During difficult breech extraction in a cesarean, fetal head entrapment occurs at a classical uterine incision. The Patwardhan maneuver would involve:

• A Delivering the shoulders first through the incision followed by the head ✓
• B Pressing on the fundus while an assistant applies suprapubic pressure
• C Converting to classical incision to facilitate delivery
• D Administering nitroglycerin IV to relax the uterus

Explanation

The Patwardhan maneuver is used for head entrapment in cesarean delivery of the aftercoming fetal head or for shoulder presentation. In the Patwardhan maneuver for shoulder presentation (shoulder dystocia at cesarean), the shoulders are delivered first through the uterine incision—the trunk is delivered, then shoulder by shoulder—followed by the head; this avoids excessive pulling on the trapped head. For head entrapment in vaginal breech delivery, IV nitroglycerin 100–200 mcg can provide rapid uterine relaxation to release the entrapped head by relaxing the lower uterine segment. Piper forceps applied to the aftercoming head is the preferred technique for vaginal breech delivery.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.