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

Appeared in: KPSC Staff Nurse - 2021

Explanation

The correct option includes statements I and III, which represent the core safety principles of managing an assisted breech delivery.
Statement I, "Never to rush," is crucial to prevent complications like cervical spasm and head entrapment, allowing for a controlled delivery.
Statement III, "Never pull from below but push from above," correctly outlines the proper technique. Pulling from below is dangerous as it can cause head extension and nuchal arms. Applying suprapubic pressure (pushing from above) helps maintain head flexion, which is essential for the safe passage of the aftercoming head through the birth canal.

Option A: This option is incorrect because it includes Statement II, which advocates for pulling from below. This action is contraindicated as it can lead to dangerous fetal head extension and other complications.
Option B: This option is incorrect because it includes Statement II. While Statement I ("Never to rush") is correct, Statement II describes an unsafe maneuver (pulling from below) that should be avoided.
Option D: This option is incorrect because not all statements are correct. Statement II is a dangerous and incorrect principle for managing a breech delivery.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Principles of Assisted Breech Delivery as background academic context rather than a clinical decision trigger.
Adherence to these principles is critical for preventing fetal morbidity and mortality. Incorrect maneuvers can lead to severe birth injuries, including brachial plexus injury, spinal cord damage, fractures, and hypoxic brain injury from head entrapment.
A nurse's role in an assisted breech delivery is to anticipate needs, ensure the correct personnel and equipment are available, and assist the provider. This includes being ready to apply suprapubic pressure when directed.
What if? If the fetal head becomes entrapped despite correct technique, the nurse must act quickly. This involves calling for immediate help (including anesthesia and pediatrics), preparing for emergency maneuvers like the Zavanelli maneuver (pushing the fetus back into the uterus for a cesarean section), and assisting with the administration of tocolytic agents like terbutaline to relax the uterus if ordered.

How to Approach the Question

First, analyze each statement (I, II, and III) individually based on established obstetric principles for breech delivery.
Evaluate Statement I: "Never to rush." Recall that patience and avoiding haste are key to preventing complications like head entrapment. This statement is correct.
Next, compare Statements II and III, which are direct opposites. Statement II suggests pulling from below, while Statement III suggests pushing from above and not pulling from below.
Recall or deduce that traction (pulling) on the fetal body is dangerous because it can cause the head to extend, making delivery more difficult and risky. This makes Statement II incorrect.
Conversely, applying suprapubic pressure (pushing from above) is a known technique (part of the Mauriceau maneuver) to help keep the head flexed. This makes Statement III correct.
Having identified Statements I and III as correct, look for the option that includes only this combination.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 27-46

Practise the full KPSC Staff Nurse - 2021

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