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.