Breech Delivery — MCQs
Identify the maneuver shown in the image:
A pregnant patient, with a history of classical cesarean section in view of fetal growth retardation in the previous pregnancy, presents to you. She is currently at 35 weeks of gestation with breech presentation. What is the next step in management?
What maneuver is used to deliver the head of a baby during a breech delivery?
Which of the following is a known cause of breech presentation?
An absolute indication for Classical cesarean section is :
In breech presentation, the following forceps/methods are used for delivery of the after-coming head EXCEPT:
Which of the following is a recognized method for the delivery of the after-coming head of a breech?
Absolute indication for cesarean section is :
A multigravida at term with a transverse lie and hand prolapse, along with a fetal heart rate of 140/min, is best managed by:
In which of the following conditions is the use of forceps contraindicated?
Breech Delivery Indian Medical PG Practice Questions and MCQs
Question 1: Identify the maneuver shown in the image:
- A. Burn Marshall
- B. Lovset
- C. Mauriceau-Smellie-Veit (Correct Answer)
- D. None of the options
Explanation: ***Mauriceau-Smellie-Veit*** - This maneuver is used for **head delivery in a breech presentation**, where the fetus's body is supported while pressure is applied to the maxilla or mandible to flex the head. - The image typically shows the operator's hand supporting the fetus's body and fingers placed on the fetal jaw to facilitate head flexion and delivery. *Burn Marshall* - The Burn Marshall maneuver involves **delivering the fetal head by applying suprapubic pressure** to the maternal abdomen while the fetal body is gently swept upwards over the maternal abdomen. - This maneuver is generally used for a **spontaneous breech delivery** if the head does not deliver easily after the body. *Lovset* - The Lovset maneuver is employed to **deliver the fetal shoulders** in a breech presentation by rotating the fetal trunk to bring the anterior shoulder under the pubic arch and then the posterior shoulder. - This maneuver aims to extract the shoulders sequentially, which might be necessary if they are impacted. *None of the options* - The visual representation aligns with the steps of the Mauriceau-Smellie-Veit maneuver, making this option incorrect. - This maneuver is clearly depicted by the hand placement and objective of aiding head delivery in breech.
Question 2: A pregnant patient, with a history of classical cesarean section in view of fetal growth retardation in the previous pregnancy, presents to you. She is currently at 35 weeks of gestation with breech presentation. What is the next step in management?
- A. Cesarean section at 37 weeks (Correct Answer)
- B. Advice USG and visit after 2 weeks
- C. Internal podalic version followed by vaginal delivery
- D. External cephalic version at 36 weeks
Explanation: ***Cesarean section at 37 weeks*** - A history of **classical cesarean section** is an absolute contraindication to vaginal birth due to the high risk of **uterine rupture**. - Performing the cesarean section at 37 weeks, rather than waiting longer, minimizes the risk of spontaneous labor and rupture while ensuring fetal maturity. *Advice USG and visit after 2 weeks* - This option does not address the critical risk of **uterine rupture** due to the previous classical cesarean section. - Delaying definitive management by two weeks could increase the risk of spontaneous labor and associated complications. *Internal podalic version followed by vaginal delivery* - An **internal podalic version** is a procedure used to change fetal lie during labor, typically for the second twin, and it is **contraindicated** with a previous classical cesarean due to rupture risk. - Given the previous classical incision, a **vaginal delivery is unsafe** and should not be attempted. *External cephalic version at 36 weeks* - **External cephalic version (ECV)** is generally contraindicated in patients with a history of a **classical cesarean section** due to the increased risk of uterine rupture. - Even if successful, the patient would still require a cesarean section for delivery given the previous uterine scar.
Question 3: What maneuver is used to deliver the head of a baby during a breech delivery?
