The Zavanelli maneuver extended: progression of a revolutionary concept.
Since description of the Zavanelli maneuver in 1984, 15 additional cases have come to light in which partially born but vaginally undeliverable fetuses have been returned to the vagina and subsequently extracted by cesarean section. Ten presentations were vertex, five breech. Half or more of each fetus had been delivered before vaginal reinsertion in eight of the 15. With one exception, all fetuses survived. There were no instances of fetal or maternal trauma. These cases represent a natural and progressive extension of the revolutionary concept behind the Zavanelli maneuver. Contrary to the age-old dicta, the process of vaginal birth, once initiated, does not have to proceed inexorably to completion with either life or death for the fetus in the balance. These cases demonstrate that delivery can be reversed at essentially any moment with excellent potential for fetal survival and relatively insignificant maternal risk.
Sandberg
E C
EC
Department of Gynecology and Obstetrics, Stanford University School of Medicine, CA 94305-5317.
D001946:Breech Presentation; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D004420:Dystocia / Q000628:therapy*; D005260:Female; D005313:Fetal Death / Q000517:prevention & control; D006801:Humans; D007746:Labor Presentation; D011247:Pregnancy; D012782:Shoulder