inkspot
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A 38-year-old woman, gravida 2, para 1, at 38 weeks' gestation has had no fetal movement for 36 hours. Her prenatal course, prenatal tests, and fetal growth have been normal. Fetal heart tones are heard by Doppler. Which of the following is the most appropriate next step in management?
A) Routine prenatal visit in 1 week
B) Maternal hydration
C) Nonstress test
D) Immediate induction of labor
E) Amniocentesis
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| inkspot
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A 30-year-old woman, gravida 2, para 1, is brought to the emergency department in labor. An episiotomy is performed. Following delivery of the head, the shoulders do not follow with the usual traction and maternal pushing. Which of the following is the most appropriate next step in management?
A) Flexing the woman's knees toward her shoulders
B) More forceful traction and fundal pressure
C) Delivering the posterior arm
D) Rotating the head 180 degrees
E) Symphysiotomy
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| nyimalay
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C
A
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| inkspot
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the answer to second one is " C " as well.
McRobert maneuver is actually flexion of HIPS not knees.
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| nyimalay
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Oh! my bad.
How could we flex knee towords shoulder. Funny, Huh .
So what should be the answer? C?
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| inkspot
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yeah it is C
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| ricardoricardo
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c
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| ricardoricardo
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c too
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| Markus2009
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C
A or C but I don't buy it, could someone explain this more...
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| HKM07
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1.C
2.A The first step in the manegement of shoulder dystocia is a. Leg in full flexion (MCRoberts maneuver) b. Anterior shoulder disimpaction (suprapubic pressure). c. Release posterior shoulder .d. Manual corkscrew. e. Episiotomy .f. Rollover (on hands and knees)
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| inkspot
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Management of Shoulder Dystocia:
Treatment
Several maneuvers can be done to displace the shoulder impaction:
Suprapubic pressure on maternal abdomen
McRoberts maneuver: Maternal thighs are sharply flexed against maternal
abdomen. This decreases the angle between the sacrum and spine
and may dislodge fetal shoulder. ( its not knees flexion, mind it )
Woods corkscrew maneuver: Pressure is applied against scapula of posterior
shoulder to rotate the posterior shoulder and “unscrew” the anterior
shoulder.
Posterior shoulder delivery: Hand is inserted into vagina and posterior
arm is pulled across chest, delivering posterior shoulder and displacing
anterior shoulder from behind pubic symphysis.
Break clavicle or cut through symphysis
Zavanelli maneuver: If the above measures do not work, the fetal head
can be returned to the uterus. At this point, a C-section can be performed.
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| inkspot
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Source: First Aid Gyne/Obs
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