- A. Pinards maneuver
- B. Prague maneuver (Correct Answer)
- C. Lovsets maneuver
- D. Burn Marshall method
Explanation: ***Prague maneuver*** - The **Prague maneuver** is used to deliver the aftercoming fetal head in breech delivery when specific traction on the shoulders is needed. - **Prague I (or Prague-Veit)**: Used when the fetal **back is anterior** - the operator's fingers hook over the shoulders while traction is applied. - **Prague II**: Used when the fetal **back is posterior** - less commonly performed. - This maneuver involves supporting the fetal body while applying traction to the shoulders to facilitate head delivery. *Pinard's maneuver* - **Pinard's maneuver** is used to assist with the delivery of the fetal **legs** in a **frank or complete breech** presentation, not the head. - This maneuver involves flexing the hip and knee to bring down a foot, aiding in the delivery of the lower extremities. *Lovset's maneuver* - **Lovset's maneuver** is used during a breech delivery to assist with the delivery of the **shoulders by rotating the fetal trunk**. - It involves rotating the baby's trunk 180 degrees to bring the posterior shoulder anterior under the pubic symphysis, allowing for easier delivery of both arms and shoulders. *Burns-Marshall method* - The **Burns-Marshall method** is another technique used to deliver the aftercoming head in breech delivery. - It involves allowing the fetal body to hang by its own weight until the **nape of the neck and hairline appear** at the vulva, then lifting the body in an arc towards the mother's abdomen to deliver the head by flexion. - While this is also used for head delivery, the **Prague maneuver** involves more direct manual traction and is the answer expected for this examination context.
Question 4: Which of the following is a known cause of breech presentation?
- A. Septate uterus
- B. Hydrocephalus
- C. Hydramnios (Correct Answer)
- D. Uterine fibroids
Explanation: ***Hydramnios*** - **Excessive amniotic fluid** (polyhydramnios) increases the space available for fetal movement, preventing the fetus from settling into a stable cephalic position - This allows **increased fetal mobility** and is a well-recognized cause of **malpresentation including breech presentation** - The lack of normal space constraints means the fetus can freely move and fail to engage in vertex position *Septate uterus* - **Uterine anomalies** including septate uterus can restrict the intrauterine space and are recognized causes of breech presentation - However, they are **less common** than other causes and may also lead to recurrent pregnancy loss or preterm delivery - While a valid cause, it's not as frequently encountered as polyhydramnios in clinical practice *Hydrocephalus* - **Fetal hydrocephalus** with enlarged head can prevent normal engagement of the fetal head in the maternal pelvis - This can lead to malpresentation, though the mechanism is more about **disproportion** preventing cephalic engagement rather than causing breech directly - It's a recognized but less common fetal factor compared to other causes *Uterine fibroids* - **Large uterine fibroids**, particularly those in the lower uterine segment, can obstruct fetal descent and cause malpresentation - They alter uterine cavity shape and can prevent normal version to cephalic presentation - However, they are a **less frequent** direct cause compared to conditions like polyhydramnios or oligohydramnios
Question 5: An absolute indication for Classical cesarean section is :
- A. Central Placenta Previa
- B. Breech presentation
- C. Carcinoma cervix (Correct Answer)
- D. Multi-fibroid uterus
Explanation: ***Carcinoma cervix*** - A **classical cesarean section** (vertical incision in the uterine body) is indicated in cases of **carcinoma of the cervix** to minimize trauma to the cervix and prevent dissemination of cancer cells. - This approach avoids cutting through the cancerous tissue, which might be necessary with a lower uterine segment incision. *Central Placenta Previa* - While **placenta previa** often necessitates a cesarean section, a **lower segment cesarean section** (LSCS) is generally preferred due to less blood loss and better healing. - A classical cesarean section would only be considered in specific, rare circumstances for placenta previa, such as an exceptionally previa anterior placenta or severe hemorrhage requiring rapid extraction, but it is not an absolute, primary indication. *Breech presentation* - **Breech presentations** are often delivered by **lower segment cesarean section** (LSCS) due to potential risks associated with vaginal delivery. - A classical cesarean section is rarely indicated for breech presentation, typically only for very premature fetuses or if the lower uterine segment is inaccessible. *Multi-fibroid uterus* - A **multi-fibroid uterus** itself is not an absolute indication for a classical cesarean section unless the fibroids obstruct the lower uterine segment, preventing an LSCS. - In most cases, a **lower segment cesarean section** can still be performed, sometimes with careful navigation around or removal of obstructing fibroids (myomectomy at C-section).
