Examkin

Soru

Zorluk: OrtaObstetric Complications

A 29-year-old G2P1 at 39 weeks gestation presents to the labor and delivery triage in the second stage of labor with an overwhelming urge to push. Her pregnancy has been uncomplicated, though she missed her final prenatal visits. Bedside ultrasound confirms a frank breech presentation. Pelvic examination reveals complete cervical dilation, complete effacement, and the fetal buttocks distending the perineum at +3 station. Continuous fetal heart rate monitoring demonstrates a reassuring Category I tracing. Given the imminent delivery, the obstetrician prepares for an assisted vaginal breech delivery.

Arrange the following obstetric maneuvers and actions in the correct chronological sequence for an assisted vaginal breech delivery.

  1. 1Maintain a hands-off approach until spontaneous delivery of the fetal body to the level of the umbilicus.
  2. 2Extract a loop of the umbilical cord to relieve tension and monitor for pulsations.
  3. 3Rotate the fetal trunk to deliver the arms via the Lovset maneuver.
  4. 4Flex and deliver the aftercoming head using the Mauriceau-Smellie-Veit maneuver.
  5. 5Apply Piper forceps if manual maneuvers fail to deliver the aftercoming head.

Cevap

The correct sequence begins with allowing spontaneous delivery to the umbilicus, followed by extracting a loop of the umbilical cord. Next, the arms are delivered using the Lovset maneuver. The aftercoming head is then flexed and delivered via the Mauriceau-Smellie-Veit maneuver. Finally, Piper forceps are applied if manual delivery of the head fails.
The correct sequence ensures the fetus remains in a flexed posture to prevent head entrapment. Traction must be rigorously avoided until the umbilicus delivers. The cord is then managed to prevent avulsion. Next, the arms must be delivered (Lovset maneuver) to clear the canal and allow the head to descend. This is followed by manual flexion of the head (Mauriceau-Smellie-Veit maneuver). Piper forceps are the definitive instrument reserved for use only if manual delivery of the head fails.

Adım Adım Çözüm

1
Identify the clinical scenario and the need for sequential intervention.
The patient is experiencing an imminent frank breech delivery, which requires a strictly adhered-to sequence of obstetric maneuvers.
Following a standardized algorithm minimizes the risk of catastrophic head entrapment, neonatal asphyxia, and birth trauma.
2
Determine the initial approach to the delivery of the lower body.
The initial step must be a hands-off approach until the umbilicus delivers.
Applying traction to the fetus before the umbilicus is delivered can cause the fetal arms to extend above the head, obstructing vaginal delivery.
3
Determine the management of the umbilical cord and upper body.
Extract a loop of the cord, then deliver the arms using the Lovset maneuver.
A loop of cord prevents avulsion. The arms must be systematically delivered from the vaginal canal to allow the fetal head to enter the maternal pelvis.
4
Determine the sequence for delivering the aftercoming head.
Perform the Mauriceau-Smellie-Veit maneuver, followed by Piper forceps if needed.
Manual flexion (Mauriceau-Smellie-Veit) is the first-line method for the head. If this fails, instrumental delivery specifically designed for breech (Piper forceps) is utilized.

Anahtar Kavram

Assisted Vaginal Breech Delivery Sequential Management

Alternatif Yöntem

If Piper forceps are unavailable or fail to deliver the entrapped head, a symphysiotomy or the Zavanelli maneuver (cephalic replacement followed by emergent cesarean delivery) may be required as life-saving last resorts.
Tahmini Süre:1m 30s
Bu soruyu puanla

Konular

Obstetric Complications

Bu konudan daha fazla soru