During a delivery complicated by shoulder dystocia, the baby’s head retracts back against the perineum after it emerges, a phenomenon known as ‘turtling’. Which of the following is the most appropriate immediate action for the healthcare provider to take?
Wait for the next contraction to try and deliver the shoulders naturally.
Perform the McRoberts maneuver to reposition the mother’s legs and widen the pelvis.
Apply fundal pressure to help push the baby out.
Use vacuum extraction to assist the delivery of the shoulders.
The Correct Answer is B
Choice A rationale
Waiting for the next contraction is inappropriate in shoulder dystocia, where immediate action is required to prevent fetal hypoxia. Delaying intervention can lead to serious complications for the newborn.
Choice B rationale
The McRoberts maneuver, involving hyperflexion of the mother's legs, widens the pelvis, facilitating shoulder delivery in cases of shoulder dystocia. This technique reduces shoulder impaction effectively.
Choice C rationale
Applying fundal pressure is contraindicated in shoulder dystocia as it may worsen the impaction by compressing the fetal shoulders against the maternal pelvis, increasing the risk of injury.
Choice D rationale
Vacuum extraction is not recommended for shoulder dystocia management. This obstetric emergency requires specific maneuvers, like the McRoberts maneuver, to relieve the impacted shoulder.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Chronic hypertension increases the risk of complications but is not necessarily the highest risk compared to elevated blood pressure and obesity combined in pregnancy.
Choice B rationale
Elevated blood pressure and a high BMI significantly increase the risk for complications like preeclampsia, gestational diabetes, and preterm birth in pregnancy.
Choice C rationale
A 16-year-old pregnant client is at risk due to age, but not as high as the compounded risks of hypertension and obesity.
Choice D rationale
A history of fetal demise increases risk, but current elevated blood pressure and high BMI in an older client present higher immediate pregnancy complication risks.
Correct Answer is C
Explanation
Choice A rationale
Erythema toxicum is a benign rash that does not cause localized swelling or cross suture lines on the newborn's head.
Choice B rationale
Cephalhematomas are subperiosteal hemorrhages that do not cross suture lines, and they do not cause generalized swelling.
Choice C rationale
Caput succedaneum is edema of the newborn's scalp that crosses suture lines, commonly resulting from vacuum-assisted delivery.
Choice D rationale
Mongolian spots are pigmented birthmarks found on the skin, not associated with swelling or crossing suture lines.
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