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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Related Questions
Correct Answer is D
Explanation
Choice A rationale
Azithromycin is an antibiotic used to treat infections and is not indicated for promoting lung maturity in preterm infants.
Choice B rationale
Indomethacin is a tocolytic agent used to delay preterm labor but does not promote lung maturity in the fetus.
Choice C rationale
Magnesium sulfate is used for neuroprotection and to prevent seizures in preeclampsia, but it does not enhance lung maturity.
Choice D rationale
Betamethasone is a corticosteroid that accelerates fetal lung development and surfactant production, promoting lung maturity in preterm infants.
Correct Answer is B
Explanation
Choice A rationale
Blood glucose level changes are unrelated to hyperbilirubinemia and phototherapy, which specifically target bilirubin metabolism in the newborn's liver and skin.
Choice B rationale
A decrease in transcutaneous bilirubin (TcB) levels shows effective phototherapy, as it converts bilirubin into water-soluble isomers that can be excreted.
Choice C rationale
Skin color changes from yellow to normal indicate reduced bilirubin levels, but the most accurate measure of phototherapy efficacy is the decrease in TcB levels.
Choice D rationale
Weight gain is not an indicator of effective phototherapy; it reflects overall nutrition and hydration status rather than bilirubin metabolism and excretion.
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