Shoulder dystocia is managed by?

Appeared in: GMCH Chandigarh - 2022

Explanation

McRoberts maneuver is a primary, non-invasive intervention for shoulder dystocia.
It involves hyperflexing the mother's thighs against her abdomen, which rotates the pelvis and flattens the sacrum.
This change in pelvic angle helps to release the impacted anterior shoulder from behind the symphysis pubis.
It is often the first maneuver attempted due to its simplicity and effectiveness, frequently combined with suprapubic pressure.
The HELPERR mnemonic, where 'L' stands for Legs (McRoberts maneuver), provides a standardized sequence for managing this obstetric emergency.

Option A: The Lovset manoeuvre is not used for shoulder dystocia in a cephalic (head-first) presentation.
Option B: The Leopold manoeuvre is a diagnostic assessment, not an intervention to resolve a delivery complication like shoulder dystocia.
Option D: The Burn Marshall manoeuvre is not indicated for shoulder dystocia.

Visual 1: Flowchart - A flowchart illustrating the steps of the HELPERR mnemonic in sequence, showing the progression of interventions for shoulder dystocia.
Visual 2: Diagram - A comparative diagram showing the incorrect application of fundal pressure versus the correct application of suprapubic pressure during shoulder dystocia.
Visual 3: Animation - An animation demonstrating the pelvic rotation and flattening of the sacrum that occurs during the McRoberts maneuver.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Shoulder Dystocia as background academic context rather than a clinical decision trigger.
Shoulder dystocia is an unpredictable obstetric emergency that requires immediate and coordinated action to prevent severe neonatal and maternal complications.
The primary risk to the neonate is brachial plexus injury (Erb's palsy) due to stretching of the neck, and hypoxic-ischemic encephalopathy if the delivery is delayed.
Maternal risks include significant perineal trauma (3rd or 4th-degree tears) and postpartum hemorrhage (PPH) from uterine atony or lacerations.

How to Approach the Question

First, identify the clinical problem presented in the question: 'Shoulder dystocia'. This is an obstetric emergency.
Recall the specific set of maneuvers used to manage this condition. The HELPERR mnemonic is a key tool for this.
Analyze the given options. Evaluate each maneuver based on its correct clinical indication.
McRoberts maneuver is a well-known first-line treatment for shoulder dystocia.
Differentiate this from maneuvers used in other contexts. Lovset and Burn Marshall are for breech deliveries, and Leopold is for assessment.
Select the option that is a direct and appropriate intervention for shoulder dystocia.

Concept Tested & Keywords

Qp4gqteQetnv384FGerQcn

Practise the full GMCH Chandigarh - 2022

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