Operative Obstetrics — MCQs

Q: What is the name of the procedure used to resolve head entrapment?

Duhrssen's incisions. **Explanation:** **Duhrssen’s Incisions** are surgical incisions made in the cervix at the 2, 6, and 10 o'clock positions to facilitate the delivery of the **entrapped aftercoming head** of a breech fetus or a trapped head in a cephalic presentation when the cervix is not fully dilated. This procedure is typically a last resort when the cervix is thin and effaced but not sufficiently dilated to allow the head to pass, posing an immediate risk of fetal asphyxia. **Analysis of Incorrect Options:** * **Symphysiotomy (Option A):** This involves the surgical division of the pubic symphysis to increase the pelvic diameters. It is used for obstructed labor or severe shoulder dystocia, not specifically for cervical entrapment of the head. * **Pinard Maneuver (Option B):** This is a maneuver used in breech extraction to bring down the fetal legs in a frank breech presentation by applying pressure to the popliteal fossa. * **Zavanelli Maneuver (Option C):** This involves cephalic replacement (pushing the fetal head back into the uterus) followed by an emergency Cesarean section. It is the definitive management for catastrophic **shoulder dystocia**, not head entrapment by the cervix. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Incisions are made at **2, 6, and 10 o'clock** to avoid the uterine arteries (located at 3 and 9 o'clock). * **Prerequisite:** The cervix must be fully effaced. * **Complication:** The most significant risk is maternal hemorrhage or extension of the incision into the lower uterine segment. * **Modern Practice:** Due to the availability of Cesarean sections, Duhrssen’s incisions are rarely performed today but remain a critical "rescue" procedure in resource-limited settings or sudden breech entrapment.

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Cesarean Section Techniques

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Vaginal Birth After Cesarean

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Instrumental Deliveries

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Breech Delivery

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Episiotomy and Repair

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Management of Multiple Gestation

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Cervical Cerclage

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Obstetric Hysterectomy

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Surgery During Pregnancy

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Surgical Complications in Obstetrics

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