Question 6: In breech presentation, the following forceps/methods are used for delivery of the after-coming head EXCEPT:
- A. Mauriceau-Smellie-Veit technique
- B. Kielland's forceps
- C. Piper forceps
- D. Wrigley's forceps (Correct Answer)
Explanation: ***Wrigley's forceps*** - **Wrigley's forceps** are **outlet forceps** designed for a fully engaged head at the pelvic outlet, with the sagittal suture in the anteroposterior diameter and the fetal scalp visible. - They are used for **cephalic presentations** to assist with delivery of the fetal head when it is low in the pelvis, not for the after-coming head in breech presentation. *Mauriceau-Smellie-Veit technique* - This is a **manual maneuver** specifically used to deliver the after-coming head in a **breech presentation**. - It involves supporting the fetal body and applying pressure to the maxilla to promote head flexion and delivery. *Kielland's forceps* - **Kielland's forceps** are used for **rotational deliveries** and can be applied in **breech presentations** for the delivery of the after-coming head, particularly when some degree of rotation is required. - Their unique design allows for application even when the head is malpositioned or high in the pelvis. *Piper forceps* - **Piper forceps** are specifically designed for the **after-coming head** in **breech delivery**. - They have a perineal curve and downward-angled shanks allowing them to be applied from below the fetal body to engage the head in the pelvis, preventing head extension and facilitating controlled delivery.
Question 7: Which of the following is a recognized method for the delivery of the after-coming head of a breech?
- A. Burns and Marshall method
- B. Malar flexion and shoulder traction
- C. Forceps method
- D. Mauriceau-Smellie-Veit maneuver (Correct Answer)
Explanation: ***Mauriceau-Smellie-Veit maneuver*** - The **Mauriceau-Smellie-Veit maneuver** is the **gold standard** and most widely recognized method for delivering the after-coming head in breech delivery. - The technique involves the accoucheur placing the **index and middle fingers over the maxilla** (malar eminence) to flex the fetal head, while the fetal body rests on the forearm. - An assistant applies **suprapubic pressure** to maintain flexion of the fetal head. - This method provides excellent **control of the fetal head** and maintains proper flexion to prevent extension and facilitate safe delivery. *Burns and Marshall method* - The **Burns-Marshall method** is also a recognized technique for assisted breech delivery, but it is typically used when the body delivers spontaneously. - This method involves holding the fetal feet and allowing the baby to hang by its own weight, promoting flexion, then sweeping the baby upward over the maternal abdomen. - While valid, it is generally considered an **alternative** to the Mauriceau-Smellie-Veit maneuver rather than the primary method. *Forceps method* - **Piper forceps** are specifically designed for the after-coming head and are a recognized method, particularly when manual methods fail or in cases of **fetal distress**. - However, forceps application requires specific expertise and may not be the first-line approach in all settings. - When used appropriately, forceps provide controlled delivery and protect the fetal head. *Malar flexion and shoulder traction* - This is **not a recognized standard method** as described. - While malar pressure is used in the Mauriceau-Smellie-Veit maneuver, **shoulder traction** is dangerous and can cause **brachial plexus injury**, **Erb's palsy**, or **spinal cord damage**. - Traction should never be applied to the shoulders during breech delivery.
