Shiralee's Revised Version of the Modified MSV Maneuver for Dealing with the Aftercoming Head of a Breech Presentation

Handling the aftercoming head in obstetrics can be quite challenging, and its entrapment is often a daunting situation for obstetricians. To prevent such scenarios, various techniques have been developed, including Burns-Marshall, MSV and its modifications, and Piper's forceps, among others. This study compared the effectiveness and safety of Shiralee's modification of the MSV technique with the traditional modified MSV approach in terms of perinatal outcomes.

It found that-

• Out of 10,276 deliveries, the incidence of term breech deliveries was 2.9%, among which only 17.5% were vaginal. 

• Most deliveries were unplanned and conducted as emergency cesarean section could not be performed. 

• One parturient in the modified MSV group encountered entrapment of the aftercoming head, requiring Dührssen's incision. 

• 26% of deliveries in Group 1 (modified MSV), while only 14% of cases in Group 2 (SRMMSV) showed adverse perinatal outcomes.

• 32% of neonates had an APGAR score <7 at 5 minutes in Group 1, compared to 20% of newborns in Group 2. 

• NICU admissions were 48% in the former and 28% in the latter. 

• The incidence of birth injuries in the two groups was 16% & 8%, respectively. 

• There was one perinatal mortality in the modified MSV group and none in the SRMMSV group.

This study proves Shiralee'sremodification of the modified MSV maneuver to be more efficacious with lesser perinatal morbidity than the existing MSV method.

Runwal S, Sagwaria P. Shiralee'sremodification of the modified mauriceau- smellie-veit manoeuvre for delivering the aftercoming head of breech. Indian Obtetrics and Gynecology. 2023;13(2)