MCQ Obstetrics Answer 15

The Correct Answer is A


Many authorities feel a large extended episiotomy is helpful in the management of shoulder dystocia. The McRobert maneuver is frequently cited as the initial maneuver to attempt: the patient’s legs are removed from the stirrups and sharply flexed against the abdomen, resulting in straightening of the sacrum relative to the lumbar spine, with rotation of the symphysis pubis cephalad. This procedure alone may free the anterior shoulder. Firm subrapubic pressure applied to the anterior shoulder by an assistant may also disimpact the shoulder, allowing the physician to successfully deliver the infant.


Other maneuvers which may be required for successful delivery include the Woods screw maneuver (rotating the infant’s posterior shoulder out of the sacrum and then delivering it below the symphysis), and delivery of the posterior shoulder or arm across the infant’s chest, followed by rotation of the infant. Forceful rotation of the head can only result in injury to the infant, as will excessive traction in any direction. Giving oxygen to the mother would not help the infant whose blood flow is compromised.


Ref: Advanced Life Support in Obstetrics Provider Course Syllabus. American Academy of Family Physicians, 1996, pp 149-155. 2) Cunningham FG, MacDonald PC, Gant NF, et al: Williams Obstetrics, ed 20. Appleton & Lange, 1997, pp 451-454.

Category: Obstetrics MCQs