1/6. Modified Zavanelli maneuver for the alleviation of shoulder dystocia.BACKGROUND: The Zavanelli maneuver has typically been instituted when conventional maneuvers have failed to alleviate shoulder dystocia. Previously reported cases involving the Zavanelli maneuver have described cephalic replacement followed by immediate cesarean delivery. CASE: We encountered a case in which, despite the McRoberts maneuver, suprapubic pressure, wood's corkscrew manuever, and attempted extraction of the posterior fetal arm, the baby could not be delivered. The fetal vertex was partially reinserted into the vagina, and this dislodged the impacted shoulders. With expulsive efforts the mother was then able to achieve vaginal delivery of a 3870 g female infant.CONCLUSION: The modified Zavanelli maneuver may be used to successfully alleviate shoulder dystocia.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/6. Spiral fracture of the radius: an unusual case of shoulder dystocia-associated morbidity.BACKGROUND: The most common neonatal complications associated with shoulder dystocia include transient brachial plexus palsy, clavicular fracture, and humeral fracture. Fracture of the fetal radius has not been previously reported. CASE: We encountered a shoulder dystocia with the fetal head in the right occiput anterior position that necessitated the McRoberts maneuver, suprapubic pressure, the wood and Rubin maneuvers, and extraction of the posterior fetal arm to effect delivery. The 4610-g infant experienced a spiral fracture of the right (anterior) radius and a fracture of the left (posterior) midhumeral shaft. CONCLUSION: Neonatal radial fracture can result from shoulder dystocia or the maneuvers employed for the alleviation of the shoulder dystocia.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/6. The Zavanelli maneuver: a different perspective.Some obstetricians recommend the Zavanelli maneuver to resolve shoulder dystocia. Descriptions in the literature report an almost automatic ease in performance of the maneuver. We report a case of severe shoulder dystocia in which management with the Zavanelli maneuver and immediate cesarean was extremely difficult. The procedure involved exact reversal of all the cardinal movements of labor, and the delivery required terbutaline, general anesthesia, and added personnel to ensure successful extraction of the fetus. A delivery requiring the Zavanelli maneuver can be difficult to perform and may be worsened by insufficient personnel and inexact reversal of all the cardinal movements of labor.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/6. relaxin deficiency in the placenta as possible cause of cervical dystocia. A case report.In a case of cervical dystocia which had to be delivered by caesarean section, the placenta was examined for relaxin content. The placenta was processed by acidic acetone extraction and separation of the raw extract on a carboxymethylcellulose column. The activity of relaxin was estimated by means of heterologous porcine radioimmunoassay. The elution profile of the placenta extract showed significant differences to that of the placenta in normal deliveries i.e. there was no evidence of typical protein peaks with relaxin activity. It is suggested that there is possibly a causal relationship between the lack of placental relaxin and the pathological behaviour of the cervix during delivery.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/6. Lower thoracic spinal cord injury--a severe complication of shoulder dystocia.Fundal pressure as a maneuver for the relief of shoulder dystocia is associated with up to a 77% fetal injury rate. The usual injuries involve the brachial plexus or orthopedic injuries. We now report a severe lower thoracic spinal cord injury with permanent neurological injury when fundal pressure was applied in an attempt to relieve shoulder dystocia. shoulder dystocia occurred in a 28-year-old nulliparous woman. A series of manual maneuvers to include episiotomy extension, McRoberts, suprapubic pressure, Woods screw, and extraction of the posterior arm all failed to achieve delivery. During these maneuvers, but not coordinated with them, fundal pressure was applied by multiple individuals. The Zavanelli maneuver and cesarean delivery ultimately allowed delivery. On Day 2 of life marked decrease in lower extremity motor function, over-flow urinary incontinence, and rectal incontinence led to imaging studies that revealed focal spinal cord injury at T-9 through T-12. Compressive forces applied to the fetal spine during fundal pressure is the likely cause of the lower thoracic spinal cord injury manifest by this newborn.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/6. hysterotomy facilitation of the vaginal delivery of the posterior arm in a case of severe shoulder dystocia.BACKGROUND: shoulder dystocia is an obstetric emergency that can be resolved usually with one or a series of maneuvers performed vaginally. On rare occasions these maneuvers may fail, and the obstetrician must employ less familiar techniques to achieve delivery. CASE: A 30-year-old, gravida 6, developed a severe shoulder dystocia while delivering a 5970 g infant. Classical vaginal maneuvers failed due to the severity of the impaction. After general anesthesia was induced, additional maneuvers such as cephalic replacement and transabdominal rotation also failed. The dystocia was resolved ultimately by a transabdominally-facilitated vaginal posterior arm delivery followed by transabdominal shoulder rotation and vaginal extraction. CONCLUSION: In catastrophic cases of shoulder dystocia, transabdominal performance or facilitation of traditional vaginal maneuvers may lead to resolution.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |