72 Obstetrics and Gynecology Board Review •••
❍ What is the name of the maneuver utilized to control the fetal breech head where the obstetrician applies
the index finger and middle finger of one hand over the maxilla, with two fingers of the other hand hooked
over the fetal neck and grasping the fetal shoulders?
Mauriceau-Smellie-Viet maneuver.
❍ The Pinard maneuver is sometimes utilized in the case of a frank breech. Describe the maneuver.
The obstetrician’s fingers are kept parallel to the femur. Pressure is placed in the popliteal fossa, resulting in flexion
of the fetal knee.
❍ Entrapment of the fetal head is potentially life threatening to a breech delivery. Describe a surgical
correction of this problem.
Duhrssen incision. The technique involves two or three incisions in the cervix at the 2, 6, and 10 o’clock positions.
❍ Of frank breech, complete breech, or footling breech, which presentation has the highest frequency
of umbilical cord prolapse?
Footling breech; 15% to 18%.
❍ True or False: Congenital anomalies are two to three times greater with a fetus in the breech presentation
compared with the cephalic presentation.
True.
❍ In approximately what percentage of twin deliveries are both twins cephalic/cephalic?
40%.
❍ What is the approximate incidence of shoulder dystocia?
0.6% to 1.4% of vertex deliveries, although there is a wide variation in the definition and methods of reporting.
❍ List at least three interpartum risk factors for shoulder dystocia.
(1) First-stage labor abnormalities, including protraction disorders or arrest disorders.
(2) Prolonged second stage of labor.
(3) Oxytocin augmentation of labor.
(4) Midforceps and midvacuum delivery.
❍ What is the approximate incidence of shoulder dystocia in a patient with diabetes mellitus and a fetus
4500 g birth weight?
50%.
❍ Name at least three antepartum risk factors for shoulder dystocia.
(1) Fetal macrosomia.
(2) Maternal obesity.
(3) Diabetes mellitus.
(4) Post term pregnancy.
(5) Male gender.