Ans. is D. i.e. Lateral cutaneous nerve of thigh

• McRobert’s maneuver is a technique to deliver babies with shoulder dystocia.
• The technique is performed by flexing the mother’s thigh towards her shoulder while she is lying on her back.
• The McRoberts maneuver does not change the actual dimension of the maternal pelvis. Rather it relieves shoulder dystocia via marked cephalad rotation of the symphysis pubis and by flattening the sacrum.

“Occasionally the mother’s symphyseal joint may become separated or the lateral femoral cutaneous nerve, damaged, most likely as a result of the overaggressive hyperflexion of the maternal legs during attempts at resolving the shoulder dystocia “.

Ans. is D. i.e. Mauriceau–Smellie–Veit maneuver

• It is used to assist in the delivery of the fetal head manually.
• While the other three maneuvers (McRoberts’ maneuver, Woods corkscrew maneuver, and suprapubic maneuver) are used in shoulder dystocia.

Mnemonic “HELPERR” as a guide for treating shoulder dystocia:

• “H” stands for help    
• “E” stands for evaluating for an episiotomy.
• “L” stands for legs(pull your legs toward your stomach McRoberts maneuver)
• “P” stands for suprapubic pressure
• “E” stands for entering maneuvers(internal rotation of baby’s shoulders)
• “R” stands for remove the posterior arm from the birth canal.
• “R” stands for roll the patient. 

McRoberts maneuver:

• Abduct the maternal thighs and sharply hyperflex them onto her abdomen.
• This straightens the lumbosacral angle, rotates the maternal pelvis upward and increases the anterior-posterior diameter of the pelvis.
• Suprapubic pressure may be used together. 
• Involves Lateral cutaneous nerve of thigh 

Wood’s maneuver:

• Under GA
• The posterior shoulder is rotated to an anterior position (180°) by a corkscrew movement by inserting two fingers in the posterior vagina.
• Simultaneous suprapubic pressure is applied.
• This helps easy entry of the bisacromial diameter into the pelvic inlet.

Ans. is A i.e. Fundal pressure
The term shoulder dystocia is used to define a wide range of difficulties encountered in the delivery of the shoulders.
Risk factors

• D = Maternal Diabetes
• O = Maternal Obesity/Fetal Obesity (Macrosomia)
• P = Post-term pregnancy
• A = Anencephaly

 
Mnemonic “HELPERR” as a guide for treating shoulder dystocia:

• “H” stands for help    
• “E” stands for evaluating for the episiotomy.
• “L” stands for legs(pull your legs toward your stomach McRoberts maneuver)
• “P” stands for suprapubic pressure
• “E” stands for entering maneuvers(internal rotation of baby’s shoulders)
• “R” stands for remove the posterior arm from the birth canal.
• “R” stands for roll the patient. 

Ans. is d i.e. None
Complications
Fetal:

• Asphyxia
• Brachial plexus injury (plexopathy) due to stretch
• Erb & Klumpke palsy
• Humerus fracture
• The clavicle or sternomastoid hematoma during delivery.
• Perinatal morbidity and mortality are high

Maternal:

• PPH (11%)
• Cervical laceration,
• Vaginal tear, perineal tear (3rd and 4th degree)
• Rupture of uterus, bladder
• Sacroiliac joint dislocation
• Morbidity

Ans. is B. i.e. Shoulder dystocia

• Shoulder dystocia is a difficulty in the delivery of the shoulder after the head is born.
• Macrosomia can lead to shoulder dystocia.
• Shoulder dystocia occurs when either the anterior or the posterior (rare) fetal shoulder impacts the maternal symphysis or on the sacral promontory respectively.

