While conducting delivery of a woman, a midwife suddenly finds that the internal rotation of shoulders is not occurring even after good uterine contractions. To release the anterior shoulder, she is performing which of the following manoeuvres in the given picture?

1. A

   Corkscrew manoeuvre

2. B

   Lovset's manoeuvre

3. C

   McRoberts manoeuvre

4. D

   Rubin manoeuvre

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

• The image displays the hallmark of the McRoberts maneuver: sharp flexion of the mother's thighs up onto her abdomen.
• This maneuver is a first-line, external, and non-invasive intervention for shoulder dystocia, which is an obstetric emergency where the baby's anterior shoulder gets stuck behind the mother's pubic bone after the head has delivered.
• The mechanism of action involves straightening the sacrum relative to the lumbar vertebrae and rotating the symphysis pubis, which increases the functional size of the pelvic outlet, often freeing the impacted shoulder.
• The image also shows the application of suprapubic pressure, a technique frequently combined with the McRoberts maneuver to further aid in dislodging the shoulder.

Why Other Options Were Wrong

• Option A: The Corkscrew (or Woods') maneuver is an internal rotational maneuver. It involves the provider inserting a hand into the vagina to rotate the posterior shoulder 180 degrees. The image shows an external maneuver involving the mother's legs.
• Option B: Lovset's maneuver is used to deliver the arms and shoulders during a breech (feet or buttocks first) delivery. The scenario describes a cephalic (head first) presentation with shoulder dystocia.
• Option D: The Rubin maneuver is an internal maneuver where the provider's fingers are inserted into the vagina to apply pressure on the posterior aspect of the baby's anterior shoulder, pushing it toward the fetal chest. The image shows an external repositioning of the mother's legs.

Related Visual

• Visual 1: Diagram - A comparison of the pelvic angle before and during the McRoberts maneuver, illustrating how it straightens the sacrum and increases the pelvic outlet.
• Visual 2: Illustration - A step-by-step guide showing the provider performing the internal Woods' corkscrew maneuver.
• Visual 3: Illustration - A depiction of the Rubin maneuver, showing the hand placement on the fetal shoulder inside the vagina.

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 can lead to severe fetal complications, including brachial plexus injury (Erb's palsy) and hypoxic brain damage, if not resolved quickly.
• Nurses play a critical role in recognizing the 'turtle sign' (retraction of the fetal head against the perineum), immediately calling for help, and assisting with maneuvers like McRoberts and suprapubic pressure.
• The HELPERR mnemonic provides a standardized, systematic approach for the team to follow, improving communication and efficiency during a high-stress event.

How to Approach the Question

• First, analyze the clinical scenario provided in the question stem. The failure of shoulder rotation after delivery of the head points to a diagnosis of shoulder dystocia.
• Next, carefully examine the image provided. Identify the specific actions being performed on the patient. In this case, the key action is the hyperflexion of the mother's thighs towards her abdomen.
• Correlate the visual information with your knowledge of obstetric maneuvers. The position shown is the classic McRoberts maneuver.
• Evaluate the given options. 'McRoberts manoeuvre' directly matches the visual evidence.
• Eliminate the other options by recalling their definitions. Corkscrew and Rubin are internal maneuvers, and Lovset's is for breech deliveries, none of which match the image or the specific clinical context of a cephalic delivery with shoulder dystocia.

Concept Tested & Keywords

• Concept Tested: Management of Shoulder Dystocia
• Stem keywords: delivery, internal rotation of shoulders, release anterior shoulder, manoeuvre
• Lead-in keywords: which of the following
• Clinical cues: Image showing hyperflexion of maternal thighs
• Clinical cues: Failure of internal rotation of shoulders despite good contractions

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Qfub2RPu1yGXShqsy5JPGv

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