Procedure to be performed in the case of arrest of after coming head due to contracted pelvis in breech
**Core Concept**
In cases of breech presentation, especially when the fetal head is arrested due to a contracted pelvis, the obstetrician must employ a specific procedure to safely deliver the baby. This involves understanding the mechanics of fetal head entrapment and the principles of obstetric maneuvers.
**Why the Correct Answer is Right**
In such situations, the procedure of choice is the **Internal Podalic Version (IPV)**. This is a surgical technique where the obstetrician manually converts a transverse lie to a footling breech presentation, allowing for a safer vaginal delivery. The procedure involves the obstetrician inserting their hand into the uterus and gently manipulating the fetus to achieve the desired presentation. The correct identification and management of the arrested head are crucial in preventing complications such as fetal distress and birth asphyxia.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not address the specific situation of an arrested head due to a contracted pelvis. A **Manual Rotation** might be performed in cases of malrotation but is not the procedure of choice in this scenario.
**Option B:** This option is incorrect because **External Cephalic Version (ECV)** is a procedure used to manually convert a breech presentation to a cephalic presentation, which is not the goal in this situation where the head is already arrested.
**Option C:** This option is incorrect because **Kerr's maneuver** is a technique used to facilitate delivery in cases of shoulder dystocia, not an arrested head due to a contracted pelvis.
**Option D:** This option is incorrect because **Breech extraction** involves the delivery of the baby through the birth canal without the assistance of instruments, which is not the recommended approach in cases of an arrested head.
**Clinical Pearl / High-Yield Fact**
In cases of arrested head due to a contracted pelvis, the obstetrician must consider the timing of delivery and the potential need for cesarean section to prevent complications.
**Correct Answer: D. Breech extraction**