Risk factors

• D = Maternal Diabetes
• O = Maternal Obesity/Fetal Obesity (Macrosomia)
• P = Post term pregnancy
• A = Anencephaly

Ans. D: Anencephaly

Complications
Fetal:

• Asphyxia
• Brachial plexus injury (plexopathy) due to stretch
• Erb & Klumpke palsy
• Humerus fracture
• The clavicle or sternomastoid hematoma during delivery.
• Perinatal morbidity and mortality are high

Maternal:

• PPH (11%)
• Cervical laceration,
• Vaginal tear, perineal tear (3rd and 4th degree)
• Rupture of uterus, bladder
• Sacroiliac joint dislocation
• Morbidity.

Shoulder dystocia poses a greater threat to the fetus than the mother. 

Risk of recurrent shoulder dystocia in the next pregnancy 1-13%.

Ans. C: Anencephaly

Several obstetrical maneuvers are sequentially performed in an attempt to facilitate delivery at this point, including :

• Gaskin maneuver involves moving the mother to an all-fours position with the back arched, widening the pelvic outlet.
• McRobert’s maneuver;
• Woods’ screw maneuver which leads to turning the anterior shoulder to the posterior and vice versa.
• Jacquemier’s maneuver, or delivery of the posterior shoulder first, in which the forearm and hand are identified in the birth canal, and gently pulled.

More drastic maneuvers include

• Zavanelli’s maneuver involves pushing the fetal head back in with performing a cesarean section.
• Intentional clavicular fracture, which reduces the diameter of the shoulder girdle that requires to pass through the birth canal.
• Symphysiotomy, which makes the opening of the birth canal laxer by breaking the connective tissue between the two pubes bones facilitating the passage of the shoulders.

Don’ts in shoulder dystocia:

• Do not give traction over baby’s head
• Do not apply fundal pressure.

Ans. is ‘b’ i.e.,  McRoberts maneuver, ‘d’ i.e., Wood’s maneuver & ‘e’ i.e., Jacquemier maneuver

Shoulder Dystocia Maneuvers 

Maternal Maneuvers

• McRoberts maneuver
• Suprapubic pressure
• Gaskin maneuver (all-fours)
• Sims maneuver (lateral decubitus)
• Ramp maneuver
• Symphysiotomy 

Fetal Maneuvers

• Rubin maneuver
• Jacquemier maneuver (posterior arm delivery)
• Wood screw maneuver
• Zavanelli maneuver (cephalic replacement)
• 4 Cleidotomy
• Shute forceps maneuver

Ans. E. All 
The complications of shoulder dystocia:
Maternal:

• PPH
• Rectovaginal fistula
• Symphyseal separation or diathesis, with or without transient femoral neuropathy
• 3^rd or 4th-degree episiotomy or tear
• Uterine rupture 

Fetal:

• Brachial plexus palsy
• Clavicle fracture
• Fetal death
• Fetal hypoxia, with or without permanent neurologic damage
• Fracture of the humerus

Ans. is B. i.e. Hegar’s maneuver

• McRoberts, Zavanelli, and Wood’s maneuvers are maneuvers in the management of shoulder dystocia.
• Hegar’s sign is a non-sensitive indication of pregnancy in women, its absence does not exclude pregnancy.
• It pertains to the features of the cervix and the uterine isthmus.
• It is demonstrated as a softening in the consistency of the uterus, and the uterus and cervix seem to be two separate regions.

Ans. is C. i.e. Femoral nerve

• McRoberts maneuver is to be done in cases of shoulder dystocia.
• When the maternal thighs are markedly flexed and abducted, pressure from the overlying inguinal ligament may lead to femoral nerve injury.

Ans. B. Suprapubic pressure
Applying a gentle suprapubic pressure is the first step in the management of shoulder dystocia after McRoberts maneuver.
Mnemonic “HELPERR” as a guide for treating shoulder dystocia:

• “H” stands for help    
• “E” stands for evaluating for the episiotomy.
• “L” stands for legs(pull your legs toward your stomach McRoberts maneuver)
• “P” stands for suprapubic pressure
• “E” stands for entering maneuvers(internal rotation of baby’s shoulders)
• “R” stands for remove the posterior arm from the birth canal.
• “R” stands for roll the patient.