Question

With reference to abnormal labor, consider the following procedures:
1. Internal podalic version
2. Forceps application
3. Assisted breech delivery

In which of these should the cervix be fully dilated?

• A. 1, 2 and 3
• B. 1 and 2
• C. 2 and 3
• D. 1 and 3

Hint:

All three listed procedures pull a fetus through the birth canal, so all three need a fully open cervix first.

Answer 1

The Correct Option is A

Step 1: Recall what full dilation is needed for.
Any operative vaginal delivery that manipulates the fetus inside the uterus or pulls it through the birth canal needs a fully open cervix. If the cervix is not fully dilated, it can tear, or it can obstruct the fetus and injure it.

Step 2: Check internal podalic version.
This procedure turns a baby, usually the second twin, inside the uterine cavity and brings down a leg so it can be delivered as a breech. Because the baby is pulled straight through the cervix right after being turned, the cervix must already be fully dilated.

Step 3: Check forceps application.
Forceps blades lock around the fetal head and traction is applied to draw the head through the birth canal. This is only safe once the cervix is fully open. An undilated cervix in the way would tear and could injure the baby's head.

Step 4: Check assisted breech delivery.
Delivering a breech baby through the vagina, including the aftercoming head, needs the same full opening of the cervix as any other vaginal delivery of a full sized presenting part.

Step 5: Combine the findings.
All three procedures need a fully dilated cervix before they are attempted, so the correct combination includes all of 1, 2 and 3, and any option leaving one of them out is wrong.

Final Answer:
Full dilation is required for internal podalic version, forceps application, and assisted breech delivery.