Editing Maternal and Newborn Nursing – RN Practice Questions (section)

==Question 7==
During a vaginal birth the fetal head delivers and then retracts tightly against the perineum, and the shoulders do not deliver with the next contraction. Which nursing action is appropriate?
# Apply firm fundal pressure to dislodge the shoulder.
# Sharply flex the client's thighs onto her abdomen and apply suprapubic pressure.
# Instruct the client to push harder and more continuously.
# Place the client in a high Fowler position.

'''Answer:''' 2 (B). Sharply flex the client's thighs onto her abdomen and apply suprapubic pressure.

''Rationale:'' This is shoulder dystocia with the turtle sign. The McRoberts maneuver flattens the sacral promontory and rotates the symphysis pubis, and suprapubic pressure adducts the fetal shoulder to free it from behind the symphysis. '''Fundal pressure (option 1) is contraindicated''' because it drives the shoulder harder into the symphysis and risks uterine rupture and worse fetal injury. Option 3 alone does not resolve mechanical impaction. Option 4 does not change the pelvic geometry in a useful way. Anticipate postpartum hemorrhage and assess the newborn for brachial plexus injury and clavicle fracture.