulder, reducing the bisacromial (shoulder-to-shoulder) diameter.
By reducing this diameter, the impacted shoulder can be dislodged from behind the maternal pubic symphysis, allowing for delivery.

Option A: The Ritgen maneuver, shown in the first image, is used to control the delivery of the fetal head and protect the perineum from tearing. It is not a maneuver for shoulder dystocia.
Option B: The McRobert's maneuver is an external maneuver that involves hyperflexing the mother's legs onto her abdomen. The image shows an internal maneuver with a hand inside the vagina.
Option D: The Leopold maneuvers are a series of four abdominal palpations performed during pregnancy to determine the position, presentation, and lie of the fetus. They are a diagnostic tool, not a delivery intervention.

Visual 1: Diagram - A step-by-step illustration of the HELPERR mnemonic for shoulder dystocia, showing the McRobert's maneuver, suprapubic pressure, and internal rotational maneuvers like Rubin and Wood's screw.
Visual 2: Animation - A 3D animation showing how the McRobert's maneuver changes the pelvic angle to release the impacted anterior shoulder.
Visual 3: Infographic - A comparison table of different internal maneuvers (Rubin, Wood's screw, posterior arm delivery) with illustrations and key actions for each.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of obstetric maneuvers for managing shoulder dystocia as background academic context rather than a clinical decision trigger.
Shoulder dystocia is an unpredictable obstetric emergency that requires a swift, coordinated team response to prevent fetal hypoxia, brachial plexus injury, or death.
Nurses play a critical role in recognizing the 'turtle sign' (retraction of the fetal head against the perineum), calling for help, assisting with maternal positioning (McRobert's maneuver), and applying suprapubic pressure.
The HELPERR mnemonic provides a standardized, evidence-based sequence of actions that improves team communication and patient outcomes during this high-stress event.

How to Approach the Question

First, carefully analyze the images provided. Identify the specific actions being performed in each illustration.
Read the question stem and identify the key clinical condition: 'shoulder dystocia'.
Evaluate each image in the context of the question. Image 1 shows head delivery control (Ritgen). Image 2 shows an internal shoulder rotation (a dystocia maneuver). The question is asking about the maneuver for shoulder dystocia.
Review the options. Match the maneuver depicted in Image 2 with its correct name from the options.
Eliminate the other options by recalling their definitions: Ritgen is for head delivery, McRobert's is external leg flexion, and Leopold's is for antenatal assessment.
Confirm your choice by recalling that the Rubin maneuver is an internal rotational technique used to resolve shoulder dystocia.

Concept Tested & Keywords

Concept Tested: Identification of obstetric maneuvers for managing shoulder dystocia.
Stem keywords: maneuver, shoulder dystocia, identify
Lead-in keywords: Identify
Clinical cues: The image shows an internal rotation of the fetal shoulder, a key technique for shoulder dystocia.

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