## Correct Answer: B. Lovset Lovset maneuver is the specific technique used to manage shoulder dystocia and arm entrapment during breech delivery, particularly when winging of the scapula occurs—a sign of shoulder impaction. The maneuver involves rotating the fetal body 180° in the anteroposterior plane while maintaining traction on the pelvis. This rotation brings the posterior shoulder anteriorly under the pubic symphysis, allowing it to deliver first, followed by the anterior shoulder. The winging of the scapula indicates that the shoulders are trapped at the pelvic inlet, with the posterior shoulder impacted against the sacral promontory. Lovset maneuver is the gold standard for this specific complication in breech delivery because it mechanically reduces shoulder diameter by rotating the shoulders from the oblique to the anteroposterior diameter of the pelvis. The maneuver is performed after delivery of the fetal body up to the umbilicus, and the operator's hands grasp the fetal pelvis (not the chest) to avoid visceral injury. This is distinct from other maneuvers used in breech delivery, which address different complications (shoulder dystocia in cephalic presentation, arm entrapment, or placental delivery). ## Why the other options are wrong **A. McRoberts** — McRoberts maneuver is used for shoulder dystocia in *cephalic* (head-first) delivery, not breech. It involves hyperflexion of maternal thighs to increase pelvic outlet diameter and flatten the sacral promontory. It has no role in breech delivery complications and does not address scapular winging, which is a breech-specific problem of shoulder impaction. **C. Woods corkscrew maneuver** — Woods corkscrew maneuver is also used for shoulder dystocia in cephalic delivery. It involves rotating the fetal shoulders by applying pressure on the anterior surface of the posterior shoulder to rotate it into the oblique diameter. It is not applicable to breech delivery and does not manage the posterior shoulder impaction seen in breech with scapular winging. **D. Pinard** — Pinard maneuver is used to deliver the *arm* in breech delivery when it is extended or trapped above the head. It involves sweeping the arm across the fetal chest to bring it down for delivery. Scapular winging indicates shoulder (not arm) impaction at the pelvic inlet, requiring Lovset rotation rather than arm mobilization. ## High-Yield Facts - **Lovset maneuver** = 180° rotation of fetal body in anteroposterior plane to convert shoulder diameter from oblique to anteroposterior, allowing delivery of impacted shoulders in breech - **Scapular winging** in breech delivery = pathognomonic sign of shoulder impaction at pelvic inlet, indicating need for Lovset maneuver - **Lovset technique** involves grasping fetal *pelvis* (not chest) to avoid visceral injury and performing rotation after umbilicus is delivered - **McRoberts and Woods maneuvers** are for shoulder dystocia in *cephalic* delivery only; they have no role in breech delivery - **Pinard maneuver** addresses arm entrapment in breech (extended arm above head), not shoulder dystocia ## Mnemonics **BREECH MANEUVERS by BODY PART** **L**ovset = **L**ower body (pelvis) rotation for **S**houlder dystocia in **B**REECH. **P**inard = **P**ull the **A**rm. **M**cRoberts/**W**oods = **M**aternal/**W**ider pelvis (cephalic delivery only). **SCAPULAR WINGING = LOVSET** When you see scapular winging in breech delivery, think **L**ovset = **L**ower body rotation. Winging = shoulder impaction = need to rotate shoulders from oblique to AP diameter. ## NBE Trap NBE commonly pairs McRoberts with any shoulder dystocia question to trap students who do not distinguish between *cephalic* and *breech* delivery. Scapular winging is a breech-specific sign that should immediately trigger Lovset, not McRoberts. ## Clinical Pearl In Indian delivery settings where vaginal breech delivery is still practiced (especially in rural centers), recognizing scapular winging immediately signals the need for Lovset maneuver to prevent fetal hypoxia and death from prolonged shoulder impaction. Delay in performing this maneuver can result in fetal demise within minutes. _Reference: DC Dutta's Textbook of Obstetrics, Ch. 23 (Breech Presentation & Delivery); Bailey & Love's Short Practice of Surgery, Ch. 72 (Obstetric Emergencies)_
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