The Burns-Marshall maneuver is a technique sometimes used in obstetrics during which specific situation?

NORCET 9 Prelims-2025

Obstetrics & Gynaecology

Easy

Appeared in: NORCET 9 Prelims-2025

Explanation

The Burns-Marshall maneuver is a technique used exclusively for the delivery of the after-coming head in a vaginal breech birth.
Its main purpose is to maintain flexion of the fetal head as it passes through the birth canal, which is crucial for preventing injury to the cervical spine.
The maneuver involves allowing the baby's body to hang downwards to use gravity to flex the head, followed by lifting the trunk in an arc over the mother's abdomen to gently deliver the head.
As seen in the image, this technique is a hands-on procedure performed by the obstetrician to facilitate the final and most delicate part of a breech delivery.

Option A: Assisting in the delivery of the placenta involves different techniques, such as controlled cord traction (Brandt-Andrews maneuver) or manual removal, which are performed during the third stage of labor after the baby is born.
Option B: Managing postpartum hemorrhage involves interventions to control excessive bleeding after childbirth, such as uterine massage, administering uterotonic drugs (e.g., oxytocin), and bimanual compression. The Burns-Marshall maneuver is unrelated to hemorrhage control.
Option D: Shoulder dystocia is a complication that occurs in cephalic (head-first) presentations when the baby's shoulder gets stuck behind the mother's pubic bone after the head has been delivered. It is managed with different maneuvers like the McRoberts maneuver, suprapubic pressure, or the Woods' screw maneuver.

Visual 1: Animation - A step-by-step animation of the Burns-Marshall maneuver would clearly illustrate the sequence of actions and the movement of the fetal head through the pelvis.
Visual 2: Diagram - A diagram comparing the Burns-Marshall maneuver with the Mauriceau-Smellie-Veit maneuver, another technique for delivering the after-coming head, would highlight the differences in hand placement and procedure.
Visual 3: Infographic - An infographic showing the different types of breech presentations (frank, complete, and footling) would provide context for why specialized delivery maneuvers are necessary.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The concept tested is the application of specific obstetric maneuvers in childbirth, particularly the Burns-Marshall maneuver for breech deliveries 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, prepare necessary equipment, and be ready for potential neonatal resuscitation, as breech babies are at a higher risk for complications.
The nurse's role includes closely monitoring the fetal heart rate during the delivery of the after-coming head, as umbilical cord compression is a significant risk during this phase.
What if? If the Burns-Marshall maneuver is unsuccessful or if the fetal neck is extended, the provider may need to use specialized forceps, such as Piper forceps, to deliver the head. The nurse must ensure these instruments are immediately available.

How to Approach the Question

First, identify the key term in the question: 'Burns-Marshall maneuver'. Recognize this as a specific obstetric technique.
Analyze the provided image. The image clearly depicts a baby being delivered feet-first (breech) and the maneuver being applied to the after-coming head. This is a major clue.
Evaluate the options in the context of a breech delivery. Option A (placenta delivery) and Option B (postpartum hemorrhage) relate to different stages or complications of childbirth.
Consider Option D (shoulder dystocia). Recall that shoulder dystocia is a complication of a head-first (cephalic) delivery, not a breech delivery.
Conclude that Option C, 'To facilitate the delivery of the after-coming head in a breech presentation,' is the only option that aligns with the visual information and the known purpose of the Burns-Marshall maneuver.

Concept Tested & Keywords

Concept Tested: The concept tested is the application of specific obstetric maneuvers in childbirth, particularly the Burns-Marshall maneuver for breech deliveries.
Stem keywords: Burns-Marshall maneuver, obstetrics, breech presentation, after-coming head
Lead-in keywords: during which specific situation
Clinical cues: The image provided shows a baby in a breech position, which is a key visual cue to the correct answer.

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