88 Obstetrics and Gynecology Board Review •••
❍ Hyperextended heads are noted in what percentage of breech fetuses that are present in labors?
3% to 5%.
❍ When there is hyperextension of the head, what is the risk of spinal cord injury?
21%.
❍ Describe the Prague maneuver?
The Prague maneuver is performed by using two fingers of one hand to grasp the shoulders of the back-down
fetus, the other hand is then used to draws the feet up out of the abdomen.
❍ When is the indication of Prague performed?
It is used when the fetal trunk fails to rotate anteriorly.
❍ What is the Pinard maneuver?
The Pinard maneuver is used with frank breech presentations to deliver a foot into the vagina or through the
uterine incision during cesarean delivery.
❍ What is the reason to delay performing artificial rupture of membranes (AROM) during vaginal breech
deliveries?
Intact membranes may decrease the risk of cord prolapse and may also assist in the dilation of the cervix.
❍ Name the types of breech presentation with the lowest rate and with the highest risk for cord prolapsed.
(1) Lowest incidence: Frank breech (0.5%).
(2) Highest incidence: Footling breech (10%).
❍ A nuchal arm is defined as?
When either one or both fetal arms are around the fetal neck.
❍ Describe three maneuvers to facilitate delivery when a nuchal arm is present.
(1) Two fingers are placed over the humerus and are then used to sweep the arm over the chest; the humerus
should be splinted with the operator’s fingers in an effort to reduce the risk of fracture.
(2) The fetus may be rotated 180 degrees, so that elbow is drawn toward the face, allowing delivery of the arm.
(3) The arm can be forcibly extracted by hooking a finger over the arm; however, this is associated with an increase
risk of fracture of humerus/clavicle.
❍ Name tree common maternal complications associated with vaginal breech delivery.
Infection (secondary to intrauterine maneuvers).
Cervical laceration.
Perineal tears and/or extension of episiotomy.