Question 8: Absolute indication for cesarean section is :
- A. Breech presentation
- B. Dystocia
- C. Fetal distress
- D. Previous rupture of uterus (Correct Answer)
Explanation: ***Previous rupture of uterus*** - A prior **rupture of the uterus** creates a significant risk of **re-rupture** in subsequent pregnancies with labor contractions, posing a severe threat to both maternal and fetal life. - Due to the high risk of catastrophic hemorrhage and fetal distress, **elective cesarean section** before the onset of labor is mandated to prevent recurrence. *Breech presentation* - While many breech presentations result in a cesarean section, it is not an absolute indication, as **vaginal breech delivery** can be attempted in selected cases under strict criteria. - Factors like type of breech, estimated fetal weight, and maternal pelvis can influence the decision, making it a relative rather than an absolute indication. *Dystocia* - **Dystocia**, or difficult labor, is a common reason for cesarean section, but often interventions like **oxytocin augmentation** or **instrumental delivery** (forceps, vacuum) are attempted first. - A cesarean section is indicated when dystocia is severe or fails to respond to other measures, making it a relative indication based on progression of labor. *Fetal distress* - **Fetal distress**, indicated by non-reassuring fetal heart rate patterns, often necessitates prompt delivery, but the mode of delivery depends on the clinical situation. - If vaginal delivery is imminent and safe, it may be preferred, but if not, **cesarean section** is performed; therefore, it's an urgent relative indication rather than an absolute one.
Question 9: A multigravida at term with a transverse lie and hand prolapse, along with a fetal heart rate of 140/min, is best managed by:
- A. External cephalic version
- B. Cesarean delivery (Correct Answer)
- C. Breech delivery
- D. Internal podalic version
Explanation: ***Cesarean delivery*** - A **transverse lie** at term is a contraindication to vaginal delivery, as the fetus cannot pass through the birth canal in this orientation. - The presence of **hand prolapse** further complicates the situation, increasing the risk of umbilical cord prolapse and fetal distress, making cesarean section the safest option. *External cephalic version* - This procedure is performed to change a **breech or transverse lie** to a cephalic presentation, but it is typically done *before* term, usually between 36-37 weeks. - It is contraindicated once labor has started or with **membrane rupture** and fetal parts prolapsed, as is implied by hand prolapse in this term patient. *Breech delivery* - Breech delivery involves the fetus presenting buttocks or feet first, which is not the case here; the presentation is **transverse lie** and **hand prolapse**. - While some breech deliveries can be attempted vaginally under specific circumstances, this patient's presentation makes it an inappropriate option. *Internal podalic version* - This procedure involves changing a **transverse lie** to a **breech presentation** by internal manipulation, often performed in cases of twin delivery for the second twin or in specific scenarios of malpresentation in earlier gestations. - It is rarely performed for a single fetus at term due to risks for both mother and fetus, especially with a **term fetus** and **hand prolapse**.
Question 10: In which of the following conditions is the use of forceps contraindicated?
- A. Twin delivery
- B. Post maturity
- C. After coming head of breech
- D. Hydrocephalus (enlarged head) (Correct Answer)
Explanation: ***Hydrocephalus (enlarged head)*** - The use of forceps in cases of **hydrocephalus** can result in severe trauma to both the fetal head and the maternal birth canal due to the disproportionately large fetal head. - The increased risk of **intracranial hemorrhage**, skull fractures, and severe maternal soft tissue injury makes forceps delivery highly contraindicated. *Twin delivery* - Forceps can be used in twin deliveries, especially for the second twin, to expedite delivery or manage presentations if there are no other contraindications. - The decision depends on various factors such as presentation, size, and fetal well-being, but twin delivery itself is not a contraindication. *Post maturity* - **Post-maturity** itself is not a contraindication for forceps delivery, although these fetuses may be larger or have less resilient skulls. - Forceps may be considered if there's a need to shorten the second stage of labor due to **fetal distress** or maternal exhaustion in a post-term pregnancy, provided there's adequate fetal head engagement and no significant cephalopelvic disproportion. *After coming head of breech* - Forceps, specifically **Piper forceps**, are often indicated and used in the delivery of the **aftercoming head of a breech presentation**. - This maneuver helps to control the rate of head delivery, preventing sudden decompression and providing stability, which reduces the risk of fetal head trauma and intracranial hemorrhage.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free