Which of the following can be done during assisted breech delivery? I. Never to rush, II. Never push from above but pull from below, III. Never pull from below but push from above, IV. All of the above

1. A

   Only II & III

2. B

   Only I & II

3. C

   Only I & III

4. D

   All of the above

Appeared in: KPSC Staff Nurse - 2021

Explanation

• Statement I, 'Never to rush,' is a core principle. A patient, hands-off approach allows for natural descent and rotation, minimizing the risk of complications like head entrapment or nuchal arms.
• Statement III, 'Never pull from below but push from above,' correctly identifies two key actions. Avoiding traction ('pulling') prevents catastrophic neck and spinal injuries. 'Pushing from above' refers to applying suprapubic pressure to maintain head flexion, which is essential for the safe delivery of the after-coming head.
• Only I & III matches the defining clue or classification criterion in the stem.
• Supporting mechanism: The option aligns with the governing rule, pattern, sequence, classification, or exam logic being tested.
• Key differentiator: It fits the one fact that separates the correct response from the closest distractor.

Why Other Options Were Wrong

• Option A: This option is incorrect because it includes Statement II, which advocates for pulling from below. Pulling on the fetus is dangerous and strictly contraindicated. Furthermore, Statements II and III are mutually exclusive.
• Option B: This option is incorrect because it includes Statement II. Pulling the baby from below can cause severe trauma, including hyperextension of the neck, spinal cord injury, and fractures.
• Option D: This option is incorrect because Statement II is wrong, and Statements II and III contradict each other. Not all listed actions are correct for an assisted breech delivery.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The question tests the knowledge of the fundamental principles and safety maneuvers required for conducting an assisted breech delivery as background academic context rather than a clinical decision trigger.
• A nurse's primary role in an assisted breech delivery is to anticipate needs, prepare equipment for a high-risk birth (including neonatal resuscitation), and assist the provider. This includes being ready to apply suprapubic pressure correctly when directed.
• It is critical for the nurse to understand the difference between suprapubic pressure (correct) and fundal pressure (incorrect and dangerous). The nurse should question any instruction to apply fundal pressure during a breech delivery, as it can lead to head entrapment and fetal injury.
• The nurse must also be a patient advocate, ensuring the team remains calm and does not rush the delivery, which could compromise safety.

How to Approach the Question

• First, identify the core topic of the question, which is the correct procedure for an 'assisted breech delivery'.
• Evaluate each Roman numeral statement (I, II, III) based on established principles of obstetric safety.
• Analyze Statement I: 'Never to rush'. This aligns with the principle of patience in high-risk deliveries to allow natural mechanisms to work and prevent complications. This is a correct principle.
• Analyze Statement II: 'Never push from above but pull from below'. The phrase 'pull from below' is a major red flag. Traction on a breech baby is known to be extremely dangerous. This statement is incorrect.
• Analyze Statement III: 'Never pull from below but push from above'. This correctly prohibits pulling. 'Push from above' refers to the accepted technique of suprapubic pressure to maintain head flexion. This statement is correct.
• Review the options. Eliminate any option that includes the incorrect Statement II. This rules out options A, B, and D.

Concept Tested & Keywords

• Concept Tested: The question tests the knowledge of the fundamental principles and safety maneuvers required for conducting an assisted breech delivery.
• Stem keywords: assisted breech delivery
• Lead-in keywords: Which of the following
• Negative lead-in flag: false

Question ID

Ql585zkcwnDWzqnaxUsDgy

Copy ID

Reference Book

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 47-55

E6 Obstetrics Williams p. 27-46